The possible physiological and biochemical etiologies of obesity are discussed, along with the clinical guidelines to evaluate these patients properly. Finally, the author reviews different treatment modalities: discussion of exercise and dieting is followed by a clinically useful review of past and present medications used to treat obesity, wherein side effects are weighed against therapeutic effects. Ethical issues in the management of obesity are also discussed. This chapter is worth reading for clinicians treating patients with obesity.

Any clinician treating patients with eating disorders will certainly encounter male patients with eating disorders. Chapter 15 addresses the issue of eating disorders in males. The author reviews the medical evaluation of male patients with eating disorders and comments on relevant specific clinical issues, such as serum testosterone levels. Also, the issue of the sexual orientation of male patients with eating disorders is discussed. It is important to realize that only 20% of men with eating disorders have a homosexual orientation.

Finally, the book ends with 2 appendices that provide useful clinical tips. In appendix II, however, wherein the author describes a bowel protocol for constipation and laxative abuse, the stimulant laxative Dulcolax is prescribed for patients who remain constipated for 5 days. Yet, it is generally recommended that stimulant laxatives be avoided when constipation is caused by laxative abuse and that bulk forming agents and stool softeners be used while patients are gradually normalizing their food intake.

I highly recommend this well-written and reasonably priced book to both medical and nonmedical clinicians treating patients with eating disorders. In their respective chapters, the

authors have successfully covered the relevant topics in cardiology, gastroenterology, endocrinology, and metabolic disorders. Family physicians and psychiatrists will find useful clinical guidelines to diagnose and manage the potentially serious medical problems associated with eating disorders. Nonmedical clinicians, including psychologists and psychotherapists, will acquire a useful medical knowledge base that will enable them to detect eating disorders sooner and more effectively and to make timely referrals for medical treatment.

Substance Abuse

Review by

Nady el-Guebaly, MD, FRCPC
Calgary, Alberta

I approached with some trepidation a book styled as a treatment primer that, through the use of a question-and-answer format, could be read “either straight through” or “as a reference text”— all in 294 pages.

The author is a faculty member of the Humanities Department at the New School for Social Research in New York and directs its Counselor Training Program. He also conducts a private practice in psychodynamic psychotherapy. He has published at least 4 other books with the same publisher on basic aspects of psychotherapy in the field. The book, divided into 5 chapters, addresses some 200 questions. The first 2 chapters aim at the definition and diagnosis of substance use and abuse and review their somatic and psychological consequences

through some 60 hypothetical questions. On first reading, the responses to the questions are of uneven quality, from the overly simplistic “What are marijuana and hashish?” to the more sophisticated “Could you summarize classifications of drug use.” As a primer for the uninitiated, some responses may perpetuate public lore. For example, a clinical addictive personality is “characterized by elevated Pd, D and Pt scales on the Minnesota Multiphasic Personality Inventory (MMPI), field dependency, impoverished self-concept, low self-esteem, external locus of control, ego weakness and stimulus augmentation.” The last time I searched that topic as a clinician, many people fit that broad profile, without necessarily being addicted. These features may also be causes or consequences of the substance abuse. The book’s reservation about the existence of a preaddictive personality is duly noted. On a second reading, the selection of questions is unclear. Why are topics like anosognosia and apraxia, selected but not the complications of thiamine deficiency? If the author wishes “to present an integrated picture of a complex phenomenon,” a description of the rationale for selecting questions would be appreciated. The author is at his best when he responds to a question with a psychodynamic perspective illustrated by a vignette, as in the description of an addiction associated with a personality disorder.

Aware of the author’s forte after reading chapters 1 and 2, I tackled the next 2 chapters on theories of addiction: one 65