Book Review
Eating Disorders
Evidence and Experience in Psychiatry. Volume 6. Eating Disorders. Mario Maj, Katherine Halmi, Juan José López-Ibor, Norman Sartorius, editors. West Sussex (UK): John Wiley & Sons Ltd; 2003. 422 p. US$110.00.
Reviewer
rating*: Excellent
Review by: Hany Bissada, MD, FRCPC
Ottawa, Ontario
This book is part of the World Psychiatric Association series on Evidence and Experience in Psychiatry, which presents the latest theory and research on specific psychiatric disorders. The current volume addresses the topic of eating disorders. It covers all aspects of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), including their diagnosis, epidemiology, medical complications, pharmacologic and psychological treatments, and the economic and social burdens associated with them. These themes are addressed in 6 chapters written by international experts in the field, and each chapter is followed by commentaries from a group of different experts who highlight points of controversy and recommend directions for future research. Although the 6 chapters and the many commentaries were written by authors from different countries, the text is uniformly well written and easy to read.
I found it intellectually stimulating to review this book: the topics are addressed in depth and often challenge existing theory or practice. For example, in the chapter on “Classification and Diagnosis,” Katherine Halmi addresses the issue of excluding amenorrhea as an essential criterion for the diagnosis of AN, citing studies that found many patients were still menstruating while meeting all the other diagnostic criteria for AN. The chapter “Epidemiology and Cultural Aspects of Eating Disorders” is a good epidemiologic review with informative discussion of culturally specific and nonspecific risk factors. In his commentary, Blake Woodside refers to the work of Lee and others that describe a type of “Chinese” or “ascetic” AN wherein deliberate food avoidance and the achievement of a low weight are not associated with body image distortion or a drive for thinness. The chapter “Physical Complications and Aberrations in Eating Disorders” is a systematic review of the possible medical complications encountered with eating disorders, accompanied whenever possible by a description of their physiological etiologies. The authors note with interest that sometimes medical complications such as amenorrhea, thought to be caused by low weight, appear before the onset of any significant weight loss and persist after weight restoration. Further research is required to investigate the possible cause–effect links between medical alterations and total or partial food deficiency.
In the chapter “The Pharmacological Treatment of Eating Disorders” the authors deplore the paucity of randomized controlled trials (RCTs) in AN. This is understandable, given its relatively low prevalence; its ego-syntonic nature, which makes patients reluctant to participate in a study leading to weight gain; and the fact that the often potentially life-threatening nature of the illness makes research unadvisable in these emaciated patients. The authors conclude their review by stating that no drug therapy is indicated at present for emaciated anorexia sufferers, although they encourage RCTs on the possible beneficial effects of some of the new atypical antipsychotics. Their review, however, does support the use of selective serotonin reuptake inhibitors in weight-restored anorexia patients, as well as in patients with BN and BED.
The chapter “Psychological Interventions for Eating Disorders” concludes that cognitive-behavioural therapy has been tested in several RCTs for BN and BED and proven effective. The situation is quite different for AN, where the authors conclude that consistent evidence for the efficacy of any psychological treatment is lacking, except for family therapy in young AN patients. It is unfortunate to note that, with the exception of BED, no conclusions can be drawn on the pharmacologic or psychological treatment of patients diagnosed with an eating disorder not otherwise specified, because they are not included in treatment trials.
The last chapter, titled “The Economic and Social Burden of Eating Disorders,” was refreshing, since that topic is rarely addressed in the literature. It is important to educate third-party payers, who are frequently reluctant to provide the required funding for treatment programs. The authors review the limited literature available about the social, occupational, and family burdens associated with eating disorders and then address the cost and cost efficacy of treating these illnesses, describing the new trends in day-hospital programs. The authors also review the morbidity and mortality of eating disorders, although this information duplicates the information provided in the chapter “Epidemiology and Cultural Aspects of Eating Disorders.”
In summary, this book, although short of being a reference, reviews in depth some of the most important aspects of eating disorders. It is informative reading for psychiatrists and psychologists specializing in eating disorders. It is, however, too expensive for those who most need it, that is, psychiatric residents and postgraduate students studying in the field of eating disorders. I urge the publisher to consider producing a more affordable, softcover version.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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