- Email: [email protected]
Anorexia Nervosa: A Multidimensional Perspective
BOOK REVIEWS Handbook of Affective Disorders Edited by E. S. Paykel, New York, The Guilford Press. 1982.457 pp. $50.
• The area of affective disorders has been of increasing interest to clinicians in recent years. With the advent of good psychopharmacologic treatment methods, the bulk of patients diagnosed as having affective disorders respond well to treatment. This kind of happy circumstance always enhances clinician interest in a problem: there is no substitute for having a category of illness that responds to therapeutic modalities. The volume edited by Paykel is an outstanding contribution to the field. Most of the authors are well known to American psychiatrists. Because of the editor's academic appointment at the University of London and his familiarity with European psychiatry, he has included a number of colleagues who are less well known in this country. Among them are some of the leading European experts in affective disorders. The presentation of their views in the text is of great value to American clinicians. The book is divided into five parts. The first focuses on descriptive aspects of affective disorders; the second, causes; the third, physical treatments; the fourth, psychosocial treatments; and the final section is devoted to special aspects. There are 33 chapters in all and, as is to be expected in any multiauthored text, the chapters vary in quality. There are obvious differences among the authors in terms of the assumptions they bring to bear on their topics. The book,
therefore, does not have the consistency of a single-author work, but it has the richness of a variety of points of view. Although this may cause some anxiety for the beginning student, it avoids the problem of premature closure in an area where knowledge continues to evolve at a rapid rate. The volume is not well suited for medical students, although residents should be able to benefit from it. Dr. Paykel is to be complemented for an excellent job of editing these many different papers into a single volume that is ideally suited for the practicing clinician. This reviewer highly recommends it. Robert Cancro, M.D. New York University
Anorexia Nervosa: A Multidimensional Perspective By Paul E. Garfinkel and David M. Garner, New York, Brunner/Mazel, 1982, 400 PI'$30.
Anorexia Nervosa: A Comprehensive Approach Edited by MeirGross, Lexington, Mass, The Collamore Press, 1982,240 pp, $22.95.
• Dr. Garfinkel and Dr. Garner, in an interesting and well-written book, give a comprehensive overview of the diagnosis, etiology, pathogenesis, treatment, and prognosis of anorexia nervosa. Their perspective is that anorexia nervosa is a multidimensional disorder with various environmental, familial, psychological, and physiologic factors that facilitate its development; as the disorder develops, additional biopsychosocial factors intervene
which may worsen the condition and hamper treatment efforts. Certain symptoms previously presumed to reflect an underlying obsessive-compulsive personality disorder, it is stressed here, are often signs and symptoms of starvation. The authors also cite the experimental starvation studies of Ancel Keys and colleagues in the I940s, which found that semistarved subjects were irritable, obsessed about food, had unusual handling of food, and dreamed about food; with weight restoration, these symptoms disappeared. But it is important to remember that Keys' study was of protein-calorie malnutrition and that anorexia nervosa patients usually have preferentially eliminated carbohydrates and fats and maintained a more nearly normal protein intake. Early chapters accurately reflect the current state of our knowledge of anorexia nervosa. Separate chapters on hypothalamic and pituitary findings, the perceptual and conceptual abnormalities, role of the family, and cultural factors in the pathogenesis of anorexia nervosa are outstanding reviews and include significant data from the authors' own large patient sample; the one on perceptual and conceptual disturbances is superb. Few other authors have documented the absence of body image disturbances in certain anorexia nervosa patients; clearly presented, too, are the puzzling findings that although patients with anorexia nervosa statistically have no more body image disturbances than apparently healthy women, the severity of the initial disturbance correlates with outcome. The cognitive disturb(continued)
JANUARY 1984 • VOL 25 • NO 1
71
• The area of affective disorders has been of increasing interest to clinicians in recent years. With the advent of good psychopharmacologic treatment methods, the bulk of patients diagnosed as having affective disorders respond well to treatment. This kind of happy circumstance always enhances clinician interest in a problem: there is no substitute for having a category of illness that responds to therapeutic modalities. The volume edited by Paykel is an outstanding contribution to the field. Most of the authors are well known to American psychiatrists. Because of the editor's academic appointment at the University of London and his familiarity with European psychiatry, he has included a number of colleagues who are less well known in this country. Among them are some of the leading European experts in affective disorders. The presentation of their views in the text is of great value to American clinicians. The book is divided into five parts. The first focuses on descriptive aspects of affective disorders; the second, causes; the third, physical treatments; the fourth, psychosocial treatments; and the final section is devoted to special aspects. There are 33 chapters in all and, as is to be expected in any multiauthored text, the chapters vary in quality. There are obvious differences among the authors in terms of the assumptions they bring to bear on their topics. The book,
therefore, does not have the consistency of a single-author work, but it has the richness of a variety of points of view. Although this may cause some anxiety for the beginning student, it avoids the problem of premature closure in an area where knowledge continues to evolve at a rapid rate. The volume is not well suited for medical students, although residents should be able to benefit from it. Dr. Paykel is to be complemented for an excellent job of editing these many different papers into a single volume that is ideally suited for the practicing clinician. This reviewer highly recommends it. Robert Cancro, M.D. New York University
Anorexia Nervosa: A Multidimensional Perspective By Paul E. Garfinkel and David M. Garner, New York, Brunner/Mazel, 1982, 400 PI'$30.
Anorexia Nervosa: A Comprehensive Approach Edited by MeirGross, Lexington, Mass, The Collamore Press, 1982,240 pp, $22.95.
• Dr. Garfinkel and Dr. Garner, in an interesting and well-written book, give a comprehensive overview of the diagnosis, etiology, pathogenesis, treatment, and prognosis of anorexia nervosa. Their perspective is that anorexia nervosa is a multidimensional disorder with various environmental, familial, psychological, and physiologic factors that facilitate its development; as the disorder develops, additional biopsychosocial factors intervene
which may worsen the condition and hamper treatment efforts. Certain symptoms previously presumed to reflect an underlying obsessive-compulsive personality disorder, it is stressed here, are often signs and symptoms of starvation. The authors also cite the experimental starvation studies of Ancel Keys and colleagues in the I940s, which found that semistarved subjects were irritable, obsessed about food, had unusual handling of food, and dreamed about food; with weight restoration, these symptoms disappeared. But it is important to remember that Keys' study was of protein-calorie malnutrition and that anorexia nervosa patients usually have preferentially eliminated carbohydrates and fats and maintained a more nearly normal protein intake. Early chapters accurately reflect the current state of our knowledge of anorexia nervosa. Separate chapters on hypothalamic and pituitary findings, the perceptual and conceptual abnormalities, role of the family, and cultural factors in the pathogenesis of anorexia nervosa are outstanding reviews and include significant data from the authors' own large patient sample; the one on perceptual and conceptual disturbances is superb. Few other authors have documented the absence of body image disturbances in certain anorexia nervosa patients; clearly presented, too, are the puzzling findings that although patients with anorexia nervosa statistically have no more body image disturbances than apparently healthy women, the severity of the initial disturbance correlates with outcome. The cognitive disturb(continued)
JANUARY 1984 • VOL 25 • NO 1
71