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Diagnostic issues in anorexia nervosa and bulimia nervosa
234
BOOK REVIEWS
importance of separating fact and opinion, using language relevant to the user, and considering the responsibilities that extend beyond the report itself. Content and style are considered, with examples, and the importance of monitoring emphasized. The remaining sections consider the authority in the different proceedings to produce reports, and contain useful guides to court powers and language. Each section is introduced with a summary, and there is a good bibliography. John Graham’s 63-page paper provides a detailed re-assessment of the literature on the link between school, disruptive behaviour and delinquency, separating these out into links between schools and delinquency, disruptive behaviour in schools and delinquency, school characteristics and disruptive behaviour, and the responses to disruptive behaviour. He considers over I 50 pieces of research, often describing their strengths and limitations. His conclusion is that, while it has not been shown that schools have a direct influence in delinquency, they do seem to have an influence on intervening variables which themselves seem to be linked to delinquency, such as behaviour, attainment and truancy. There is a link, for example, between school failure and delinquency, while truancy and disruptive behaviour are possibly linked to school failure. His survey of responses to disruptive behaviour is pessimistic about past attempts, but suggests that multidisciplinary school support teams which support a number of schools may offer more success. The final pamphlet is the report of a working group set up by NACRO to consider issues arising from the placement of children and young people convicted of grave crimes. The use of section 53(1) and (2) of the Children and Young Persons Act 1933 has dramatically increased in recent years, and this report brought together much concern previously voiced in an unfocused manner. This small group of young people tend to make up a Iarge part of the clientele of Youth Treatment Centres and secure care facilities. Their situation has been somewhat anomalous, bypassed by other reforms and sitting astride the penal and welfare legislation. The report found that those subject to section 53 were disproportionately black, and were subject to significant discretion and variation between courts and regions; often inappropriately placed, receiving inadequate education and training, and cared for by professionals who were often unsure about their own authority and responsibility. It makes a series of recommendations for legislative change and practice.
Denis Jones
Diagnostic issues in Anorexia Nervosa and Bulimia Nervosa Garfinkel, P. E. (eds). New York: BrunnerlMazel,
Garner,
D. M. and
1988.
edited by David Garner and Paul Garfinkel, is an ambitious and timely undertaking. Disagreements among researchers in the area of eating disorders regarding the definitions and boundaries of diagnoses have sparked confusion and controversy. This volume is a collaborative effort by several well-respected authorities to address a few of the primary diagnostic concerns regarding anorexia nervosa and bulimia nervosa.
Diagnostic issues in Anorexia nelvosa and Bulimia Netvosa,
BOOK
REVIEWS
235
The first half of the work addresses issues in the classification, definition, and delimitation of the eating disorders. An explanution of the revisions for bulimia nervosa found in the DSM-III-R (1987) is given, clarification is provided of the various criteria employed, and the diagnostic process itself is examined. The relationship between anorexia nervosa and bulimia nervosa is considered in light of the questions as to whether or not these two syndromes are distinct entities. The information provided leads to the preliminary conclusion that these are indeed separate but highly related disorders. Clinical features shared by anorexia nervosa and bulimia nervosa are emphasized. It is argued that diagnostic criteria need to reflect the close association of the two syndromes. In the latter half of the volume, the relationships of eating disorders to other syndromes are considered. For some time there has been a tendency to associate the eating disorders with affective disorders, particularly in light of observations that: (a) depression is common in both eating disordered individuals and their families; (b) the two disorders share some biological markers; and (c) some patients with bulimia nervosa have been successfully treated with antidepressant medications. Evidence is presented here that suggests that while eating disorders and affective disorders may coexist in the same individual, it is premature to presume common underlying mechanisms. The need for more direct studies of the relationship between affective and eating disorders is evident. Another important concern is the differential diagnosis and treatment of eating disorders where a personality disorder may also exist. The book provides an overview of three levels of personality (traits, disorders, and structures), as well as a summary of the typical personality factors in anorexia nervosa and bulimia nervosa. It is suggested that, where a personality disorder exists in conjunction with an eating disorder, the personality disorder would be the primary focus of treatment, at least initially. Finally, the book contains an exploration of the often neglected issue of eating disorders in males. The summary of available research indicates that, for males, there is less concern with body weight and size and greater focus on body shape. The editors acknowledge that their book is not an exhaustive effort. Rather their intentions were to bring to the fore some major diagnostic issues and pave the way for further exploration. They do a commendable job of both answering and inspiring questions in regard to diagnostic and treatment considerations in eating disorders. Regardless of one’s theoretical orientation, Garner and Garfinkel have brought together a collaborative work that belongs on the reading list of everyone working with, or interested in, eating disorders.
Mary E. L&y
Cults, Converts, and Charisma. T. Robbins, Newbury Park, CA: Sage, 1988. Falling jbn the Faith: Causes and Consquences of Rel@ious Apostasy. D. G. Bromley (Ed.).
Newbury Park, CA: Sage, 1988.
The two volumes considered here provide perspectives on the processes through which individuals are attracted and drawn to religion and the processes of religious
BOOK REVIEWS
importance of separating fact and opinion, using language relevant to the user, and considering the responsibilities that extend beyond the report itself. Content and style are considered, with examples, and the importance of monitoring emphasized. The remaining sections consider the authority in the different proceedings to produce reports, and contain useful guides to court powers and language. Each section is introduced with a summary, and there is a good bibliography. John Graham’s 63-page paper provides a detailed re-assessment of the literature on the link between school, disruptive behaviour and delinquency, separating these out into links between schools and delinquency, disruptive behaviour in schools and delinquency, school characteristics and disruptive behaviour, and the responses to disruptive behaviour. He considers over I 50 pieces of research, often describing their strengths and limitations. His conclusion is that, while it has not been shown that schools have a direct influence in delinquency, they do seem to have an influence on intervening variables which themselves seem to be linked to delinquency, such as behaviour, attainment and truancy. There is a link, for example, between school failure and delinquency, while truancy and disruptive behaviour are possibly linked to school failure. His survey of responses to disruptive behaviour is pessimistic about past attempts, but suggests that multidisciplinary school support teams which support a number of schools may offer more success. The final pamphlet is the report of a working group set up by NACRO to consider issues arising from the placement of children and young people convicted of grave crimes. The use of section 53(1) and (2) of the Children and Young Persons Act 1933 has dramatically increased in recent years, and this report brought together much concern previously voiced in an unfocused manner. This small group of young people tend to make up a Iarge part of the clientele of Youth Treatment Centres and secure care facilities. Their situation has been somewhat anomalous, bypassed by other reforms and sitting astride the penal and welfare legislation. The report found that those subject to section 53 were disproportionately black, and were subject to significant discretion and variation between courts and regions; often inappropriately placed, receiving inadequate education and training, and cared for by professionals who were often unsure about their own authority and responsibility. It makes a series of recommendations for legislative change and practice.
Denis Jones
Diagnostic issues in Anorexia Nervosa and Bulimia Nervosa Garfinkel, P. E. (eds). New York: BrunnerlMazel,
Garner,
D. M. and
1988.
edited by David Garner and Paul Garfinkel, is an ambitious and timely undertaking. Disagreements among researchers in the area of eating disorders regarding the definitions and boundaries of diagnoses have sparked confusion and controversy. This volume is a collaborative effort by several well-respected authorities to address a few of the primary diagnostic concerns regarding anorexia nervosa and bulimia nervosa.
Diagnostic issues in Anorexia nelvosa and Bulimia Netvosa,
BOOK
REVIEWS
235
The first half of the work addresses issues in the classification, definition, and delimitation of the eating disorders. An explanution of the revisions for bulimia nervosa found in the DSM-III-R (1987) is given, clarification is provided of the various criteria employed, and the diagnostic process itself is examined. The relationship between anorexia nervosa and bulimia nervosa is considered in light of the questions as to whether or not these two syndromes are distinct entities. The information provided leads to the preliminary conclusion that these are indeed separate but highly related disorders. Clinical features shared by anorexia nervosa and bulimia nervosa are emphasized. It is argued that diagnostic criteria need to reflect the close association of the two syndromes. In the latter half of the volume, the relationships of eating disorders to other syndromes are considered. For some time there has been a tendency to associate the eating disorders with affective disorders, particularly in light of observations that: (a) depression is common in both eating disordered individuals and their families; (b) the two disorders share some biological markers; and (c) some patients with bulimia nervosa have been successfully treated with antidepressant medications. Evidence is presented here that suggests that while eating disorders and affective disorders may coexist in the same individual, it is premature to presume common underlying mechanisms. The need for more direct studies of the relationship between affective and eating disorders is evident. Another important concern is the differential diagnosis and treatment of eating disorders where a personality disorder may also exist. The book provides an overview of three levels of personality (traits, disorders, and structures), as well as a summary of the typical personality factors in anorexia nervosa and bulimia nervosa. It is suggested that, where a personality disorder exists in conjunction with an eating disorder, the personality disorder would be the primary focus of treatment, at least initially. Finally, the book contains an exploration of the often neglected issue of eating disorders in males. The summary of available research indicates that, for males, there is less concern with body weight and size and greater focus on body shape. The editors acknowledge that their book is not an exhaustive effort. Rather their intentions were to bring to the fore some major diagnostic issues and pave the way for further exploration. They do a commendable job of both answering and inspiring questions in regard to diagnostic and treatment considerations in eating disorders. Regardless of one’s theoretical orientation, Garner and Garfinkel have brought together a collaborative work that belongs on the reading list of everyone working with, or interested in, eating disorders.
Mary E. L&y
Cults, Converts, and Charisma. T. Robbins, Newbury Park, CA: Sage, 1988. Falling jbn the Faith: Causes and Consquences of Rel@ious Apostasy. D. G. Bromley (Ed.).
Newbury Park, CA: Sage, 1988.
The two volumes considered here provide perspectives on the processes through which individuals are attracted and drawn to religion and the processes of religious