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Eating Disorders and Obesity, Second Edition
Book Reviews DILIP RAMCHANDANI, M.D. BOOK REVIEW EDITOR
Eating Disorders and Obesity, Second Edition Edited by Christopher Fairburn and Kelly D. Brownell New York Guilford Press 2000, 623 pages, $65.00 ISBN 1-57230-688-2 Reviewed by Penelope C. Duvall, M.D.
T
he subtitle to this book is “A Comprehensive Handbook,” thus setting a daunting task for the authors. However, they meet the challenge well and have created a book that should be one of the main resources for anyone who has to deal with patients with eating disorders or obesity. The chapters are short and easy to read. They follow a pattern of explaining the history, etiology (psychoanalytic as well as biopsychosocial), natural course, interventions (medical and psychiatric), and potentials for cures versus relapses for each of the eating disorders. The authors do an excellent job of refining the definitions of each of the eating disorders so that, for example, one would be able to differentiate between anorexia nervosa, bingeing type, and bulimia nervosa. They also integrate the various treatment modalities so that one is able to have an overall picture of the differing treatment options and how they can interact with as well as augment one another. The high rates of relapse for all of the eating disorders continue to be one of the greatest challenges in psychiatry. The inclusion of obesity in this
510
book adds another strong dimension. Obesity in our society is close to reaching epidemic proportions, and the longterm health effects are devastating. The authors do an excellent job of both describing the problems—from genetics to the super-sizing of fries—and offering some well-reasoned approaches to helping people deal with restricting calories and increasing exercise. This book should be required reading for all medical students, who will soon be dealing with patients with all of these eating disorders in their many disguises. It is also a wonderful quick reference book for anyone treating patients with eating disorders because the chapters are well written, short, and to the point. Each chapter is limited to specific aspects of each disorder, so one can easily find the relevant information they are seeking. Dr. Duvall is a consultation-liaison psychiatrist at Temple University Hospital and an Assistant Professor of Psychiatry at the School of Medicine.
The Heart of Addiction By Lance Dodes, M.D. New York HarperCollins 2002, 257 pages, $24.95 ISBN 0-06-019811-7 Reviewed by Ralph Spiga, Ph.D.
B
ehavior that is repetitive, that occurs at high personal and social cost, and that occurs despite knowledge of these costs is termed addictive. Since the early 1950s, psychodynamic clini-
cians have attempted to characterize the psychological motives for addictive behavior. For instance, chronic alcoholics were characterized as passivedependent, depressed, schizoid, and hostile.1 They were considered passivedependent because of their reliance on others for care, security, comfort, and acceptance; depressed because of obvious sadness, self-deprecation, and futility; schizoid because of shallow attachments; and hostile because of an overwhelming rage. Some clinicians treating the addictions viewed addictive behavior, particularly substance use, as a means for relieving these negative affects. The result was the selfmedication hypothesis of addiction.2 The self-medication hypothesis sees addictive behavior as a means “to selftreat or manage an internal psychological problem” (p. 131). In The Heart of Addiction, Dr. Dodes presents a thesis grounded in this tradition and pointing to a “new way of thinking” about addictions. His purpose is to reveal the “powerful unconscious, inner drive at the heart of addictions” (p. 110). His method is empathetic listening. And his data are the clinical cases. Dr. Dodes’ analysis differs from this hypothesis only in specifying the phenomenological content and interaction of addictive acts and psychological problem. In Chapter 1, he argues that an overwhelming sense of helplessness and powerlessness drives addictive behavior. The addictive act permits the addict to regain control, or at the very least a momentary autonomy, thereby reversing the sense of powerlessness and helplessness. As the determinant of addiction is
Psychosomatics 43:6, November-December 2002
Eating Disorders and Obesity, Second Edition Edited by Christopher Fairburn and Kelly D. Brownell New York Guilford Press 2000, 623 pages, $65.00 ISBN 1-57230-688-2 Reviewed by Penelope C. Duvall, M.D.
T
he subtitle to this book is “A Comprehensive Handbook,” thus setting a daunting task for the authors. However, they meet the challenge well and have created a book that should be one of the main resources for anyone who has to deal with patients with eating disorders or obesity. The chapters are short and easy to read. They follow a pattern of explaining the history, etiology (psychoanalytic as well as biopsychosocial), natural course, interventions (medical and psychiatric), and potentials for cures versus relapses for each of the eating disorders. The authors do an excellent job of refining the definitions of each of the eating disorders so that, for example, one would be able to differentiate between anorexia nervosa, bingeing type, and bulimia nervosa. They also integrate the various treatment modalities so that one is able to have an overall picture of the differing treatment options and how they can interact with as well as augment one another. The high rates of relapse for all of the eating disorders continue to be one of the greatest challenges in psychiatry. The inclusion of obesity in this
510
book adds another strong dimension. Obesity in our society is close to reaching epidemic proportions, and the longterm health effects are devastating. The authors do an excellent job of both describing the problems—from genetics to the super-sizing of fries—and offering some well-reasoned approaches to helping people deal with restricting calories and increasing exercise. This book should be required reading for all medical students, who will soon be dealing with patients with all of these eating disorders in their many disguises. It is also a wonderful quick reference book for anyone treating patients with eating disorders because the chapters are well written, short, and to the point. Each chapter is limited to specific aspects of each disorder, so one can easily find the relevant information they are seeking. Dr. Duvall is a consultation-liaison psychiatrist at Temple University Hospital and an Assistant Professor of Psychiatry at the School of Medicine.
The Heart of Addiction By Lance Dodes, M.D. New York HarperCollins 2002, 257 pages, $24.95 ISBN 0-06-019811-7 Reviewed by Ralph Spiga, Ph.D.
B
ehavior that is repetitive, that occurs at high personal and social cost, and that occurs despite knowledge of these costs is termed addictive. Since the early 1950s, psychodynamic clini-
cians have attempted to characterize the psychological motives for addictive behavior. For instance, chronic alcoholics were characterized as passivedependent, depressed, schizoid, and hostile.1 They were considered passivedependent because of their reliance on others for care, security, comfort, and acceptance; depressed because of obvious sadness, self-deprecation, and futility; schizoid because of shallow attachments; and hostile because of an overwhelming rage. Some clinicians treating the addictions viewed addictive behavior, particularly substance use, as a means for relieving these negative affects. The result was the selfmedication hypothesis of addiction.2 The self-medication hypothesis sees addictive behavior as a means “to selftreat or manage an internal psychological problem” (p. 131). In The Heart of Addiction, Dr. Dodes presents a thesis grounded in this tradition and pointing to a “new way of thinking” about addictions. His purpose is to reveal the “powerful unconscious, inner drive at the heart of addictions” (p. 110). His method is empathetic listening. And his data are the clinical cases. Dr. Dodes’ analysis differs from this hypothesis only in specifying the phenomenological content and interaction of addictive acts and psychological problem. In Chapter 1, he argues that an overwhelming sense of helplessness and powerlessness drives addictive behavior. The addictive act permits the addict to regain control, or at the very least a momentary autonomy, thereby reversing the sense of powerlessness and helplessness. As the determinant of addiction is
Psychosomatics 43:6, November-December 2002