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The etiology of bulimia nervosa—The individual and family context
898
BOOK REVIEWS
PAUL MARTIN and PATRICKBATESON:Measuring Behaaiour-An Cambridge, U.K. (1993). xvi + 222 pp. E9.95.
Introductor_v Guide, 2nd Edn. Cambridge
University
Press,
One of the main early contributions of behaviour therapy to the general areas of abnormal psychology and therapy for disordered behaviour was the emphasis on measurement. Objective measures, based on observation and experimentation, were brought into the field of therapy, and were seen as an essential part of the behaviour therapeutic approach. In more recent years, there have been signs of measurement being relegated to a position of less importance. and it is not rare to find therapists, who claim to practice behaviour therapy, paying scant attention to rigorous measurement. Some. sadly, lack proper expertise in measurement. The book under review. the first edition of which appeared in 1986. provides an excellent introduction to the measurement of behaviour. While it is intended for students, it is also suitable for practitioners, who need to be competent in measuring behaviour. The basics of measuring behaviour arc covered, clearly and systematically. The book is written as a practical guidebook, and is thus particularly useful for training purposes, While the book as a whole covers behavioural measurement in a research setting, many of the sections are equally relevant to clinical settings where systematic measuring and recording are required. It is to be hoped that books such as this---and they are rare-are used in the training of therapists. Emphasis on good measurement is neither a luxury nor an irritating extra in the work of a behaviourally oriented therapist. It is an integral part of it, and should be given high priority. E. K. Roomc;o
P. J. COOPER:Bulimia Nercosa: A Guide 10 Recover),, Including u Se!f-Help Mamul./br Suffker.v. Robinson, xii + 130 pp. f5.99.
London
(1993).
In 1992, bulimia nervosa made its debut into the international medical arena and was coded F50.2 in the 10th edition 01 the International Classification qf Diseases. By this time, the syndrome was only 13 years old and had barely reached the medical and psychological curriculum and texts. However. 2% of young women are only too well aware of the condition as they personally suffer from it. This book aims to bridge this gap between need and skills within the Health Service. It is written by a leading expert in the field. The book is divided into two parts. The first. “About Bulimia”, has chapters on the clinical presentation, physical complications, causes, and general treatment. Most of these are suitable for the lay reader and arc accurate. informative and well written. 1 am unsure whether the chapter on classification was necessary. The second part is a self-help manual for people with bulimia nervosa. This is in 6 stages and describes a structured programme with the main emphasis on behavioural rather than the cognitive elements of cognitive-behavioural therapy. The strategies include the use of a food diary, a prescription of regular eating, and techniques to eliminate bingeing. It has a very good introduction written in a friendly style which aims to motivate the sufferer. Throughout the text, the sufferer is encouraged to share the process with a helper, and it is suggested that the general practitioner could take this role. I am sure that all health professionals dealing with clients with bulimia nervosa will welcome adding this book to their therapeutic tools. JANETTKI:ASIJKK
W. HERZOG, H. C. DETER and W. VANDEREYKEX(Eds): The Course qf‘Earing Disorders. Springer, DM 148.00.
Berlin (1992). xxv + 377 pp.
The need to ensure that medical costs are well spent has focused attention onto the course of illness. Eating disorders strike young people and so the duration of the illness can have profound implications upon health care requirements. Treatments are now subjected to audit, and benefits in terms of quality of life are costed. This volume contains much of the information needed to answer questions, such as these, which lie in the domain of health economics. It has contributions from Russell, Theander and Tolstrup who each has a lifetime’s experience working with patients with eating disorders. Their chapters are both authorative and clearly written. Many of the other contributions document ‘work in progress’ from several European centres. These are ambitious projects which are planned to follow the broad progress of large cohorts over time. The discussion charts the methodological difficulties that have to be surmounted in such surveys, and some early results are presented. A coherent, consistent picture emerges. The mortality rate of anorexia nervosa is approximately 1% per year of observervation. Suicide is the cause of death in half of these cases. One third of cases develop bulimic symptoms during the course of their illness. Social life is also profoundly affected with fewer patients marrying compared to their peers. If in your practice as a care provider you get asked, “Will she get better? What will happen?“, then this is the book for you. If as a purchaser you want to know “How serious a problem is this? What are the health dithculties that arise?“, then again, this is the book for you. JAX‘;ETTKEASLXE
J. H. CROWTHER, D. L. TENNENBAUM,S. E. HOBFELL and M. A. P. STEPHENS (Eds): The Eriology of Bulimia Nertosu-The Individual and Family Confexf. Hemisphere, Washington (1992). xvi + 252 pp. f35.00. Ever since Russell gave his definitive account of bulimia nervosa in 1979. this disorder has attracted increasing attention from clinicians, researchers and the media. There has been a massive growth in publications on this subject in the last IO years. The number of cases of bulimia nervosa coming for treatment has matched this increase. The book under review is the work of the Kent State University in Ohio. In 1990, they chose this as the subject of the Second Kent Annual Psychology Forum. The book was produced as the accompanying volume for the Forum, with aetiology as the main focus.
899
BOOK REVIEWS
After an introductory chapter on epidemiology, there is a section on developmental and familial factors, followed by one on individual factors. The final, brief, section is on future directions. The chapters, together, discuss the aetiology of bulimia nervosa and aims to provide an integration of theory and research. While this is a laudable aim, the book’s major use is likely to be as a source book, the individual chapters of which will be selectively read by those interested in the various sub-topics. There is a particularly valuable chapter by James Rosen on body image disorder, and an equally valuable one by Todd Heatheton and Janet Polivy on chronic dieting and eating disorders. The latter provides a plausible spiral model. There are several other chapters, too, which make valuable contributions. The most thought-provoking one, perhaps, is the chapter discussing possible ways of prevention, written by Ruth Striegel-Moore. On the whole, this is a good, well edited book, which should find a place in psychology and psychiatry libraries. By the very nature of the subject area chosen, there is not much in this for therapists that is of immediate practical use. There is, however, a lot which has implications for therapy. P. DE SlLVA
MARSHA M. LINEHAN: Cognitive-Behavioral
Treatment
ofBorderline
Personality
Disorder. Guilford
Press, New York (1993).
xvii + 558 pp. $39.50. This is a very comprehensive book of over 500 pages and is accompanied by a skills training manual based upon the book and theory. In overview, it ranges from a basic theoretical review to special treatment strategies for this very difficult patient population. Briefly, this approach represents a “gold standard” for treatment of this diagnostic category. However, like all theories, it has a “limited range of convenience”. Dr Linehan deals specifically and only with female patients carrying the diagnosis of Borderline Personality Disorder who also exhibit parasuicidal behaviour. Further, the patients must understand and commit to a specific treatment contract. Patients who do not meet these criteria are excluded from consideration. This is not necessarily a fault, only a limitation. Part I of the book is a refreshingly erudite review and overview of the theory of borderline personality disorder. Part II is a review of the treatment approach and includes very sensible consideration of specific issues in therapy. Part III of the book presents the basic treatment strategies and clarifies the idea that “the primary therapy dialectic is that of change in the context of acceptance of reality as it is”. The specific means of applying “dialectic behavioural therapy” then are described for approximately another 200 pages. This is indeed a very thorough presentation of the ‘nuts and bolts’ of this therapeutic approach. Part IV of the book is devoted to strategies for specific tasks. These tasks range from structural strategies such as forming the contract and starting treatment to termination of treatment and making appropriate referrals. As well, there is detailed consideration of special treatment strategies for events such as crises, suicidal behaviour, telephone contact and ancillary treatment, As Dr Linehan notes, nothing in her approach is entirely new, but the specific presentation is extremely thorough and extremely useful. A caveat is that the approach requires peer supervision/consultation, supportive colleagues and relatively straightforward access to emergency hospitalization. In short, this is not an approach designed for a solo practitioner in a private practice setting. However, the thoroughness of the consideration this text gives to this difficult group of patients implies that perhaps such solo practitioners should not attempt completely independent treatment of patients in this category. This, of course, is a question amenable to research, which I would expect to see Dr Linehan and others examine in the future. CHARLES R. BRASFIELD
BOOK REVIEWS
PAUL MARTIN and PATRICKBATESON:Measuring Behaaiour-An Cambridge, U.K. (1993). xvi + 222 pp. E9.95.
Introductor_v Guide, 2nd Edn. Cambridge
University
Press,
One of the main early contributions of behaviour therapy to the general areas of abnormal psychology and therapy for disordered behaviour was the emphasis on measurement. Objective measures, based on observation and experimentation, were brought into the field of therapy, and were seen as an essential part of the behaviour therapeutic approach. In more recent years, there have been signs of measurement being relegated to a position of less importance. and it is not rare to find therapists, who claim to practice behaviour therapy, paying scant attention to rigorous measurement. Some. sadly, lack proper expertise in measurement. The book under review. the first edition of which appeared in 1986. provides an excellent introduction to the measurement of behaviour. While it is intended for students, it is also suitable for practitioners, who need to be competent in measuring behaviour. The basics of measuring behaviour arc covered, clearly and systematically. The book is written as a practical guidebook, and is thus particularly useful for training purposes, While the book as a whole covers behavioural measurement in a research setting, many of the sections are equally relevant to clinical settings where systematic measuring and recording are required. It is to be hoped that books such as this---and they are rare-are used in the training of therapists. Emphasis on good measurement is neither a luxury nor an irritating extra in the work of a behaviourally oriented therapist. It is an integral part of it, and should be given high priority. E. K. Roomc;o
P. J. COOPER:Bulimia Nercosa: A Guide 10 Recover),, Including u Se!f-Help Mamul./br Suffker.v. Robinson, xii + 130 pp. f5.99.
London
(1993).
In 1992, bulimia nervosa made its debut into the international medical arena and was coded F50.2 in the 10th edition 01 the International Classification qf Diseases. By this time, the syndrome was only 13 years old and had barely reached the medical and psychological curriculum and texts. However. 2% of young women are only too well aware of the condition as they personally suffer from it. This book aims to bridge this gap between need and skills within the Health Service. It is written by a leading expert in the field. The book is divided into two parts. The first. “About Bulimia”, has chapters on the clinical presentation, physical complications, causes, and general treatment. Most of these are suitable for the lay reader and arc accurate. informative and well written. 1 am unsure whether the chapter on classification was necessary. The second part is a self-help manual for people with bulimia nervosa. This is in 6 stages and describes a structured programme with the main emphasis on behavioural rather than the cognitive elements of cognitive-behavioural therapy. The strategies include the use of a food diary, a prescription of regular eating, and techniques to eliminate bingeing. It has a very good introduction written in a friendly style which aims to motivate the sufferer. Throughout the text, the sufferer is encouraged to share the process with a helper, and it is suggested that the general practitioner could take this role. I am sure that all health professionals dealing with clients with bulimia nervosa will welcome adding this book to their therapeutic tools. JANETTKI:ASIJKK
W. HERZOG, H. C. DETER and W. VANDEREYKEX(Eds): The Course qf‘Earing Disorders. Springer, DM 148.00.
Berlin (1992). xxv + 377 pp.
The need to ensure that medical costs are well spent has focused attention onto the course of illness. Eating disorders strike young people and so the duration of the illness can have profound implications upon health care requirements. Treatments are now subjected to audit, and benefits in terms of quality of life are costed. This volume contains much of the information needed to answer questions, such as these, which lie in the domain of health economics. It has contributions from Russell, Theander and Tolstrup who each has a lifetime’s experience working with patients with eating disorders. Their chapters are both authorative and clearly written. Many of the other contributions document ‘work in progress’ from several European centres. These are ambitious projects which are planned to follow the broad progress of large cohorts over time. The discussion charts the methodological difficulties that have to be surmounted in such surveys, and some early results are presented. A coherent, consistent picture emerges. The mortality rate of anorexia nervosa is approximately 1% per year of observervation. Suicide is the cause of death in half of these cases. One third of cases develop bulimic symptoms during the course of their illness. Social life is also profoundly affected with fewer patients marrying compared to their peers. If in your practice as a care provider you get asked, “Will she get better? What will happen?“, then this is the book for you. If as a purchaser you want to know “How serious a problem is this? What are the health dithculties that arise?“, then again, this is the book for you. JAX‘;ETTKEASLXE
J. H. CROWTHER, D. L. TENNENBAUM,S. E. HOBFELL and M. A. P. STEPHENS (Eds): The Eriology of Bulimia Nertosu-The Individual and Family Confexf. Hemisphere, Washington (1992). xvi + 252 pp. f35.00. Ever since Russell gave his definitive account of bulimia nervosa in 1979. this disorder has attracted increasing attention from clinicians, researchers and the media. There has been a massive growth in publications on this subject in the last IO years. The number of cases of bulimia nervosa coming for treatment has matched this increase. The book under review is the work of the Kent State University in Ohio. In 1990, they chose this as the subject of the Second Kent Annual Psychology Forum. The book was produced as the accompanying volume for the Forum, with aetiology as the main focus.
899
BOOK REVIEWS
After an introductory chapter on epidemiology, there is a section on developmental and familial factors, followed by one on individual factors. The final, brief, section is on future directions. The chapters, together, discuss the aetiology of bulimia nervosa and aims to provide an integration of theory and research. While this is a laudable aim, the book’s major use is likely to be as a source book, the individual chapters of which will be selectively read by those interested in the various sub-topics. There is a particularly valuable chapter by James Rosen on body image disorder, and an equally valuable one by Todd Heatheton and Janet Polivy on chronic dieting and eating disorders. The latter provides a plausible spiral model. There are several other chapters, too, which make valuable contributions. The most thought-provoking one, perhaps, is the chapter discussing possible ways of prevention, written by Ruth Striegel-Moore. On the whole, this is a good, well edited book, which should find a place in psychology and psychiatry libraries. By the very nature of the subject area chosen, there is not much in this for therapists that is of immediate practical use. There is, however, a lot which has implications for therapy. P. DE SlLVA
MARSHA M. LINEHAN: Cognitive-Behavioral
Treatment
ofBorderline
Personality
Disorder. Guilford
Press, New York (1993).
xvii + 558 pp. $39.50. This is a very comprehensive book of over 500 pages and is accompanied by a skills training manual based upon the book and theory. In overview, it ranges from a basic theoretical review to special treatment strategies for this very difficult patient population. Briefly, this approach represents a “gold standard” for treatment of this diagnostic category. However, like all theories, it has a “limited range of convenience”. Dr Linehan deals specifically and only with female patients carrying the diagnosis of Borderline Personality Disorder who also exhibit parasuicidal behaviour. Further, the patients must understand and commit to a specific treatment contract. Patients who do not meet these criteria are excluded from consideration. This is not necessarily a fault, only a limitation. Part I of the book is a refreshingly erudite review and overview of the theory of borderline personality disorder. Part II is a review of the treatment approach and includes very sensible consideration of specific issues in therapy. Part III of the book presents the basic treatment strategies and clarifies the idea that “the primary therapy dialectic is that of change in the context of acceptance of reality as it is”. The specific means of applying “dialectic behavioural therapy” then are described for approximately another 200 pages. This is indeed a very thorough presentation of the ‘nuts and bolts’ of this therapeutic approach. Part IV of the book is devoted to strategies for specific tasks. These tasks range from structural strategies such as forming the contract and starting treatment to termination of treatment and making appropriate referrals. As well, there is detailed consideration of special treatment strategies for events such as crises, suicidal behaviour, telephone contact and ancillary treatment, As Dr Linehan notes, nothing in her approach is entirely new, but the specific presentation is extremely thorough and extremely useful. A caveat is that the approach requires peer supervision/consultation, supportive colleagues and relatively straightforward access to emergency hospitalization. In short, this is not an approach designed for a solo practitioner in a private practice setting. However, the thoroughness of the consideration this text gives to this difficult group of patients implies that perhaps such solo practitioners should not attempt completely independent treatment of patients in this category. This, of course, is a question amenable to research, which I would expect to see Dr Linehan and others examine in the future. CHARLES R. BRASFIELD