(Jim Kirkpatrick, MD and Paul Caldwell, MD Firefly Books, Buffalo, NY. 2001, 201 pp., $14.95)

Written by two experienced family physicians, one of whom has treated several hundred patients with eating disorders as an eating disorders “intensivist,” this highly informative book will provide patients, families and others with an authoritative, up-to-date review of all aspects of eating disorders. Topics covered include diagnoses and associated concepts, factors that complicate eating disorders (i.e., co-morbid conditions), pathogenesis, medical and psychological treatments, and the recovery process.

As you would expect in a book by such authors, the medical aspects of eating disorders are covered extremely well. A body mass index chart will demystify this measurement for lay people. Issues regarding hunger, satiety, set point theory, medical consequences of semi-starvation and problems resulting from repeated vomiting, binge eating, overexercise, misuse of laxatives, diuretics and emetics are all described simply and accurately, including impact on menstrual function, osteopenia-osteoporosis, and other health consequences. Line drawings of the pertinent physiological systems help illustrate these accounts.

Complicating factors discussed include mood disorders, obsessive-compulsive disorder, personality disorders, alcohol and substance abuse, pregnancy, diabetes mellitus and sexual abuse. The chapter on understanding eating disorders spans social causes from media influences to exercise trends. Psychological factors described include personality in general, perfectionism, self-esteem, identity factors, coping functions of eating disorders, gratifications associated with disordered eating, and self-punishment. Biological factors considered range from genetics to the set point theory. An excellent section discusses family-related issues: Is there a typical family? Is the family to blame? How do eating disorders change families? What sorts of family dynamics affect recovery? What can the family do? The section ends with advice to parents and others on how to deal with a family member with an eating disorder.

Medical treatment chapters outline the rationale and goals of treatment and discuss appropriate settings, for treatment, including various hospital and community base programs. They address issues such as when involuntary hospital treatment should occur. Refeeding programs, the uses and limitations of medications for treating eating disorders and their consequences are considered.

The psychological treatment sections reveal that the authors have an excellent understanding of compassionate, humane psychotherapy. The basic components of healing relationships are described, including warmth, trust, hopefulness and empathy, following which the discussion addresses rationales for and specific values of cognitive-behavioral and interpersonal approaches, nutritional education, individual, group and family therapies, experiential therapies, and others. There is a strong admonition and excellent discussion of the need to watch out for quackery in psychotherapy.

The final chapter, “The Road to Recovery,” will appeal to many patients who are beginning to think about how to turn their disorders around. Here are stories of women who are struggling with all stages of recovering – tentatively contemplating getting started, muddling along, considering whether formal treatment is needed, seeking options for what might help when nothing seems to be working, trying to prevent relapses, and considering a large selection of self-help strategies. Useful lists of sources and resources are appended.

The book is formatted in a highly readable form, with box inserts in each chapter that sidebar and highlight special points, the subjective voices of sufferers, and interesting oddities: Consider “What do people feel their eating disorders are about?”; “Were the Roman Emperors Bulimic?”; “Vomiting and Diarrhea as Medical Treatments”; “Leptin: the hormone of obesity?”; “Perfectionism makes eating disorders worse”; and many others.

In short, I will gladly recommend this thin, easy-to-read, accurate, informative and helpful book to my patients and their families. I expect it may answer many questions for them and raise others that we can fruitfully discuss during treatment.

— J.Y.