(Sheila M. Reindl, Harvard University Press, 2001; 337 pages, $29.95)

Sheila Reindl, a psychologist at Harvard ‘s Bureau of Study Counsel, offers a perceptive account of the experience of bulimia nervosa and recovery from it. The material for this book was based on semi-structured interviews with 13 women, none of whom were ever Reindl’s clients. Instead, the women were recruited through personal referrals, self-help groups and posters on health-club bulletin boards. On average these women were 17 years old when their bulimia nervosa began, and they had been severely symptomatic for an average of five years. The women were all Caucasian, and the large majority were graduate students or professionals, educated and productive. Several wrestled with alcohol and drug problems and serious depression along with bulimia nervosa. With considerable nuance, in response to interview questions, they described their subjective experiences of the disorder, their ambivalent feelings about bulimic symptoms, the pivotal events that led them to seek help, and how they ultimately learned to sense and tolerate pain, adequacy, authenticity, pleasure, separateness, legitimacy, limitations and humanity.

Reindl’s findings parallel those of other investigators such as Rorty (Int J Eat Disord 1993; 14:249). Recovery often required good social support, good therapists, good self-help groups and, sometimes, good medications. Reindl and her subjects appreciate the complexities of what goes into recovery—enhancing motivation and determination, promptings by external events, the nature and quality of personal and professional helpers, and sometimes a dose of good fortune.

Reindl’s premise is that part of what led these women to bulimia nervosa in the first place, and part of what they had to grapple with and overcome, were deficits in self-structure and self-regulation. These deficits were due in part to profound disconnection from the women’s own feelings and in part were a result of emotional neglect and/or abuse. They also constituted a defensive structure organized against the terrifying and disabling emotions that start with shame, which Reindl emphasizes as a core process for these women. Shame is then accompanied by humiliation, self-disparagement and self-doubt, all of which are so painful that defensive maneuvers are taken to thwart their full impact. Instead of staying steeped in psychic pain, these women relied on bulimic symptoms, thoughts, preoccupations, and behaviors to numb, dissociate and disconnect them from the extremely unpleasant emotional states they would otherwise have experienced. Recovery required reclaiming their sensations.

Using metaphors based on the fairytale Beauty and the Beast, Reindl develops interesting metaphors for certain aspects of the recovery process, describing how many of these women relate to their inner monsters and what they must finally do to put them to rest. Recovery requires acceptance and re-integration of the ugly, “beast part” of oneself, rather than attempts to simply banish or ban these beasts.

Inevitably, a book such as this, based on interviews with a relatively small group of demographically and culturally homogenous subjects, leaves many questions unanswered. For example, to what extent are the similarities in accounts and explanatory models due to the fact that these women have all grown up in the same culture, hearing and reading similar things about bulimia nervosa from friends and therapists? How do shame and bulimic behaviors influence one another regarding onset and persistence of symptoms? What other pathways of genesis and recovery exist for people with bulimia nervosa? Future qualitative research using larger samples and other types of subjects may provide answers.

This is a richly written book; the personal accounts are telling; and the implications that the author draws for practice and theory are thoughtful. Clinicians will immediately recognize the authenticity of these voices and appreciate the subtlety with which Reindl captures their painful experiences and challenges. Just as important, those still struggling with bulimia nervosa will find much here to ponder and much to offer hope and direction for their own recoveries.

— J.Y.