The Treatment of Eating Disorders
Reprinted from Eating Disorders Review
January/February 2010 Volume 21, Number 1
©2010 Gürze Books
What a nice way to start a new decade. For this substantial and substantive new clinical handbook, Drs. Grilo and Mitchell have recruited an internationally renowned group of authorities to compile an excellent resource. The handbook accomplishes several feats. First, its clearly written chapters review the tried and true; next it updates the growing evidence base on which practices have increasingly relied; and finally it describes some of the newer and still-evolving theoretical paradigms and practices concerning treatment strategies for eating disorders, some of which have not been previously featured in major handbooks. This collection represents as clear a status report as I’ve seen regarding how the field is thinking about treatment and what’s currently available.
Because the 35 chapters cover all aspects of treatment, interested readers should go to the Internet to peruse the detailed table of contents. Suffice it to say that the topics amply cover the field—anorexia nervosa, bulimia nervosa, binge-eating disorder/EDNOS, and night-eating syndrome. Obesity per se is not covered separately, although chapters on obesity in relation to eating disorders and on psychiatric aspects of gastric surgery for obesity are included. Treatment paradigms include nutrition, pharmacology, multiple types of individual psychotherapies, family-based treatments, inpatient, partial hospital and outpatient settings, self-help approaches, and the application of newer technologies to these disorders. The editors introduce each of the five parts with a brief overview of contents: an overview of eating disorders, treatment of anorexia nervosa, treatment of bulimia nervosa and binge-eating disorder, special topics in treatment, and research issues. Chapters describing the usual approaches of CBT, IPT, psychodynamic psychotherapy, medication management, and the like provide scholarly reviews, updates, treatment principles, and a few “mini-manuals.” Since a blow-by-blow review of each chapter is not possible here, I’ll simply offer a few random observations and highlight several offerings that strike me as novel.
Although the presentation and discussion of diagnosis in the obligatory overview section may have to be updated and tweaked after the updated DSM-V appears in a few years, the basic concepts concerning diagnosis and assessment are likely to remain substantially similar to those comprehensively covered in Part I.
Tucked in among nine excellent chapters on the treatment of anorexia nervosa in Part II are three devoted to specialist-supportive clinical management, cognitive remediation therapy, and compulsory (involuntary) treatment for anorexia nervosa. Among nine excellent chapters in Part III devoted to the treatment of bulimia nervosa and binge-eating disorder are three focusing on dialectical behavior therapy, integrative cognitive-affective therapy, and self-help approaches. And among the eight excellent contributions brought together as special topics in Part IV are chapters on the treatment of childhood eating difficulties and disorders, obesity treatment for binge-eating disorder in the obese, treatment of night-eating syndrome, and new technologies in the treatment of eating disorders (including Internet-based treatments, e-mail, texting, telehealth and PDA- assisted approaches). This section also includes a notable chapter focusing on those who care for individuals with eating disorders, dealing with carer distress and burden. To my knowledge these topics have not previously been covered in such detail in clinical handbooks.
Part V, addressing the assessment of eating disorder treatment efficacy and needs for future research, goes beyond the usual job description of a clinical handbook and points to knowledge gaps and future needs for empirical investigation. The material included here will be useful to investigators and funding agencies developing policies and research agendas, but is of less concern to the average clinician.
The bottom line: Clinicians and students interested in the assessment and treatment of patients with eating disorders will definitely want to own this book. It’s a keeper.