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Eating Disorders: A Guide to Medical Care and Complications, 2nd Edition
Reviewed by William Stewart Agras, M.D.
Am J Psychiatry 2010;167:1282-1283. doi:10.1176/appi.ajp.2010.10050664
View Author and Article Information
Stanford, Calif.

Book review accepted for publication May 2010

The author reports no financial relationships with commercial interests.

Accepted May , 2010.

Copyright © American Psychiatric Association

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The medical management of patients with eating disorders is often minimized or overlooked by patients themselves, families, and even sometimes caretakers. This book is a valuable antidote to such minimization. In this second edition, the authors, a psychiatrist and internist who are experts in the management and treatment of eating disorders, decided to write the book themselves rather than having different authors for each chapter, as was the case in the first edition. This makes the book more cohesive and an easier read.

The chapters are usually short, and each begins with a list of common questions pertinent to the topic, followed by one or two case examples and expert discussion of the topic. The chapters cover the entire range of issues encountered in the management of eating disorders, with a particular emphasis on severe anorexia nervosa. Especially valuable are the chapters on the diagnosis and treatment of eating disorders in primary care as well as on the team treatment approach and the multiple chapters on the medical complications of eating disorders and their management. The discussions of the topics are up-to-date, and one cannot take issue with the advice given on diagnosis and management.

Among the more unusual chapters rarely covered in other books is one on the therapeutic use of the physical examination and laboratory results. This chapter makes the point that when carefully done, with results presented in understandable ways and letting the patient see the original reports, this approach may help to break down the denial that eating disorder patients so often exhibit.

Ethical conflicts encountered in the treatment of anorexia nervosa are also carefully discussed. The authors suggest that four principles underlie the care of the patient with anorexia nervosa: 1) respect for autonomy; 2) nonmaleficence (do no harm); 3) beneficence (doing what is best for patients, even without their consent); and 4) justice (balancing individual and social costs, benefits, and risks). The authors take issue with the "passive agreement to no treatment" that has been discussed in both Europe and the United States in the context of drawing similarities between untreatable cancer and severe anorexia nervosa resistant to treatment. When should the physician opt for no further treatment?

In the same chapter, the authors also point out that all too few residency programs teach evidence-based psychotherapies, such as cognitive-behavioral therapy, for the eating disorders. This is a point that might be more belabored given the fact that it may be unethical not to at least inform the patient about the evidence-based treatments that exist for their disorder.

The only limitation of this book is that it reflects the somewhat distorted view, widely shared by the profession and the public, that anorexia nervosa is an adult disorder characterized by a skeletal appearance. Yet the majority of cases of anorexia nervosa first occur in adolescence, and a chapter or two on the medical approach to adolescents with eating disorders would have nicely rounded out this otherwise excellent volume.

Overall then, this book should be useful to anyone who encounters eating disorders in their professions, whether they be physicians, psychologists, school counselors, or athletic coaches. It is particularly useful for the primary care physician or for physicians and psychologists who are a regular part of a team treating severe cases of anorexia nervosa.

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