Book Review

Binge Eating: Nature, Assessment, and Treatment

N Engl J Med 1994; 331:1317-1318November 10, 1994

Article

Binge Eating: Nature, Assessment, and Treatment
Edited by Christopher G. Fairburn and G. Terence Wilson. 419 pp. New York, Guilford Press, 1993. $40. ISBN: 0-89862-995-0

Research news on nutrition, eating behavior, and body weight is currently capturing headlines in the medical literature and the popular press. This multiauthored book provides a timely, comprehensive overview of current research on bulimia nervosa, for which binge eating is a sine qua non, and explores the role of binge eating in anorexia nervosa and obesity.

In their preface, the editors state, “Some books seem contrived: To us this book seemed almost a necessity.” The prospective reader may indeed wonder whether a book whose focus is binge eating can accurately portray the complex behavioral and medical symptoms associated with bulimia nervosa and anorexia nervosa. In fact, this heuristic theme works notably well, with a few exceptions. The book is methodically organized into major sections covering clinical characteristics, epidemiology and etiology, and evaluation and treatment -- a structure that contributes to its readability and accessibility as a reference work.

The introduction attempts to define binge eating -- a surprisingly complex task -- and includes a fascinating historical overview of the medical literature on binge eating. For nonspecialists hoping for an update on psychiatric nosology for the eating disorders, this book provides a cogent guide to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), recently published by the American Psychiatric Association (Washington, D.C., 1994). It also includes an overview of newly developed recommendations for the subclassification of patients with bulima nervosa according to whether they engage in recurrent purging, and of patients with anorexia nervosa according to whether they engage in recurrent binge eating or purging.

As noted in this book, there has been less extensive research on the prevalence and role of binge eating in obesity. Reflecting the need for additional information in this area, the DSM-IV includes research criteria for “binge-eating disorder” in an appendix. In this context, the psychosocial factors, medical consequences, and treatment of obesity itself are largely beyond the scope of Binge Eating.

With a format reflecting scholarly, detailed reviews of the research literature, the book reflects points of view that are eclectic and inclusive. A consideration of the cause of the behavior, for example, discusses developmental, psychological, and psychobiologic mechanisms. Individual chapters on treatment discuss pharmacologic interventions, short-term psychological approaches, and psychodynamic psychotherapy. Clinical approaches for the treatment of patients with refractory illness, such as hospitalization, are less well covered, reflecting a less extensive research literature in these areas.

The chapters reflect the expertise and individual points of view of the contributors, who are active investigators in the field. The bibliography in each chapter is comprehensive and up to date, and the index is notably complete. Readers involved in clinical teaching may note the relative paucity of illustrative case presentations. The concluding section, however, contains an extensively researched interview questionnaire for the standardized assessment of patients with eating disorders and a detailed outline describing a cognitive-behavioral treatment approach for bulimia nervosa.

In summary, this is a user-friendly, comprehensive summary of the current research literature on bulimia nervosa and related eating disorders. Generalists will find this book a valuable reference. For clinicians and researchers who work regularly with patients who have eating disorders, this should prove a welcome handbook.

David C. Jimerson, M.D.
Beth Israel Hospital, Boston, MA 02215