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«Vaincre l’Anorexie Mentale», by JohanVanderlinden
Edition De Boeck Université, 176 pp (2003).
Reviewed by : Dr. Delphine Barbier, Dr. Brigitte Remy, and Melle Anne Fischler
Dr Johan Vanderlinden is an experienced and renowned psychologist and researcher specialising in eating disorders and works at the University Psychiatric Center KULeuven Campus Kortenberg (Belgium). His book, published in French - “Vaincre l’anorexie mentale” i.e. “Overcoming Anorexia Nervosa” was first published in 2003. Though dating back a few years, this book still provides detailed and useful information on anorexia nervosa for patients and their families who will gain a better understanding of the key issues of this pathology and of the therapeutic process described by Dr. Vanderlinden, using principally a cognitive behavioural approach. Professor Philippe Jeammet writes a preface, with special mention of the useful practical advice that one can find throughout the book.
First, a detailed review of the clinical symptoms of anorexia nervosa, of both the physical and psychological consequences, and the triggering factors that may provoke anorexia nervosa are presented. Next the author gives an overview of the current understandings clinicians have of the problem, together with a clear and detailed description of the different steps to be taken in the process of treatment and recovery.
Dr. Vanderlinden emphasizes how crucial it is to stimulate motivation before considering treatment in itself, in order to reinforce collaboration with the therapist and sustain continuity in the process of change. The three phases - denial, doubt and acceptance of the problem with full awareness of the gravity of the situation, are explored thoroughly with the patients who are then invited to evaluate and reflect on their condition.
The importance of prevention and information on the risks and dangers of anorexia nervosa is clearly outlined in direct language but is neither dramatized nor understated. The reader is invited to make a list of the advantages and disadvantages of anorexia nervosa and of recovery, as well as two other lists: one of all anorexic thoughts and beliefs, and a second of more rational thoughts, to be written with what the author calls “the voice of inner wisdom”. We find this dynamic and interactive approach interesting. It has the advantage of avoiding counter-attitudes and inducing an immediate dialogue, thus enhancing the capacity of the patient to observe his/her own ambivalence and fears without guilt.
Examples of cases, summaries, self-evaluation questionnaires and simple lists of tasks are given at the end of each chapter. It helps readers recognize and evaluate the gravity of the symptoms and become aware of the negative cognitions that have to be worked at.
Helping patients to change requires working in synergy on the following three levels: symptoms, perception of self and body image and relationships with others. A genuine plan of action is discussed in collaboration with the patient. The positive and reassuring attitude of the writer-as-therapist invites the patients to define and observe their own cognitions and to re-evaluate them in a more objective and positive way. Emotions and possible cognitive errors are explained, but asked to be set aside in order to give place to more rational and adaptive thoughts that enhance the ability to learn new patterns, and acquire new behaviours and attitudes that will be more realistic and less extreme. Challenging perfectionism, restoring self-confidence, learning to eat again and to accept a normal weight, loosening up excessive control, changing the way they think about themselves and others are the goals clearly defined in this book. The way to work on these false cognitions is explained step-by-step with concrete examples. The role of the family is described in order to reinforce collaboration and positive communication and therefore to avoid the often encountered pitfalls of negative judgment and criticism. In order to answer parents’ most frequent questions, concrete and useful advice is offered and a list of tasks are proposed.
A separate chapter deals with how to work with eating disorder patients with a history of trauma. A review of the different mediating factors in trauma and the eating disorder link is described and attention is also given to the neurobiological aspects involved when confronted with trauma experiences.
The final chapter focuses on a range of general questions such as when to seek help from professionals, how to choose a treatment, what kind of therapy is indicated, when medication is necessary, etc. The author also suggests when and why hospitalisation can be indicated and what to expect from it. All these crucial questions are discussed in a way that provides concrete information with the aim of helping patients take positive action on their own behalf.
The direct and simple style makes it accessible to patients of all ages and their families. The experience and the subtle approach of the author make this book a perceptive self-help guide. This book can definitely be recommended to patients as a useful manual, a self-help guide that will accompany them in each step of the process of change.
Throughout this book, we find that Dr Vanderlinden successfully uses his clinical and psychotherapeutic competence, in order to stimulate hope and willingness to overcome anorexia nervosa. After all, we believe this is one of the key issues in the treatment of eating disorder patients.
Dr Brigitte Remy ( bremy@mgen.fr)
Dr Delphine Barbier
Melle Anne Fischler
83 rue Lauriston,
75116 Paris,

Clinical Handbook of Eating Disorders: An Integrated Approach (2004) by Timothy D. Brewerton (Editor)
Marcell Dekker, inc. New York.

Review by: Tímea Kovács

Romania as a post- communist country has gone through enormous changes, that allowed the appearance of the process called “westernization” in our society, this being one of the factors that influences the development of eating disorders.  During my student years and now as a PhD. student, my interest has been focused on the problem of eating disorders; a field neglected in our country by most of the researchers. This handbook achieves what it sets out to do. That is, it provides an integrated overview giving full attention to the very well known eating disorders – anorexia nervosa, bulimia nervosa and binge eating disorder.           

Initially, the book presents a modern overview of the diagnosis and assessment of the eating disorders (Chapter 1), then in chapter 2 presents the most common and reliable psychometric instruments used in the assessment of eating disorder patients. It then analyses feeding disorders in infancy, which are increasingly recognized in the pediatric population.

In chapter 4, by highlighting the gender, age and cultural differences, the book analyses the epidemiology of eating disorders and later points out the long term out-comes and mortality of the life-threatening illness. Risk Factors, Etiology and Co-morbidity are discussed in detail in chapters 6 to 10.

An exploration of recent research regarding neurotransmitter deregulation in eating disorders, and some of the very exciting findings regarding neuroendocrine and neuropeptide deregulations is followed by reviews of the data which underlay the brain mechanisms involved in the development of these disorders and covers clearly the role of molecular biology in elucidating the role of genes in the etiology of eating disorders.

Eight chapters of the handbook (15-23) are dedicated to the treatment of eating disorders presenting a detailed overview of the models of cognitive behavioral therapy, family therapy, interpersonal psychotherapy and dialectical behavioral therapy.

Chapter 21 discuss the role of psychopharmacology in the treatment of AN, BN and BED which is not sufficient or optimal for the treatment of any of the eating disorders. The final chapter it is about future directions in the field exploring several areas where there is need for new data.            

I found this book to be different and unique by pointing out the insufficiencies in the field. For example it conceded that only slender research findings are available in the case of binge eating.  A strong preference for prospective longitudinal studies is expressed and the book proposes new diagnostic criteria for anorexia nervosa, dividing them between culture- independent criteria and criteria which are culture specific.

Since my own research is focused on the effect of westernization upon the cultures coexisting in Romania, namely the Hungarian, Gipsy and Saxon minorities and the Romanian majority and upon the analyses of socio-cultural factors regarding eating disorders in these three cultural groups, this new diagnostic approach offered me a new and helpful point of view.

In summary, the Clinical Handbook of Eating Disorders is a well-structured, complex work and I am glad to recommend it to a large group of scientists, researchers, therapists and clinicians and also for students and scholars who are searching for a better understanding of the nature of eating disorders or treatment of patients.  This book has helped me to fulfill many of the insufficiencies I had in this field and offered me information on which to ground my future research.

Timea Kovács, (
kovacstimea@yahoo.com )
Sapientia-Transilvanian Hungarian University of Science, Romania.
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