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This volume is reflective of the current biopsychosocial attitudes toward psychiatric and psychosomatic illness. It is remarkable to read an entire volume with but two comments about psychoanalytic research on anorexia nervosa, bulimia, and obesity. It is even more remarkable to have this volume espouse Minuchin's family therapy, behavior modification, psychopharmacology and self-help groups, while including only a brief note by one of the authors that psychoanalytic workers have also investigated these illnesses.
The authors thus attempt to find genetic and experiential factors which either predispose to or result in endocrine, metabolic, or other physiologic dysfunction. The recommended therapeutic interventions are pharmacological and/or psychosocial, with emphasis on behavioral therapies.
Psychiatric Clinics, not withstanding its particular bias, has something important to offer analysts and psychotherapists who treat patients with eating disorders. Clearly delineated are the myriad research endeavors involving endocrine, metabolic, genetic, and environmental factors. Also described are the many therapeutic approaches, some derived from research findings, some empirical. In addition, the volume explores anorexia, bulimia, and obesity as separate entities, descriptively biologically, and therapeutically. A brief comment about the findings presented for each of these groups may demonstrate the relevance of these data for those doing analysis or analytically oriented psychotherapy with these patients.
Primary anorexia nervosa, as defined in the chapter by R. Munoz, refers to patients who have "no other known psychiatric disorder." These patients must show (1) "a distorted implacable attitude toward eating, food, or weight, that overrides hunger, admonitions, reassurance and threats"; (2) an age of onset prior to 25 years; (3) anorexia with accompanying weight loss of at least 25% of body weight; (4) evidence of typical manifestations of anorexia nervosa: "ame