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Janice Cauwels, a professional medical writer and former English professor, has written a book on bulimia that attempts to clarify the many problems associated with this increasingly common eating disorder. The book is for people with bulimia and their families. It is based on conversations with patients and interviews with a spectrum of professionals working in the field. The clinical vignettes are accurate and convincing. Bulimia is correctly described as an addiction, and the fact that many bulimics are also addicted to alcohol and/or drugs is emphasized.
Particularly important for the lay public is the emphasis on the dangers of gorging, vomiting, and purging, which can lead to an abnormally low blood potassium that can cause neuromuscular problems ranging from weakness to paralysis, gastrointestinal disorders, kidney disease, an irregular heartbeat, heart failure, and death. Irreversible tooth damage can also be produced by the self-induced vomiting that washes acid over the teeth. The emphasis of the book is upon psychological causes and psychotherapeutic treatments, but possible chemical, genetic, and neurogenic factors are also briefly reviewed. For example, John H. Rau and Richard S. Green have hypothesized a neurogenic cause of binge eating, comparable to epilepsy and treatable with Dilantin. Medical doubts about and criticisms of this hypothesis are detailed.
It is emphasized that many anorexics develop amenorrhea before they lose weight, which casts doubt on the idea that it is simply a result of starvation. The brief descriptions of the psychological and emotional problems of bulimics are accurate. These include perfectionism, traceable to family attitudes, depression, anger, stormy mood shifts, disturbed interpersonal relationships, narcissism, and a disturbed sense of identity.
The section on treatment is eclectic. The resistances of the bulimic, and their manipulativeness, withholding, lying, and impatience are underscored. A broad range of