Eating disorders: A patient centred approach.

Eating disorders: A patient centred approach

Berg KM, Hurley DJ, McSherry JA, Stange NE, Radcliffe Medical Press Ltd, Abingdon, 2002, 198 pages, $71.14, ISBN 1-85775-922-2

The aims of this book are to describe a patient-focused approach in the management of eating disorders and to 'bridge the gap between clinical method and the application in practice'. The book is a thorough overview of the role of members of the multidimensional team in eating disorders. The authors prefer the term multidimensional rather than multidisciplinary because they believe it more accurately describes the whole person behind the diagnostic label i.e. the patient is more than just a case of under nutrition and requiring weight gain by a dietitian. The authors have a background in medicine, clinical psychology, dietetics, social work and family therapy. They are well credentialled to discuss management of eating disorders with all having considerable clinical and research experience.

The authors describe the patient-centred approach in eating disorders as addressing such topics as:

* mutually defining the problem and goals of treatment

* what impact the illness is having on the patient's functioning

* what is expected from the clinician

* patient views on factors which promote or sabotage recovery. Traditionally this is not often heard in treatment.

Particular strengths in the book are a description of the patient-clinician approach from the dietetic perspective, including steps in nutritional counselling, building a therapeutic relationship and attributes of dietitians working in eating disorders. It highlights such points for the dietitian as being supportive, being flexible, and being a role model regarding healthy eating style and reflecting a positive body image.

Having empathy, an ability to collaborate with rather than control the patient, and realistic expectations of the patient are similarly important. Being calm and patient, providing optimism about recovery and allowing patients to move forward at their own pace are other key points.

The text highlights the importance of the multidimensional team in treatment, particularly emphasising the patient as part of the team, and the importance of collaborating and negotiating treatment rather than controlling the patient. The book includes a patient's perspective, 'Rose's Story', which is used very effectively throughout the text. The 'Eating Disorder Voice' (EDV), a technique which externalises the eating disorder thoughts and beliefs is well described. This is a useful tool and would be worth reading for any practitioners not familiar with the 'Eating Disorder Voice' but who are seeing clients with dieting disorders. An excellent table summarises cognitive distortions in eating disorders.

The book is a good general text for eating disorder management and would be most relevant to people who are interested in learning more about eating disorders or have just started working with eating disorder clients and would be a useful text for students. It does not give any drastically new information but it is a good description of a different perspective on managing this challenging client group.

Susan Hart

Northside Clinic Eating Disorder Program, Greenwich

PhD Candidate, Department of Obstetrics and Gynaecology, University of Sydney