Customer Reviews

When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia

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This small book by Michel and Willard is one of the best and most accessible pieces of writing I have read about eating disorders. Without the hype and drama that the conditions usually inspire, the authors discuss calmly and thoughtfully the possible root causes of anorexia and bulimia as well as the route to recovery. There were several items in this book that I found useful - one was the comprehensive discussion of the ideal team approach to treating the disorders. The role of the dietitian is particularly interesting - I had never thought of the possibility that someone with an eating disorder would need a professional with that training not just for information about eating healthfully but to give the patient an outlet for his or her obsessive concerns about food, so that therapy could address other issues. Along those lines, Michel and Willard highlight the roles that other health professionals, such as dentists, can play in identifying and treating eating disorders. This is a must read for any health professional who might ever encounter someone with an eating disorder and not be sure of what to do. I also welcomed the discussion of the male patterns with respect to eating disorders - very often we categorize these as female problems and overlook the fact that boys and men can and do suffer from them, albeit in slightly different proportions and manners. I think this is also one of the few texts that discusses the role of the family without implicitly blaming family members for what has happened - and that is valuable to all concerned. All in all, a good read - quick and informative - and essential for anyone who has an eating disorder or knows someone who does.

This is 7 years post our incredibly difficult year when our then 14 year old daughter was treated by the philosophy as described in this book. It is 7 years that I have had time to research and worked to better understand eating disorders. I have since become a parent advocate for others going through what my family did. Luckily for me, not only have I learned a great deal, but the field is rapidly changing. However, at the time of my daughter's illness we were in a huge crisis and sinking rapidly. As I also work with special needs children in my own career, my initial gut instinct was very 'behavioral'.

"You can't go to school if you haven't eaten. You need to stay at the table until you eat. Not eating is a non-option."

I just didn't know that my own instincts were precursor to the up and coming, most successful to date as of today, treatment for anorexia nervosa in adolescents that there is.

However, I backed off. Why? Many reasons. Because extreme and scary behaviors I'd never seen from her before and didn't know to expect as part and parcel of the illness. Because of lack of adequate support and education (that's a long story--too long for here, but finding good help and information quickly for this illness wasn't easy), because I was told not to be the food police, that she needed to be "in control" and decide. I ended up believing that this illness was a choice she was making, was about control and that, somehow, unknowingly, her unhappiness was linked to us and something we'd done or not done. I was devastated and scared as hell.

I am extremely glad to say I was WRONG. I only wished I'd known that then.

The good things I can say about this book is that the people who wrote it are kind and caring. But, the book badly needs updating to reflect the new research coming out that shows, in most cases, putting families in charge and supporting them gives young people the best chance at the fastest track back to lasting health with less risk of relapse. Families can be critical to healing, rather than expendable. Families can aid in healing their own (and be healed themselves I might add). This turns traditional therapy upside-down (what a relief!!).

Its called family-BASED therapy and it sees families as allies in treatment. It does not exclude them or presume any kind of guilt. It does not presume overprotectiveness, or chaos, or uninvolvement etc as a `family style'. Yes, the ILLNESS ITSELF can cause these reactions in a family big time where it didn't exist before. But, you have to separate out REACTION to save a life from CAUSE. Super big difference.

And, I contend, all mental health providers have a duty to respect the family's mental health as well. It's part of the living system of the adolescent (or even adult sufferer)--if the family is made to feel blame or alienation, who will stick around to help the sufferer for the longer term that may be needed? How will family relations fare years post-illness if the family or the sufferer is seen as causal? Damaged? Not unlikely...has anyone done a study on this? Could be interesting!

What do I want now?

I want:

-- inpatient units to take a look at their practices...separation of children and families for weeks, limiting of phone calls, the search for underlying `causes' of the eating disorder. It reeks of guilt...sometimes subtly, sometimes not.

-- parents to be able to stay near by/visit often their ill adolescents throughout their hospitalizations just as parents of cancer stricken children do. Separation presumes guilt. I say wrongly. I say you take away emotional support of regressed, ill adolescents when it is most needed by the very ones that love and know them the best.

--I want parents included as part of the team to wellness.

--I want parent education based on the latest in evidenced-based practice. I want all information out there updated to reflect the latest in `best practice' and I want clinicians who practice best practice. I want clincians to say when something is theory and not known vs. best practice. I want informed parents.

--I want parents presented with choices and options the minute the present at the door of their pediatrician with an eating disordered child.

--I want parents included in doctor, therapist and nutritionist meetings (when and if they are needed), so the ED does not triangulate. Not kept outside as the chauffeur only.

--I want the eating disordered world to know that parents are speaking up.

www.feast-ed.org
www.eatingwithyouranorexic.com
www.maudsleyparents.org

Deborah Michel and Susan Willard have drawn from their wealth of experience treating patients in one of the most enduring and effective inpatient eating disorders programs to create a concise introduction to anorexia nervosa and bulimia. When Dieting Becomes Dangerous is written plainly enough to provide a working knowledge of eating disorders to patients and families while going into sufficient depth to give treating professionals a valuable resource. It provides an elegant model of the treatment team, clearly defining the roles of each member as the team deals with both the target behaviors and the underlying struggle to create an enduring sense of self beyond the limits of body image.

Richard A. Moskovitz, MD, author of Carousel Music and Lost in the Mirror, 2nd Edition: An Inside Look at Borderline Personality Disorder