Reflections
Book review
Volume 196 - Issue 11
Abnormal eating
Author: Judith Fleming
Med J Aust 2012; 196 (11): 711. || doi: 10.5694/mja12.10507
Published online: 18 June 2012
Published online: 18 June 2012
PATIENTS WITH eating disorders are like canaries in the mines warning of some of the ills of Western society. In broader society, we have lost our way with eating. There are mixed messages on desirable weight and eating. We fret about obesity. No wonder a young person with little sense of self-worth stumbles into dieting and develops an eating disorder. The publisher’s website states that “Fast ...
The publisher’s website states that “Fast Facts” is a series of books aiming to educate health professionals and the general public about medical conditions. The authors are professors involved in adolescent clinical psychiatry with North American perspectives, both with an interest in eating disorders.
Unfortunately, the book is “neither fish nor fowl”, varying from plain speech to clunky and esoteric jargon, and appears formulaic. The authors could have used their knowledge and experience to integrate the diverse aspects to be more useful.
The book splits anorexic patients into the good, perfectionist and obsessive-compulsive sphere, and those with bulimia into a more chaotic spectrum. The term “borderline personality” is used only twice. However, it is specific life experiences, such as conflict, neglect, disengagement, parental drug and alcohol misuse, and sexual, emotional and physical abuse, that appear to be factors associated with all eating disorders. In this context, treatment is increasingly about risk reduction.
Worryingly, the book states that bradycardia less than 30 beats per minute is common, adaptive and of no concern without other electrocardiogram changes. I think the point of deterioration in these patients would be difficult to predict. In any case, when severely underweight patients are acutely medically unwell, such as with bradycardia and electrolyte derangement, they are unstable and should be managed by medical staff accordingly. Re-feeding is poorly discussed; nasogastric feeding and the role of involuntary treatment not at all.
No one intends to develop an eating disorder — people slip into it without awareness of what is happening. But it is very difficult to recover from one.