Pathology of Eating. Psychology and Treatment . By Sara Gilbert. (Pp. 246; £14.95.) Routledge & Kegan Paul: London. 1986.

There appears to be little doubt that as the modern industrialized world becomes increasingly engrossed in the pleasures of eating, fascination with so-called eating pathology grows apace. Paradoxically, as food supplies become more abundant, more refined and more concentrated, we strive to achieve thinner and more perfect bodies. Ascetism at the foot of food mountains; the sophisticated and successful must be slim. Even the anorexic may receive grudging admiration from her family or friends until she loses too much weight and thereby turns the ideal into a sad caricature. There is considerable evidence that the desirable, attractive female stereotype has become thinner, while the average weight of women in the population has increased. Obesity is regarded as a modern scourge, on aesthetic as much as medical grounds. Concern about slimness, body shape and diet has become a preoccupation for many women and an increasing number of men, with an attendant proliferation of popular guides to slimming and health. There has also been a surge of scientific and popular texts about the disorders of eating and one might question the value of yet another. For the non-specialist, however, the strength of Sara Gilbert's book lies in its breadth of subject matter. As the title suggests, the spectrum covered is far wider than the usual concepts of eating disorder such as anorexia or bulimia nervosa. Beginning with an introductory section on the cultural, cognitive and biological control of normal eating, the book then goes on to describe, in turn, disorders of eating secondary to physical or psychological conditions, anorexia nervosa, overeating and obesity, and finally bulimia nervosa and allied states. Thus anorexia and bulimia nervosa are set firmly within the context of normal and abnormal eating behaviours as a whole. In the third and final section broad areas of treatment and outcome are considered briefly but skilfully, and the reader quickly senses the mire of conflicting claims for the many treatment strategies available. Although eschewing any one particular treatment approach, it appears, nonetheless, that the author favours a cognitive-behavioural style, particularly for binge eating and purging. The need to tailor treatment to the individual is emphasized; just as there are no simple mechanisms to explain obesity or anorexia nervosa, there are also no simple recipes for intervention. With reference to obesity, the author warns that behavioural change is extremely difficult for many people, that dieting may be foreign to their usual lifestyle and that failure to achieve possibly unrealistic goals brings much misery. She goes on to raise the important ethical issue of whether to treat at all, and suggests that obese patients be given the chance to consider what it means to them personally to be overweight, just what is involved in becoming thinner, and whether they should endeavour to cope with the societal stigma in other ways. The author takes a reasoned, uncontroversial approach to her subject, perhaps at the expense of some of the more interesting sidelines. Surprisingly little is documented about sex differences, particularly with regard to anorexia and bulimia nervosa. It has been claimed that environmental determinants must be more pronounced for anorexia nervosa to develop in men (Hall et al. 1985). Sexual conflicts in the male may be related to sexual orientation (Herzog et al. 1984) and therefore appear to be rather different to those of females. Finally, it may be that eating disorders are more common in males than is usually supposed, but because of the stereotype of the young, white, middle or upper class female patient, may be overlooked or misdiagnosed (Anderson & Mickalide, 1983). As many others in this field have pointed out, the development of eating disorders in males may provide new insight into the aetiology of the condition in both sexes (Vandereycken & Van den Brouke, 1984; Crisp et al. 1986).