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The psychology of bulimia nervosa: a cognitive perspective
  1. M Hodes

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    Myra Cooper. Published by Oxford University Press, Oxford, 2003, pp 332, £29.50. ISBN 0-19-263265-5

    The first description of bulimia nervosa was published in 1979 by Russell. Since that time there has been a burgeoning literature on all aspects of the disorder. This has coincided with the growth of cognitive psychology and cognitive behaviour therapy (CBT). As might be expected, the cognitive approach has been used in the investigation of bulimia nervosa with considerable success, and CBT has become the “gold standard” for adults requiring treatment on the basis of many randomised controlled trials. This book is a timely review of the literature, at a time when it is still just possible for a single author to achieve adequate understanding of the field.

    The background chapters cover the diagnostic features, epidemiology, and theories of aetiology of the disorder. There is description of the main treatments, with special emphasis on CBT. Fairburn’s established model of CBT balances the focus on changing eating patterns with cognitions and is fairly described. This is the foundation for Cooper’s own original work, which places more emphasis on core beliefs, for example regarding the self and how they relate to beliefs about eating and dieting. Although Cooper’s model has some evidence in support of its rationale, there is no evidence from treatment trials that it achieves greater benefits than Fairburn’s approach, and so CBT practitioners might wonder why they should change to the new approach.

    Overall this is a well written and well organised book. Each chapter has numerous useful summary tables of the main points covered in the text. Weaknesses of the book are its rather poor coverage of developmental issues, and negative bias with regard to drug treatments. Despite these points, the book achieves very well its main aim of providing a cognitive perspective. The book would be very useful for trainees and more experienced clinicians, and should have a place in any well stocked library.

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