Books of Interest
Book Reviews

Jan 20, 2009, 20:30

By Kathryn Zerbe, M.D.
New York: W.W. Norton & Company, Inc.
ISBN 13: 978-0-393-70442-6

Reviewed by Leon Pyle, Ph.D.

Eating disorders have the highest mortality rate of any psychiatric illness and cause significant medical and psychological morbidities in patients who do not succumb (Zerbe, 2008, p. 1)1

As every parent who has tried to help a child with an eating disorder knows, if we are to be helpful, we need the best source of understandable, practical advice we can get. Dr. Kathryn Zerbe's new book, Integrated Treatment of Eating Disorders, based on her 25 years of clinical experience and painstaking research (her book includes over 750 professional references!), provides the most up-to-date resource available today.

In normal problem solving, one's thinking is directed toward the solving of an external problem using mental and other resources. For eating disordered patients, both the problem and the imagined solution (a different body shape or size) are internal. Thus, insulated from external reality, the patient is extremely difficult to reach and influence.

The patient's intention, Dr. Zerbe states, is to become a better person, but he or she creates instead a dangerous routine of purging, exercising far beyond what is physically healthy, binging, dieting, and the like. Because of the internal nature of the battle, these patients do not see the danger in their belief about how to create this "better person," and may put their lives at risk in pursuit of their delusional goal.

The complexity and medical implications associated with eating disorders are enormous and, at times, frightening. Dr. Zerbe makes the case that there is no single answer, no simple cure. What is required is a plan that integrates the best treatments offered by medicine, various forms of psychotherapy, nutrition and the like.

Dr. Zerbe's book, while written with mental health professionals in mind, is user-friendly, jargon-free, and will enable parents to better understand and evaluate treatment options offered by their team of practitioners.

Dr. Zerbe advises that treatment must begin with a thorough evaluation of possible medical problems caused by the disorder and an assessment of the nutritional interventions necessary to stabilize the patient. In severe cases, hospitalization may be required. Simultaneously, "talk therapy" is undertaken to begin to understand and support the patient. Dr. Zerbe warns that the patient's self-deception and denial prevent him or her from talking openly about aspects of his or her problem in the early phase of treatment. She also warns that parents and therapists need to avoid expectations that are too high.

Dr. Zerbe advises the reader on how to talk with the patient in ways that are both tactful and useful. Ironically, a good sign that the therapy is beginning to work is when the patient begins to complain more vociferously about treatment and the mental health professionals attending him or her. It is an indication that some of the negativity that has been inwardly focused is beginning to be externalized, providing a bit of relief to the patient (but dismay to the unprepared parent or therapist who is working so hard to be helpful).

Dr. Zerbe notes that, as therapy progresses, patients, parents and therapists will at times feel that the same topics are being discussed ad nauseam. It may be difficult to see the progress that is being made as the subtle deepening of understanding occurs, and the two-steps-forward, one-step-backward kind of progress will at times be discouraging to all involved. But with "containment" of the problem, and empathic understanding of the patient, progress will occur. It is especially important during difficult times for parents and therapists to hold the potentiality of the patient in mind, reflecting back to the patient what is possible so as not to get lost in the struggle of the moment.

Even when therapy is completed, a perfect solution will not be obtained. However, the patient's improved understanding of the negative consequences that the eating disorder has had on him or her and the painful feelings that led to the attempt to solve the problems through a change in bodily appearance will be vastly improved. The previously incessant self-preoccupation will diminish. The patient will begin to consider what he or she wants to do with his or her life, as well as what steps will be required to accomplish the new goals. Secrets will be exposed and lose their power. Self-forgiveness will occur. A capacity for intimacy will improve. A leap into the unknown future can be made.

Dr. Zerbe's book is a Godsend to anyone who wants to be helpful to someone suffering from an eating disorder. It will help both parents and therapists think about the disorder and its solution in new, holistic and practical ways, as well as create new strategies to deal with the many issues involved.

About the Reviewer:
Leon Pyle, PhD, is a Licensed CA psychologist, an OR Licensed Professional Counselor, a Private Practitioner and originator of He is located in Ashland, OR and can be reached by email at

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