BOOK REVIEWS 209

The book begins with the evolution and development of the concept of relapse prevention and its potential application with sex offenders. Several short chapters explore various problem areas and high-risk situations where relapse prevention procedures and techniques can be applied. Subsequent chapters highlight the importance of identifying high-risk factors and situations, and various assessment strategies are described. Finally, specific procedures and programmes are described.

What is lacking in the book is a systematic evaluation of the effectiveness of relapse prevention. This is not surprising considering the recent application of relapse prevention ideas to sex offenders. Nevertheless, the book is likely to be of interest and value to all those clinicians who are required to assess and treat sex offenders.

G. H. GUDJONMN

M. M. FIGHTER (Ed.): Bulimia Nervosa-Basic Research, Diagnosis, and Therapy. Wiley, Chichester (1990). xii + 364 pp. f45.00.

The balance between appetite and satiety, and their interaction to maintain body weight within healthy limits, is itself a fascinating study in physiology. When this balance becomes disrupted not only is the resultant body weight abnormal but if emesis and purgation are used to upset this balance, there may be severe metabolic consequences. The psychological causes and consequences complete the fascination of the syndrome and all are tackled in this excellent book.

The physiology and psychology of eating behaviour and nutrition are not in the mainstream of physiological teaching and yet they are dearly under the control of feedback mechanisms and autoregulation that are as critical for the survival of the individual in the long term as cardiovascular reflexes are in the short term. There are chapters on both the central and peripheral controls of food intake and another which describes the perturbations in these systems in response to stress. The psychopha~acology of hunger and satiety are succinctly described. These chapters are complements by those which describe the pathophysiological features of bulimia, for example the central neurotransmitter disturbances, the endocrine dysfunction and the disturbed perception of satiety.

Forty authors from around the world have contributed but the book remains of manageable size at a little over 300 pp. tt would be invidious to name some, and purposeless to name all. They have produced an eminently readable book which deals with all aspects of the subject including diagnostic criteria, presenting symptoms, the course of the illness, its aetiology, biological basis, and therapy. The study of bulimia nervosa has been uneven. While some areas have been the subject of much research, there is very little published on others. Thus, some chapters are authoritative reviews of a comprehensive literature. The chapters on affective disorders and bulimic syndromes and on medical complications fall into this category. On the other hand, there is relatively little written about the disease in children and in the male, and the authors writing on these under-researched areas can do little more than open avenues of further enquiry.

Many specific therapeutic skills are required for the successful management of bulimia nervosa. Behavioural therapy, nutritional counselling, psychotherapy, psychopharmacology, and recognition of a disordered body image may all play a part. The final section of the book details all the practical guidelines drawn from clinical experience and research that a therapist would require. This book will be valuable to all psychiatrists, clinical psychoiogists and any physician that has to cope with the rising tide of young women with this disorder.

JANET TREASURE

T. J. POWELL and S. J. ENRIGHT: Anxiety and Stress Management. Routledge, London (1990). xii + 196 pp. f9.99.

By a curious inversion, this text is likely to be of more value to its supposed secondary audience, the clients seeking help with their stress/anxiety, than to its intended primary readership, health professionals who offer help with these problems. The intention of the book is to provide a theoretical framework and practical guidance for cognitive-behavioural intervention, and the strategy adopted is largely a modelling procedure: “this is what we do in our clinical practice, and this is how we say it”. The bulk of the text is therefore written as if speaking to the client, with language kept concrete, liberal use of example and analogy, and theory pruned of complexity. This approach has clear advantages, in that the info~ation is presented in a manner which is easy to digest and which illustrates a useful form of words for communicating with clients. The disadvantage, however, is a loss of scope for more detailed and abstract discussion. The book therefore delivers only a very superhcial explanation of underlying concepts and cognitive-~havioura~ principles, certainly inadequate to equip the uninitiated with an adaptable set of treatment techniques and with little to stimulate the more theoretically knowledgeable therapist. There is virtually no critical evaluation of specific intervention strategies; so, for example, relaxation is presented as more or less integral to exposure treatment, with no comment on the controversy SUFFOUnding this assumption. There is likewise little discussion of results from treatment trials indicating success rates, limitations of the interventions, client characteristics which affect outcome, OF other clinically relevant information. Whilst most clinicians probably do use a melange of methods, focussing on several response systems simultaneously, appropriate selection and modification of techniques in the individual case depends on clarity and depth of understanding of general principles.

This said, however, the book provides a valuable source of clinical wisdom derived from the authors’ extensive experience in the field. Their detailed suggestions for running a stress management group provide a useful guide for therapists who have hitherto concentrated on individual interventions, and the client information handouts are excellent, It also serves as an interesting introduction for the lay reader and, as indicated earlier, could be recommended as reading for clients in treatment.

JANE POWELL