NEW HOPE FOR BINGE EATERS: Bulimia: The Secret Epidemic

Psychiatrists Pope and Hudson, of Harvard Medical School, argue for recognition of the eating disorder, bulimia, as a manifestation of depression--thus offering another new model for its treatment. In bulimia, which they define in detail, recurrent episodes of binge eating are accompanied by a group of associated symptoms such as self-induced vomiting. Readers are encouraged to test themselves for the presence of the disorder, or a predilection for it. (""Do you find yourself thinking continuously about food for the entire day?"" etc.) From scrutiny of past and current investigations, Pope and Hudson develop their own argument that bulimia is closely related to major affective disorder (specifically, a form of depression) and present the supporting evidence--studies in phenomenology and genetics, laboratory tests, treatment response. They also undertake to refute current theories in disagreement with their own. (Most of the experimental results are open to a wide range of interpretations.) After reviewing successful cases in their own experience, Pope and Hudson advise readers on ""How to Get Good Treatment""--with, in their view, antidepressant medication. They recommend finding a knowledgeable psychopharmacologist (a specialist in the use of psychiatric medications); give pointers on ""Choosing an Antidepressant""; and suggest that concurrent psychotherapy may be helpful. Readers seeking thoughtful, well-grounded guidance should also see Bulimarexia, by Marlene Boskind-White and William C. White (p. 217). This is a responsible presentation of a variant approach.