Pergamon

Behav. Res. Ther. Vol. 32, No. 7, pp. 193-198, 1994 Elsevier Science Ltd. Printed in Great Britain

BOOK REVIEWS

ULRIKE SCHMIDT and JANET TREASURE: Getting Better Bit(e) by Bit(e). A Survival Kit for Sufferers of Bulimia Nervosa and Binge-eating Disorders, Lawrence Erlbaum, Hove (1993). xiv + 143 pp. f 19.95 Hardback; E9.95 Paperback.

As eating disorders increase in frequency in the population, it becomes more and more difficult to provide specialist treatment for every individual. “From specialist care to self-directed treatment”, a recent British Medical Journal editorial by these authors, describes a general trend in medicine and psychiatry towards self-help, with minimal initial specialist input. This book, a self-help manual, reflects that trend. It includes a wealth of clinical examples which illustrate the spectrum of the disorders, and with which the sufferer may identify. The book has been field-tested, showing equal efficacy in symptom reduction to cognitive-behavioural treatment, after an eight-week period. It uses the analogy of a journey, reminiscent of “The Pilgrim’s Progress”, with the sufferer negotiating many pitfalls and setbacks on the route to recovery. A particular strength of the book is its imaginative and clever use of cartoons, depicting the various plights of the traveller at various stages.

The sufferer is initially asked to consider if and why recovery really is an ambition. Then separate chapters describe the potential temptations and hazards along the route, with practical suggestions on how to negotiate these, e.g. “Vomiting, Laxatives and Diuretics: Have Your Cake and Eat It--Or Not?“; “Relapse: Walking In Circles-Or Not?“; and “Dieting: A Health Warning”. Several chapters include useful reading lists, should the sufferer wish to explore a particular issue further. Besides addressing actual symptomatology in a behavioural way, the book also discusses characteristic self-defeating patterns of thought and behaviour found in people with eating disorders, such as the drive for perfection, the dominance of guilt, and the “Dictatorship of Control”. “The Slippery Slope of Booze and Drugs”, and shoplifting (“Do You Like Russian Roulette?‘) are addressed. Family, friends and work, often also affected by these disorders, are discussed. For example, some people with eating disorders have workaholic tendencies “out of a sense of battling against personal failure or out of perfectionism”. Again, friends may have been gradually lost or turned away, and in particular sexual relationships may have been affected by the disorder. Ways of approaching these problems are suggested.

This book does not claim to be a cure, but says it “can help you get much better, so that the eating disorder doesn’t rule your life anymore”. It is clearly and directly written, from a wealth of practical experience, and does indeed provide the sufferer with a “survival kit” on the road to recovery. It can be recommended, not only to sufferers, but to professionals dealing with these patients, and to family and friends who wish to become involved in the recovery process.

ANNE WARD

JUDY DUNN: Young Children’s Close Relationship-Beyond Attachment, Sage, London (1993). 141 pp. f14.50.

This book presents a meticulous and perceptive account of the nature of young children’s relationships with others. It takes a broad remit, describing not only the dyadic interactions of child-parent, child-sibling, and child-friend, but also examining the connections between relationships within the family and between family relationships and friendships. Judy Dunn confronts this task in its full complexity by skilfully blending objective, systematic research findings with observational reports that are both sensitive and insightful. In so doing, she has written an immensely readable, coherent “state of the art” account of children’s relationships, simultaneously forging an argument that challenges the paradigm within which much current research takes place.

The thrust of Dunn’s argument is thus: if we continue to concentrate on the key dimension of security of attachment, we shall not achieve a full understanding of children’s relationships. In her view, an adequate account must acknowledge the other ways-apart from attachment-in which the child-mother relationship differs; it needs also to take on board the multidimensional and developmental aspects of children’s relationships with both parents, with siblings and with peers. Whilst recognising that security of attachment is of major importance, Dunn asks why other factors that are known to be important in adult relationships-such as warmth, frequency of conflict, frequency of expressed affection, shared communication, shared humour, self disclosure, and connectedness-are neglected when looking at children. Furthermore, she queries the concept that children’s relationships with their mothers serve as a template for other relationships and reports studies that reveal no significant relationship between security of child-mother attachment at age one and friendship patterns at age five, suggesting that children may compensate through their friendships for emotionally unsatisfying parentxhild relationships.

The case presented in this book is difficult to refute: as participants in relationships throughout life, we “know” that our relationships are complex, multi-faceted and shifting, and that there are both links and striking differences amongst our different relationships. It is perhaps this very complexity that has encouraged researchers to adopt a narrowed framework for study in order to impose some measure of control. Dunn’s argument is that we can no longer afford to constrain research in this way: in the final chapter she writes, “The attachment framework has been useful in illuminating aspects of the parent-child relationships and their significance in later life, as well as in setting up hypotheses about what processes may be important. However, its typology is both limited and limiting.”

The challenge will be to translate into testable hypotheses the issues raised in this book. To address this, Dunn reports on a model, proposed by Hinde, that appreciates connections between the quality of relationships and both the wider social context and differences in individuals. Furthermore, in order to describe the key dimensions in which relationships differ, she presents detailed accounts of three 4-year-olds’ relationships with their mothers. Other testable hypotheses are also discussed: for example, the possibility that differences in parentxhild discourse about feelings and the social world may be related to the subtlety of children’s competence in peer relationships, or that early shared humour may later be related to the ability to enjoy wit and light-heartedness in relationships.

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