In the words of Dr. Martin Luther King Jr., education has a twofold function. Education must first, “enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction” (King 1947, p. 10). But education cannot stop here; it must further guide one’s studies to ensure that “worthy objectives” are the targets of concentrated efforts (King 1947, p. 10).
The Handbook of Assessment and Treatment of Eating Disorders is masterful in achieving this twofold mission. It is a scholarly volume that provides thoughtful review and critical analysis of the state of the field. Each chapter grapples with complex and imperfect data; each chapter also provides practical and thoughtful integration of material to guide clinical practice and inform future research. It is easy to get bogged down by the lacunae in the empirical database, leading some mental health professionals to distance themselves from research and discount what is known. It is also easy to go into overdrive research mode to fill these gaps and lose sight of the priority clinical issues that should guide our work to maximize impact. This handbook has achieved the fine balance between research and clinical practice, between quantitative and qualitative ways of knowing, and between articulating clearly what we don’t yet know and, nonetheless, working with what we do know to produce a useful text to guide clinical care and future research.
The impetus for the handbook was the publication of DSM-5 (American Psychiatric Association 2013), and this is most appropriate given that any study of eating disorders should begin with a careful consideration of our diagnostic system-what we call an eating disorder and the related phenomenology. Developed under the auspices of the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM) system is an American classification system; however, it has been adapted to varying degrees in countries around the world, particularly with regard to research programs. As described in several chapters in the book, the success of DSM is variable in terms of its ability to accurately capture the clinical syndromes of eating pathology that cause suffering and propel individuals to seek treatment. DSM is further challenged in its ability to capture the most important aspects of eating disorders for diverse segments of the population (e.g., men) and across cultures. Around the globe, these are critical issues that will become more and more prominent in the near future as eating disorders become increasingly recognized in diverse cultural and economic contexts.
The Global Burden of Disease Study demonstrates that the health burden of eating disorders is steadily increasing (Vos et al. 2012), primarily because eating disturbances outside high-income, Western countries are rapidly growing in concert with rising rates of population weight. This is true in terms of both disability-adjusted life years and years lived with disability. In 81% of countries around the world, population weight has increased significantly over the past 30 years, with 36.9% of men and 38% of women falling in the overweight or obese categories today (Vandevijvere et al. 2015). In the United States, 39.96% of men and 29.74% of women are overweight, and an additional 35.04% of men and 36.84% of women are obese (Yang and Colditz 2015). Such demographic trends in eating and weight pathology call for global innovative interventions, including translation of assessment instruments, adaptation of treatment interventions, leveraging new technologies for assessment and treatment, and development of more aggressive treatments such as bariatric surgery.
Although the health consequences of eating disorders are well understood, the significance of the disability burden has largely been ignored within the global health field. Even more broadly, despite the fact that mental illness is the leading cause of disability around the world, mental health remains largely overlooked, if not invisible, within the health agendas and budgets of many nations around the globe. This failure might be considered unfortunate but understandable given the myriad health and other priorities that burden governments everywhere, until we consider the following: We have treatments for eating disorders that can reduce suffering for the majority of individuals; we have evidence of the successful implementation of psychotherapies for depression in low- and middle-income countries, suggesting that we can do the same for eating disorders; and we know that focusing on women’s health has a multiplicative effect for families and communities. In the same way that focusing on women’s education and empowerment has a positive impact on the educational achievement of the next generation, focusing on women’s mental health must become a priority that is appreciated for the benefits accrued to the individual as well as the positive pay-it-forward benefits for the next generation.
The wisdom contained in the Handbook of Assessment and Treatment of Eating Disorders has the potential to guide both research agenda setting and clinical care for the field of eating disorders. Each chapter sifts and weighs evidence, discerns the true from the false, the real from the unreal, and the facts from the fiction. Each chapter provides incisive guidance on the worthy objectives for the field of eating disorders. Collectively, these chapters represent a volume of knowledge that promises to enhance every reader’s education about eating disorders and better prepare us to carry forward the work of advancing understanding and care for individuals suffering from eating disorders around the world.
Kathleen M. Pike, Ph.D.
Professor of Psychology in Psychiatry and Epidemiology Director, Global Mental Health Program Columbia University, New York, New York
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013
King ML Jr: The purpose of education. The Maroon Tiger, February 1947, p 10
Vandevijvere S, Chow CC, Hall KD, et al: Increased food energy supply as a major driver of the obesity epidemic: a global analysis. Bull World Health Organ 93:446-456, 2015
Vos T, Flaxman AD, Naghavi M, et al: Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2163-2196, 2012 23245607
Yang L, Colditz GA: Prevalence of overweight and obesity in the United States, 2007-2012. JAMA Intern Med June 22, 2015 26098405 [Epub ahead of print]