Le Grange D, Lock J (eds): Eating Disorders in Children and Adolescents—A Clinical Handbook

Abstract

Eating disorders commonly become manifest during late childhood and adolescence. It is thus indeed time for an edited volume that focuses on eating disorders in this age range. Daniel Le Grange and Jim Lock—two distinguished specialists in the treatment of young patients with eating disorders—have undertaken this valuable task. Their book is divided into seven parts, each one of which includes one to eleven articles written by experts in the respective fields. The first part (Aetiology and Neurobiology; Kaye; Racine and co-workers) expands on state and trait markers of anorexia nervosa (AN) and covers the neurobiology of appetite, imaging studies and reward processing in patients with AN. Twin studies have revealed moderate heritability estimates for eating disorders and disordered eating. The finding that variance in disordered eating was predominantly due to shared and non-shared environmental effects in 11-year-old twins in contrast to high heritability estimates in 17-year-old twins underscores the importance of developmental factors. Neurobiological hypotheses to explain the female predominance of eating disorders include the influence of oestrogen and estradiol, the rapid change in body composition during female puberty and the neuropeptides modulating metabolism. Molecular genetic findings are not dealt with; however, it should be pointed out that genome-wide significant loci have not been identified for any eating disorder in contrast to obesity, for which over 30 predisposing single nucleotide polymorphisms have been confirmed. Strobe and Peris in a ‘neuroscience perspective’ of the aetiological role of the family environment analyse the typical life history of patients, which is rarely burdened with conspicuous vulnerability. The importance of gene–environment effects is stressed. Throughout Part 1, the importance of anxiety in the aetiology of eating disorders is looked upon from different perspectives. Part 2—Epidemiology and Course: In spite of a substantial increase in epidemiological studies over the past 30 years, data on children and adolescents remains inconsistent and inadequate. Norris and co-workers summarize incidence and prevalence rates for AN, bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Whereas it is uncertain if these rates have increased overall, the adolescent rates have seemingly increased potentially due to an earlier age of onset. Steinhausen reviews the outcome literature including mortality, global outcome, psychiatric disorders at follow-up and prognostic factors for both AN and BN. Part 3—Diagnosis and Classification: Bryant-Waugh and Nicholls and Eddy et al. focus on issues related to diagnosis and classification of disordered eating in childhood and adolescence, respectively. It has been proposed to eliminate the division into child and adolescent versus adult feeding and eating disorders for both ICD-11 and DSM-5. Part 4—Medical Issues and Assessment: Katzman and Findlay provide a synopsis of the medical issues and complications of eating disorders that have been reported in children and adolescents including electrolyte imbalances, renal, cardiovascular, oro-gastrointestinal, endocrine and haematological complications. Loeb et al. address the assessment of eating disorders in children and adolescents. This section of the appropriate way to operationalize low body weight leaves the reader with more questions than answers; it remains unclear as to how a paediatrician or a J. Hebebrand (&) Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen, Germany e-mail: Johannes.Hebebrand@uni-due.de