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For example, restraint theory, a widely embraced theory emphasizing the role of dieting in the etiology of binge-eating problems does not seem satisfactory to account for the development of BED, particularly since only about half of BED patients dieted before the onset of their eating disorder (Spurrell et al, 1997) According to interpersonal vulnerability models of eating disorders (eg Wil ey et al, 1997), some of the missing factors in the restraint model include interpersonal functioning, mood, and self-esteem, all of which are empirically supported as related to the onset/maintenance of eating disorder symptoms First, there is a great deal of evidence that interpersonal problems and de cits play a signi cant role in all three eating disorders Individuals with eating disorders are more lonely (O Mahony & Hollwey, 1995) and perceive lower social support than do non-eatingdisordered individuals.

Aerts, J.J.M. (1992) Early identi cation and diagnosis of anorexia and bulimia nervosa by general practitioners (in Dutch). Dissertation, University of Maastricht. APA (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV). Washington, D.C.: American Psychiatric Association. Andersen, A.E. & Mickalide A.D. (1983) Anorexia nervosa in the male: An underdiagnosed disorder. Psychosomatics, 24, 1066 1075. Banasiak, S.J., Paxton, S.J. & Hay, P.J. (2000) Cognitive-behavioural guided self-help for bulimia nervosa in primary care. Paper presented at the Academy of Eating Disorders 9th International Conference on Eating Disorders, New York, 4 7 May. Bartelds, A.I.M., Fracheboud, J. & Van der Zee, J. (1989) The Dutch Sentinel Practice Network: Relevance for Public Health Policy. Utrecht: Netherlands Institute of Primary Health Care (NIVEL). Bloois, M. de (1987) Anorexia nervosa from within. How do patients with anorexia nervosa evaluate their treatment (in Dutch). Dissertation, University of Leiden. Bryant-Waugh, R.J., Lask, B.D., Shafran, R.L. & Fosson, A.R. (1992) Do doctors recognise eating disorders in children Archives of Diseases in Childhood, 67, 103 105. Bryant-Waugh, R. & Lask, B. (1999) Eating Disorders A Parents Guide. Harmondsworth. Penguin Books.

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They have fewer support gures, less emotional and practical support, and are less likely to seek out support as a way to cope with problems (Ghaderi & Scott, 1999; Rorty et al, 1999; Tiller et al, 1997; Troop et al, 1994) Eating disorders are associated with dif culty in various areas of social adjustment including work, social/leisure, extended family, and global functioning (Herzog et al, 1987) Eating disordered women also report and demonstrate lower competence, relative to subclinical and normal control women, in coping with social stress and social problem situations, including independence from family, family con ict, female peer con ict, and male rejection (Grissett & Norvell, 1992; McFall et al, 1999) This lack of competence is especially relevant because serious life stresses that involve the patients relationships with family or friends tend to precede.

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To date, CBT with the eating disorders has been based on models where the central pathology involves cognitions and behaviours that are highly focused on food, weight and body shape (e.g. Fairburn, 1981; Garner & Bemis, 1982). The aims of treatment within these models have been clearly described elsewhere (e.g. Fairburn & Cooper, 1989), but centre on the modi cation of behaviours and cognitions that maintain the existing behaviour. In CBT terms, the main foci are the modi cation of negative automatic thoughts and dysfunctional assumptions relating to food, weight and shape, and the breaking of behavioural and physiological chains that maintain the unhealthy eating behaviours and cognitions. This model has been used to develop clearly operationalised treatments, although it would be a mistake to conclude that these manualised protocol-driven treatments lack an individualised component (see above). Nor are these models static, as evidenced by the recent modi cations to Fairburn s model of bulimia nervosa (Fairburn, 1997). From a clinical and scienti c perspective, the bene t of the clear operationalisation of these (or any other) treatments is that one can be more conclusive about their effectiveness and limitations.

Shot noise See Photon noise Signal-to-noise (S/N) ratio The ratio of the signal of an object to the noise of the surrounding background, where noise is the square root of the sum of the variances of contributing noise components In the case that noise is photon limited and background noise may be approximated by the square root of the background signal, S/N gives the number of standard deviations that distinguish the object signal from the mean signal of the background 217, 247, 276, 299 Sign of birefringence In polarization optics, a reference to the sign of birefringence b, where b ne no For the case that the refractive index describing the trajectory of the E ray is greater than that describing the trajectory taken by the O ray, the sign of birefringence of the material is positive 127 Silicon-intensifier target (SIT) camera.

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