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Intricate links between aquatic animals and their environment expose them to chemical and pathogenic hazards, which can disrupt seafood supply. Here we outline a risk schema for assessing potential impacts of chemical and microbial hazards on discrete subsectors of aquaculture—and control measures that may protect supply. As national governments develop strategies to achieve volumetric expansion in seafood production from aquaculture to meet increasing demand, we propose an urgent need for simultaneous focus on controlling those hazards that limit its production, harvesting, processing, trade and safe consumption. Policies aligning national and international water quality control measures for minimizing interaction with, and impact of, hazards on seafood supply will be critical as consumers increasingly rely on the aquaculture sector to supply safe, nutritious and healthy diets.

Nine metals including Al, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn were analysed from sediment samples collected from 29 stations since 2007 from Bahraini waters. Within this study, it was investigated whether concentrations of these determinants are at concentrations above internationally established Assessment Criteria (AC). The majority of sites were considered not to pose a toxicological risk in terms of metal contamination. Where breaches occurred, they were mainly from historic samples related to Cr, Cu and Ni contamination. A trend assessment revealed that out of 59 significant trends, 36 were downwards and 23 upwards, indicating that some determinants like Al, Zn and Ni are improving strongly across some sites, whilst areas associated with industrial activity still see some increasing trends for Al, Cd, Pb and Zn. Supplementary information The online version contains supplementary material available at 10.1007/s10661-021-09722-7.

An understanding of astrophysical feedback is important for constraining models of galaxy formation and for extracting cosmological information from current and future weak lensing surveys. The thermal Sunyaev-Zel'dovich effect, quantified via the Compton-$y$ parameter, is a powerful tool for studying feedback, because it directly probes the pressure of the hot, ionized gas residing in dark matter halos. Cross-correlations between galaxies and maps of Compton-$y$ obtained from cosmic microwave background surveys are sensitive to the redshift evolution of the gas pressure, and its dependence on halo mass. In this work, we use galaxies identified in year one data from the Dark Energy Survey and Compton-$y$ maps constructed from Planck observations. We find highly significant (roughly $12\sigma$) detections of galaxy-$y$ cross-correlation in multiple redshift bins. By jointly fitting these measurements as well as measurements of galaxy clustering, we constrain the halo bias-weighted, gas pressure of the Universe as a function of redshift between $0.15 \lesssim z \lesssim 0.75$. We compare these measurements to predictions from hydrodynamical simulations, allowing us to constrain the amount of thermal energy in the halo gas relative to that resulting from gravitational collapse., Comment: 21 pages, 12 figures, comments welcome

We statistically evaluate the relative orientation between gas column density structures, inferred from Herschel submillimetre observations, and the magnetic field projected on the plane of sky, inferred from polarized thermal emission of Galactic dust observed by BLASTPol at 250, 350, and 500 micron, towards the Vela C molecular complex. First, we find very good agreement between the polarization orientations in the three wavelength-bands, suggesting that, at the considered common angular resolution of 3.0 arcminutes that corresponds to a physical scale of approximately 0.61 pc, the inferred magnetic field orientation is not significantly affected by temperature or dust grain alignment effects. Second, we find that the relative orientation between gas column density structures and the magnetic field changes progressively with increasing gas column density, from mostly parallel or having no preferred orientation at low column densities to mostly perpendicular at the highest column densities. This observation is in agreement with previous studies by the Planck collaboration towards more nearby molecular clouds. Finally, we find a correspondence between the trends in relative orientation and the shape of the column density probability distribution functions. In the sub-regions of Vela C dominated by one clear filamentary structure, or "ridges", we find a sharp transition from preferentially parallel or having no preferred relative orientation at low column densities to preferentially perpendicular at highest column densities. In the sub-regions of Vela C dominated by several filamentary structures with multiple orientations, or "nests", such a transition is also present, but it is clearly less sharp than in the ridge-like sub-regions. Both of these results suggest that the magnetic field is dynamically important for the formation of density structures in this region., Comment: 16 pages, 17 figures. Submitted to A&A

Limited data are available on the characteristics of adolescents with obesity who seek bariatric surgery. Existing data suggest that adolescent surgery candidates have a higher body mass index (BMI) than comparison adolescents with obesity, but the limited findings regarding psychosocial functioning are mixed. This study aimed to compare BMI and psychosocial functioning among adolescent bariatric surgery candidates, outpatient medical-treatment-seeking adolescents with obesity (receiving lifestyle modification), and adolescents in the normal-weight range. All adolescents completed self-report measures of impulsivity, delay discounting, depression, anxiety, stress, eating pathology, family functioning, and quality of life, and had their height and weight measured. Adolescent surgical candidates had higher BMIs than both comparison groups. Surgical candidates did not differ from medical-treatment-seeking adolescents with obesity on any measure of psychosocial functioning, but both groups of adolescents with obesity reported greater anxiety and eating pathology and poorer quality of life than normal-weight adolescents. Quality of life no longer differed across groups after controlling for BMI, suggesting that it is highly related to weight status. Adolescents with obesity may experience greater anxiety, eating pathology, and quality of life impairments than their peers in the normal-weight range regardless of whether they are seeking surgery or outpatient medical treatment. Clinical implications and directions for future research are discussed.

We describe two related experiments that measured the anisotropy in the cosmic microwave background (CMB). QMAP was a balloon-borne telescope that flew twice in 1996, collecting data on degree angular scales with an array of six high electron mobility transistor-based amplifiers (HEMTs). QMAP was the first experiment to use an interlocking scan strategy to directly produce high signal-to-noise CMB maps. The QMAP gondola was then refit for ground based work as the MAT/TOCO experiment. Observations were made from 5200 m on Cerro Toco in Northern Chile in 1997 and 1998 using time-domain beam synthesis. MAT/TOCO was the first experiment to see both the rise and fall of the CMB angular spectrum, thereby localizing the position of the first peak to l_{peak}=216 +/- 14. In addition to describing the instruments, we discuss the data selection methods, checks for systematic errors, and we compare the MAT/TOCO results to those from recent experiments. We also correct the data to account for an updated calibration and a small contribution from foreground emission. We find the amplitude of the first peak for l between 160 and 240 to be T_{peak}=80.9 +/- 3.4 +/- 5.1 uK, where the first error is statistical and the second is from calibration., Comment: 31 pages, 11 figures, Submitted to ApJ

We present the second generation BLASTbus electronics. The primary purposes of this system are detector readout, attitude control, and cryogenic housekeeping, for balloon-borne telescopes. Readout of neutron transmutation doped germanium (NTD-Ge) bolometers requires low noise and parallel acquisition of hundreds of analog signals. Controlling a telescope's attitude requires the capability to interface to a wide variety of sensors and motors, and to use them together in a fast, closed loop. To achieve these different goals, the BLASTbus system employs a flexible motherboard-daughterboard architecture. The programmable motherboard features a digital signal processor (DSP) and field-programmable gate array (FPGA), as well as slots for three daughterboards. The daughterboards provide the interface to the outside world, with versions for analog to digital conversion, and optoisolated digital input/output. With the versatility afforded by this design, the BLASTbus also finds uses in cryogenic, thermometry, and power systems. For accurate timing control to tie everything together, the system operates in a fully synchronous manner. BLASTbus electronics have been successfully deployed to the South Pole, and flown on stratospheric balloons., Presented at SPIE Ground-based and Airborne Telescopes V, June 23, 2014. To be published in Proceedings of SPIE Volume 9145

We report on a measurement of the angular spectrum of the CMB between $l\approx 100$ and $l\approx 400$ made at 144 GHz from Cerro Toco in the Chilean altiplano. When the new data are combined with previous data at 30 and 40 GHz, taken with the same instrument observing the same section of sky, we find: 1) a rise in the angular spectrum to a maximum with $\delta T_l \approx 85~\mu$K at $l\approx 200$ and a fall at $l>300$, thereby localizing the peak near $l\approx 200$; and 2) that the anisotropy at $l\approx 200$ has the spectrum of the CMB.

During the fifth flight of the Microwave Anisotropy Experiment (MAX5), we revisited a region with significant dust emission near the star Mu Pegasi. A 3.5 cm$^{-1}$ low frequency channel has been added since the previous measurement (\cite{mei93a}). The data in each channel clearly show structure correlated with IRAS 100 \micron\ dust emission. The spectrum of the structure in the 6, 9 and 14 cm$^{-1}$ channels is described by $I_{\nu}\propto\nu^{\beta}B_{\nu}(T_{dust})$, where $\beta$ = 1.3 and $T_{dust}$ = 19~K and $B_{\nu}$ is the Planck function. However, this model predicts a smaller amplitude in the 3.5 cm$^{-1}$ band than is observed. Considering only linear combinations of the data independent of the best fit foreground spectrum for the three lower channels, we find an upper limit to CMBR fluctuations of $\Delta T/T = \langle \frac{C_l~l(l+1)}{2\pi}\rangle^{\frac{1}{2}} \leq 1.3\times 10^{-5}$ at the 95\% confidence level. The result is for a flat band power spectrum and does not include a 10\% uncertainty in calibration. It is consistent with our previous observation in the region.

This paper reviews the use of medication in the treatment of bulimia nervosa and of binge eating disorder. There is now compelling evidence from double blind, placebo-controlled studies that antidepressant medication is useful in the treatment of bulimia nervosa. What is less clear is which patients are most likely to benefit from antidepressant medications and how to best sequence the various therapeutic interventions available. The utility of antidepressant medications in bulimia nervosa has led to their evaluation in binge eating disorder. The limited information currently available suggests that antidepressant treatment may be associated with a reduction in binge frequency in obese patients with binge eating disorder, but does not lead to weight reduction. Additional studies of the use of medication in the treatment of binge eating disorder and of the role of pharmacotherapy in the treatment of bulimia nervosa are needed.

The BOOMERANG (Balloon Observations Of Millimetric Extragalactic Radiation aNd Geophysics) experiment is an international effort to measure the Cosmic Microwave Background (CMB) anisotropy on angular scales of 20' to 40 degrees, with unprecedented sensitivity, sky and spectral coverage. The telescope will be flown from Antarctica by NASA-NSBF with a long duration stratospheric balloon (7-14 days), and is presently scheduled for flight in 1995-1996. The experiment is designed to produce an image of the Cosmic Microwave Background with high sensitivity and large sky coverage. These data will tightly constrain the baryon density, the reionization history, and the formation of large-scale structure in the universe. BOOMERANG will test technologies and return science data that are essential to the design of a future space-borne mission to map CMB anisotropy.

We present cosmological parameters derived from the angular power spectrum of the cosmic microwave background (CMB) radiation observed at 148 GHz and 218 GHz over 296 deg^2 with the Atacama Cosmology Telescope (ACT) during its 2008 season. ACT measures fluctuations at scales 500, Comment: 20 pages, 13 figures. Submitted to ApJ. This paper is a companion to Hajian et al. (2010) and Das et al. (2010)

The Atacama Cosmology Telescope was designed to measure small-scale anisotropies in the Cosmic Microwave Background and detect galaxy clusters through the Sunyaev-Zel'dovich effect. The instrument is located on Cerro Taco in the Atacama Desert, at an altitude of 5190 meters. A six-met.er off-axis Gregorian telescope feeds a new type of cryogenic receiver, the Millimeter Bolometer Array Camera. The receiver features three WOO-element arrays of transition-edge sensor bolometers for observations at 148 GHz, 218 GHz, and 277 GHz. Each detector array is fed by free space mm-wave optics. Each frequency band has a field of view of approximately 22' x 26'. The telescope was commissioned in 2007 and has completed its third year of operations. We discuss the major components of the telescope, camera, and related systems, and summarize the instrument performance.

We present the first results from a new 250, 350, and 500 micron Galactic Plane survey taken with the Balloon-borne Large-Aperture Submillimeter Telescope (BLAST) in 2005. This survey's primary goal is to identify and characterize high-mass proto-stellar objects (HMPOs). The region studied here covers 4 sq. deg near the open cluster NGC 6823 in the constellation Vulpecula (l=59). We find 60 compact sources ( 0) velocities combined with a variety of other velocity and morphological data in the literature. In total, 49 sources are associated with a molecular cloud complex encompassing NGC 6823 (distance ~2.3kpc), 10 objects with the Perseus Arm (~8.5kpc) and one object is probably in the outer Galaxy (~14kpc). Near NGC 6823, the inferred luminosities and masses of BLAST sources span ~40-10^4 L_\odot, and ~15-700 M_\odot, respectively. The mass spectrum is compatible with molecular gas masses in other high-mass star forming regions. Several luminous sources appear to be Ultra Compact HII regions powered by early B stars. However, many of the objects are cool, massive gravitationally-bound clumps with no obvious internal radiation from a protostar, and hence excellent HMPO candidates.

Background: We performed a retrospective analysis of data involving 121 inpatients to examine the rate of weight gain during antipsychotic-free periods and during treatment with various antipsychotic drugs. Method: Data were analyzed to determine differences in weekly weight change during antipsychotic-free (N = 65), typical antipsychotic (N = 51), or atypical antipsychotic (N = 130) treatment periods. Atypical antipsychotic treatment periods were further subdivided into olanzapine (N = 45), clozapine (N = 47), or risperidone (N = 36) treatment periods. A paired comparison was conducted on 65 patients who had an antipsychotic-free treatment period preceding or following a neuroleptic drug treatment period. In addition, patients were classified as either non-obese (with a body mass index [BMI] ≤ 29.9 kg/m 2 ) or obese (BMI ≥ 30.0 kg/m 2 ) to test whether the rate of weight gain during treatment periods was related to initial BMI. Results: Across all treatment periods, weekly weight gain was as follows: 0.89 lb/wk (0.40 kg/wk) on atypical antipsychotic medication, 0.61 lb/wk (0.27 kg/wk) on typical antipsychotic medication, and 0.21 lb/wk (0.09 kg/wk) on no antipsychotic medications. The atypical antipsychotic versus antipsychotic-free comparison was significant (F = 3.51; df = 2,231; p =.031), while the typical antipsychotic versus antipsychotic-free comparison was not. Among the individual atypical antipsychotic medications, significantly more weight gain occurred during olanzapine treatment (1.70 lb/wk) (0.76 kg/wk) than with either clozapine (0.50 lb/wk) (0.22 kg/wk) or risperidone (0.34 lb/wk) (0.15 kg/wk) treatments (F = 7.77; df = 2,117; p =.001). In the paired analysis with patients serving as their own controls, the difference between weekly weight gain during atypical anti psychotic treatment and antipsychotic-free treatment was significant (t = -3.91; df = 44; p =.001), while the difference between weight gain during typical antipsychotic treatment and antipsychotic-free treatment was not significant. With the individual drugs, treatment with both olanzapine and clozapine caused significantly higher weekly weight gain than antipsychotic-free treatment (p =.001 and p =.036, respectively), while treatment with risperidone did not. Non-obese patients (BMI 30.0 kg/m 2 ) did not differ significantly in their weight gain during typical or atypical antipsychotic treatment. Conclusion: Treatment with atypical antipsychotics was associated with more weight gain than treatment with typical antipsychotics. Among the atypical drugs, olanzapine was associated with more weight gain than either clozapine or risperidone. The patient's admission BMI was not associated with the amount of weight gained during subsequent antipsychotic treatment.

Patients presenting with both obesity and BED face multiple challenges: normalizing their eating, improving their physical health, and working to enhance their own acceptance of their body image. In an effort to feel better about themselves, they often have become trapped in a cycle of desperately attempting to diet, then losing control, binge eating, and gaining even more weight. Several psychological and pharmacologic treatment approaches have been used in this population. Most suppress binge eating in the short term, and some seem promising in the long term as well. However, sustained weight loss remains a largely unrealized goal. More recently, BED treatment programs have attempted to address these goals sequentially or in combination. In either approach, it is clear that adopting a long-term focus and promoting enhanced self-acceptance, which have so often been missing from these patients' previous attempts at recovery, are important tasks of treatment that are likely to lead to beneficial lifestyle changes and long-term improvements in physical and psychological health.

This open clinical trial examined the efficacy of treating obese patients with binge eating disorder (BED) with phentermine and fluoxetine in the setting of cognitive-behavioral therapy (CBT).Sixteen obese women received individual CBT along with phentermine/fluoxetine. Treatment goals included elimination of binge eating, weight loss, and reduced psychological distress. Following active treatment, patients were offered once-monthly maintenance treatment for 3 years.Patients showed significant reduction in binge frequency, weight loss, and psychological distress at the end of active treatment, but regained most of the weight within 1 year. At 18-month follow-up, there was an ongoing reduction in binge eating for patients who continued maintenance.Treatment produced comparable binge suppression and more weight loss than most reported studies of CBT alone. However, there is significant weight regain, particularly following medication discontinuation. This study does not support the long-term clinical utility of adding phentermine/fluoxetine to CBT for BED.

While most individuals with bulimia nervosa begin dieting prior to the onset of binge eating, some individuals begin binge eating prior to dieting. The purpose of this study was to assess the differences between these two groups.Participants (N = 120) in a treatment study for bulimia nervosa were separated into two groups (Binge First vs. Diet First) based on the ages they reported for the onset of binge eating and of dieting and then compared across a number of variables.Individuals in the Binge First group reported higher weight, higher shape and weight concern, lower age of onset of eating disorder symptoms, and an altered relationship of binge eating to vomiting when compared to individuals in the Diet First group.The differences between the two groups suggest that there may be subgroups of individuals with purging bulimia nervosa and that individuals in the Binge First group more closely resemble individuals with binge eating disorder than do those in the Diet First group.

The aim of this study was to determine whether temporal patterns of food selection during binges in obese subjects with binge eating disorder (BED) differ from those of patients with bulimia nervosa (BN).Ten obese women with BED and 10 weight-matched women without BED each consumed a multiple-item meal identical to that used in previous studies with bulimics, and all subjects were instructed to binge. An experimenter recorded the subjects' food choices every 10 s throughout the meal via a closed-circuit TV camera.Subjects with BED consumed significantly more meat than subjects without BED (397.78 vs. 270.64 kcal), but the food choices and percentages of time spent eating each of the foods were similar among BED, non-BED, and normal weight controls. While bulimics ate dessert foods earlier in the meals, all other groups ate meat towards the beginning of their meal and ate more dessert foods towards the end of the meal.Food selection patterns during binges in subjects with BED are more similar to eating patterns of noneating disordered subjects, than to patterns seen in patients with BN. These data suggest that binge episodes between different groups of eating-disordered populations are qualitatively different.

The National Institutes of Health (NIH) Workshop on the Development of Research Priorities in Eating Disorders was convened in New York on April 24 and 25, 1996. The goals of the workshop were (1) to identify important unanswered questions in the study and treatment of eating disorders, (2) to discuss potentially fruitful approaches to answering these questions through basic and clinical research, and (3) to assist the NIH and other funding agencies in assigning priorities for research on eating disorders. The program consisted of a series of brief presentations by moderators, each followed by facilitated discussion of the topic with members of the audience. Three reporters (CMG, MJD, FMC) took detailed notes of the proceedings, which have been incorporated into this article. A summary of this workshop is presented, along with recommendations for future research that were identified by workshop participants.

We present a Wiener filtered map of the Cosmic Microwave Background (CMB) fluctuations in a disk with 15 degree diameter, centered at the North Celestial Pole. The map is based on the 1993-1995 data from the Saskatoon (SK) experiment, with an angular resolution around 1 degree in the frequency range 27.6-44.1 GHz. The signal-to-noise ratio in the map is of order two, and some individual hot and cold spots are significant at the 5 sigma level. The spatial features are found to be consistent from year to year, reenforcing the conclusion that the SK results are not dominated by residual atmospheric contamination or other non-celestial signals., Comment: Minor modifications to match published version. 12 pages, with 3 figures included. Extra color figures at http://www.sns.ias.edu/~max/saskmap.html (faster from the US), from http://www.mpa-garching.mpg.de/~max/saskmap.html (faster from Europe) or from max@ias.edu

We present measurements of cosmic microwave background (CMB) anisotropy near the stars HR5127 and Phi Herculis from the fifth flight of the Millimeter-wave Anisotropy eXperiment (MAX). We scanned 8\arcdeg\ strips of the sky with an approximately Gaussian 0\fdg5 FWHM beam and a 1\fdg4 peak to peak sinusoidal chop. The instrument has four frequency bands centered at 3.5, 6, 9, and 14~cm$^{-1}$. The IRAS 100~\micron\ map predicts that these two region have low interstellar dust contrast. The HR5127 data are consistent with CMB anisotropy. The Phi Herculis data, which were measured at lower flight altitudes, show time variability at 9 and 14~cm$^{-1}$ which we believe to be due to atmospheric emission. However, the Phi Herculis data at 3.5 and 6~cm$^{-1}$ are essentially independent of this atmospheric contribution and are consistent with CMB anisotropy. Confusion from galactic foregrounds is unlikely based on the spectrum and amplitude of the structure at these frequencies. If the observed HR5127 structure and the atmosphere independent Phi Herculis structure are attributed to CMB anisotropy, then we find $\Delta T/T = \langle\frac{l(l+1)C_l}{2\pi}\rangle^{1/2} = 1.2^{+0.4}_{-0.3}\times 10^{-5}$ for HR5127 and $1.9^{+0.7}_{-0.4}\times 10^{-5}$ for Phi Herculis in the flat band approximation. The upper and lower limits represent a 68\% confidence interval added in quadrature with a 10\% calibration uncertainty., Comment: 17 pages, 2 Postscript figures, uses aasms4.sty

We present results from a four frequency observation of a 6 x 0.6 degree strip of the sky centered near the star Gamma Ursae Minoris during the fourth flight of the Millimeter-wave Anisotropy eXperiment (MAX). The observation was made with a 1.4 degree peak-to-peak sinusoidal chop in all bands. The FWHM beam sizes were 0.55 +/- 0.05 degrees at 3.5 cm-1 and 0.75 +/-0.05 degrees at 6, 9, and 14 cm-1. During this observation significant correlated structure was observed at 3.5, 6 and 9 cm-1 with amplitudes similar to those observed in the GUM region during the second and third flights of MAX. The frequency spectrum is consistent with CMB and inconsistent with thermal emission from interstellar dust. The extrapolated amplitudes of synchrotron and free-free emission are too small to account for the amplitude of the observed structure. If all of the structure is attributed to CMB anisotropy with a Gaussian autocorrelation function and a coherence angle of 25', then the most probable values of DeltaT/TCMB in the 3.5, 6, and 9 cm-1 bands are 4.3 (+2.7, -1.6) x 10-5, 2.8 (+4.3, -1.1) x 10-5, and 3.5 (+3.0, -1.6) x 10-5 (95% confidence upper and lower limits), respectively., 16 pages, postscript

This study examined the reliability and validity of binge eating disorder (BED), which has been proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders ([DSM] 4th ed.; American Psychiatric Association, in press). The interrater reliability of the BED diagnosis compared favorably with that of most diagnoses in the revised third edition of the DSM. To assess validity, we compared obese individuals with and without BED and bulimia nervosa patients. BED subjects differed from the non-BED obese group on variables related to dieting and weight histories but did not differ significantly on other important variables, including measures of psychopathology. When compared with bulimia nervosa patients, subjects with BED had significantly less psychopathology and reported significantly less dietary restraint. This study lends some support to the concept of BED but suggests that additional studies of the characteristics of this disorder at different degrees of obesity would be useful.

In order to examine the eating behavior of individuals with the newly proposed diagnosis, binge eating disorder (BED), standardized meals were served to 20 obese women, 10 with BED and 10 without BED. When asked to binge eat from a multiple-item array of foods, obese subjects with BED consumed significantly more calories than did obese subjects without BED. Significant differences between the two groups were also found on several of the self-report measures.

In view of reports of a high incidence of Axis II disorders among patients with bulimia nervosa, we assessed personality diagnoses and traits in a sample of bulimic patients both preceding and following treatment for the eating disorder.The Personality Disorder Examination, a structured interview to assess DSM-III-R personality disorders, was administered to 34 in-patients and 49 outpatients with bulimia nervosa entering treatment. Thirty of 49 outpatients were reassessed after 6 weeks of treatment with desipramine or placebo.At initial assessment, 38% of inpatients (N = 13) and 29% of outpatients (N = 14) fulfilled criteria for at least one personality disorder, most frequently borderline personality disorder. There were significant correlations between Personality Disorder Examination trait scores and clinical measures of eating disorder and depressive symptoms. Of 30 outpatients who were reinterviewed following treatment, 3 of 9 patients lost one or more personality diagnoses at post-treatment assessment, and 2 of 21 patients without initial Personality Disorder Examination diagnoses received one or more diagnoses at the second interview. Changes in Personality Disorder Examination trait scores, but not diagnoses, were correlated with changes in some clinical measures.These data suggest that the assessment of Axis II disorders in patients with bulimia nervosa is problematic and raise the possibility that personality features in this group may be influenced by the course of their Axis I disorder.

There is substantial evidence that antidepressant medication is significantly superior to placebo in the short-term treatment of bulimia nervosa. Further work is needed to determine long-term outcome of patients with bulimia nervosa who receive antidepressant treatment, the role of antidepressants in patients who are receiving psychological treatment, and the utility of sequential medication trials. In the treatment of anorexia nervosa, there is little evidence that psychotropic medications, including antipsychotics, antidepressants, and cyproheptadine, are of significant benefit to most patients who are in the acute phase of treatment and are receiving behavioral treatment to promote weight gain. There is preliminary evidence that antidepressant medication, specifically fluoxetine, may be useful in preventing relapse in weight-recovered patients with anorexia nervosa, but this has not yet been documented in randomized, double-blind, controlled trials.

The syndrome of anorexia nervosa, with its striking juxtaposition of psychological and physiological features, has, since the earliest clinical descriptions (Morton 1689; Gull 1874; Lasegue 1873) eluded a comprehensive and integrated understanding of etiology and pathophysiology. Clinical thinking about anorexia nervosa has largely proceeded along two somewhat divergent lines: the first, originating with Simmonds’ report in the early years of this century of a wasting syndrome associated with pituitary lesions in a postpartum woman (Simmonds 1914), has directed itself toward the uncovering of a primary central nervous system abnormality which gives rise to anorectic behavior; the second, advanced by such clinicians as Bruch (1973) has concerned itself with the detailed description of patients and their typical family backgrounds, intrapsychic conflicts, and cognitive distortions. As work has continued, it has become increasingly clear that consideration of both psychological and physiological aspects of the illness is essential, and that there is likely to be no simple unifactorial etiology. To complicate matters further, a marked increase in the incidence of anorexia nervosa over the past decade (Herzog and Copeland 1985), along with the progression of the related syndrome of bulimia from psychiatric “zebra” to everyday occurrence on college campuses (Zuckerman et al. 1986), has not only underscored the importance of epidemiologic and sociocultural analysis in attempting to understanding eating disorders, but has added a rapidly increasing clinical incentive to the already compelling theoretical interest which anorexia nervosa has always inspired.