Reference no: EM132393320

What is the diagnosis for this case study:

Ms. T is a 28-year-old single insurance policy analyst who presents for consultation regarding her eating problems. She is the third of four children of a well-to-do Midwestern attorney and his wife, who was a homemaker while Ms. T was growing up. No one in the family has had a problem with being overweight, but a premium has always been placed on being strong, fit, and "in shape." As a child, Ms. T was a good student and an athlete and developed an interest in figure skating. As a young teenager, she place well in local competitions and gradually devoted more time and energy to training.

At age 15, as she entered her sophomore year of high school, Ms. T transferred to an all-girls boarding school in the East because her parents felt this would increase her chances of being admitted to an Ivy League college. She made several friends, did well in her courses, and generally coped well with the demands of the new school. She continued to pursue her interest in figure skating and began training with a new coach. Although for the most part supportive and encouraging, the coach did comment on one occasion that Ms. T might do better competitively if she lost a few pounds. At this time, Ms. T's weight was 128 pounds, normal for her age and height of 5'7", and her diet was not unusual. Stung by her coach's remark, Ms. T embarked on a vigorous program of exercise and dieting. In addition to her daily skating practices, she went to an aerobics class 6 days a week. She also eliminated desserts and red meat from her diet. Because of the time-consuming nature of these activities, she grew distant from the new friends she had made at school.

During the first year at boarding school, Ms. T's weight dropped from 128 to 100 pounds, and her menstrual periods, which had been regular since age 13, ceased. When she returned home for summer vacation, Ms. T's parents were very concerned by her obvious weight loss and insisted that she see her pediatrician who, in turn, referred her to a psychiatrist. It is not clear what diagnosis was made and, after a few visits, Ms. T refused to continue treatment. During the summer, however, her eating habits began to change. Although Ms. T tried to maintain the dieting program she had begun at school, she found herself struggling to control her appetite and, on several occasions, ate a box of cookies and pint of ice cream late at night after the rest of the family had gone to bed. When she returned to school, Ms. T continued to intermittently overeat and eventually developed a pattern of dieting during the week and overeating on weekends. Although she continued to skate competitively, she was unable to maintain the vigorous exercise program she had initiated during her first year at boarding school. Her weight gradually rose through the rest of high school to 125 pounds, and her menses resumed after 9 months of amenorrhea.

After she graduated from high school, Ms. T entered a competitive Ivy League college where she majored in history and was a good, but not outstanding, student. Her weight continued to rise, reaching a high of 150 pounds in the fall of her freshman year. When she was home for Christmas that year, she found herself unable to stop eating the holiday cookies and snacks in the house. Greatly distressed at the prospect of gaining more weight, she decided she would induce vomiting after overeating. She did so and thus began a pattern of overeating and then inducing vomiting several times a week that has persisted for the past 10 years. On nights when she knows her roommate will be out, Ms. T typically buys a pint of ice cream and a box of chocolate chip cookies on the way home from work. After arriving home, she consumes the cookies and ice cream and any other leftover desserts in the refrigerator over the course of an hour while she watches TV. She then induces vomiting. Ms. T is very ashamed of this "disgusting habit" and has resolved to stop on numerous occasions; however, she has been unable to do so for more than 2 weeks at any given time. When she is not overeating, Ms. T attempts to diet rigorously. She continues to avoid red meat and desserts and her weight is reasonably stable at 145 pounds. She views her appearance as "gross."

Ms. T has been reasonably successful professionally. Since graduating from college, she has been employed by a large insurance firm and is progressing well in the middle-management ranks. She shares an apartment with a woman she views as her best friend but whom she has not told about her eating problem. Ms. T reports that her social life has been impaired by her concern about her eating and her weight. She is self-conscious about both and is reluctant to go to dinner with male friends because she fears that her strict dieting will seem incongruous in light of "how big I am."