Andrea is a 19-year-old college student. She has requested counseling from her college counseling center at the urging of her friends. Andrea's friends believe that she may have an eating disorder. Andrea sees herself as fat, but to her friends she is startlingly thin. In fact, she is so thin that they are afraid that she will become seriously ill. Andrea maintains this low weight mainly by eating practically nothing and drinking two quarts of water a day. She says that she thinks about foods "all the time" when she is restricting her food intake, but that she does not want to eat because she is afraid of getting fat. At other times, however, her hunger is so intense that she feels like she has to give in to the cravings. At those times she "binges" and eats huge amounts of food. For example, she once ate a half gallon of ice cream in a little over one hour. After her "binges" she works to get rid of the excess calories she has consumed by vomiting. She says she is starting to agree that she may have an eating problem. After interviewing Andrea, you are convinced that she meets the criteria for a diagnosis of both anorexia and bulimia.

You are also interested in obtaining some background information about Andrea, to aid in understanding her. You find out that Andrea is 19 years old and a freshman at your college. She says that she started really worrying about her weight two years ago, when she was a junior in high school. At that time, her parents were quarreling a lot and had even talked about a divorce. She says that managing her eating made her feel more in control. She also noticed that, even though she still felt fat, people seemed to pay more attention to her and to respond to her better as she got thinner. She indicates that she likes having a more "boyish," more athletic figure. (From Diehl, V., 1999.)