At a height of 5 feet 7 inches and a weight of 79 pounds, Sandy, a 17-year-old white female, had the look of an emaciated fashion model when she arrived for for the initial assessment. Unlike a model, she was dressed in secondhand clothes and worn-out flip-flops, which stood in stark contrast to her parent's more polished professional presentation. Sandy didn't really think there was anything wrong with her, but her parents knew that her current condition warranted immediate clinical attention. Sandy had been evaluated by her family physician earlier and he reported the following medical problems: irregular heartbeat, amenorrhea (loss of menstrual cycles due to malnutrition) for the past 7 months, and potassium deficiency. They medical evaluation also found no significant medical history and no physical illness to explain her weight loss. During the parental interview, Sandy's parents reported significant weight loss and hoarding behaviour from their daughter (eg., saving food from other students' lunches and bringing it home). They mentioned that she would always read food labels to count calories/fat grams and analyze other nutritional information, and that she read cookbooks voraciously and talked about food incessantly. According to her parents, Sandy was an athletic girl who in the past had been very involved in her high school's dance society and sports teams, including soccer and volleyball. However, she dropped out of these extracurricular activities a year ago; at about the same time, she began exercising beyond what her parents thought was 'normal' – for hours on end, Sandy would engage in endless repetitions of pushups and situps, and drove herself relentlessly on the stationary bicycle her parents had given her one Christmas. Often times, her parents could hear her exercising at 1 or 2 in the morning. Always a straight-A student, Sandy became obsessed with obtaining perfect marks in... [continues]
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