Phyllis and her husband were regulars at Annabelle’s Restaurant. Every Saturday night, they arrived promptly at 7:00 PM to begin Phyllis’s first dinner meal of the evening. While she ordered a complete dinner featuring prime rib, baked potato,

vegetables and a house salad, her husband nursed a cup of coffee. Following dinner, the wait staff cleared the table and replaced the silverware before the couple joining Phyllis and her husband for an 8:30 PM dinner arrived. Phyllis ordered a meal identical to the one she had eaten earlier and this dinner proceeded as if this were her first evening meal. Following the second dinner, she routinely went to the ladies’ room for approximately one half hour. Upon her return, the couples left the restaurant. Despite the large quantity of food she consumed every Saturday evening, Phyllis was rail thin, weighing approximately 100 lbs. at a height of 5’10”. Several wait staff believed that this pattern was repeated at least one other time each week at a neighboring restaurant.

On the basis of the information presented, what diagnosis would you expect would be most likely to be given to Phyllis, and what other associated clinical features might you expect to find in this case?

What will be an ideal response?

Phyllis is most likely suffering from anorexia nervosa, binge eating/purging subtype. Her behavior of bingeing dinners followed by lengthy visits to the restroom, as well as her below average body weight, are suggestive of the disorder. It is most likely that Phyllis has an intense fear of gaining weight and may commonly complain of “feeling fat” despite the physical evidence that she is underweight. She may also associate her weight with her sense of self-worth, and fluctuations in her weight may result in a downward spiral of self-esteem. As a consequence of low body weight, Phyllis may have amenorrhea, and she may be experiencing denial of her illness and resist treatment.