Lisa is a twenty-seven year old woman who entered therapy after her twenty-first birthday. Lisa was resistant at first to see a psychologist. She was referred for sudden weight loss, but did not believe she had a problem. As a child, she was always on the chubby side and was accustomed to hearing random comments about her weight from coaches, family, and friends. Lisa was always a perfectionist. Even as young as three, her parents recall her intense frustration with herself when she could not accomplish a task quickly and easily. In high school, Lisa decided to go on a diet because she was tired of looking “less than perfect” in her eyes. She had an idea of what her ideal body weight should be and was determined to reach this goal. She began going to the gym to work out every morning before school for two hours and then ran track after school. She set up a meal plan for herself that consisted of 1200 calories per day with little or no fat in her diet. This structured plan worked well during her senior year and she was happy to report that she lost ten pounds. She recalls looking better and feeling better at that time. The compliments she received from everyone about her will power, her drive, and her appearance boosted her self-esteem immensely.
Lisa went to college with the same plan in place. However, upon entering college, something shifted for her. In high school, everything always seemed to fall into place for her. People perceived her as smart, pretty, funny, and outgoing. In college, she struggled with the workload, the party scene, and the friendships she made. She did not expect to have these struggles and felt completely off balance. She was highly overwhelmed and felt much more insecure. She coped with these feelings by isolating herself and by the time she entered her sophomore year, she had only one friend left. She moved into a single room apartment and found comfort and security in going to class, studying, and working out at the gym.
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