Lisa’s parents recognized her struggles and decided to surprise her with a trip to Europe to visit her cousins. She had an open-ended ticket to spend as much of the summer overseas as she desired before returning to school in the fall. Lisa was excited to go. Before she left, she was eating healthy and at a normal body weight for her height and body type. However, when she returned three months later, she weighed thirty-eight pounds less. Her hair was falling out, she appeared pale and malnourished, and she had stopped menstruating. She was so emaciated that she could not sit in a chair comfortably because her bones protruded from her skin.
Lisa talked about her trip to Europe in counseling. It was NOT everything she had hoped for. She got into a fight with her cousin the second week she was there, which left them not speaking to one another for the rest of the summer. Lisa felt incredibly alone in a foreign country without her cousin’s companionship. To make matters worse, she noted that she had her first sexual experience while in Amsterdam which was not a pleasant one for her. Lisa was in a pub with a thirty-year-old foreigner who befriended her following the fight with her cousin. He bought her several drinks and asked her to come to his home. Lisa, who was intoxicated at the time, went with him, feeling she had nowhere else to go.
Once at his home, he started taking her clothes off. She vehemently protested many times, but he put her on his bed and had sex with her anyway. Lisa felt the experience to be “dirty and unpleasant.” After the sexual experience, he left the room and never came back. She stayed in his room not knowing what to do. Early the next morning, she got up to leave and found his family sitting around the breakfast table looking at her “strangely.” She was incredibly embarrassed and ashamed of herself.
She got herself back to her cousin’s house where she spent the next several days in her room by herself, mentally and physically beating herself up for making such a “bad choice.” She blamed herself and hit herself physically as punishment for putting herself in a stupid situation. She could not eat and could not sleep. She became very depressed. When she missed her first menstrual cycle a few weeks later, she was certain she was pregnant. Lisa remembers thinking if she were to starve herself, maybe the baby would not get the nutrients it needed and she would miscarry. This is when she stopped eating completely.
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