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Kelly Case Study

Kelly is a 28-year-old married white female whose chief complaint is, “I can’t stop eating.” She loves foods rich in carbohydrates, such as sugar and flour, and claims that once she starts eating refined foods, she cannot stop (i.e., she loses the ability to control the size of her food portions). Her belief is that once she takes a bite of something that is sugary, “the bite takes me and I’m off to the races.” She admits to eating when she is not hungry and reports that she eats quickly, “stuffing it into my face.”

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Kelly has struggled with food since she was nine years old. Kelly was always “overweight as a child”; she is presently 5 feet 6 inches tall and weighs 200 pounds. She constantly obsesses about food, planning each day what she will eat and where she will obtain food. Often (at least four days a week) she will buy large quantities of ice cream and cake from the store, binge, and then sleep. When she wakes up, she feels depressed, guilty, and full of self-loathing. She often has crying jags because she feels so bad. When questioned, she denied any regular purging, but said that she resorted to laxatives “about once every two weeks.”

In the past Kelly has attempted to lose weight. For example, when she was 10 years old she joined a recreational track team and was moderately successful in losing weight. However, although her weight began to normalize according to body mass index figures, Kelly would still binge on certain foods, such as pizza, pasta, and desserts. This pattern of behavior continued later during cross-country and cheerleading seasons. She recalls that despite the binge episodes, she would maintain a normal weight and sometimes would even weigh less than what was considered healthy for her height and frame, although she never met the criteria for anorexia. During off-seasons, when she was not participating in sports activities, however, her binge eating would result in significant weight gains.

Since her teenage years, Kelly has made multiple attempts to deal with her eating disorder. These include a “healthy” diet devised by a nutritionist; behavioral modifications designed to moderate and control her intake of carbohydrate-rich foods; psychodynamic psychotherapy to explore the causes that led to her binge eating; and CBT to examine her faulty thinking concerning food, body shape, and size. In her mid-20s she also admitted herself to a residential program that specialized in women and empowerment, and attended Overeaters Anonymous (OA), a 12-step support group for compulsive eaters.

There is a strong history of addiction-related disorders in Kelly’s family, including alcoholism on the paternal side, and eating disorders, primarily binge eating, on the maternal side. Kelly’s mother is a first-generation Italian immigrant who believes that food can be an “emotional comfort.” Further, Kelly’s mother suffered from bulimia herself; she exercised for weight compensation, even running marathons. An uncle also sexually abused Kelly’s mother when she was a child.

Kelly has two sisters and three brothers, all of whom are obese. She is close to her sisters and less close to her brothers. All of the brothers exhibit alcoholism to varying degrees, as does her father. Additionally, some of the males in the extended paternal side of the family are described as “gutter” alcoholics.

Kelly’s parents had an antagonistic relationship with each other during Kelly’s formative years, in which Kelly’s father physically and sexually abused Kelly’s mother; Kelly witnessed this abuse. Kelly’s father works for the post office, while Kelly’s mother is a school bus driver, placing the family as lower middle class. They are Catholic and attend mass regularly.

Upon graduating from high school, Kelly attended college, but after the first year, she switched to a community college in order to live at home. She told her family about her eating disorder and was able to derive some emotional support from her sisters and mother. She also attended OA meetings with her mother. Because she had to move to another state to attend graduate school, Kelly was lonely and would use both food and men to fill her emotional void. She also stopped going to OA.

As a result of meeting a man through a personal ad, she married within the year. She admitted that she didn’t know him well because they had lived in different areas and had not spent much time together. After the wedding, Kelly discovered that her husband was controlling and verbally abusive. He ordered her around, wanted her to cater to his needs, and called her “fat” and “lazy with no willpower.” Although Kelly admits that her husband “pushed and shoved her around” physically, when asked about physical abuse, Kelly became silent and repeatedly avoided talking about the subject. Kelly recently learned that she was six weeks pregnant. In an attempt to abort the baby in utero, she repeatedly punched herself in the stomach (this was not successful) and used ipecac (an over-the-counter emetic often used by bulimic individuals) to purge after binge eating. She also felt suicidal. One day, she wrote a suicide note; placed the note beside her on the car seat in the garage, which was closed; and started the engine in an attempt to commit suicide through carbon monoxide poisoning. However, she then called one of her sisters, who was able to talk her out of the attempt.

Kelly is adamant about wanting a divorce but is concerned about her financial status. Although she has successfully completed graduate school, she has been unable to find a job. She admits that she feels too disgusted with herself even to try. “Who’s going to want me when I look like this?” She feels incredibly ashamed of her appearance and her unsuccessful marriage.

Kelly made no friends at graduate school, and the phone contact she maintains with her family members is inadequate to meet her needs for social and emotional support. Kelly presents as a tearful, poorly groomed individual (her hair is not brushed, and she attended initial therapy sessions in baggy pants and an inside-out sweatshirt), with suicidal ideation because of her binge eating and deteriorating marital situation.