Social Interpersonal Growth Psychotherapy

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Fatty

Case Study:

Andrea Simpson weighed 230 pounds when she returned to her former therapist to get help for the eating and weight problems that had caused her grief since she was a child. She was again having uncontrollable eating binges, and had gained over 50 pounds in 6 months.

Andrea recalled being called “fatty” by her schoolmates in early elementary school, and had had frequent arguments with her mother throughout childhood and adolescence about her excessive eating and weight. During high school she nibbled throughout the day. After each bite, she vowed to herself that this would be the last, and she would go on a diet, but always was unable to keep her vow. She felt very ashamed of her weight, but gradually gained more. She did most of her eating in private so as to be unobserved by others. At graduation from high school, with a height of 5 feet, 5 inches, she weighed 203 pounds.

Andrea believes that her binge eating began in college. She lost about 40 pounds by dieting when she began college, and then began to alternate between periods of dieting and overeating, lasting several weeks to several months. During periods of overeating, she often ate a big breakfast (e.g., several eggs with cheese, two or three slices of toast, and two large glasses of orange juice). She would then take large quantities of food to her dorm room (e.g., two or three peanut butter sandwiches, two or three dozen cookies, potato chips, and sometimes cheese), which she ate over the next few hours. She ate until she felt physically uncomfortable and then fell asleep. She felt very depressed and ashamed about her weight during this time. She does not recall feeling out of control during the eating because she always believed that she would stop when she had finished whatever piece of food she was eating, although this seldom happened. She had a number of weight fluctuations in college, her weight ranging from 170 to 230 pounds.

In her last year of college, Andrea got down to a normal weight, and after graduation, got married. She began to overeat again on her honeymoon. Her husband was angry about the eating and weight gain. They argued a great deal about this and about her dishonesty concerning her eating (motivated largely by shame about what she had eaten). She feels that her eating problems contributed significantly to her subsequent divorce.

Over the next several years, Andrea continued to struggle with her weight and eating. She went to Weight Watchers several times, tried numerous diets in magazines, used prescribed and illicit amphetamines, and spoke to internists about her weight and tried diets they gave her. However, she continued to be overweight, with marked weight fluctuations. During periods of dieting, she was preoccupied with food and urges to eat.

Andrea was in psychotherapy in her mid-20s for issues related to her divorce and family. Although she tried to discuss her weight and eating problems, the therapy was ineffective in this area as the therapist’s interventions were largely limited to suggesting diets.

She describes the periods of binge eating as “a nightmare” during which she is preoccupied with fighting the urge to eat, planning additional eating, and feeling guilty and ashamed about her eating and the inevitable weight gain that would follow. Her worst period of daily binge eating, lasting about 10 months, occurred approximately 2 years ago. She ate boxes of cookies, ice cream and other sweets, large amounts of peanut butter and bread, and many bowls of cereal when there was nothing else in the house. She felt out of control and desperate about her inability to stop binge eating. She often ate until she had stomach pains, never felt hungry because she was always eating so much, essentially lost all semblance of a meal structure, avoided eating in front of others because she was ashamed of the eating, and constantly felt depressed. She gained 90 pounds during that period of binge eating.

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