DENIAL PRESENTS A SPECIAL PROBLEM WHEN A PHYSICAL ILLNESS occurs along with other psychological or behavioral signs or symptoms.1 In these cases a patient may emphasize a psychiatric disorder to defend against the anxiety of confronting the physical illness. When this denial is supported by those around the patient, in particular family and physicians, the patient's self-assertions are legitimized and possible physical causes further negated.

This is a case study of a 19-year-old college student (referred to here as Ann) who presented with an atypical eating disorder—but subsequently was found to have an intradural extramedullary dorsal meningioma at T4. The patient first sought medical help 3 months after the onset of her eating disorder. Although she was evaluated medically and psychiatrically numerous times, her tumor was not diagnosed until 1½ years later when it had progressed almost to the point of total obstruction. The meningioma was removed; remission of symptoms both of the tumor and of anorexia nervosa followed.