Therapist: Elsa is seventeen years old. She was referred to me by the doctor who has been treating her for weight loss for the last five months. She had also asked to have a surgical operation to reduce her breasts. The doctor described her as a patient who alternates between periods of good response to the treatment and others when, out of uncontrollable voracity, she can put on five kilos in a short time, for example over a weekend. What worried him the most in the patient was her state of mind after those episodes when she expressed a lack of desire to live, she isolated herself and took in large doses of diuretics combined with other tablets. This was a health risk and alarmed those around her.

She came to the initial interview with her mother, a good-looking woman who seemed younger than she said she was. I let them into my office together. My patient had made herself up very carefully and she was wearing the latest fashions. You could