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A 16-year-old girl was taken to her general practitioner by her mother, who was concerned that, after becoming vegetarian the previous year, the girl was now eating all of her meals in her bedroom. She had previously considered herself overweight (BMI of 22) and her father, brother and several friends had made comments about this. She had taken to wearing loose, heavy clothing in the middle of summer. She was more weepy and irritable and her school grades had dropped. She was now 4 kg underweight (BMI of 17) and her periods had stopped six months previously. A restrictive eating pattern was revealed. Routine blood studies gave normal results.

She reported her parents as "intrusive", and ate in her room because meal times had become "war zones". She was having less to do with her friends, some of whom now had boyfriends.

She was referred to a local dietitian, who commenced a food diary and sensible eating program and instituted weekly follow-up (including weighing). The general practitioner saw the rest of the family for education and reassurance, including recommendations for reading material. The mother said that she herself had experienced short periods of restricted eating (when stressed and during times of change) starting as a teenager. She then expressed grief for an older daughter who had died in a car accident three years previously. Later, her husband aired his feelings about this loss, stating that he had not felt able to grieve openly for fear of distressing his wife. Discussion with the parents also focused on relieving the anxiety around mealtime and leaving the responsibility for eating with the daughter.

The girl also benefited from 12 sessions of cognitive-behavioural therapy with a clinical psychologist, aimed at changing her dysfunctional ideas about food, eating and body shape. After two months the dietitian was satisfied with the change in types and quantity of food consumed. The girl was eating with her family, her teachers reported that she was concentrating better and seemed happier. Monthly reviews with the general practitioner and dietitian were organised for the next year.

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