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A 19-year-old girl had recently started work and left home to live in shared accommodation. She presented with tiredness, weepiness and erratic sleeping. She grudgingly admitted to self-induced vomiting, which had been occasional in the past but much more regular since leaving home. She stated that she could no longer control her vomiting and had started taking up to one packet of laxatives per day. She had no physical or biochemical abnormalities.

She agreed to take a selective serotonin reuptake inhibitor, which led to rapid improvement in mood and gradual improvement in sleep pattern. The general practitioner showed her a book outlining a self help program for binge eating that she was prepared to follow under general practitioner supervision. She understood that dietitian referral was an option, but preferred to "give it a go" by herself first. She also undertook to stop taking laxatives. She was encouraged to use a problem-solving approach to her current difficulties, as outlined in the self help book.

She then decided to break up a current relationship with a man because "it isn't going anywhere" and talked to her new boss about work-related difficulties. Subsequently, she felt happier about her ability to cope. She was seen weekly for the first month and then fortnightly for three months.

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