Ellen - Ellen Ellen a single 35-year-old insurance company...

Ellen
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Ellen, a single 35-year-old insurance company executive, came to a psychiatric emergency room of a
university hospital with complaints of depression and the thought of driving her car off a cliff. An articulate,
moderately overweight, sophisticated woman, Ellen appeared to be in considerable distress. She reported a 6-
month period of increasingly persistent dysphoria and lack of energy and pleasure. Feeling as if she were
“made of lead”, Ellen had recently been spending 15-20 hours a day in her bed. She also reported daily
episodes of binge eating, when she would consume “anything I can find,” including entire chocolate cakes or
boxes of cookies. She reported problems with intermittent binge eating since adolescence, but these episodes
had recently increased in frequency, resulting in a 20-pound weight gain over the past few months. In the past
her weight had often varied greatly as she had gone on and off a variety of diets. She denied preoccupation
with thinness or a history of episodes of vomiting or other weight-reduction procedures to compensate for the
binge eating.