"Julia Measuring Up I grew up in a northeastern suburban town, and I’ve lived in the same house for my entire life. My father is a lawyer, and my mother is the assistant principal at our town’s high school. My sister, Holly, is 4 years younger than I am. My parents have been married for almost 20 years. Aside from the usual sort of disagreements, they get along well. In fact, I would say that my entire family gets along well. We’re not particularly touchy-feely: It’s always a little awkward when we have to hug our grandparents on holidays, because we just never do that sort of thing at home. That’s not to say that my parents are uninterested or don’t care about us. Far from it; even though they both have busy work schedules, one of them would almost always make it to my track and cross-country meets and to Holly’s soccer games. My mother, in particular, has always tried to keep on top of what’s going on in our lives. In high school, I took advanced-level classes and earned good grades. I also got along quite well with my teachers, and ended up graduating in the top 10 percent of my class. I know this made my mother really proud, especially since she works at the school. She would get worried that I might not be doing my best and “working to my full potential.” All through high school, she tried to keep on top of my homework assignments and test schedules. She liked to look over my work before I turned it in, and would make sure that I left myself plenty of time to study for tests. Describe the family dynamics and school pressures experienced by Julia. Under what circumstances might such family and school factors become problematic or set the stage for psychological problems? In addition to schoolwork, the track and cross-country teams were a big part of high school for me. I started running in junior high school because my parents wanted me to do something athletic and I was never coordinated enough to be good at sports like soccer. I was always a little bit chubby when I was a kid. I don’t know if I was actually overweight, but everyone used to tease me about my baby fat. Running seemed like a good way to lose that extra weight; it was hard at first, but I gradually got better and by high school I was one of the best runners on the team. Schoolwork and running didn’t leave me much time for anything else. I got along fine with the other kids at school, but I basically hung out with just a few close friends. When I was younger, I used to get teased for being a Goody Two-Shoes, but that had died down by high school. I can’t remember anyone with whom I ever had problems. I did go to the prom, but I didn’t date very much in high school. My parents didn’t like me hanging out with boys unless it was in a group. Besides, the guys I had crushes on were never the ones who asked me out. So any free time was mostly spent with my close girlfriends. We would go shopping or to the movies, and we frequently spent the night at one another’s houses. It was an ...

1. "Julia Measuring Up I grew up in a northeastern suburban town,
and I’ve lived in the same house for my entire life. My father is
a lawyer, and my mother is the assistant principal at our town’s
high school. My sister, Holly, is 4 years younger than I am. My
parents have been married for almost 20 years. Aside from the
usual sort of disagreements, they get along well. In fact, I
would say that my entire family gets along well. We’re not
particularly touchy-feely: It’s always a little awkward when we
have to hug our grandparents on holidays, because we just never
do that sort of thing at home. That’s not to say that my parents
are uninterested or don’t care about us. Far from it; even though
they both have busy work schedules, one of them would almost
always make it to my track and cross-country meets and to
Holly’s soccer games. My mother, in particular, has always
tried to keep on top of what’s going on in our lives. In high
school, I took advanced-level classes and earned good grades. I
also got along quite well with my teachers, and ended up
graduating in the top 10 percent of my class. I know this made
my mother really proud, especially since she works at the
school. She would get worried that I might not be doing my best
and “working to my full potential.” All through high school, she
tried to keep on top of my homework assignments and test
schedules. She liked to look over my work before I turned it in,
and would make sure that I left myself plenty of time to study
for tests. Describe the family dynamics and school pressures
experienced by Julia. Under what circumstances might such
family and school factors become problematic or set the stage
for psychological problems? In addition to schoolwork, the
track and cross-country teams were a big part of high school for
me. I started running in junior high school because my parents
wanted me to do something athletic and I was never coordinated
enough to be good at sports like soccer. I was always a little bit
chubby when I was a kid. I don’t know if I was actually
overweight, but everyone used to tease me about my baby fat.

2. Running seemed like a good way to lose that extra weight; it
was hard at first, but I gradually got better and by high school I
was one of the best runners on the team. Schoolwork and
running didn’t leave me much time for anything else. I got
along fine with the other kids at school, but I basically hung out
with just a few close friends. When I was younger, I used to get
teased for being a Goody Two-Shoes, but that had died down by
high school. I can’t remember anyone with whom I ever had
problems. I did go to the prom, but I didn’t date very much in
high school. My parents didn’t like me hanging out with boys
unless it was in a group. Besides, the guys I had crushes on
were never the ones who asked me out. So any free time was
mostly spent with my close girlfriends. We would go shopping
or to the movies, and we frequently spent the night at one
another’s houses. It was annoying that although I never did
anything wrong, I had the earliest curfew of my friends. Also, I
was the only one whose parents would text me throughout the
night just to check in. I don’t ever remember lying to them
about what I was doing or who I was with. Although I felt like
they didn’t trust me, I guess they were just worried and wanted
to be sure that I was safe. Julia Coping With Stress Now I am
17 years old and in the spring semester of my first year at
college. I was awarded a scholar-athlete full scholarship at the
state university. I’m not sure of the exact cause of my current
problems, but I know a lot of it must have to do with college
life. I have never felt so much pressure before. Because my
scholarship depends both on my running and on my maintaining
a 3.6 grade point average, I’ve been stressed out much of the
time. Academic work was never a problem for me in the past,
but there’s just so much more expected of you in college. It was
pressure from my coach, my teammates, and myself that first
led me to dieting. During the first semester, almost all my
girlfriends in college experienced the “freshman 15” weight
gain—it was a common joke among everyone when we were up
late studying and someone ordered a pizza. For some of them it
didn’t really matter if they gained any weight, but for me it did.

3. I was having trouble keeping up during cross-country practices.
I even had to drop out of a couple of races because I felt so
awful and out of shape. I couldn’t catch my breath and I’d get
terrible cramps. And my times for the races that I did finish
were much worse than my high school times had been. I know
that my coach was really disappointed in me. He called me aside
about a month into the season. He wanted to know what I was
eating, and he told me the weight I had gained was undoubtedly
hurting my performance. He said that I should cut out snacks
and sweets of any kind, and stick to things like salads to help
me lose the extra pounds and get back into shape. He also
recommended some additional workouts. I was all for a diet—I
hated that my clothes were getting snug. In addition, I was
feeling left out of the rest of the team. As a freshman, I didn’t
know any of the other runners, and I certainly wasn’t proving
myself worthy of being on the team. At that point, I was 5′6″
and weighed 145 pounds. When I started college I had weighed
130 pounds. Both of these weights fell into the “normal” body
mass index range of 18.5 to 25, but 145 pounds was on the
upper end of normal. Was the advice from Julia’s coach out of
line, or was it her overreaction to his suggestions that caused
later problems? Dieting was surprisingly easy. The dining hall
food bordered on inedible anyway, so I didn’t mind sticking to
salads, cereal, or yogurt. Occasionally I’d allow myself pasta,
but only without sauce. I completely eliminated dessert, except
for fruit on occasion. If anyone commented on my small meals,
I just told them that I was in training and gearing up for the big
meets at the end of the season. I found ways to ignore the urge
to snack between meals or late at night when I was studying. I’d
go for a quick run, check Facebook and Twitter, take a nap—
whatever it took to distract myself. Sometimes I’d drink water
or Diet Coke and, if absolutely necessary, I’d munch on a
carrot. Many eating disorders follow a period of intense dieting.
Is dieting inevitably destructive? Are there safeguards that can
be taken during dieting that can head off the development of an
eating disorder? Once I started dieting, the incentives to

4. continue were everywhere. My race times improved, so my
coach was pleased. I felt more a part of the team and less like
an outsider. My clothes were no longer snug; and when they saw
me at my meets my parents said I looked great. I even received
an invitation to a party given by a fraternity that only invited
the most attractive first-year women. After about a month, I was
back to my normal weight of 130 pounds. At first, my plan was
to get back down to 130 pounds, but it happened so quickly that
I didn’t have time to figure out how to change my diet to
include some of the things that I had been leaving out. Things
were going so well that I figured it couldn’t hurt to stick to the
diet a little longer. I was on a roll. I remembered all the people
who I had seen on television who couldn’t lose weight even
after years of trying. I began to think of my frequent hunger
pangs as badges of honor, symbols of my ability to control my
bodily urges. I set a new weight goal of 115 pounds. I figured if
I hit the gym more often and skipped breakfast altogether, it
wouldn’t be hard to reach that weight in another month or so.
Of course this made me even hungrier by lunchtime, but I didn’t
want to increase my lunch size. I found it easiest to pace myself
with something like crackers. I would break them into several
pieces and only allow myself to eat one piece every 15 minutes.
The few times I did this in the dining hall with friends I got
weird looks and comments. I finally started eating lunch alone
in my room. I would simply say that I had some readings or a
paper to finish before afternoon class. I also made excuses to
skip dinner with people. I’d tell my friends that I was eating
with my teammates, and tell my teammates that I was meeting
my roommate. Then I’d go to a dining hall on the far side of
campus that was usually empty, and eat by myself. I remember
worrying about how I would handle Thanksgiving. Holidays are
a big deal in my family. We get together with my aunts and
uncles and grandparents, and of course there is a huge meal. I
couldn’t bear the stress of being expected to eat such fattening
foods. I felt sick just thinking about the stuffing, gravy, and
pies for dessert. I told my mother that there was a team

5. Thanksgiving dinner for those who lived too far away to go
home. That much was true, but then I lied and told her that the
coach thought it would be good for team morale if we all
attended. I know it disappointed her, but I couldn’t deal with
trying to stick to my diet with my family all around me, nagging
me to eat more. Julia Spiraling Downward I couldn’t believe it
when the scale said I was down to 115 pounds. I still felt that I
had excess weight to lose. Some of my friends were beginning
to mention that I was actually looking too thin, as if that’s
possible. I wasn’t sure what they meant—I was still feeling
chubby when they said I was too skinny. I didn’t know who was
right, but either way I didn’t want people seeing my body. I
began dressing in baggy clothes that would hide my physique. I
thought about the overweight people my friends and I had
snickered about in the past. I couldn’t bear the thought of
anyone doing that to me. In addition, even though I was running
my best times ever, I knew there was still room there for
improvement. Look back at Case 9, Bulimia Nervosa. How are
Julia’s symptoms similar to those of the individual in that case?
How are her symptoms different? Around this time, I started to
get really stressed about my schoolwork. I had been managing
to keep up throughout the semester, but your final grade
basically comes down to the final exam. It was never like this in
high school, when you could get an A just by turning in all your
homework assignments. I felt unbearably tense leading up to
exams. I kept replaying scenarios of opening the test booklet
and not being able to answer a single question. I studied
nonstop. I brought notes with me to the gym to read on the
treadmill, and I wasn’t sleeping more than an hour or two at
night. Even though I was exhausted, I knew I had to keep
studying. I found it really hard to be around other people.
Listening to my friends talk about their exam schedules only
made me more frantic. I had to get back to my own studying.
The cross-country season was over, so my workouts had become
less intense. Instead of practicing with the team, we were
expected to create our own workout schedule. Constant studying

6. left me little time for the amount of exercise I was used to. Yet
I was afraid that cutting back on my workouts would cause me
to gain weight. It seemed logical that if I couldn’t keep up with
my exercise, I should eat less in order to continue to lose
weight. I carried several cans of Diet Coke with me to the
library. Hourly trips to the lounge for coffee were the only
study breaks I allowed myself. Aside from that, I might have a
bran muffin or a few celery sticks, but that would be it for the
day. Difficult though it was, this regimen worked out well for
me. I did fine on my exams. This was what worked for me. At
that point, I weighed 103 pounds and my body mass index was
16.6. Based on your reading of either the DSM-5 or a textbook,
what disorder might Julia be displaying? Which of her
symptoms suggest this diagnosis? After finals, I went home for
winter break for about a month. It was strange to be back home
with my parents after living on my own for the semester. I had
established new routines for myself and I didn’t like having to
answer to anyone else about them. Right away, my mother
started in; she thought I spent too much time at the gym every
day and that I wasn’t eating enough. When I told her that I was
doing the same thing as everyone else on the team, she actually
called my coach and told him that she was concerned about his
training policies! More than once she commented that I looked
too thin, like I was a walking skeleton. She tried to get me to go
to a doctor, but I refused. Dinner at home was the worst. My
mother wasn’t satisfied when I only wanted a salad—she’d
insist that I have a ‘’well-balanced meal” that included some
protein and carbohydrates. We had so many arguments about
what I would and wouldn’t eat that I started avoiding
dinnertime altogether. I’d say that I was going to eat at a
friend’s house or at the mall. When I was at home I felt like my
mother was watching my every move. Although I was worried
about the upcoming semester and indoor track season, I was
actually looking forward to getting away from my parents. I just
wanted to be left alone—to have some privacy and not be
criticized for working out to keep in shape. Was there a better

7. way for Julia’s mother to intervene? Or would any intervention
have brought similar results? Since I’ve returned to school, I’ve
vowed to do a better job of keeping on top of my classes. I
don’t want to let things pile up for finals again. With my
practice and meet schedule, I realize that the only way to devote
more time to my schoolwork is to cut back on socializing with
friends. So, I haven’t seen much of my friends this semester. I
don’t go to meals at all anymore; I grab coffee or a soda and
drink it on my way to class. I’ve stopped going out on the
weekends as well. I barely even see my roommate. She’s asleep
when I get back late from studying at the library, and I usually
get up before her to go for a morning run. Part of me misses
hanging out with my friends, but they had started bugging me
about not eating enough. I’d rather not see them than have to
listen to that and defend myself. Even though I’m running great
and I’m finally able to stick to a diet, everyone thinks I’m not
taking good enough care of myself. I know that my mother has
called my coach and my roommate. She must have called the
dean of student life, because that’s who got in touch with me
and suggested that I go to the health center for an evaluation. I
hate that my mother is going behind my back after I told her
that everything was fine. I realize that I had a rough first
semester, but everyone has trouble adjusting to college life. I’m
doing my best to keep in control of my life, and I wish that I
could be trusted to take care of myself. Julia seems to be the
only person who is unaware that she has lost too much weight
and developed a destructive pattern of eating. Why is she so
unable to look at herself accurately and objectively? Rebecca
Losing a Roommate When I first met Julia back in August, I
thought we would get along great. She seemed a little shy but
like she’d be fun once you got to know her better. She was
really cool when we were moving into our room. Even though
she arrived first, she waited for me so that we could divide up
furniture and closet space together. Early on, a bunch of us in
the dorm started hanging out together, and Julia would join us
for meals or parties on the weekends. She’s pretty and lots of

8. guys would hit on her, but she never seemed interested. The rest
of us would sit around and gossip about guys we met and who
liked who, but Julia just listened. From day one, Julia took her
academics seriously. She was sort of an inspiration to the rest of
us. Even though she was busy with practices and meets, she
always had her readings done for class. But I know that Julia
also worried constantly about her studies and her running. She’d
talk about how frustrating it was to not be able to compete at
track at the level she knew she was capable of. She would get
really nervous before races. Sometimes she couldn’t sleep, and
I’d wake up in the middle of the night and see her pacing
around the room. When she told me her coach suggested a new
diet and training regimen, it sounded like a good idea. I guess I
first realized that something was wrong when she started acting
a lot less sociable. She stopped going out with us on weekends,
and we almost never saw her in the dining hall anymore. A
couple of times I even caught her eating by herself in a dining
hall on the other side of campus. She explained that she had a
lot of work to do and found that she could get some of it done
while eating if she had meals alone. When I did see her eat, it
was never anything besides vegetables. She’d take only a tiny
portion and then she wouldn’t even finish it. She didn’t keep
any food in the room except for cans of Diet Coke and a bag of
baby carrots in the fridge. I also noticed that her clothes were
starting to look baggy and hang off her. A couple of times I
asked her if she was doing okay, but this only made her
defensive. She claimed that she was running great, and since
she didn’t seem sick, I figured that I was overreacting. Why was
Rebecca inclined to overlook her initial suspicions about Julia’s
behaviors? Was there a better way for the roommate to
intervene? I kept believing her until I returned from
Thanksgiving. It was right before final exams, so everyone was
pretty stressed out. Julia had been a hard worker before, but
now she took things to new extremes. She dropped off the face
of the earth. I almost never saw her, even though we shared a
room. I’d get up around 8:00 or 9:00 in the morning, and she’d

9. already be gone. When I went to bed around midnight, she still
wasn’t back. Her side of the room was immaculate: bed made,
books and notepads stacked neatly on her desk. When I did
bump into her, she looked awful. She was way too thin, with
dark circles under her eyes. She seemed like she had wasted
away; her skin and hair were dull and dry. I was pretty sure that
something was wrong, but I told myself that it must just be the
stress of the upcoming finals. I figured that if there were a
problem, her parents would notice it and do something about it
over winter break. When we came back to campus in January, I
was surprised to see that Julia looked even worse than during
finals. When I asked her how her vacation was, she mumbled
something about being sick of her mother and happy to be back
at school. As the semester got under way, Julia further
distanced herself from us. There were no more parties or
hanging out at meals for her. She was acting the same way she
had during finals, which made no sense because classes had
barely gotten going. We were all worried, but none of us knew
what to do. One time, Julia’s mother sent me a message on
Facebook and asked me if I had noticed anything strange going
on with Julia. I wasn’t sure what to write back. I felt guilty, like
I was tattling on her, but I also realized that I was in over my
head and that I needed to be honest. How might high schools
and universities better identify individuals with serious eating
disorders? What procedures or mechanisms has your school put
into operation? I wrote her mother about Julia’s odd eating
habits, how she was exercising a lot and how she had gotten
pretty antisocial. Her mother wrote me back and said she had
spoken with their family doctor. Julia was extremely
underweight, even though she still saw herself as chunky and
was afraid of gaining weight. A few days later, Julia approached
me. Apparently she had just met with one of the deans, who told
her that she’d need to undergo an evaluation at the health center
before she could continue practicing with the team. She asked
me point-blank if I had been talking about her to anyone. I told
her how her mother had contacted me and asked me if I had

10. noticed any changes in her over the past several months, and
how I honestly told her yes. She stormed out of the room and I
haven’t seen her since. I know how important the team is to
Julia, so I am assuming that she’ll be going to the health center
soon. I hope that they’ll be able to convince her that she’s taken
things too far, and that they can help her to get better. How
might the treatment approaches used in Cases 2, 4, and 9 be
applied to Julia? How should they be altered to fit Julia’s
problems and personality? Which aspects of these treatments
would not be appropriate? Should additional interventions be
applied?"
"Julia Measuring Up I grew up in a northeastern suburban town,
and I’ve lived in
the same house for my entire life. My father is a lawyer, and my
mother is the
assistant principal at our town’s high school. My sister, Holly,
is 4 years younger
than I am. M
y parents have been married for almost 20 years. Aside from the
usual sort of disagreements, they get along well. In fact, I
would say that my
entire family gets along well. We’re not particularly touchy
-
feely: It’s always a little
awkward when we have to
hug our grandparents on holidays, because we just
never do that sort of thing at home. That’s not to say that my
parents are
uninterested or don’t care about us. Far from it; even though
they both have busy
work schedules, one of them would almost always m
ake it to my track and cross
-
country meets and to Holly’s soccer games. My mother, in
particular, has always

11. tried to keep on top of what’s going on in our lives. In high
school, I took
advanced
-
level classes and earned good grades. I also got along quite
well with
my teachers, and ended up graduating in the top 10 percent of
my class. I know
this made my mother really proud, especially since she works at
the school. She
would get worried that I might not be doing my best and
“working to my full
potential.”
All through high school, she tried to keep on top of my
homework
assignments and test schedules. She liked to look over my work
before I turned it
in, and would make sure that I left myself plenty of time to
study for tests.
Describe the family dynamics a
nd school pressures experienced by Julia. Under
what circumstances might such family and school factors
become problematic or
set the stage for psychological problems? In addition to
schoolwork, the track
and cross
-
country teams were a big part of high sch
ool for me. I started running
in junior high school because my parents wanted me to do
something athletic
and I was never coordinated enough to be good at sports like
soccer. I was
always a little bit chubby when I was a kid. I don’t know if I
was actually

12. overweight, but everyone used to tease me about my baby fat.
Running seemed
like a good way to lose that extra weight; it was hard at first,
but I gradually got
better and by high school I was one of the best runners on the
team. Schoolwork
and running di
dn’t leave me much time for anything else. I got along fine with
the
other kids at school, but I basically hung out with just a few
close friends. When I
was younger, I used to get teased for being a Goody Two
-
Shoes, but that had
died down by high school.
I can’t remember anyone with whom I ever had
problems. I did go to the prom, but I didn’t date very much in
high school. My
parents didn’t like me hanging out with boys unless it was in a
group. Besides,
the guys I had crushes on were never the ones who as
ked me out. So any free
time was mostly spent with my close girlfriends. We would go
shopping or to the
"Julia Measuring Up I grew up in a northeastern suburban town,
and I’ve lived in
the same house for my entire life. My father is a lawyer, and my
mother is the
assistant principal at our town’s high school. My sister, Holly,
is 4 years younger
than I am. My parents have been married for almost 20 years.
Aside from the
usual sort of disagreements, they get along well. In fact, I
would say that my
entire family gets along well. We’re not particularly touchy-

13. feely: It’s always a little
awkward when we have to hug our grandparents on holidays,
because we just
never do that sort of thing at home. That’s not to say that my
parents are
uninterested or don’t care about us. Far from it; even though
they both have busy
work schedules, one of them would almost always make it to my
track and cross-
country meets and to Holly’s soccer games. My mother, in
particular, has always
tried to keep on top of what’s going on in our lives. In high
school, I took
advanced-level classes and earned good grades. I also got along
quite well with
my teachers, and ended up graduating in the top 10 percent of
my class. I know
this made my mother really proud, especially since she works at
the school. She
would get worried that I might not be doing my best and
“working to my full
potential.” All through high school, she tried to keep on top of
my homework
assignments and test schedules. She liked to look over my work
before I turned it
in, and would make sure that I left myself plenty of time to
study for tests.
Describe the family dynamics and school pressures experienced
by Julia. Under
what circumstances might such family and school factors
become problematic or
set the stage for psychological problems? In addition to
schoolwork, the track
and cross-country teams were a big part of high school for me. I
started running
in junior high school because my parents wanted me to do

14. something athletic
and I was never coordinated enough to be good at sports like
soccer. I was
always a little bit chubby when I was a kid. I don’t know if I
was actually
overweight, but everyone used to tease me about my baby fat.
Running seemed
like a good way to lose that extra weight; it was hard at first,
but I gradually got
better and by high school I was one of the best runners on the
team. Schoolwork
and running didn’t leave me much time for anything else. I got
along fine with the
other kids at school, but I basically hung out with just a few
close friends. When I
was younger, I used to get teased for being a Goody Two-Shoes,
but that had
died down by high school. I can’t remember anyone with whom
I ever had
problems. I did go to the prom, but I didn’t date very much in
high school. My
parents didn’t like me hanging out with boys unless it was in a
group. Besides,
the guys I had crushes on were never the ones who asked me
out. So any free
time was mostly spent with my close girlfriends. We would go
shopping or to the