Megan

Megan, age 13, seems both miserable and angry. She mopes around the house, complaining that she has no friends, and that other kids are laughing at her behind her back. She is irritable with her parents and she objects bitterly when asked to help with housework. She resents family rules, and she recently told her mother, “When I'm at home, I feel like a prisoner. All I ever do here is work.” At meal times, she is sullen and withdrawn, uninterested in communicating with her parents or her younger sister. She has taken to wearing black and using black lipstick, and she has developed an interest in grunge music and reading about Kurt Cobain, the grunge musician who committed suicide in 1996. She listens to his music late into the night, seemingly unable to sleep.

Megan also overeats. She raids the refrigerator late at night, trying to cope with a pervasive empty feeling. The snacking gives her moments of pleasure, but that feeling subsides with the last bite of each snack and is quickly replaced by shame and guilt about the eating and about her noticeable weight gain. In fact, some of Megan's social isolation stems from embarrassment about her appearance. She hates to have peers see how “fat” she is now. She has been skipping PE class because she thinks she looks “disgusting” in her gym outfit – shorts and a T-shirt. Of course, skipping PE means less calorie burning and even more weight gain. Megan is aware of this causal chain, and she sees the situation as “hopeless.”