This morning I had a half of a grapefruit for breakfast, and some coffee—no sugar or cream.

For
lunch, I had an apple and a diet soda. For dinner, I had some plain white rice and a
salad with just some lemon squeezed over it. So I was feeling really good about myself, really
virtuous. That is, until Jackie came over, and completely messed up my day. She
brought over a movie to watch, which was fine. But then she insisted on ordering a pizza. I told
her I didn’t want any, that I wasn’t hungry (which was a lie, because I was starving).
But she ordered it anyway. The pizza arrived, and I thought I could be good and not have any.
But it was just sitting there on the table, and I couldn’t think of anything except having
some. I couldn’t concentrate on the movie. I kept smelling the pizza and feeling the emptiness in
my stomach. Like a weakling, I reached out and got one piece, a small piece. It was
ice cold by then, and kind of greasy, but I didn’t care. I ate that piece in about 5 seconds flat.
Then I had another piece. And another. I stopped after four pieces.
But I still couldn’t pay attention to the movie. All I could think about was what a pig I was for
eating that pizza, and how I’ll never lose the 10 pounds I need to lose to fit into size 2
jeans. Jackie’s gone now, and I still keep thinking about how ugly and fat I am, and how I have
no willpower. I didn’t deserve to have that pizza tonight, because I haven’t lost
enough weight this month. I’m going to have to skip breakfast and lunch tomorrow, and exercise
for a couple of hours, to make up for being a complete pig tonight.

1. Make a list of the symptoms.

2. What could be the diagnosis? Be ready to explain.

I would spread my paper out in front of me, set the yogurt aside, check my watch. I’d read the
same sentence over and over, to prove that I could sit in front of food without snarfing
it up, to prove it was no big deal. When five minutes had passed, I would start to skim my
yogurt. . . . You take the edge of your spoon and run it over the top of the yogurt, being
careful to get only the melted part. Then let the yogurt drip off until there’s only a sheen of it on
the spoon.
Lick it—wait, be careful, you have to only lick a teeny bit at a time, the sheen should last at least
four or five licks, and you have to lick the back of the spoon first, then turn the spoon
over and lick the front, with the tip of your tongue. Then set the yogurt aside again. Read a full
page, but don’t look at the yogurt to check the melt progression.
Repeat. Repeat. Do not take a mouthful, do not eat any of the yogurt unless it’s melted. Do not
fantasize about toppings, crumbled Oreos, or chocolate sauce. Do not fantasize about
a sandwich. A sandwich would be so complicated.

1. Make a list of the symptoms.

2. What could be the diagnosis? Be ready to explain.

“The day after New Year’s Day I got my check cashed. I usually eat to celebrate the occasion,
so I knew it might happen. On the way to the bank I steeled myself against it. I kept
reminding myself of the treatment and about my New Year’s resolution about dieting. . . . “Then
I got the check cashed. And I kept out a hundred. And everything just seemed to go
blank. I don’t know what it was. All of my good intentions just seemed to fade away. They just
didn’t seem to mean anything anymore. I just said, ‘What the hell,’ and started eating,
and what I did then was an absolute sin.”
He described starting in a grocery store where he bought a cake, several pieces of pie, and
boxes of cookies. Then he drove through heavy midtown traffic with one hand, pulling
food out of the bag with the other hand and eating as fast as he could. After consuming all of his
groceries, he set out on a furtive round of restaurants, staying only a short time in
each and eating only small amounts. Although in constant dread of discovery, he had no idea
what “sin” he felt he was committing. He knew only that it was not pleasurable. “I didn’t
enjoy it at all. It just happened. It’s like a part of me just blacked out. And when that happened
there was nothing there except the food and me, all alone.” Finally he went into a
delicatessen, bought another $20 worth of food and drove home, eating all the way, “until my
gut ached.”

1. Make a list of the symptoms.

2. What could be the diagnosis? Be ready to explain.