Phoebe was a classic all-American girl: popular, attractive, intelligent, and talented. By the time she was a senior in high school, she had accomplished a great deal. She was a class officer throughout high school, homecoming princess her sophomore year, and junior prom queen. She dated the captain of the football team. Phoebe had many talents, including a beautiful singing voice and marked ability in ballet. Each year at Christmastime, her ballet company performed the Nutcracker Suite, and Phoebe attracted much attention with her poised performance in a lead role. She played on several school athletic teams. Phoebe maintained an A-minus average, was considered a model student and was headed for a top-ranked university. 

However, Phoebe had a secret: She was haunted by her belief that she was fat and ugly. Every single bite of food that she put in her mouth was, in her mind, another step down the inexorable path that led to the end of her success and popularity. Phoebe had been concerned about her weight since she was 11. Ever the perfectionist, she began regulating her eating in junior high school. She would skip breakfast (over her mother's protestations), eat a small bowl of pretzels at noon, and allow herself half of whatever she was served for dinner. This behavior continued into high school, but as Phoebe struggled to restrict her eating, she occasionally binged on junk food. Sometimes she stuck her fingers down her throat after a binge (she even tried a toothbrush once), but this tactic was unsuccessful. During her sophomore year in high school, Phoebe reached her full adult height of 5 feet 2 inches and weighed 110 pounds; she continued to fluctuate between 105 and 110 pounds throughout high school. By the time she was a senior, Phoebe was obsessed with what she would eat and when. She used every bit of her willpower attempting to restrict her eating, but occasionally she failed.

 One day during the fall of her senior year, she came home after school and ate two big boxes of candy alone in front of the television. Depressed, guilty, and desperate, she went to the bathroom and stuck her fingers farther down her throat than she had dared. She vomited. Moreover, she kept vomiting. Although so physically exhausted that she had to lie down for half an hour, Phoebe never had in her life felt such an overwhelming sense of relief from the anxiety, guilt, and tension that always accompanied her binges. She realized she had gotten to eat all that candy, and now her stomach was empty. It was the perfect solution to her problems. Phoebe quickly learned what foods she could easily vomit. Moreover, she always drank lots of water. She began to restrict her eating even more, and her bingeing increased. 

This routine continued for about six months, until April of her senior year in high school. By this time, Phoebe had lost much of her energy, and her schoolwork was deteriorating. Her teachers noticed this and saw that she looked bad. She was continually tired, her skin was broken out, and her face puffed up, particularly around her mouth. Her teachers and mother suspected that she might have an eating problem. When they confronted her, she was relieved her problem was finally out in the open and stopped binging for a while, but mortally afraid of gaining weight and losing her popularity, Phoebe resumed her pattern, but she was now much better at hiding it. 

For six months, Phoebe binged and purged approximately 15 times a week. When Phoebe went away to college that fall, things became more difficult. Now she had a roommate to contend with, and she was more determined than ever to keep her problem a secret. Although the student health service offered workshops and seminars on eating disorders for freshman women, Phoebe knew that she could not break her cycle without the risk of gaining weight. To avoid the communal bathroom, she went to a deserted place behind a nearby building to vomit. She kept her secret until the beginning of her sophomore year when her world fell apart. One night, after drinking beer and eating fried chicken at a party, she attempted to cope with her guilt, anxiety, and tension in the usual manner, but when she tried to vomit, her gag reflex seemed to be gone. Breaking into hysterics, she called her boyfriend and told him she was ready to kill herself. Her loud sobbing and crying attracted the attention of her friends in her dormitory, who attempted to comfort her. She confessed her problem to them. She also called her parents. At this point, Phoebe realized her life was out of control and needed professional help.