Abby, a 29-year-old female, is married and the mother of a 5-year-old girl. Her husband, Tom, is a rising young executive at a local business firm. Abby does not work outside the home has mentioned that Tom has certain expectations about how she should care for their daughter and their home. Abby is the only child of a professional couple who also had high expectations of her. In the past, Abby has felt unable to measure up to her parents' expectations and developed anorexia nervosa during her sophomore year in high school, which the family had reportedly spent several years in family therapy. Abby went to college in a distant city and did not go home to visit often because of the anxiety that her family creates for her. She joined a sorority in college but often felt as though she did not quite fit in with the young women in her group. She felt very flattered when Tom began to pay attention to her during her junior year in college but continued to feel anxious and insecure. She reports that during those periods of anxiety she would resort to maladaptive eating patterns to cope. During her college years the eating behavior more often took the form of bingingshe would eat whole boxes of cookies, cakes, or candyfollowed by periods of intense depression. In order to keep from gaining weight, Abby would self-induce vomiting or take massive doses of laxatives. She exercised excessively and managed to keep her weight within normal limits while hiding her behavior from her boyfriend and classmates. Once she and Tom were married some of the anxiety subsided and she relied less on the maladaptive eating behaviors. However, lately she has been called on by her husband to entertain business associates, which has created a great deal of anxiety for Abby. Tom tells her exactly how he expects things to be and tells her how much her appearance and behavior affect how these business associates will view them. She feels a great deal of pressure from Tom to be "the perfect wife" and just doesn't feel she can measure up. She has begun to binge and purge daily. Last night, she was binging after Tom and their daughter had gone to bed. Tom heard her vomiting in their bathroom and got up to investigate and found her leaning over the toilet, in which he noted a large amount of blood. He took her to the emergency department, where she was treated for a bleeding esophageal varicosity. She was stabilized and admitted to the psychiatric unit with a diagnosis of Bulimia Nervosa.