Case 29: A manager who secretly eats large amounts of sweets

Case 29: A manager who secretly eats large amounts of sweets

A 36-year-old manager, married with one child, who for a year has been secretly eating large amounts of sweets and then vomiting.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 36-year-old married woman with one child comes for a psychiatric consultation after much hesitation. Her brother, a doctor, referred her. She holds a senior post at work and for the past year has felt under "continuous stress" there. Over that time she has begun eating large amounts of food in secret, mostly sweets and pastries. Afterwards she feels heavy in the stomach, guilty and afraid of getting fat, and she vomits: at first she made herself sick, later it happened without her doing so. She cannot control these episodes, which now happen every day. Her weight is normal and has not changed.

Summary

Diagnosis

Bulimia nervosa.

What points to it

  • Recurrent binges: large amounts of food eaten with a sense of losing control.
  • Compensatory behaviour: vomiting to prevent weight gain.
  • Guilt and fear of fatness after a binge.
  • Normal, stable body weight, which is typical, and secrecy, which is why it is often found late.

What else it could be

If she were underweight, the diagnosis would be anorexia nervosa, binge-purge type. Binge eating disorder has binges without regular compensatory behaviour. Bingeing can also come with depression or a personality disorder, and recurrent vomiting has physical causes in the gut and the brain.

Management

  • A physical assessment: potassium can fall dangerously with daily vomiting, so check electrolytes, and do an ECG if they are abnormal. Look for dental erosion, swollen salivary glands and oesophageal injury. Ask about laxatives, diuretics, alcohol and self-harm.
  • Outpatient treatment, unless there is a suicide risk or a serious physical complication.
  • First, bulimia-focused guided self-help based on CBT. If that is not enough, individual CBT for eating disorders, about 20 sessions.
  • Work on the stress at her job and on how she copes with it.
  • An SSRI may be added, but not as the only treatment. Fluoxetine is the one with the best evidence, at a higher dose than for depression, 60 mg a day.

Outlook

Relatively good. Her age, the support of her family and the absence of complications are in her favour, and many recover with CBT. Relapses happen, often at times of stress.