The Case of Cruella

The Case of Cruella

Cruella, a 40-year-old tall, slender woman, working in a large New York fashion house, was referred to you by her family doctor and psychiatrist with concerns that Cruella had drifted below the 10th percentile for weight. The psychiatrist had been treating Cruella for her perfectionist traits that stemmed from her need to create perfectly patterned outfits for her fashion clientele. Cruella’s perfectionist traits began to cause significant anxiety for Cruella. You learn that the psychiatric sessions focused on Cruella’s work anxiety, not on eating behavior.

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Cruella’s eating difficulties began when she was in fashion school, when she began refusing to eat and reporting a fear that she would vomit. At the time, she sought treatment from her family doctor, who continued to evaluate her yearly explaining, that she would grow out of the fear. As a teenager, Cruella was above the 25th percentile for both weight and height, but by her college years she dropped to the 5th percentile.

The only child of two fashion icons, who had divorced when Cruella was a child, Cruella split weekdays and weekends with her mother and father. Cruella’s mother was a tall, skinny woman who always wore animal patterned clothes. Cruella remembers playing dress up in her mother’s wardrobe and hoping to one day join her family’s famous fashion house. Cruella’s medical history was significant for her premature birth at 34 week’s gestation. Cruella was slow to achieve her initial milestones, but by age 2 Cruella was developmentally normal. Cruella had always been “skinny”, but her height and weight never fell below he 25th percentile during her childhood.

As an adult, Cruella was a talented fashion icon, with the ability to make any person look amazing in her couture fashion line. Cruella never had many friends and stated that having too many friends would stop her from achieving fashion greatness. Cruella was firm and demanding at her fashion house, but she also gave praise to her employees for a job well done. Cruella reported that recently socialization was not a key priority, as her stomach felt “calmer” when she was in her lavish New York apartment.

For the prior 2 years, Cruella had only eaten very small amounts of food over very long durations of time. He assistant tried to pique her interests by experimenting with foods from different cultures. Cruella’s apartment would smell of different foods from all over the world, but most of the food would be eaten by her assistant and staff. Nothing seemed to be effective in improving Cruella’s appetite. Cruella’s assistant also would ask her to pick her favorite restaurants, but Cruella would turn up her nose and go back to designing clothes. Cruella would sit with everyone at her large dining room table but spent most of her time cutting her food into tiny pieces. Cruella would lash out if anyone suggested that she eat large pieces of food or what she deemed an access of food. Cruella also began to refuse to attend planned events for her fashion house if she knew there was food at the events.

In your session, Cruella appeared well put together, but her skin appeared gray. Cruella was also very thin, and you noticed her ribs through her tight dress. Cruella tried to remain covered with her larger than life faux fur coat, but you still noticed her gaunt figure. When asked more about her fear of vomiting, Cruella remembered one specific incident when she was a teenager. Cruella stated that she ate a cup of green soup and her stomach became upset. Cruella remembered running to the bathroom and vomiting. More recently, Cruella developed a fear of eating in public and would not eat while she was at work. When educated about the dangers of low body weight, Cruella became tearful and expressed a desire to gain weight. Cruella stated that she did not allow her models to be unhealthy and stated that she needed to set a good example for her fashion house.

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