Ellen Farber, a single 35-year-old insurance company executive, came to a psychiatric emergency room of a university hospital with complaints of depression and the thought of driving her car off a cliff. An articulate, moderately overweight, sophisticated woman, Ms. Farber appeared to be in considerable distress. She reported a 6-month period of increasingly persistent dysphoria and lack of energy and pleasure. Feeling as if she were "made of lead," Ms. Farber had recently been spending 15–20 hours a day in her bed. She also reported daily episodes of binge eating, when she would consume "anything I can find," including entire chocolate cakes or boxes of cookies. She reported problems with intermittent binge eating since adolescence, but these episodes had recently increased in frequency, resulting in a 20-pound weight gain over the past few months. In the past her weight had often varied greatly as she had gone on and off a variety of diets. She denied preoccupation with thinness or a history of episodes of vomiting or other weight-reduction procedures to compensate for the binge eating.