Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self‐destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms. © 1995 by John Wiley & Sons, Inc.

This article is based on the first author's doctoral dissertation in clinical psychology in partial fulfillment of the requirements for the doctoral degree at Ohio University. The dissertation was conducted under the direction of the second authorWe gratefully acknowledge the assistance of John

Examined the specific and generalized effects of contractual agreements on a childhood recollectin task (N = 131). As predicted, Ss who signed a written contract complied significantly more to the specific aspects of the contracted task than did verbal agreement Ss and controls. Generalized behaviors that were not part of the contract showed no group differences. Implications for the use of therapeutic contracts were discussed.

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