Sam is a 15-year-old male with anorexia nervosa who was referred to me for individual therapy by a clinician working with the family as a whole. In our first meeting, I am struck by his height – he stands nearly 6’ 2” tall – and by the prominent muscles in his arms. As I later learn, Sam is avidly interested in body building and, before treatment, often spent several hours at the gym each day. After sustaining a shoulder injury that made upper body exercise impossible, Sam began to limit his diet to high protein foods and, over several months, his eating became increasingly restricted.