The patient: “Maile,” a 35-year-old hotel concierge.

Why she came to see me: I had met Maile years before when she accompanied her mother to my health center, but the woman who walked into my office was hardly recognizable as the same person. Gone were the stylish clothes, the bright smile, and the engaged, curious demeanor; in their place stood a disheveled, rather gaunt woman who had trouble meeting my eyes.

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