Disordered eating: a case of anorexia 1

Case presentation A. arrives in my office after that her parents in the last 2 mounths weren’t able to let her come out from her room. She’s 16 years old and with a BMI of 14. With a large range of symptoms of depression too.

After a brainstorming with a interdisciplinary team (nutritionst; psychiatric; clinical) we decided to suggest (in the next two day after our session) a recovery in the city hospital in which I can supervise her treatment. She spent there 2 months then we start with ambulatory individual psychoterapy and at the same time her family started a familiar intervention.

Why I didn’t use tests as assessment? Because at the beginning of the therapy she was completely dehydrated and the clinical issues would be significantly invalidated the results. After the recovery (without any form of constricted eating or remedies) I use EDI 2 but she doesn’t report significant results. In BIAAQ the initial point was of 29.

And this was the therapeutic relationship at the beginning…

Our relationship at the beginning was hard to built because she was really undernourished and was at the hospital; I decided let her free to choose: she had the chance every day to phone me and I went weekly to the hospital for our experiential exercise;

From the first day she use the phone call just to say me “hello, I’m feeling bad”: I appreciate this openness and every little step she was doing with the food increasing; After the first two week she doesn’t need the support of a weekly phone call as she reported in the session, because she “believe in us” (FAP consistent).

(1) She report about herself: “I’m shy and angry!” (2) Completely avoidance of foods; emotions; bodily sensations and her body image (3)She isn’t in contact with the present moment but she’s fuse in thoughts about the disordered eating and the depression (4)Social isolation; food restriction, self vomiting, Hyperactivity (5)Her parents; a couple of friends (6) Completely fused with the failures she reported in her past: in doing diet; at school; with a boyfriend ACT Question

In the first 4 months In the first 4 months we explore together MINDFUL EATING at the hospital of different foods she avoided; then A. wrote down a list of “forbidden food” (she usually eat during bingeing episodes)and we start to eat them once in session than she gradually reintroduce them in daily nutrition.

Then…she have to choose: the dancer me my life

Treatment in ambulatory: For 6 months she came in session weekly; then twice a month for other 6 months. We explored this strategies: Body acceptance: defusion and acceptance of bad and negative thoughts about body weight, shape and images that emerged in “mindful mirror exposures”;

Values: recognize and follow with committed actions her values against behave in an “avoidance mode” (as an example with school);

Defusion: She learned to defuse herself from the “thoughts of the disordered eating” and started to self-reinforce for positive thoughts and her ability in express thoughts and emotions to others.

Acceptance: she start to appreciate and accept herself in a more open way: not only as a “perfect dancer” or a “perfect daughter”, or a “perfect girlfriend” but as a teenager. She started to accept and confront herself and copying with negative emotion and confusion of this period of her life in session first, and then outside practicing at school, in family, with her friends and with her boyfriend.

Committed action: she started to act consistently with her values. For example at school she take responsibility for her results and discover different style for studying; with friend she start to speak more directly and to act in way to spend more time with them; with family becoming “less than perfect”

Contact with the present moment: with the gradual exposure to food she started even to decide and explore the daily life that she wanna have: going to school and being present (we do imagery exercise on that); going to the gym for the pleasure to be there (and not for weight managment) and so on.

Self as a content: was really nice the description she give of herself at the beginning of the therapy; she started telling me that she was “shy and introvert”; during our sessions sometimes she reported her surprise in the feedback she received from others (boyfriend; family members; friends) and gradually became aware of the changes that follow her personal growth.

An experiental exercise in imagery…

At the end of the treatment: BMI 22; No disordered eating symptoms (reported even in EDI 2); BIAAQ 50; She reports to like her familiar and her social life; She see herself “in a different way even as before the problem

And now…she’s ready to go

(1) She said about herself hironically”I’m normally…me!” (2) She accept herself and her body (3)She uses mindfulnes and breathing tecniques; physical activity as a way to relax and be mindful of her body (4)She lives as an adolescent: she’s studying; going out with friens; having a loving relationship. (5)Her family; pleasure activities; friends of different group; her boyfriend; the desired to do a work she love to do. (6) she’s in contact with present moment even in difficult periods ACT Question

and now, would you like to try to conceptualize a case by yourself with one of your client?

ACT Question