Ambivalence and Resistance in a Patient with Anorexia Binge-purging: a Case Report

Abstract

Introduction Eating disorders (ED) are long-term psychiatric illnesses defined by abnormal eating habits and associated with a number of psychological and environmental factors. The underlying psychological components of ED are difficult to detect and patients frequently can be strongly ambivalent about changing, although their apparent willingness to recover. Objectives The study of the subjective meanings of the patients' ambivalence has a positive function to address treatment resistance. Aims To consider patients' perspectives on pervading ambivalence supports the empathically comprehension of the feelings, defenses and thoughts that underpin ED. Methods We describe a clinical case of an out-patient attending at the Department of Psychiatry, University of Sassari. Results I.O. is a 36 years-old woman, with anorexia (AN) binge/purging since she was 19, with low academic and social functioning. She made a residential treatment for 6 months when she stopped binge/purging behavior. In outpatient setting the binge/purging behavior restarted with blame, incapacity and resignation feelings. Empathic comprehension of ambivalent motivation contributes during treatment to disclose the adaptive function of AN, the interior conflict between need and fear of autonomy, need of differentiation from her mother and her mother's endorsement, with reduction of blame feelings and binge/purging behavior. Conclusions Weight restoration should be considered the starting point of a treatment whose main goal should be the modification of the inner world, the defenses and the thoughts that underpin ED.