A chronic anorexia nervosa patient hospitalized 10 times over a 10 year period: Therapeutic intervention for 'obsessive defense' (report 1: Outpatient therapy)

In eating disorders, there are not only mild cases, but also severe and/or prolonged cases. Therapies developed for the latter are controversial, but show promise as more cases of effective treatment are being presented. We report here a case of a 29-year old woman who has been suffering from anorexia nervosa hospitalized 10 times over a 10 year period. Whenever she lost weight, there was a trouble between her and her mother who was critical about her weight loss. To get away from her mother, she acquiesced to hospitalization. However, during her stay at the hospital when the weight gain raised her fear of getting fat, she would discharge herself from the hospital halfway through the treatment and rapidly lose her weight. She was very obsessive/compulsive and extremely anxious and resistant to changes that might lead to successful treatment of the disease, as she had been psychologically very dependent on the disease. In our outpatient clinic, we treated her with a focus on motivating her toward hospitalization for her own well-being. One year later, she accepted the hospitalization contract with a definite goal of inpatient therapy. We herein discuss the relationship between obsessive/compulsiveness and the length and severity of eating disorders. The course of inpatient therapy of this patient will be reported in Report 2.