I work in mental institution (in-patient unit) and learn CBT approach. I'd like to ask how to work with an anorectic patient. She's young female ( she's 20 years old), she was brought to the hospital after commiting suicide. For 4 years she's been dieting (since 2001 she drinks just a cup of coffee and few times a day she "chews" some cheese or vegetables- after chewing she spitts it away. According to the patient that's all what she eats. Interesting thing is that her minimum weight was 47 kg (163 cm)- she never weighted less than that.
Now I'm really confused- her version of her life and behavior is very different from what her parents and friends claim to be. Besides I can't work out the critical incident- it seems that nothing has triggered it. Another thing is that a goal for her is 'to eat not to get fat', and I understand it as still the same concentration on weight. I suppose that maybe besides anorexia there might be BPD (there are some rationale for that). And what now? What shall I concentrate on? She said, she prefers to deal with her low self-esteem, that she's tired with listening about her low weight. When we work on self-esteem we come back to the wieght. Vicious- cirles. What would you advice?
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