A chronic anorexia nervosa patient hospitalized 10 times over a 10 year period: Therapeutic intervention for 'obsessive defense' (report 2: Inpatient therapy)

We report here a case of a 29-year old woman. In our outpatient clinic, we treated her with a focus on motivating her toward hospitalization (cf. Report 1). Inpatient treatment was based on Cognitive-behavioral therapy using behavioral restriction. The patient 1 repeated unreasonable criticism of the therapist for perceived excessive restriction and made unreasonable demands for changes in her therapy in the first stage of admission, 2 and then, continued her psychopathological habits and views and pursued excessive body weight gain, 3 complained of anxiety about restriction being lifted in the last stage. These attitudes and behaviors seemed to be caused by anxiety/resistance against change. We present in this report our therapeutic interventions and the process of her accepting change. We found the behavioral restriction to be very useful in the treatment of anorexia nervosa, but with some side effects if mechanically used, and herein report how to effectively utilize behavioral restriction.