CHANGES IN DEPRESSIVE DEFENSES IN ANOREXIA NERVOSA TREATED WITH DYNAMIC PSYCHOTHERAPY

Eating disorders (ED) are frequent in adolescence and often associated with depression and other physical and mental disorders. Anorexia Nervosa (AN) is a challenging ED because it is perceived as an ego-syntonic syndrome that somehow protect the patient from a number of developmental tasks. The present study analyzed changes in defensive and personality functioning and AN severity in a 16-years old girl treated with long-term dynamic psychotherapy. Defense mechanisms were assessed using the Defense Mechanisms Rating Scales Q-sort (DMRS-Q) every six months for three years and at follow up. Personality functioning and Body Mass Index (BMI) were also monitored with the same cadency. Defensive and personality functioning gradually improved during the therapeutic process, while a healthy BMI was reached only after a 6-months residential treatment. Depressive defenses were associated with AN severity and low personality functioning. Improvement in defensive functioning predicted healthy BMI at follow up. Long-term dynamic psychotherapy might help in fostering self-awareness of psychological distress and in enhancing mature defensive strategies to manage it. However, an integrated dynamic-behavioral approach in treating severe AN is essential for the complete ED symptoms remission.