Abstract
The number of patients suffering from eating disorders (ED) is increasing in Japan and in advanced countries. Most patients with ED are unmarried young women who desire to lose weight, or women who have a fear of getting fat. ED patients also have a strong belief that they are healthy and that they are not suffering from a mental or a physical illness. Recently, the number of married women with ED has been increasing. In this paper, we report the case study of a 39 year old married woman suffering from ED.The patient has been gradually losing weight since she had caught cold 3 years ago. When she was brought to the hospital by her family against her will, she was unable to perform any tasks due to severe malnutrition. At the time of admission, her weight was 26.4 kg (height 162 cm and BMI=10.1). Medical examinations indicated that the patient did not suffer from an organic disorder, depression, schizophrenia, or a body image disturbance. She was diagnosed as suffering from ED.Her developmental history made it clear she believed that she was neglected and unloved by her parents because she was a female. She felt that her parents took better care of her brother because he was to inherit their father's business. Her developmental history (sibling rivalry) resulted in denial of her self-esteem.The patient had a history of habitual shoplifting. Even though she wanted to stop this habit, she was unable to do so. She was unable to talk about this problem with other people. She was lonely and suffered from feelings of guilt associated with shoplifting. She had a need to be punished for her evil acts and felt that not eating would result in weight loss and ill health and that ill health would atone for her shoplifting.We believe that her desire for ill health was the cause of her ED.During therapy, we advised her to speak out her feelings to her family because we considered that this would reduce the feelings of guilt associated with shoplifting. According to our advice, she confessed her shoplifting and her desire for self punishment. Her family accepted her confession uncritically (she had family support), and as a result her desire for self punishment decreased. Following this experience, she was able to eat again and her body weight gradually increased to 38.4kg. She was discharged from hospital after 4 months of treatment.
