ABSTRACT
This naturalistic clinical case study describes the assessment and treatment of Linda who presented with anorexia nervosa (AN) and major depression. Her early maladaptive schemas (EMSs), including emotional deprivation, abandonment, defectiveness, and failure, had their origins in a history that featured maternal unpredictability and depression, childhood illnesses and family conflicts. These painful early experiences were shut down by several coping modes, most prominent of which was an overcompensatory eating disordered mode (Anorexic Overcontroller). Cognitive-behaviour therapy (CBT) methods alone had limited impact. A schema therapy (ST) conceptualisation and emotion focused imagery and dialogue work focused on understanding and reparenting her Vulnerable Child, and working with the conflict between her Healthy Adult and the Anorexic Overcontroller. Therapy ended when Linda relocated. It is argued that the ST conceptualisation and the experiential work based on it, created a platform for healing which, had it been followed up, constituted a meaningful path towards further resolution. The clinical material reveals the complexities of the underlying mode structure in an eating disorder. It highlights how automatically the Anorexic Overcontroller coping was activated to shut down the emotional pain at the EMS level and points towards ways in which a ST approach can address deeply ingrained automatic patterns.
