Helen's Case of Anorexia Nervosa
Money, Davies, and Tchanturia (2011) reported a case of a 19-year-old, Helen, suffering from anorexia nervosa. Helen experienced a difficult childhood, during which she witnessed her father abuse her mother. Her parents separated when she was young. Her mother's second partner also acted violently, and they separated shortly after Helen was first admitted to an adolescent inpatient unit for anorexic patients.
Helen was a successful athlete and began competitive gymnastics at the age of seven. She trained four to five times a week and described this as a way of avoiding her problems at home, described by PBT as normal repression (see Rofé, 2000, pp. 105-106). At the age of 14, Helen suffered an injury preventing her from participating in any sport for 6 weeks. During this time, she began to lose significant amounts of weight. From then on, she spent the majority of her time in inpatient wards. The authors noted,
"Until this point, athletics had been Helen's means of escape from home life and the difficult feelings this created, alongside giving her a sense of being in control of an aspect of her life. Exercise had become a way of managing her feelings of anxiety. Without it, Helen needed an alternative way to gain a sense of control in a chronic home life. This became the function of her [anorexia]" (p. 115; for additional case study of anorexia see Karbasi, 2010).
Money et al., noted that in addition to a means of distraction, the patient "perceived the AN [anorexia] as a means of gaining attention from her mum and protecting her from further violence… AN became a means to manage difficult feelings and ensured that she was looked after. It enabled her to move away from the caring role she felt toward her mother. She craved stability, warmth, and guidance from her mum and found this was more present when she became unwell" (p. 115).
Thus, Helen was subjected to difficult life conditions during her childhood, where she used her athletic skills to block the accessibility of stress-related thoughts (i.e., normal repression). When she lost this coping mechanism, as a result of injury, and apparently experienced intensification in her level of stress, she adopted anorexia nervosa. This pathological coping mechanism enabled her to both repress stress-related thoughts and to shape her stressful environment to serve her psychological needs.