I don’t deserve anything good: Perfectionistic self-recrimination in a
case of comorbid personality and eating disorder.
Abstract
In this case study we present the course of the psychotherapy of Myriam,
a 19-year old female with a severe personality disorder and comorbid
eating disorder. During the initial assessment she reported high levels
of neuroticism that parallel the diagnosis of obsessive-compulsive
personality disorder, borderline personality disorder, and anorexia
nervosa. Myriam showed a severely impaired personality functioning
defined by perfectionism, self-criticism, interpersonal guilt and
overcontrol. Her daily experience was shaped by a self-recriminative
inner dialogue associated with maladaptive patterns in the form of food,
water and sleep restrictions, self-harm behaviors, and suicidal
ideation. She accessed an integrative treatment based on individual
(Evolutionary Systems Therapy) and group psychotherapy (Mindful
Compassion for Perfectionism). At the end of 14-month intervention she
remitted from all the categorical diagnoses and showed reliable changes
in several measures. These outcomes were maintained at 3-month
follow-up. We describe the integrative conceptualization based on
Myriam’s perfectionistic self-recrimination patterns, and the consequent
treatment that targeted these patterns rather than focusing on symptom
reduction exclusively.