Metacognitive Interpersonal Therapy ‐ Eating Disorders (MIT‐ED) in the Case of an 18‐Year‐Old Girl With Avoidant and Obsessive‐Compulsive Personality Disorders, Binge Eating Disorder and Obesity

Personality disorders (PD) in adolescents are a significant risk factor in the development and maintenance of eating disorders (ED). Comorbid PD and ED can influence each other and significantly impact on the young person's well-being, worsening interpersonal relationships and social functioning. Patients with ED often use coping mechanisms related to food and body shape as maladaptive attempts to manage PD-related problems, like negative ideas about self and others. We describe the case of an 18-year-old adolescent presenting with binge eating disorder (BED), stage I obesity, and Avoidant and Obsessive-Compulsive Personality Disorders, treated with Metacognitive Interpersonal Therapy for Eating Disorders (MIT-ED). The patient reported low self-esteem and insecurity about her decision. When her need for autonomy was frustrated, she adopted dysfunctional behaviors such as chasing perfectionistic goals to increase her self-esteem. Further, when criticized feeling useless, she would mitigate her feelings of shame and sadness through social withdrawal and binge eating. Therapy focused on improving awareness of the mental states that contribute to social withdrawal and dysfunctional eating behaviors and to build psychological resources to support self-worth and autonomy. We describe the addition of family therapy to the treatment protocol to address some of the interpersonal and relational dynamics that maintained Asia's sense of herself as worthless and unable to pursue her own goals. Implications for treating adolescents presenting with comorbid PD and ED are discussed.