Eating Disorders - fieldi

Individual Psychotherapy 143
During the early months of our work, she spoke about drinking
in high school but denied excessive drinking since starting treatment.
She was most guarded in revealing the details of her eating
patterns and purging. She was a vegetarian who limited her diet to
a few foods she felt she could handle. She would vomit whenever
she felt she ate too much, often after eating an amount that would
be normal for most people. Early in treatment, she acknowledged
that her vomiting was as much a response to her emotional state as
it was to what and how much she had eaten. Body-image distortion,
preoccupation with weight, and terror of becoming fat were prominent
early in treatment and continued to persist throughout, gradually
lessening in intensity as she progressed in her recovery.
A significant feature in her presentation was her tendency to
become confused and blocked in her ability to think when she was
anxious. This confusion and blocking was noted to some extent in
every one of our sessions for years. Her difficulty in thinking could
be attributed to her Alexithymia (McDougall 1991) but also suggested
cognitive difficulties in processing information and her
thoughts. Exploration of her school history revealed that, although
she had learned little, she had managed to pass because she was
quiet, compliant, and well-behaved. She could read mechanically
but had little comprehension and recall of what she had read. Her
fund of information was very limited. She was surprised that she
was promoted from grade to grade and even graduated from high
school given her marginal performance. The first summer I saw
Laura, she enrolled in a college-level course to see if she could handle
college. She was anxious and overwhelmed to the point that she
could not follow the instructor’s lecture or comprehend the textbook.
Although I felt that other factors were operating—such as her
drinking, anxiety, and depression—I suspected significant learning
disabilities and referred her for a psychoeducational evaluation. The
evaluation found significant weaknesses in auditory-processing
skills, reading comprehension, word retrieval, knowledge of linguistic
rules, study skills, and general fund of knowledge. She followed
the recommendations of the evaluator and enrolled in remedial college
courses, which she was able to complete successfully. Her initial
reaction to this information about her learning difficulties was to
feel that her sense of worthlessness and hopelessness about her