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This is a case report of comorbidity involving psychiatric disorders. The case could only be understood and managed effectively due to the combination of the therapeutic alliance as the cornerstone of mindful medical practice, psychotherapeutic approaches, and medication.
A 27-year-old woman started a psychiatric treatment because of her alcohol problem. She drank daily until she passed out. After assessment, she was admitted into a detoxification facility for a month. As an outpatient, she remained abstinent for periods of time (1-9 months). She also struggled with binge eating, purging and disturbed perception of body image (perceiving herself as obese).
The therapeutic alliance was the main component of treatment. She felt understood and not judged. She kept an open mind to understand her psychopathology.
Psychoeducation was an important tool. It included sessions on addiction and the core symptoms of anorexia nervosa. Behavioural analysis and skills training helped to identify an anxiety disorder at the basis of all clinical presentation. The patient realized how ambivalent she was to change. After several episodes of alcohol use, binge eating and purging, she redefined her life goals. As a result, her motivation to change evolved. She became mindful of triggers and began to have fewer episodes of alcohol use.
She could decrease her binge eating, purging behaviour, and became aware of her distorted perception of her body. She accepted to take medication to control her pathological anxiety, as well as started using paced breathing and muscle relaxation.
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