Restrictive Eating, Social Comparison, and Body Image Disturbance: A Psychological Case Study of an Adolescent Female with Anorexia Nervosa

Abstract

Anorexia Nervosa (AN) is a severe eating disorder associated with marked psychological, physical and psychosocial impairment. It is particularly prevalent among adolescent females. This case study presents S.M., a 17-year-old female referred for outpatient psychotherapy with a progressive history of food restriction, compulsive post-meal walking, body image disturbance and secondary amenorrhea. Onset followed a period of upward social comparison with an older sister who received positive attention for her fitness. The client internalized these ideas as a personal standard of worth tied to thinness. Comprehensive assessment, including the Mini-Mental State Examination, the Eating Disorder Examination Questionnaire, the Eating Attitudes Test, the Beck Depression and Anxiety Inventories and the House-Tree-Person projective technique indicated intact cognitive functioning alongside clinically significant eating-disorder psychopathology, mild depressive symptoms, moderate anxiety. The client met DSM-5-TR criteria for Anorexia Nervosa, Restricting Type. A phased outpatient intervention combining Cognitive Behavioral Therapy and Exposure and Response Prevention was implemented, addressing psychoeducation, structured eating, fear-food exposure, cognitive restructuring of appearance-based self-worth and relapse prevention. This case illustrates how sibling-based social comparison and contingent self-worth can interact with cognitive and behavioral mechanisms to initiate and sustain Anorexia Nervosa, and underscores the utility of an integrated CBT and ERP framework in adolescent eating-disorder treatment.

Keywords: Anorexia Nervosa, Restrictive Eating, Social Comparison, Body Image Disturbance, Contingent Self-Worth, Cognitive Behavioral Therapy, Exposure and Response Prevention, Adolescent Psychopathology