Psychodynamic Aspects in an Indonesian Adolescent with Anorexia Nervosa: A Case Report

Abstract

Background: Anorexia nervosa (AN) is a severe eating disorder characterized by extreme dietary restriction, fear of weight gain, and distorted body image. In Indonesia, research on AN is still limited and no case reports have yet documented its presentation, particularly from a psychodynamic perspective. Applying a psychodynamic framework, this paper seeks to uncover unconscious conflicts and internal dynamics that may underlie symptom formation, thereby offering a complementary perspective for the management of AN. Case: We report the case of a 15-year-old Indonesian female who experienced profound weight loss, from 76 kg to 27 kg. During hospitalization, psychiatric evaluation confirmed a diagnosis of restricting-type anorexia nervosa accompanied by a moderate depressive episode. The patient’s condition was further complicated by depressive symptoms, including suicidal threats and social withdrawal. Within nine months after discharge, she required rehospitalization following a partial relapse. Discussion: This case report describes an adolescent girl with restricting-type AN and comorbid depression who experienced severe weight loss and partial relapse. Disordered eating, excessive exercise, low self-esteem, and body image disturbance were prominent. Treatment involved family-based therapy, cognitive behavioral therapy, and antidepressants. Psychodynamic factors, including perfectionism, external validation, and family dynamics, contributed to illness persistence. Sociocultural influences such as body shaming and thin-ideal internalization further increased vulnerability and relapse risk. Conclusion: This report therefore aims to examine the patient’s psychodynamic profile, with particular attention to how emotional conflicts, unconscious processes, and relational patterns may have contributed to the onset and course of the disorder.