A cycle hidden by appointment attendance
A patient attends every therapy appointment and can recite nutrition facts. Between visits, they restrict rigidly, experience loss-of-control episodes, feel intense shame and then fast to compensate. Body checking briefly reassures them but increases concern later. The current service reviews only attendance and whether a worksheet was completed. The patient says the plan feels like another perfection test and reports difficulty eating during work shifts. Their medical and nutritional needs are being assessed by the appropriate team, and there is no acute instability specified in this case. The clinician is asked to build a coherent formulation and evaluate meaningful change rather than select more unrelated techniques or treat repeated attendance as proof of recovery.
1. Which maintaining processes and treatment targets are supported?
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The restriction-binge-compensation sequence, shame, checking and rigid perfection rules are relevant processes to examine collaboratively. Appropriate structured eating, cognitive and behavioral work can be linked to these targets, while the team reviews shift-related barriers and medical or nutrition requirements.
2. How should progress and relapse planning be measured?
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Review the actual eating and compensatory pattern, beliefs, flexibility, distress and function. Worksheet completion is not the outcome itself. Identify specific warning signs, supports and responses to setbacks; avoid presenting a lapse as proof that every gain has disappeared or using shame as the intervention.