"Hitting rock bottom" and recovery-oriented change in long-standing anorexia nervosa: A case report

Long-standing anorexia nervosa is often associated with severe medical and psychosocial deterioration and difficulty sustaining engagement in treatment. Although "hitting rock bottom" experiences have been described as turning points in recovery from addiction, their clinical significance in long-standing anorexia nervosa remains poorly understood.

We report the case of a woman in her late thirties with long-standing anorexia nervosa, binge-eating/purging type, who had a history of multiple hospitalizations without sustained nutritional restoration. Following COVID-19 infection and profound malnutrition, she underwent a life-threatening medical deterioration. This was followed by genuine regret over the life she had lost, a renewed desire to live, and the emergence of a personally meaningful aspiration: to regain her health and be able to play with her child. During hospitalization, supportive care and collaborative exploration of personally meaningful values helped stabilize this aspiration, leading to sustained engagement in treatment and measurable physical improvement from a body mass index of 10.9 at psychiatric admission to 12.9 at discharge.

This case illustrates how, even in long-standing anorexia nervosa, a "hitting rock bottom" experience was followed by recovery-oriented change, accompanied by genuine regret, renewed aspiration, and the emergence of a meaningful image of improved health. The process may be understood from the perspective of the aspiration framework described in recovery-oriented cognitive therapy, as involving not only renewed motivation, but also the restoration of a psychological horizon that allows a healthier future self to become imaginable.