Case Report: Motivational ambivalence and family dynamics in severe adolescent anorexia nervosa treated in a Mexican...

This case report describes the clinical course of two adolescent females (ages 12 and 14) with severe restrictive-type anorexia nervosa (AN) and comorbid anxiety and depressive symptoms. Both presented with extreme malnutrition (BMI-for-age <1st percentile), amenorrhea, distorted body image, and marked ambivalence toward weight restoration. Their families, characterized as structured, were engaged with the treatment. Care involved short-term hospitalization followed by intensive outpatient multidisciplinary treatment integrating cognitive-behavioral and dialectical behavior therapy strategies, nutritional rehabilitation, psychopharmacology, and structured caregiver involvement, alongside a psychodynamic-systemic family intervention informed by initial assessment. This model provided a framework to identify relational and emotional processes underlying motivational ambivalence. Over 6 months, both patients achieved weight restoration (approximately 50th-60th percentile BMI-for-age), with reduced eating disorder (ED) symptoms and improved emotional awareness, accompanied by changes in family functioning. However, residual anxiety, perfectionism, fluctuating insight, family conflict, and treatment fatigue persisted. One patient discontinued treatment prematurely despite clinical stabilization, with family and couple conflict. These cases highlight the complicated interaction between symptom remission, motivational ambivalence, and family dynamics in adolescent AN, emphasizing that weight restoration represent positive response, but alone does not constitute full recovery multidisciplinary, and family-focused interventions are essential.