Depressione maggiore e DCA: remissione sintomatologica in una storia di depressione in comorbidità con bulimia nervosa

A., a 24-year-old woman, came to me during a year and a half of psychoanalytic-oriented individual psychotherapy and psychopharmacological therapy with antidepressants and benzodiazepines (alprazolam, fluoxetine, and citalopram) for a depressive disorder with reported bulimia nervosa, but without significant relief. The patient reported the onset of her psychopathology at age 18, when she began complaining of low thymic tone, significant levels of free and somatic anxiety, and initial and central insomnia, resulting in difficulty completing high school, given her psychopathological condition. Gradually, she began experiencing bulimic episodes, initially sporadic and only in the evening, which subsequently increased to an average of approximately 8–10 episodes of binge eating and self-induced vomiting per week over the past 12 months. Based on this frequency, the patient's level of bulimia nervosa was classified as “severe” according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (8–13 episodes per week). Clinical assessment, as determined by the score on the Eating Disorders Examination Questionnaire [EDE-Q; (30, 31)], confirmed the severity of the illness.