{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:57:16Z","timestamp":1790679436694,"version":"4.1.0"},"reference-count":7,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long\u2010standing anorexia nervosa is often associated with severe medical and psychosocial deterioration and difficulty sustaining engagement in treatment. Although \u201chitting rock bottom\u201d experiences have been described as turning points in recovery from addiction, their clinical significance in long\u2010standing anorexia nervosa remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report the case of a woman in her late thirties with long\u2010standing anorexia nervosa, binge\u2010eating\/purging type, who had a history of multiple hospitalizations without sustained nutritional restoration. Following COVID\u201019 infection and profound malnutrition, she underwent a life\u2010threatening 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case illustrates how, even in long\u2010standing anorexia nervosa, a \u201chitting rock bottom\u201d experience was followed by recovery\u2010oriented 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\u2010oriented 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70384","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:45:16Z","timestamp":1784803516000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cHitting rock bottom\u201d and recovery\u2010oriented change in long\u2010standing anorexia nervosa: A case report"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1486-4094","authenticated-orcid":false,"given":"Ayumu","family":"Kocha","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-2571","authenticated-orcid":false,"given":"Atsuo","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna University School of Medicine Kawasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Kocha","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Sakuragaoka Municipal Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-024-01006-y"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-024-01079-9"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/07347324.2015.1050934"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2018.1517909"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15m10393"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00206"},{"key":"e_1_2_12_8_1","volume-title":"Cognitive therapy for serious mental health conditions","author":"Beck AT","year":"2020"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70384","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pcn5.70384","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:13:06Z","timestamp":1790676786000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/pcn5.70384"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70384","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"2026-03-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70384"}}