{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:20:14Z","timestamp":1787898014031,"version":"build-2784847793"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>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 &amp;lt;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\u202fmonths, both patients achieved weight restoration (approximately 50th\u201360th 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.<\/jats:p>","DOI":"10.3389\/fpsyg.2026.1890098","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:05:40Z","timestamp":1787897140000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Motivational ambivalence and family dynamics in severe adolescent anorexia nervosa treated in a Mexican multidisciplinary setting"],"prefix":"10.3389","volume":"17","author":[{"given":"Jorge Armando Barriguete","family":"Mel\u00e9ndez","sequence":"first","affiliation":[{"name":"Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran","place":["Mexico City, Mexico"]},{"name":"Department of Nutrition, Universidad An\u00e1huac","place":["Mexico City, Mexico"]},{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Valdez-Aguilar","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Regina P\u00e9rez","family":"Bustinzar","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]},{"name":"Department of Psychology, Universidad Iberoamericana","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Gonz\u00e1lez Garcia","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Barriguete Ch\u00e1vez-Pe\u00f3n","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Viladoms","family":"Portugal","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Elisa Montes","family":"de Oca Moncada","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Jim\u00e9nez Miranda","sequence":"additional","affiliation":[{"name":"Cl\u00ednica \u00c1ngeles TCA, Hospital \u00c1ngeles Lomas","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e74003","DOI":"10.7759\/cureus.74003","article-title":"Effective treatment approaches for eating disorders in children and adolescents: a review article","volume":"16","author":"Alharbi","year":"2024","journal-title":"Cureus"},{"key":"ref2","volume-title":"Diagnostic and Statistical Manual of mental Disorders: DSM-5","year":"2013"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1002\/eat.20674","article-title":"Perfectionism across stages of recovery from eating disorders","volume":"43","author":"Bardone-Cone","year":"2010","journal-title":"Int. J. Eat. Disord."},{"key":"ref5","first-page":"1301","article-title":"Intensive outpatient treatment for eating disorders in Mexico, contextualized for Latin America","volume":"42","author":"Barriguete Mel\u00e9ndez","year":"2026","journal-title":"Nutr. Hosp."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.20960\/nh.05984","article-title":"Tratamiento ambulatorio intensivo para trastornos de la conducta alimentaria en m\u00e9xico, contextualizado para Am\u00e9rica Latina","volume":"42","author":"Barriguete-Mel\u00e9ndez","year":"2025","journal-title":"Nutrici\u00f3n hospitalaria: \u00d3rgano oficial de la Sociedad Espa\u00f1ola de Nutrici\u00f3n Cl\u00ednica y Metabolismo (SENPE)"},{"key":"ref25","article-title":"Una aplicaci\u00f3n del modelo psicodin\u00e1mico sist\u00e9mico de evaluaci\u00f3n familiar en pacientes con trastornos de la conducta alimentaria","volume":"6","author":"Barriguete Mel\u00e9ndez","year":"2020","journal-title":"Letra en Psicoan\u00e1lisis."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s40519-019-00643-6","article-title":"Combining day treatment and outpatient treatment for eating disorders: findings from a naturalistic setting","volume":"25","author":"Beintner","year":"2020","journal-title":"Eat. Weight Disord."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1002\/erv.2175","article-title":"Are maladaptive Schema domains and perfectionism related to body image concerns in eating disorder patients?: perfectionism, schemas, and eating disorders","volume":"21","author":"Boone","year":"2013","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.appet.2012.06.015","article-title":"Is there a perfectionist in each of us? 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Disord."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1002\/eat.23916","article-title":"Eating disorders prevention programs in Latin American countries: a systematic review","volume":"56","author":"Dunker","year":"2023","journal-title":"Int. J. Eat. Disord."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.psc.2019.01.004","article-title":"Family-based treatment of eating disorders","volume":"42","author":"Gorrell","year":"2019","journal-title":"Psychiatr. Clin. North Am."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2273","DOI":"10.3389\/fpsyg.2017.02273","article-title":"The Egosyntonic nature of anorexia: an impediment to recovery in anorexia nervosa treatment","volume":"8","author":"Gregertsen","year":"2017","journal-title":"Front. 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Disord."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1037\/0021-843X.116.2.422","article-title":"A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms","volume":"116","author":"Keel","year":"2007","journal-title":"J. Abnorm. Psychol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1537844","DOI":"10.3389\/fpsyg.2025.1537844","article-title":"Case report: from disordered eating to an eating disorder-a case study of an orienteering athlete with anorexia nervosa and the shortcomings of the multidisciplinary approach","volume":"16","author":"Kov\u00e1cs","year":"2025","journal-title":"Front. Psychol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1002\/eat.22980","article-title":"Family-based treatment: where are we and where should we be going to improve recovery in child and adolescent eating disorders","volume":"52","author":"Lock","year":"2019","journal-title":"Int. J. Eat. Disord."},{"key":"ref27","year":"2017"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"90","DOI":"10.22201\/fesi.20071523e.2025.1.834","article-title":"Efectos de la terapia dial\u00e9ctico conductual en l\u00ednea sobre la insatisfacci\u00f3n corporal y s\u00edntomas de trastornos alimentarios en mujeres: Estudio piloto","volume":"15","author":"Ortega Luyando","year":"2025","journal-title":"Rev. Mex. Trastor. 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Disord."},{"key":"ref31","first-page":"169","article-title":"Modelo psicodinamico\u2014Sistemico de evaluacion familiar","volume":"44","author":"Salinas","year":"1992","journal-title":"Rev. Investig. Clin."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2779","DOI":"10.3390\/ijerph18052779","article-title":"Depression, anxiety and eating disorder-related impairment: moderators in female adolescents and young adults","volume":"18","author":"Sander","year":"2021","journal-title":"Int. J. Environ. Res. 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