Schema Therapy Case Study: Overcoming Food Phobia

Client Profile

Name: Sarah L. (pseudonym)
Age: 32
Gender: Female
Occupation: Marketing Manager
Marital Status: Single
Presenting Problem: Severe food phobia, emotional distress related to eating, social avoidance, and impaired daily functioning
Therapist: Franco Greco, Internationally Accredited Schema Therapist & Clinical and Counselling Psychologist, Your Psychologist Elsternwick, Victoria.

Presenting Issues

Sarah is a high-achieving marketing manager who has been struggling with severe food phobia for several years. Despite excelling in her career and having a solid social network, her relationship with food is deeply distressed. Sarah experiences overwhelming anxiety at the thought of eating certain foods, particularly those perceived as unhealthy or high in calories. Her fear is not limited to specific foods, but extends to all meals, particularly in social or work-related settings.

Sarah avoids eating in public and often skips meals to avoid the distressing emotions triggered by food. When she does eat, she experiences extreme guilt, leading to cycles of restriction followed by episodes of binge eating. She has adopted rigid eating rules to maintain control, such as categorizing foods as "good" or "bad" and severely restricting her intake of "bad" foods. These behaviors have created a significant barrier in her social and professional life, leading her to withdraw from social gatherings, feeling constantly judged for her eating habits, and avoiding work events involving food.

Her food phobia is compounded by an intense fear of weight gain, which has led to a distorted body image and further reinforcement of her restrictive eating behaviors. Despite her success in other areas of life, Sarah feels trapped by her irrational fear of food, which continues to affect her emotional wellbeing.

Therapeutic Approach: Schema Therapy with Franco Greco

Franco Greco applied Schema Therapy to address the underlying emotional roots of Sarah’s food phobia. Schema Therapy is particularly effective in dealing with deeply ingrained emotional patterns that have developed from early life experiences. As an Internationally Accredited Schema Therapist and Clinical and Counselling Psychologist, Franco uses this approach to help clients like Sarah uncover the schemas (deeply held beliefs) that drive unhealthy coping mechanisms like food phobia.

For Sarah, the goal was to identify and heal her maladaptive schemas and help her develop a healthier relationship with food, one that would allow her to eat with less anxiety and guilt. The treatment also focused on strengthening Sarah’s Healthy Adult mode to support balanced decision-making and emotional regulation.

Early Maladaptive Schemas (EMS) Identified

During therapy, Sarah and Franco identified several key schemas that were contributing to her food phobia:

• Emotional Deprivation Schema
    Belief: "My emotional needs won’t be met, and I am unworthy of nurturing."
    Outcome: Sarah’s food phobia stemmed from an emotional void that she tried to fill by controlling food. Her need to restrict what she ate was a way of coping with feelings of inadequacy and unworthiness, as she felt emotionally deprived.
• Unrelenting Standards Schema
    Belief: "I must be perfect, including how I eat, or I will be judged and rejected."
    Outcome: Sarah’s rigid eating rules and extreme control over her diet were a manifestation of her belief that anything less than perfection—both in her body and in how she ate—was unacceptable. This led to feelings of intense shame and anxiety whenever she ate "imperfectly."
• Defectiveness/Shame Schema
    Belief: "There is something fundamentally wrong with me."
    Outcome: Sarah’s food phobia was driven by her deep sense of shame about her body and eating habits. She believed that if she ate too much or too little, it would confirm her sense of defectiveness, leading to cycles of self-criticism and avoidance of food.
• Failure Schema
    Belief: "I will inevitably fail and disappoint others."
    Outcome: Sarah felt that eating in a socially acceptable way was a measure of success. She feared that failing to control her food would reveal her inner "failure" to others, further isolating her and reinforcing her avoidance.

Schema Modes Identified

Franco also helped Sarah identify the different schema modes she shifted into when dealing with food-related stress:

• The Detached Protector Mode
    Function: Numbs emotional pain by disconnecting from the emotional experience of eating.
    Behavior: Sarah would avoid eating altogether, particularly in social settings, or restrict her intake to an extreme, detaching herself from the discomfort of hunger or the emotional aspects of eating.
• The Compliant Surrender Mode
    Function: Submits to external pressures, such as others’ expectations around food, but struggles to meet internal emotional needs.
    Behavior: During social events, Sarah would eat excessively to avoid judgment or conflict, but this was followed by extreme guilt, feelings of shame, and self-punishment for failing to adhere to her rigid food rules.
• The Punitive Parent Mode
    Function: Internalized harsh self-criticism, particularly when food-related behaviors are perceived as a failure.
    Behavior: After eating, especially after binge eating, Sarah would engage in self-criticism, mentally berating herself for not adhering to her rules. This mode fueled her food phobia and her inability to move forward.
• The Vulnerable Child Mode
    Function: Holds unmet emotional needs for love, security, and acceptance.
    Behavior: Sarah’s food anxiety often came from a sense of vulnerability, feeling that eating was a reflection of her emotional insecurity, leading her to avoid situations where she might feel judged or rejected.
• The Healthy Adult Mode (Underdeveloped)
    Function: The ability to make balanced, nurturing decisions that promote self-care and emotional regulation.
    Goal: Strengthening this mode was essential for Sarah, as it would allow her to manage her food anxieties without resorting to extremes and rebuild a healthier relationship with eating.

Therapeutic Goals

1. Heal the Emotional Deprivation and Perfectionism Schemas: Work to reduce Sarah’s feelings of emotional emptiness and need for perfectionism in eating behaviors, helping her embrace vulnerability without fear of judgment.
2. Strengthen the Healthy Adult Mode: Develop Sarah’s internal resources to make balanced, values-based decisions around food, without excessive guilt or anxiety.
3. Reduce the Impact of Shame and Failure Schemas: Promote self-compassion and understanding to lessen the harsh internal criticism Sarah felt after eating.
4. Interrupt the Avoidance and Restriction Cycle: Gradually expose Sarah to food-related situations, helping her face the fear of eating in public and at social events.
5. Establish Healthy Eating Patterns: Rebuild a positive relationship with food through mindful eating practices, helping Sarah enjoy food in a way that nurtures both her body and her emotions.

Key Schema Therapy Techniques Used

• Imagery Rescripting – Revisiting early memories to reframe and heal the emotional pain tied to food, eating, and body image.
• Chair Work – Facilitating internal dialogue between different modes (e.g., the Punitive Parent, the Vulnerable Child, and the Healthy Adult) to address conflicting emotional states around food.
• Mode Dialogues – Helping Sarah explore the emotions and beliefs tied to each schema mode and how they influenced her food-related behaviors.
• Cognitive Restructuring – Challenging Sarah’s distorted beliefs around food and body image, helping her recognize that eating is a natural and nurturing act.
• Exposure Therapy – Gradually encouraging Sarah to eat in more relaxed and social settings, helping her build tolerance to anxiety-provoking situations.

Outcome After Six Months of Schema Therapy

After six months of Schema Therapy, Sarah made significant progress:

• Reduction in Food-Related Anxiety: Sarah experienced less anxiety about eating in social situations and was able to participate in meals with family and friends without feeling overwhelmed by fear.
• Improved Relationship with Food: She developed a more flexible and balanced approach to eating, without the extremes of restriction or bingeing. She was able to make food choices based on health and enjoyment, rather than fear or guilt.
• Decreased Self-Criticism: Sarah’s inner dialogue became more compassionate. She no longer berated herself after meals, and instead practiced self-compassion when her eating habits deviated from her ideal.
• Stronger Emotional Resilience: Sarah was better able to manage her food-related anxiety, facing her vulnerabilities without resorting to avoidance or perfectionism.
• Improved Social Engagement: She began attending social events and work-related lunches without the overwhelming anxiety she previously felt around food.

Sarah continues therapy with Franco to consolidate her progress and strengthen her emotional resilience in managing food-related anxieties.

Why These Credentials Matter: Franco Greco’s Expertise

Franco Greco’s qualifications as an Internationally Accredited Schema Therapist and Clinical and Counselling Psychologist are particularly valuable when working with issues like food phobia, where deeply rooted emotional patterns influence behaviors. Schema Therapy’s focus on uncovering and healing maladaptive schemas allows Franco to help clients like Sarah explore the emotional roots of their phobias and reshape their behaviors with lasting impact.

About Franco Greco

Franco Greco is a Clinical and Counselling Psychologist and Internationally Accredited Schema Therapist practicing at Your Psychologist in Elsternwick, Victoria. He specializes in treating emotional avoidance, eating disorders, phobias, and self-sabotaging behaviors. Franco’s empathetic, structured approach provides clients with the support they need to make meaningful, sustainable changes.

To learn more or book a session with Franco, call him.