Anorexia patients and scientists point out the dangers of alternative PRI therapy: ‘I wouldn’t wish this on anyone’

An alternative treatment has become popular among vulnerable girls with severe anorexia, which experts are very concerned about. The therapy is called Past Reality Integration (PRI). PRI therapists speak of a groundbreaking, potentially ‘life-saving therapy’. Scientific authorities consider the treatment ‘life-threatening’.

It started innocently enough with healthy eating at the age of thirteen, says 18-year-old Esther*. Until she notices that she is losing weight as a result. That feels so good that she eats less and less. Every few weeks she has to reach a new target weight. If that fails, she feels like she no longer has control over her life.

After breakfast she doesn’t eat anything until dinner. Eventually her situation deteriorates so much that she no longer goes to school. An emergency admission to hospital follows and she is given tube feeding to gain strength. She will not say how much she weighed at the time.

Mental healthcare

Esther does not receive the care she needs within mental health care. According to her, too much emphasis is placed on the symptoms of the disease, on eating and gaining weight. She is happy when she accidentally hears about PRI and starts the treatments. “It was only then that I realized how much trauma I had from my earlier childhood.”

About 5,600 people, most of them women, suffer from the eating disorder anorexia nervosa. The condition usually occurs during puberty. For years it has been the deadliest of all mental illnesses. Every year, five to ten percent of the often young patients die, so in absolute numbers this amounts to hundreds of people.

Since the end of 2019, PRI therapists have increasingly been treating girls with anorexia. At least seventy patients have undergone the therapy. PRI is an alternative, unproven therapy that focuses on ‘repressed and denied’ feelings from early childhood. The treatment was devised by psychologist Ingeborg Bosch and focuses on confronting traumas caused by events that people have ‘repressed’ themselves.


Trauma can already occur, Bosch says in an internet video, if you were not comforted by your mother as a baby. Even if you don’t remember this. These repressed memories, which she believes everyone has, can also cause an eating disorder. This is also stated in a chapter about PRI in the book Recovery from eating problems by Peer van der Helm. He is a psychologist and lecturer in Residential Youth Care at Leiden University of Applied Sciences.

“Complete nonsense,” responds Ineke Wessel, associate professor of clinical psychology at the University of Groningen. As a researcher, she has been studying memory for decades. “Such a theory of forgotten memories sounds attractive. But they don’t exist. At most the ones you would rather not think about.”

Linking repressed memories in early childhood to an eating disorder goes much too far for her. “There is no scientific evidence for this.” She also points out a danger. “If you spend months forced by a therapist to search for ‘repressed’ memories, you can also start to remember things that never happened.”

For example, she tells about a young woman whose alternative therapist suggested that sexual abuse had occurred in her early childhood, before she was three years old. As a result, this patient actually ‘remembered’ it and had a terrible time. Years later, the woman retracted her words. It had never happened. “In such a case, the real cause of someone’s problem is not addressed,” says Pim Cuijpers, emeritus professor of clinical psychology at the Vrije Universiteit Amsterdam. “And on top of that, this person suffers additional trauma.”


Founder Bosch claims on the internet that her treatment is ‘groundbreaking’ and possibly ‘life-saving’ for eating disorders. She refers to scientific research, but when asked for further specification of that research she cannot provide any study.

Pim Cuijpers has searched scientific databases, but cannot find anything. “This is life-threatening,” says the scientist. “They claim that PRI works, but it has never been properly researched.” He gives the often vulnerable young girls a practitioner who knows what he is doing. “And no bullshit.”

The emeritus professor says that the problem is that parents of girls with anorexia are usually desperate, for example because of long waiting lists in eating disorder clinics. According to him, that makes these people willing to get involved in anything that sounds like a solution. “If it doesn’t do any harm, it won’t do any harm, they think.”

Until the end of January, the PRI website stated that eight PRI therapists were treating vulnerable girls with severe anorexia. After questions from De Telegraaf, the information was adjusted. There are still six therapists active. All practitioners have been trained at the PRI Academy set up by Bosch. Specific prior training in mental health care was not required for admission. For example, the therapists have done strategy and organization or the academy for homeopathy.

Teaching materials

Nine former students of the PRI Academy tell De Telegraaf anonymously that they learned very little during the training. For example, they received hardly any teaching materials and there was only one other ‘trainer’ besides Bosch. Above all, they had to dig into their own traumas. And learn how to deal with their own ‘defenses’ differently.

According to Bosch, PRI works with ‘elements from cognitive behavioral therapy and trauma therapy within a schema-oriented approach’. “Sounds wonderful,” says psychologist Pim Cuijpers. “But if you seriously want to offer this type of therapy, you must at least be a mental health psychologist and know exactly what you are doing.”

According to inquiries, no PRI therapist meets that requirement. To protect patients against careless or incompetent actions, the so-called BIG register exists in which healthcare providers such as doctors and psychologists are registered. This register is linked to medical disciplinary law. Inquiries show that no PRI therapist is BIG registered. Cuijpers: “This means that no one can be held liable for what happens.”

Bond between parents and children

In addition to Esther, the newspaper D Telegraaf recently spoke with four other girls who were treated with PRI. They say that their problems only became worse because they were told everything. It was their own fault if the therapy did not work and they had to dig deeper and deeper into ‘traumas’.

Parents and children were told that the eating disorder was the fault of the father and mother. “You should never say that,” says Sandra Mulkens, professor by special appointment of nutrition and eating disorders at Maastricht University. “We don’t yet know how an eating disorder develops. Moreover, this can seriously damage the bond between parents and children.”

The photo that Femke* shows shows a thin, young girl with hardly any color in her face. Her zest for life seems to be hard to find. In May 2020, the then 13-year-old girl developed an eating disorder. If, after a period of losing weight, she loses another ten kilos in a month, she will be temporarily admitted and force-fed. Shortly afterwards, her parents came across a Facebook video about PRI. “It was presented as the solution. This would save her life,” says mother Saskia*.

To damage

Femke starts her PRI treatment in good spirits. She has a session every week. There she has to talk about her traumas. She is forced to pick them all up. When she stands outside crying after such a session, she has no idea what to do with all the emotions that stir up the old ‘traumas’. Because she doesn’t learn that. She has no idea how to process it.

This makes her relive everything in her head. As a result, she starts to damage herself more and more. When the rest of the family also has to undergo PRI therapy, her parents refuse. They are told that they do not really want their daughter’s situation to improve.

Shortly afterwards, Femke’s therapy stops. “I was completely devastated mentally,” she says. “I thought it was all up to me and I didn’t trust anyone anymore.” She goes through a deep valley, but eventually finds the right help. That’s why now, two years later, things are finally going much better. Her eating disorder is now under control. She thinks it is important to tell her story because she wants to warn others. “I wouldn’t wish what I went through on anyone.”

* Fictitious names