Caring for the patient I am about describe was so challenging it could have cost me my job.
Antoaneta was a middle-aged native of an eastern European country who came to the U.S. at age 10. She spoke perfect English with a charming accent and I recalled treating her for irritable bowel syndrome a few years earlier. Now she was referred for a nutritional evaluation. (In addition to my work as a gastroenterologist, I also directed the nutrition support team at the hospital.) The reason for this was that she had steadily lost a total of 113 lbs (51 kg) over the preceding 15 months due to anorexia nervosa. Her primary clinician had already checked for other conditions that might have caused her weight to fall from 223 lbs (101 kg) to 110 lbs (50 kg) on a 5′ 6″ (1.68m) frame but found no other problems.
Antoaneta had many characteristics typical of anorexia nervosa. In addition to the weight loss she feared gaining weight, her body image was distorted with a belief that she was still “fat” and her thoughts about food were clearly disturbed. More positively, she was still menstruating monthly (a sign she still had decent nutritional status). Also, blood tests revealed good protein stores, normal vitamin levels, no anemia and she was not exercising excessively, vomiting or misusing laxatives, diuretics or enemas.
Unfortunately, though her primary care clinician had been trying to persuade her to accept psychiatric help for a year, she had steadfastly refused. More in the next post…
Tags: anorexia, childhood stress
