Continuing the story of Antoaneta, I was glad to find that her nutritional status was still within normal values despite her profound weight loss to 110 lb (50 kg) and body mass index of just under 18 (normal 20 – 25). However, a review of her chart revealed steady loss of 7-8 lbs (3.5 kg) every month for over a year and it was clear she would soon be in serious, potentially life-threatening trouble.
When I asked about her refusal to accept psychiatric care her first response was about unfortunate encounters with mental health professionals in Eastern Europe when she was a child and she had no desire for a repetition. I assured her that I could schedule her with an expert in her condition who would be compassionate and understanding. She replied that she had encountered an American therapist about five years earlier and that experience, too, had been unhelpful at best.
I saw no alternative but to point out that her primary clinician and I concurred that her illness could threaten her life in a matter of months and that mental health intervention was the only known effective treatment. It was then that she handed me the most challenging ethical dilemma of my career: she asked me to be her counselor and was clear she would not see anyone else. To be continued…
Tags: anorexia, childhood stress
