When Antoaneta insisted she would allow no one but me to counsel her about her anorexia nervosa, my first reaction was that this was analogous to asking a dermatologist to treat your heart attack or a plumber to fix your computer. Even among therapists experienced in treating anorexia, success rates are not ideal. As the NIMH Eating Disorders site puts it, “no specific psychotherapy appears to be consistently effective for treating adults with anorexia.”
I told Antoaneta that my formal professional training as a gastroenterologist was not appropriate for her needs and that I routinely referred my many other patients with eating disorders to mental health practitioners with experience in her condition. I made it clear she could be risking her life if she sought anything less than the best possible care. She was unmoved, pointing out that I had counseled her several years earlier and almost completely relieved her irritable bowel syndrome. I countered with the argument that there was a world of difference (so I believed) between stress-related bowel problems and the poorly understood, individually variable world of eating disorders. That argument didn’t work either.
At that point I could see what was coming. If I refused to treat her she would deteriorate until a medical complication developed that forced psychiatric intervention, but by then it might be too late to turn her nutritional deficits around. On the other hand, if I tried to treat her there was a good chance she would continue to lose weight, suffer a complication and be admitted to the hospital where review of her records would show that I was far out of my area of expertise. My employment and possibly my license to practice would be subject to serious review.
More to follow…
Tags: anorexia, childhood stress
