A Case Study on Severe Anorexia Nervosa

Photo by Chris Lawton on Unsplash

On TikTok and YouTube, nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD recently discussed a case study of a patient with severe anorexia nervosa. This individual was dangerously restricting her intake but maintaining her weight — an interesting juxtaposition that shows how challenging it can be to appropriately treat an eating disorder.

Let’s dig into this case study on severe anorexia nervosa.

To start, we’ll look at the numbers. The female patient is five feet tall and first came to The Kahm Clinic in July 2020. She weighed 105.6 pounds and had a lean mass of 72.9 pounds. In August 2020, her weight was 106.2 pounds with a lean mass of 73.6 pounds. The following month, in September 2020, she weighed 105.4 pounds with a lean mass of 72.8 pounds. 

Even so, this patient was hardly eating anything, consuming only 150 to 300 calories per day. Expanding on this, Elaina adds, “Her intake was like a handful of blueberries, a cucumber, some baby carrots, and, if we’re lucky, an apple.” Her family also verified her diet. 

As another point of proof, she also ended up in the emergency room for self-harm after what she thought was a binge. In reality, her “binge” was two bites of steak. So it’s clear that this patient was really struggling, despite the fact that her weight wasn’t budging.

“The reason this case was really problematic for me is that I was advocating for her to get a higher level of care for her eating disorder,” Elaina explains. “But because her weight appears normal, her treatment team was not on board with it. The client was able to convince herself that she wasn’t ‘sick enough.’

So why is it so challenging to get the appropriate level of care for patients with severe anorexia nervosa?

This mental illness is a deadly but misunderstood disease. An estimated 30 million Americans will suffer from an eating disorder at some points in their lives. These patients suffer from a number of physical symptoms that can become life-threatening. In fact, roughly six percent of those diagnosed with anorexia will diet from the disease, either due to suicide (three percent) or physical complications stemming from starvation, most often cardiac arrest (three percent). 

Finding treatment becomes more difficult as the disease increases in severity. This challenge is in part because patients (like the one profiled in this case study) often doubt that their eating disorder is serious, especially if they’ve been praised for losing weight in the past. 

That’s why it’s so important to seek care as early as possible. At The Kahm Clinic, we create a treatment team that includes a nutritionist, a therapist, a primary care physician, and even a psychiatrist. Then, we work to develop a recovery strategy for each patient to adequately and uniquely treat their eating disorder. We are also opening a partial hospitalization program/intensive outpatient program (PHP/IOP) in the coming months to better serve the residents of Vermont.

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