Bridging Gaps: Inpatient Management of Extreme Anorexia Nervosa

Anorexia nervosa (AN) is a complex and deadly psychiatric disorder characterized by co-occurring psychiatric diseases and widespread physiological changes that affect every organ system. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be managed by an appropriate multidisciplinary team early in the course of the disorder. In this context, an interdisciplinary team encompasses a physician to provide medical care, a physician to provide psychiatric care and a registered dietitian or nutritionist to provide nutritional support. Extreme AN (defined as body mass index (BMI) < 15 kg/m²) has been associated with higher rates of mortality when compared to patients with AN who have higher BMIs (> 15 kg/m²). Unfortunately, it is not uncommon for hospitals to lack the necessary means to appropriately treat these extreme patients, as is evidenced by the presented case. This case involves a 20-year-old patient diagnosed with extreme AN (BMI 10 kg/m²) restrictive type that presented for medical instability. The admitting institution lacked a prepared multidisciplinary team, including inpatient psychiatry and eating disorder (ED) specialists. As a result, this patient’s care was delayed during the most crucial time of her diagnosis. This case serves to detail the complexity in the management of extreme AN as well as highlight the importance of an institution having a prepared multidisciplinary team that is capable of handling cases of extreme EDs.