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January 6, 1999

Clinical Crossroads: A 24-Year-Old Woman With Anorexia Nervosa—Reply

Author Affiliations

Margaret A.Winker, MDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(1):35-36. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-1-jbk0106

In Reply: Dr Harper believes my discussion illustrates remedicalization of psychiatry. I have always made the assumption that psychiatry is part of medicine and that all of medicine needs to listen to the voice of the patient. Ms K eloquently stated her overwhelming sense of ineffectiveness, worthlessness, and depression. That did not need to be restated. Ms K also expressed feeling safe and comfortable with her present treatment team, which implies they have empathetically recognized her dilemma and have respected her voice. This team requested (I did not offer) my consultation after their efforts for more than a year dealing with her actual existential, relational, and developmental situation had less effect than they had wished. The question then became what else can we do? Ms K stated "a lot of my treatment involves trying to make things positive." This is an indication that the treatment team is addressing Ms K's overwhelming sense of ineffectiveness (except in dieting) and worthlessness. In her maturation to the age of 24 years, Ms K did not have the experiences she personally needed to become self-confident and secure. Her therapy must and is focusing on developing these positive experiences. Garner and Bemis1 developed cognitive-behavioral therapy for anorexia nervosa with great empathy and concern for the anorectic patient. This technique can be used to deal with both developmental and interpersonal issues.2