On the exhaustion of treatment team

─ consideration for the treatment of anorexia nervosa ─

Abstract

Treatment of anorexia nervosa is often accompanied by difficulties. Although psychological and physical approaches are necessary, the patients are not always cooperative to the treatment team that provides such interventions. Case A was a 40-year-old female with a body mass index (BMI) of 9.04kg/m². She did not observe the rules of the psychiatric ward and exerted coercive pressure on inexperienced staff. She seemed to reject every offer of help and we found it difficult to set goals for her. In such a situation, our team gradually became exhausted and felt isolated from other staff. In the treatment of refractory cases, the therapists are likely to find it difficult to seek help from other staff, resulting in feeling of isolation. Opportunities for consulting others regularly, such as multi-disciplinary meetings, would be helpful to guard against such isolation. It is also important to openly discuss limitations of our intervention with patients. This is the effort to partner with a healthy part of her mind. Consequently, case A was transferred to another hospital, but treatment was continued. In the treatment of refractory cases, flexible thinking that enables us to consider various alternatives other than discharge is needed.