Disorder

Anorexia Nervosa Case Study: Battling the Silent Hunger Within

Written By

Jagruti Rehab

Last Updated on: 27 May 2025

Patient Information:

• Age: 17
• Gender: Female
• Background: High-achieving high school student from a middle-class suburban family

History or Cause:

Pooja, a 17-year-old whose stunning smile masks a deep-seated storm. On the exterior, she seemed like an idyllic adolescent: stellar grades at her school, captain of the debate team, and a rising artist. But inside, she was crumbling.

Pooja’s struggles began innocently enough during her first year of high school. She started to obsess about food, weight, and body image—partially inspired by a constant barrage of "ideal" bodies on social media and partially based on her desire for perfection. After initially skipping snacks to “stay on track,” Pooja’s rate of eating turned from skipped meals to counting calories obsessively, exercising excessively, and eventually, extreme food limitation.

The family noticed her infected size but wrongly dismissed this as a phase or bad diet. Meanwhile, Pooja’s energy dropped, mood swings increased, and she completely withdrew socially. An inevitable trajectory of the insidious onset of anorexia nervosa.

Diagnosis:

Pooja was sent to a specialist due to a dangerously low BMI of 16.2, after being flagged during a school health check (normal for her age is somewhere around 18.5-24.9). The diagnostic process included:

• Clinical interviews: Interview regarding her thoughts about food, eating habits, and body image.
• Physical exams: Vital signs, discrimination of nutritional status.
• Psychological assessment: Professionals used the DSM-5 criteria, and confirmed that Pooja met the criteria for Anorexia Nervosa, Restricting Type:
  1. Intense fear of gaining weight. 
  2. Distorted body image. 
  3. Severe restriction of food intake, leading to significantly low body weight. 
  4. Denial of the seriousness of the illness.
• Intense fear of gaining weight. 
• Distorted body image. 
• Severe restriction of food intake, leading to significantly low body weight. 
• Denial of the seriousness of the illness.
• Intense fear of gaining weight. 
• Distorted body image. 
• Severe restriction of food intake, leading to significantly low body weight. 
• Denial of the seriousness of the illness.

Blood work revealed electrolyte imbalances, low potassium, and anaemia, which indicated that intervention was needed urgently.

Treatment:

Approach: 

Pooja’s treatment was a logistical, whole-person approach to restore the physical body, address psychological conditions, and restore a healthy relationship with food and self.  

Program:

1. Medical stabilisation: Hospitalisation was essential because of her medical weight and other medical parameters. The medical team managed her refeeding process with high-level oversight because it is also a delicate balance to manage refeeding syndrome from starvation, which is life-threatening if not managed properly. 
2. Nutritional rehabilitation: A registered dietitian created a menu for Pooja that saved her a meal. Each meal plan was progressive, returning her caloric intake to recommended levels while providing mental as well as physical safety.
3. Psychotherapy:

• Cognitive Behavioural Therapy (CBT): CBT served as the primary treatment modality, which facilitated Pooja's effort to uncover and undo the unhelpful, distorted thoughts around weight, shape, and self-worth, which maintained her disorder.
• Family Based Therapy (FBT): Getting her family involved was also an important part of the treatment. They learned to help support her and overcome their natural tendency to enable her harmful behaviours, which allowed the necessary environment for her to recover.
• Group therapy: Hearing stories and experiences from other peers who have been through similar struggles helped combat isolation and instil resiliency.

4. Medical treatments: Although no medications have been demonstrated to cure anorexia, we started a few medications in tandem with psychotherapy:

• SSRIs (Selective Serotonin Reuptake Inhibitors) for Pooja's underlying anxiety and depression.
• Reduction in the risk of vitamin and electrolyte deficiency, by the addition of vitamin and electrolyte supplementation.

Improvements/Recovery Timeline:

• Week 1-2: In the hospital, the most important focus was physiological stabilisation. The concern was essentially to prevent the possibility of Pooja experiencing refeeding syndrome. She was abstractly compliant, but appeared ambivalent, and other staff were making her remain in a situation of attention that was overwhelming. 
• Weeks 3-4: Pooja was accepted into outpatient programming with intensive therapy. Although risk was real, it felt as if Pooja began to make her first significant breakthroughs in the first few sessions of CBT therapy. She first began by recognising the "all or nothing" way of thinking that had kept her locked into disordered thinking. 
• Weeks 5-8: Pooja's weight began to increase weekly, she was euphoric in regard to her affect, and perhaps most importantly was growing insight into her thought patterns. Family therapy was introduced to help her and her parents assist Pooja without any pressure or judgment from her. 
• Weeks 9-12: Pooja demonstrated tremendous shifts in cognition during this time. With just over 12 months of recovery, she had learned to separate her value from her body shape and size and was re-engaging with friends socially and participating in the arts again as a passion for self-expression.
• Months 4-6: Recovery was focused on moving from survival to beginning to regain her life. Pooja spontaneously reported she no longer felt fearful of food, yet would be wise not to think that way every day for the long term. Regardless, she developed a number of viable coping strategies to confront the anxious feelings she experienced. 
• One Year Mark: Pooja remained at a stable weight, completed her high school education, and spoke about her journey out loud, voicing her ambivalence, which ultimately shifted into an advocacy for mental health awareness.

Our Success:

Impact on Patient’s Life:

Pooja's story is an example - it shows we can run a recovery-oriented recovery support process for anorexia nervosa, and that, although an incredible challenge, individuals can fully recover and return to their former selves with timely, comprehensive recovery support. As Pooja recuperated, she recovered her physical self, but also her creative self, which had long been buried beneath layers of fear and control.  Pooja re-engaged passionately, and her outlook shifted from limited expectations to possibilities.

Family and Community:

The recovery journey for Pooja had a ripple effect. As her family transformed from confused and helpless to controlled and hopeful, they began to engage with Pooja in her recovery journey. As her community, school, friends, and peers observed Pooja's recovery process, they cultivated a deeper understanding of the complexity of overcoming an invisible and potent battle. Pooja's advocacy work further enhanced public awareness of eating disorders by breaking stigma and promoting empathy.  

Bottom Line: The Silent Battle Worth Fighting

Anorexia nervosa is a quiet thief. It robs individuals of their youth, vitality, and in some cases, life altogether. However, Pooja's journey denotes an important truth: recovery is possible. Recovery is neither rapid nor easy. However, through the integration of medical care, psychological therapies, family support, and each person's personal fortitude, recovery and victory are possible. 

The future of anorexia treatment exists in early intervention, education of society to reduce the unrealistic beauty expectations that cause disordered eating, and delivery of treatment programs that are individualised and able to honour each unique recovery story. For each Pooja, there needs to be a readiness of available layers of care that will catch her.

Author

Jagruti Rehabilitation Centre is a leading facility specializing in mental health, dementia, and addiction recovery. The team of psychiatrists, psychologists, and caregivers is committed to empowering individuals on their journey to recovery.