Introduction: Anorexia nervosa (AN) is a psychiatric illness characterized by restricted energy intake, intense fear of gaining weight, and a disturbance in body image. A 2011 meta-analysis estimated the mortality rate for anorexia nervosa to be over 5 times that of the general population, with one-fifth of deaths in AN patients being due to suicide. Treating this disease is notoriously difficult, and treatment is complicated by these patients’ characteristically poor insight.

Case summary: Here we present the case of a 37 year old woman who visited the ED with complaints of nausea and weakness; she was admitted due to hypoglycemia, bradycardia, and a dangerously low BMI of 12.8 kg/m2. She was hospitalized for 54 days with the goal of increasing her BMI to 15 kg/m2, but this course was drastically complicated by her poor insight, her reluctance to be treated, and hospital staff’s difficulty managing her condition and personality. She was discharged when her BMI reached 15 kg/m2 with little improvement in her insight into her psychiatric condition.

Conclusions: This report serves to demonstrate the difficulties in balancing the medical, psychiatric, and ethical considerations that are inherent to treating severely anorexic patients. We explore the various complications presented by this case in the hopes to provide a sliver of insight to the difficulties providers are likely to face when attempting to help these patients.