Anorexia Nervosa (LINKED)

1.I had a station in my mock MRCPsych CASC where we have to talk to the mother of a daughter with anorexia? She wants her to be sectioned and treated in hospital as she is worried she is going to die. Could you provide guidance?

 Yes, this is an interesting alternate scenario that I hadn’t covered during the tutorial.

I’ve listed the key things to include in a structure for this scenario here:

Halo-Intro-Set the scene

Explore her current concerns

Relevant history of Anorexia symptoms (Use criteria for instant admission – you may have some of this information in a question)

Explain issues around using MHA and capacity assessment

We would obviously follow our standard introduction and set the scene, being as empathic as possible given the mother is concerned.

I would then ask an open question “I’ve got some information on you daughter and obviously we are all extremely worried about her. Could you share with me what your main concerns are?”

The next questions would all depend on how much information you already have about the daughter’s current condition and whether she warrants immediate admission under the mental health act. If you remember in the tutorial that some of the key things to look for were:

BMI<15

Severe malnutrition and syncope

Suicide risks

History of rapid weight loss

Current need for naso-gastric feeds

Poor social support

So I would want to find out information on her history specific to these criteria. Some of this information may be in the question anyway, but I would definitely inquire into whether she has had any fainting spells, rapid weight loss, who is at home to look after her, whether she has expressed any suicidal ideation and if she has required feeding by nasogastric feeds and under restraint.

In terms of addressing the mother’s concerns, I will focus here on her concerns about admission. (other queries she might have e.g “What is Anorexia?” I have covered in the Anorexia Nervosa tutorial on the site)

1.She needs to come into hospital under section and mum wants her to.

This would be straightforward in terms of explaining the need for admission for treatment. She required admission for life-saving treatment. Also, that under the MHA she can be fed if required to maintain a safe weight. She does however have the right to appeal and be given an independent hearing.

2.She needs to come into hospital under section and mum does not want her to.

This would obviously have a communication skills element to it. However, the key things to emphasise is that Anorexia has a high mortality rate if untreated so she definitely needs to come in, her BMI is low which is likely effecting her capacity to make a decision about her own treatment, she can appeal against the section and will have a hearing etc.

2.She doesn’t need to come into hospital, but the mum wants her sectioned.

Explain that her current symptoms are not life threatening. She is accepting of treatment in the community and at present the risks are low. However, we would monitor this on a regular basis and if there are any concerns at all regarding her weight then we would assess her again for admission and if required use the MHA.