Chapter 4: Recognizing Diversity and Expanding Treatment Paradigms: Working With a Midlife Jewish Woman With Anorexia Nervosa

Anorexia nervosa (AN) is a debilitating illness characterized by significantly low body weight, intense fear of weight gain, and distortion in the way weight or shape is perceived (American Psychiatric Association [APA], 2013). Though frequently trivialized, glamorized, or misunderstood as a disorder of choice (Gordon, 2000; Walsh et al., 2020), the burden of this illness is extremely high. AN has one of the highest mortality rates of any mental disorder, second only to substance use disorders (Chesney et al., 2014), with premature deaths attributed to both medical complications and suicide. Comorbidity with other psychiatric disorders is common, especially for anxiety disorders, obsessive compulsive disorder, and depressive disorders (Bühren et al., 2014; Carrot et al., 2017, Levinson et al., 2018). AN also has a high rate of relapse, with estimates ranging from 6–57% depending on the length of follow-up and the application of targeted relapse prevention strategies (Berends et al., 2016).