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Helen.

Patient's self-reported feeling of nervousness before dinner and partial meal avoidance indicate potential relapse risk.
Caregiver's report of patient's joking during lunch may suggest a disconnect between patient's reported feelings and actual emotional state.

Two missed meals in one day, a self-reported drop in perceived support, and marked social withdrawal, which are strong indicators of acute relapse risk in adolescent anorexia nervosa.
The downward trend from earlier in the week — including avoidance of calorie-dense foods and reduced readiness for recovery — suggests an escalating pattern that requires immediate intervention.