Anorexia nervosa (AN) is a severe psychiatric disorder characterized by profound metabolic, psychological, and social dysfunction, and current biomedical and psychotherapeutic interventions achieve long-term recovery in only a subset of patients. Despite advances in understanding its neurobiological and psychosocial mechanisms, a substantial proportion of patients develop chronic, treatment-resistant illness. Since conventional medical models may not fully account for the persistent refractoriness observed in severe cases, this suggests that additional explanatory frameworks may be required. Emerging interdisciplinary research and clinical observations indicate that spiritual and karmic factors, as described in Buddhist traditions, may play a contributory role in illness persistence and recovery. Therefore, this study integrates Buddhist worldviews with clinical case analysis to explore the karmic and spiritual dimensions of severe AN. We present a Dharma dialogue elucidating potential spiritual mechanisms and a detailed case of recovery following intensive Buddhist practices. The findings suggest that Buddhist interventions may serve as meaningful complementary strategies for refractory AN, supporting a more integrative biopsychosocial–spiritual model of care.