Compulsory Treatment and Coercion for Anorexia Nervosa Patients

Personality disorders and patient attitudes were highlighted in two studies.

Compulsory treatment of patients with anorexia nervosa (AN) is still a topic of great debate. Research suggests that patients are often subject to compulsion and coercion for treatment even without formal compulsory treatment orders, and also that patients with AN can change their minds and perspectives in retrospect about being coerced to be treated. Two studies addressed outcome and patient attitudes toward compulsory treatment.

Personality disorders, substance abuse, emerged in one group

In a Danish study, Dr. J.S. Holm and colleagues at the Center for Eating Disorders, Odense University Hospital, assessed five fatal cases of AN that were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006 (Int J Eat Disord 2011; Feb 22. doi: 10.1002/eat.20915. [Epub ahead of print]). Information on inpatient, ambulatory, and emergency room treatment was extracted from a population-based registration system.

Personality disorders were diagnosed in all 5 patients and substance abuse in 3. In all cases, the patients had been ill longer than 10 years, and late onset was seen in two cases. None of the deaths were due to suicide. Involuntary hospital admission was instituted for 3 patients, but only 1 was detained more than once. Four patients died after discontinuing treatment.

The authors concluded that compulsory treatment may be crucially important for preventing deaths in patients with long-standing AN and psychiatric comorbidity who discontinue treatment. They infer that ongoing compulsory treatment may have been life-saving for some of these patients.

Examining patient attitudes

In an earlier study, J.O. Tan and colleagues at the Ethox Center at the University of Oxford, UK, assessed patients’ views of compulsory treatment for AN (Int J Law Psychiatry 2010 33:13). The 686 women were between 15 to 25 years of age and currently or recently had anorexia nervosa when they were interviewed.

The researchers reported that the women felt compulsory treatment for AN was appropriate when the illness was life-threatening. The perception of compulsion was moderated by relationships. That is, what mattered most to this group of patients was not the loss of freedom or of choice but the nature of their relationships with parents and mental health professionals.