From Across the Desk: When Patients Refuse Treatment

In this issue, our lead article turns a spotlight on one of the most difficult treatment challenges in ED—caring for patients who refuse treatment. Patients with severe and lasting EDs who refuse treatment generally fall into two categories—those who refuse all treatment and those who refuse treatment but actually want something from professionals. This may include personal contact, caring attention, and medications. As Dr. Joel Yager points out, merely refusing to treat these patients poses ethical problems, while attempting to treat them with involuntary hospitalization brings ethical, legal and practical challenges. Much can be done, according to Dr. Yager.

Another article in this issue turns a spotlight on social media, in this case, the mobile app, Tik Tok.  Some teens may be inspired by what they see on the Tik Tok homepage, they may be redirected. The algorithm can’t yet discriminate between harmless and harmful content, and the teen may be led along by pro-ana videos, where users support and encourage each other to lose weight. Some harmful videos are blocked, but not all—one of the authors’ patients accidentally slipped through the safety net and became anorexic.

Finally, look for an article describing a new self-report measure for orthorexia nervosa, or a fixation on “healthy eating” that goes too far. The authors believe this screening test, the TON-17, offers promise as a way to assess the severity of orthorexia and may be useful in treatment.


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