Compulsory treatment in anorexia nervosa: A review

Authors

  • Isis F.F.M. Elzakkers MD, MSc,

    Corresponding author
    1. Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
    • Correspondence to: Isis Elzakkers, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Wenshoek 4, 3705 WE, Zeist, The Netherlands. E-mail: i.elzakkers@altrecht.nl

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  • Unna N. Danner PhD,

    1. Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
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  • Hans W. Hoek MD, PhD,

    1. Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
    2. Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands
    3. Department of Psychiatry, University Medical Center Groningen, The Netherlands
    4. Department of Epidemiology, Mailman School of Public Health, Columbia University New York
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  • Ulrike Schmidt MD, PhD, FRCPsych,

    1. Section of Eating Disorders, King's College London, Institute of Psychiatry, London, United Kingdom
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  • Annemarie A. van Elburg MD, PhD

    1. Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
    2. Department of Social Sciences, Utrecht University, The Netherlands
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  • Supported by Nuts Ohra Foundation.

ABSTRACT

Objective

Compulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for AN.

Method

Three large databases were searched for studies regarding compulsory treatment in AN.

Results

Detained patients have more severe symptoms and comorbidity and a longer duration of inpatient stay. In the short term compulsory refeeding in AN appears to be beneficial, but the longer term effects remain uncertain. Clinicians report no worsening of the therapeutic relationship after compulsory treatment.

Discussion

In severe cases of AN where the patient refuses life-saving treatment compulsory treatment needs to be considered. Future research should focus on the longer term effects of compulsory treatment and also on questions related to mental capacity in AN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:845–852)

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