Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T16:21:38.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Compulsory treatment in anorexia nervosa

Short-term benefits and long-term mortality

Published online by Cambridge University Press:  03 January 2018

Rosalind Ramsay ,
Anne Ward ,
Janet Treasure  and
Gerald F. M. Russell
Rosalind Ramsay*
Affiliation:
Eating Disorders Unit, The Maudsley Hospital, London
Anne Ward
Affiliation:
Psychotherapy Unit, The Maudsley Hospital, London
Janet Treasure
Affiliation:
Institute of Psychiatry, London
Gerald F. M. Russell
Affiliation:
Institute of Psychiatry, London
*
Professor Gerald Russell, Hayes Grove Priory Hospital, Prestons Road, Hayes, Kent BR2 7AS
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Anorexia nervosa is a mental disorder with a high long-term mortality. Patients are ambivalent about treatment and often avoid it. Of necessity, compulsory treatment sometimes must be considered. A report from the Mental Health Act Commission has helped to reduce previous confusion.

Aims

To identify the premorbid and clinical features that predisposed to compulsory admissions, the short-term benefits of the treatment and the long-term mortality rates (derived from the National Register)

Method

Eighty-one compulsory patients were compared with 81 voluntary patients.

Results

Predisposing factors to a compulsory admission were a history of childhood sexual or physical abuse or previous self-harm. Detained patients had more previous admissions. Detained patients gained as much weight during admission as voluntary patients, but took longer. More deaths among compulsory than voluntary patients (10/79 v. 2/78) were found 5.7 years (mean) after admission.

Conclusions

Compulsory treatment is effective in the short term. The higher long-term mortality in the detained patients is due to selection factors associated with an intractable illness.

Type
Papers
Information
The British Journal of Psychiatry , Volume 175 , Issue 2 , August 1999 , pp. 147 - 153
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appelbaum, P. S. & Rumpf, T. (1998) Law, ethics, and psychiatry in the general hospital: civil commitment of the anorexic patient. General Hospital Psychiatry, 20, 225–230.CrossRefGoogle Scholar
Brahams, D. (1993) Medicine and the law. Lancet, 341, 1143–1144.CrossRefGoogle Scholar
Eckart, E. D., Halml, K. A., Marchi, P., et al. (1995) Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychological Medicine, 25, 143–156.CrossRefGoogle Scholar
Goldner, E. M., Birmingham, C. L. & Smye, V. (1997) Addressing treatment refusal in anorexia nervosa: clinical, ethical, and legal considerations. In Handbook of Treatment for Eating Disorders (2nd edn) (eds Garner, D. & Garfinkel, P.), pp. 450–461. New York: Guilford.Google Scholar
Griffiths, R. A., Beumont, P. J. V., Russell, J., et al (1997) The use of guardianship legislation for anorexia nervosa: a report of 15 cases. Australian & New Zealand Journal of Psychiatry, 31, 525–531.CrossRefGoogle ScholarPubMed
Lanceley, C. & Travers, R. (1993) Anorexia nervosa: forced feeding and the law (letter). British Journal of Psychiatry, 163, 835.CrossRefGoogle Scholar
Lelchner, P. (1991) The ethics of forced feeding in anorexia nervosa. Canadian Medical Association Journal, 144, 1205.Google Scholar
Mantal Health Act Commission (1997) Guidance on the Treatment of Anorexia Nervosa under the Mental Health Act 1983 (Guidance Note 3 issued August 1997), pp. 1–6. Nottingham: Mental Health Act Commission.Google Scholar
Rathner, G. (1998) A plea against compulsory treatment of anorexia nervosa patients. In Treating Eating Disorders: Ethical, Legal and Personal Issues (eds W. Vandereycken & P. J. V. Beaumont), pp. 179–215. London: Athlone Press.Google Scholar
Ratnasuriya, R. H., Elsler, I., Szmulder, G. I., et al (1991) Anorexia nervosa: outcome and prognostic factors after 20 years. British Journal of Psychiatry, 158, 495–502.CrossRefGoogle Scholar
Robinson, P. (1993) Treatment for eating disorders in the United Kingdom. Part I. A survey of specialist services. Eating Disorders Review, 1, 4–9.CrossRefGoogle Scholar
Russell, G. F. M. (1983) Anorexia nervosa and bulimia nervosa. In Handbook of Psychiatry. Vol. 4. The Neuroses and Personality Disorders (eds Russell, G. F. M. & Hersov, L. A.), pp. 285–298. Cambridge: Cambridge University Press.Google Scholar
Russell, J. (1995) Treating anorexia nervosa: humbling for doctors. British Medical Journal, 311, 584.CrossRefGoogle Scholar
Serfaty, M. & McCluskey, S. (1998) Compulsory treatment of anorexia nervosa and the moribund patient. European Eating Disorders Review, 4, 27–37.Google Scholar
Sullivan, P. F. (1995) Mortality in anorexia nervosa. American Journal of Psychiatry, 152, 1073–1074.Google Scholar
Theander, S. (1985) Outcome and prognosis in anorexia nervosa and bulimia: some results of previous investigations, compared with those of a Swedish long-term study. Journal of Psychiatric Research, 19, 493–508.CrossRefGoogle ScholarPubMed
Theander, S. (1992) Chronicity in anorexia nervosa: results from the Swedish long-term study. In The Course of Eating Disorders (eds Herzog, W., Deter, H.-C. & Vandereycken, W.), pp. 214–227. Berlin: Springer Verlag.Google Scholar
Tillar, J., Schmidt, U. & Treasure, J. (1993) Compulsory treatment for anorexia nervosa: compassion or coercion? British Journal of Psychiatry, 162, 679–680.Google Scholar
Tolstrup, K., Brinch, M., Isager, T., et al (1985) Long-term outcome of 151 cases of anorexia nervosa. The Copenhagen anorexia nervosa follow-up study. Acta Psychiatrica Scandinavica, 71, 380–387.CrossRefGoogle ScholarPubMed
Touyz, S. W., Beumont, P. J. V., Glaun, D., et al (1984) A comparison of lenient and strict operant conditioning programmes in refeeding patients with anorexia nervosa. British Journal of Psychiatry, 144, 517–520.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.