Anorexia nervosa: forced feeding and the law

Abstract

He was commenced on an alcohol detoxification regime and further investigation of his hypokalaemia was attempted. During the course of his admission he confided to a member of staff that he had been vomiting on an almost daily basis for 25 years, following criticism of his weight by his father. He admitted bingeing (often daily), but denied the use of diuretics or laxatives. Following this he received some cognitive psychotherapy and his depressive symptoms were treated with a serotonin specificreuptakeinhibitorantidepressant.Onthisregimehis depressive and bulimic symptoms improved dramatically. His clinical chemistry returned to normal.

Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision‐making model

“…Contrary to popular belief and the plethora of literature on force-feeding anorectics (Devereux, 1995;Draper, 2003;Giordano, 2003;Goldner, McKenzie, & Kline, 1991;Hébert & Weingarten, 1991;Kluge, 1991;Lanceley & Travers, 1993;Leichner, 1991;Lewis, 1999;McSherry, 1997;Starzomska, 2006b), forced tube feeding occurs relatively infrequently among this population (Russell, 2001). More commonly clients in this position opt to eat solid foods or liquid supplements in order to gain privileges and prevent more restrictive treatment options from occurring (such as bed rest).…”

“…In recent years, the claim that compulsory treatment irreparably impairs the therapeutic alliance and undermines the likelihood of seeking future treatment (Dresser, 1984a;Giordano, 2005;Lanceley & Travers, 1993;Richmond, 2001) has gained increased attention (Fedyszyn & Sullivan, 2007) and empirical support (Vandereycken & Vansteenkiste, 2009). Two studies (Guarda et al, 2007;Vandereycken & Vansteenkiste, 2009) published to date have empirically investigated clients' perceptions of coercive treatment for eating disorders.…”

“…Furthermore, those opposed to involuntary treatment argue that such treatment is not curative and indicative of longer chronicity and an increased risk of suicide (Birmingham et al, 2005). A major tenet of those against involuntary treatment involves the ruptured therapeutic alliance and decreased likelihood of seeking subsequent treatment after a compulsory admission (Dresser, 1984a;Giordano, 2005;Lanceley & Travers, 1993;Richmond, 2001). …”

Compulsory treatment in anorexia nervosa: A review

“…Interestingly, three studies have shown that mental capacity is frequently overestimated by medical staff in general. [42][43][44] Mental capacity in AN has been subject to much theoretical debate [6][7][8][9][10][11][12][13][45][46][47][48][49][50][51][52][53] but few empirical data are available. Only two small studies have looked specifically at the mental capacity of AN patients.…”

“…1 Refusal of treatment may result in danger to oneself and compulsory treatment can therefore be considered for patients with AN, similar to other mental disorders. Compulsory treatment in AN has been a topic of hot (and also public) debate for many years [6][7][8][9][10][11] and as recently as in 2012 High Court judges in the UK gave very different rulings in two very severe cases (see http://www.bbc.co.uk/news/uk-19369239 and http://www.bbc.co.uk/news/uk-wales-18469963). Whilst compulsory treatment is seen as an accepted treatment (if necessary) in psychotic disorders, controvery still surrounds this issue in AN.…”