Involuntary treatment: A qualitative study from the perspectives of individuals with anorexia nervosa

Abstract

ObjectiveInvoluntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN.MethodThirty adult participants, who had been treated involuntarily for AN in the past, completed self‐report measures and qualitative interviews. Interview transcripts were coded using thematic analysis.ResultsThree themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remained negative, showed no changes in their recovery post‐treatment.ConclusionsInvoluntary treatment for AN was recognized, in retrospect, as being beneficial by individuals with AN who were doing well, but individuals who continued to struggle with their eating disorder reported negative consequences.

Involuntary Treatment for Child and Adolescent Anorexia Nervosa—A Narrative Review and Possible Advances to Move Away from Coercion

“…This was also supported by a recently published case report highlighting the relief and reduced feelings of guilt and anxiety related to the choice to receive nutrition on the part of patients receiving involuntary tube feeding [86]. However, a recent study on the individual perspectives of patients highlighted that this was only the case for patients reporting favorable changes in their ED symptoms [87]. Patients whose perspectives about IVT remained negative showed no changes in their ED recovery post treatment [87].…”

“…However, a recent study on the individual perspectives of patients highlighted that this was only the case for patients reporting favorable changes in their ED symptoms [87]. Patients whose perspectives about IVT remained negative showed no changes in their ED recovery post treatment [87].…”

Longitudinal investigation of patients receiving involuntary treatment for extremely severe anorexia nervosa

“…In previous studies, the negative experience of involuntary treatment has been associated with feelings of injustice, powerlessness (Seed et al., 2016) and loss of autonomy (Tan et al., 2010). On the other hand, even I‐AN proved able to gradually acknowledge the need for involuntary treatment in the context of short‐term life threat (Kendall, 2014; Rienecke et al., 2023). This major finding adds some evidence to the debate on the long‐term effects of involuntary treatment in AN (Clausen et al., 2018; Clausen & Jones, 2014; Rienecke et al., 2023; Schmitz‐Buhl et al., 2019; Strand et al., 2020) and may help practitioners to advocate for the use of involuntary treatment primarily for nutritional and somatic support, especially in the absence of documented psychiatric comorbidities (Appelbaum & Rumpf, 1998).…”

“…On the other hand, even I‐AN proved able to gradually acknowledge the need for involuntary treatment in the context of short‐term life threat (Kendall, 2014; Rienecke et al., 2023). This major finding adds some evidence to the debate on the long‐term effects of involuntary treatment in AN (Clausen et al., 2018; Clausen & Jones, 2014; Rienecke et al., 2023; Schmitz‐Buhl et al., 2019; Strand et al., 2020) and may help practitioners to advocate for the use of involuntary treatment primarily for nutritional and somatic support, especially in the absence of documented psychiatric comorbidities (Appelbaum & Rumpf, 1998). In any case, practitioners should strive for treatment acceptance even after involuntary admission (Tan et al., 2010).…”

Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality

“…These negative experiences may influence future avoidance and distrust of ED treatment [ 115 , 116 ]. Some individuals (but not all; [ 110 ]) who are treated involuntarily report retrospective gratitude or other benefits for involuntary treatment [ 111 , 117 , 118 ]. For some, this gratitude may coexist with having experienced involuntary treatment as traumatic, abusive, and degrading [ 12 , 111 , 115 ].…”