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

Abstract

IntroductionInvoluntary treatment may be a life‐saving option for extremely severe anorexia nervosa (AN) in the context of life‐threatening conditions and refusal of care. The long‐term outcomes of patients undergoing involuntary treatment for AN are poorly understood. This study aims to explore quality of life, long‐term outcomes and attitudes towards involuntary treatment in patients involuntarily treated for extremely severe AN.Methods23 patients involuntarily admitted for extremely severe AN (I‐AN), and 25 voluntarily admitted patients (V‐AN) were compared for body mass index (BMI), residual symptoms, quality of life, and attitudes towards treatment almost four years after discharge. In I‐AN, clinical variables were also compared between admission and follow‐up.ResultsAt follow‐up, weight restoration was higher in V‐AN (p = 0.01), while differences in quality of life, BMI, and mortality rates were not significant between I‐AN and V‐AN (p > 0.05). In I‐AN, BMI increased and weight‐controlling strategies decreased at follow‐up (p < 0.05). Despite negative experiences of involuntary treatment, the perception of the necessity of treatment increased from admission to follow‐up (p < 0.01) and became comparable to V‐AN (p > 0.05).DiscussionInvoluntary treatment for AN does not appear to be a barrier to weight gain and clinical improvement, nor to long‐term attitudes towards treatment.

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

“…However, study results for adult as well as adolescent patients with AN all suggested that the overall effect of IVT is comparable to that of voluntary treatment regarding treatment outcomes [8,26,37]. First, similar results on weight gain and BMI at discharge were reported across all studies [8,37,39], with one earlier study from 2000 even reporting greater weight gain for involuntarily admitted patients [50]. These results demonstrate that IVT does not seem to be inferior to voluntary treatment regarding weight gain and that the potentially lower weight at admission is successfully increased.…”

“…This review article summarized the scarce empirical data comparing voluntary and involuntary treatment in patients with AN with a special focus on children and adolescents, suggesting no specific inferiority of IVT regarding the specific treatment outcomes at different follow-up points [8,26,37,39,50]. However, involuntary hospital treatments have been shown to take longer [8,37], and patients admitted involuntarily seem to struggle significantly more during weight restoration, with a higher rate of nasogastric feeding [8,26], a higher rate of refeeding syndrome [55], and increased use of psychotropic medications [26].…”

“…The results of a meta-analysis [37], including three studies that assessed follow-up data [26,47,54], found no differences in mortality risk between voluntarily and involuntarily admitted patients [37]. A very recent study confirmed these results and further reported no differences between involuntarily and voluntarily admitted patients regarding BMI, readmissions, or quality of life on average 4 years after discharge [39]. In a previous study, Ayton et al (2009) even showed significantly better long-term outcomes for adolescent patients treated involuntarily, including better general functioning and normalization of weight [26].…”