Civil commitment of the anorexic patient.
Involuntary commitment appears to be an infrequently used intervention with anorexic patients, in part because of clinicians' uncertainty about its applicability to this population. In contrast to overtly suicidal patients, anorexic patients typically fail to express an intent to harm themselves, although their actions may result in severe harm. Examination of the language of civil commitment statutes, however, suggests that when the behavior of anorexic patients endangers their lives, they will usually be committable under grave disability standards. This appears to comport with the practices of experts in the treatment of anorexia, and with practices in other countries as well. Involuntary commitment should be used as an approach of last resort, when patients decline voluntary hospitalization and their physical safety is at risk. Moreover, civil commitment should probably also be limited to circumstances in which therapeutic gain is likely from hospitalization. Many severely ill anorexic patients will lack competence to make treatment decisions on their own behalf, allowing involuntary feeding and other procedures to take place, if necessary. Civil commitment is a tool that can legitimately be used in emergent situations with anorexic patients.
Appelbaum
P S
PS
Department of Psychiatry, University of Massachusetts Medical School, Worcester, USA.
Rumpf
T
T
D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D001291:Attitude of Health Personnel; D003134:Commitment of Persons with Psychiatric Disorders / Q000592:standards; D003657:Decision Making; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014481:United States