title: Compulsory treatment in anorexia nervosa. Short-term benefits and long-term mortality.
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.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Eating Disorders Unit, Maudsley Hospital, London.
authors.forename: R
authors.initials: R
authors.lastname: Ramsay
authors.forename: A
authors.initials: A
authors.lastname: Ward
authors.forename: J
authors.initials: J
authors.lastname: Treasure
authors.forename: G F
authors.initials: GF
authors.lastname: Russell
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000401:mortality / Q000628:therapy*; D003134:Commitment of Persons with Psychiatric Disorders; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D011379:Prognosis; D015996:Survival Rate