Compulsory treatment in anorexia nervosa. Short-term benefits and long-term mortality.
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.
Ramsay
R
R
Eating Disorders Unit, Maudsley Hospital, London.
Ward
A
A
Treasure
J
J
Russell
G F
GF
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