title: Perceived coercion and change in perceived need for admission in patients hospitalized for eating disorders.
abstract: OBJECTIVE
  Ambivalence toward treatment is characteristic of eating disorders, and patients are often admitted to inpatient programs under pressure from clinicians, family, friends, educators, or employers. This study evaluated patient perceptions of the admissions process and perceived need for hospitalization and assessed whether these perceptions remain stable in the short term.
  
  
  METHODS
  A total of 139 patients with eating disorders completed a 13-item self-report scale on the admission experience when they were admitted to a behavioral inpatient specialty program and again 2 weeks into their hospitalization.
  
  
  RESULTS
  Patients with anorexia nervosa reported higher levels of perceived coercion and pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18 (N=35) reported more perceived coercion than did adult patients (N=104), and a trend was noted for them to disagree that they needed hospitalization. Perceptions of coercion, of pressure by others toward hospitalization, and of procedural justice were stable in the short term. However, of the 46 patients (30 of them adults) who initially did not endorse needing admission, 20 patients (17 of them adults) changed their minds by 2 weeks into hospitalization and agreed that they needed hospital admission.
  
  
  CONCLUSIONS
  Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these findings suggest a need for studies assessing the long-term outcome and ethics of pressuring patients with eating disorders into treatment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University Hospital, Meyer 101, 600 N. Wolfe St., Baltimore, MD 21287, USA. aguarda@jhmi.edu
authors.forename: Angela S
authors.initials: AS
authors.lastname: Guarda
authors.forename: Angela Marinilli
authors.initials: AM
authors.lastname: Pinto
authors.forename: Janelle W
authors.initials: JW
authors.lastname: Coughlin
authors.forename: Shahana
authors.initials: S
authors.lastname: Hussain
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Haug
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Heinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy; D001294:Attitude to Health; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003068:Coercion; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000592:standards; D010555:Personality Inventory; D012017:Referral and Consultation; D011795:Surveys and Questionnaires