Forced treatment of patients with anorexia.
OBJECTIVE
To consider clinical, ethical and legal approaches to forced feeding in patients with anorexia nervosa in the light of recent literature.


RESULTS
An Australian retrospective record analysis compared 27 coercive with 96 informal hospitalizations and found more previous inpatient treatments, comorbidities, and a lower BMI at admission of 13.2 (SD 1.67) kg/m, but no significantly different weight gain [4.96 (SD 6.56) kg]. In a higher proportion of the involuntary group a re-feeding syndrome, treatment in a locked ward, and tube feeding were recorded. In Germany 25 women with anorexia nervosa with an admission BMI of 12.09 (SD 1.51) kg/m gained 12.44 (SD 1.21) kg. Twenty were treated involuntarily and 22 received tube feeding- 20 of whom were fed a via transdermal duodenal tube, four of whom as voluntary patients.


CONCLUSIONS
As full recovery is possible in life-threatening anorexia nervosa, detention is sometimes justifiable and may indeed be necessary. Compulsory admission, however, does not necessarily imply a need for forced or tube feeding. Highly skilled nursing seems preferable, and so it may be better to admit the patient before the BMI drops below 13 kg/m. The validity of this proposal should be examined using a prospective research design with a follow-up period.
Thiels
Cornelia
C
Department of Social Studies, University of Applied Sciences Bielefeld, Germany. cornelia.thiels@fh-bielefeld.de
D000856:Anorexia Nervosa / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D015992:Body Mass Index; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003674:Defense Mechanisms; D004750:Enteral Nutrition / Q000941:ethics; D005858:Germany; D006801:Humans; D007872:Legal Guardians; D016743:Mental Competency / Q000331:legislation & jurisprudence; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015430:Weight Gain