title: A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics.
abstract: OBJECTIVE
  Involuntary treatment of anorexia nervosa is controversial and costly. A better understanding of the conditions that determine involuntary treatment, as well as the effect of such treatment is needed in order to adequately assess the legitimacy of this model of care. The aim of the present study was to investigate the frequency and duration of involuntary treatment, the characteristics of this group of patients, the kind of involuntary actions that are applied and the effect of such actions.
  
  
  METHODS
  Relevant databases were systematically searched for studies investigating the involuntary treatment of individuals diagnosed with anorexia nervosa.
  
  
  RESULTS
  The studies included in the review contained people treated in an inpatient setting for severe or severe and enduring anorexia nervosa. People that were treated involuntarily were characterised by a more severe psychiatric load. The levels of eating disorder pathology between involuntary and voluntary groups were similar and the outcome of involuntary treatment was comparable in terms of symptom reduction to that of voluntary treatment.
  
  
  CONCLUSIONS
  Despite inconsistent findings, the comparable levels of eating disorder pathology observed between involuntary and voluntary patient-groups together with findings of higher co-morbidity, more preadmissions, longer duration of illness and more incidences of self-harm for involuntary patients suggest that involuntary treatment is not a reaction to the severity of eating disorder symptoms alone, but is most likely a response to the complexity of the patient's situation as a whole.
authors.affiliation: Centre of Child- and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, DK-8240 Risskov, Denmark.
authors.forename: Loa
authors.initials: L
authors.lastname: Clausen
authors.affiliation: Institute of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Jones
keywords: Anorexia nervosa; Coercion; Compulsory treatment; Forced treatment; Involuntary treatment; Treatment outcome; Tube feeding