title: Perceived coercion in inpatients with Anorexia nervosa: Associations with illness severity and hospital course.
abstract: OBJECTIVE
  The use of coercion in the treatment for anorexia nervosa (AN) is controversial and the limited studies to date have focused on involuntary treatment. However, coercive pressure for treatment that does not include legal measures is common in voluntarily admitted patients with AN. Empirical data examining the effect of non-legal forms of coerced care on hospital outcomes are needed.
  
  
  METHODS
  Participants (N = 202) with AN, Avoidant/Restrictive Food Intake Disorder (ARFID), or subthreshold AN admitted to a hospital-based behavioral specialty program completed questionnaires assessing illness severity and perceived coercion around the admissions process. Hospital course variables included inpatient length of stay, successful transition to a step-down partial hospitalization program, and achievement of target weight prior to program discharge.
  
  
  RESULTS
  Higher perceived coercion at admission was associated with increased drive for thinness and body dissatisfaction, but not with admission BMI. Perceived coercion was not related to inpatient length of stay, rate of weight gain, or achievement of target weight although it was predictive of premature drop-out prior to transition to an integrated partial hospitalization program.
  
  
  CONCLUSIONS
  These results, from an adequately powered sample, demonstrate that perceived coercion at admission to a hospital-based behavioral treatment program was not associated with rate of inpatient weight gain or achieving weight restoration, suggesting that coercive pressure to enter treatment does not necessarily undermine formation of a therapeutic alliance or clinical progress. Future studies should examine perceived coercion and long-term outcomes, patient views on coercive pressures, and the effect of different forms of leveraged treatment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287.
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Schreyer
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287.
authors.forename: Janelle W
authors.initials: JW
authors.lastname: Coughlin
authors.affiliation: Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Catonsville, Maryland, 21250.
authors.forename: Saniha H
authors.initials: SH
authors.lastname: Makhzoumi
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Redgrave
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hansen
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Guarda
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods; D015992:Body Mass Index; D003068:Coercion; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D010351:Patient Discharge; D010465:Perception; D011795:Surveys and Questionnaires; D013851:Thinness / Q000523:psychology / Q000628:therapy; D015430:Weight Gain / Q000502:physiology
keywords: Anorexia nervosa; ethical principles; inpatient treatment; perceived coercion; treatment outcomes; weight restoration