Why (and when) clinicians compel treatment of anorexia nervosa patients

Objective: This paper addresses the question of the circumstances which lead clinicians to use legal coercion in the management of patients with severe anorexia nervosa, and explores similarities and differences between such formal coercion and other forms of ‘strong persuasion’ in patient management. Method: Logistic regression and other statistical analysis was undertaken on 75 first admissions for anorexia nervosa from a sample of 117 successive admissions to an eating disorder facility in New South Wales, Australia, where an eating disorder was the primary diagnosis. Admissions with other primary diagnoses, such as bulimia nervosa (25 episodes), and entries with a co-morbid diagnosis (e.g. depression or opiate overdose), were discarded, leaving 96 admissions by 75 individuals. Results: Resort to measures of legal coercion into treatment was found to be associated with three main indicators: the patient’s past history (number of previous admissions); the complexity of their condition (the number of other psychiatric co-morbidities); and their current health risk (measured either by Body Mass Index (BMI) or the risk of re-feeding syndrome). Conclusions: Our study is consistent with the few earlier studies about indicators for legal coercion in anorexia nervosa management, and suggests that clinicians use legal coercion very sparingly, distinguishing legal coercion from other forms of close clinical management of patients.