Contributor: Leigh Bell, BA, writer for Eating Disorder Hope
It’s heartbreaking to watch a loved one suffering from anorexia, withering away but refusing to get help. Yet the alternative may be equally difficult for family members, therapists, and physicians of people with anorexia who desperately need help but refuse to get it.
Involuntary hospitalization, sometimes escalating to legally forcing civil commitment, is heartrending for all involved, but it may be the faint line between life and death.
Involuntary hospitalization, which can be into inpatient and/or outpatient facilities, does help, according to many studies, but for how long is uncertain. Resistance to treatment is extremely common in eating disorders — few people desire treatment, but go realizing they’re powerless and need help.
When Does Involuntary Hospitalization Happen?
People with anorexia who are involuntarily hospitalized are obviously some of the sickest; if they weren’t, hospitalization wouldn’t be needed. Patients involuntarily admitted, compared to those who come in voluntarily, have struggled longer with anorexia and been hospitalized significantly more times, according to empirical studies1.
They more commonly have a history of childhood abuse and self-mutilative behaviors, this research finds; and although weight restoration was equally effective in both the involuntarily and voluntarily admitted groups, it didn’t study long-term outcomes. Other studies found similar results2.
The Success Rates of Involuntary Admittance
It does appear, though, that those involuntarily admitted with anorexia nervosa are less successful long-term, according to a study of 162 patients, of whom half were admitted against their will3. Researchers followed these patients for an average of 5.7 years and discovered the mortality rate at follow-up for detained patients was 12.7%, compared to 2.6% for voluntary patients.
Now this doesn’t necessarily mean the involuntary admission was detrimental; it could be the fact that those unwillingly admitted are simply sicker and more resistant to treatment and/or recovery. Still, it’s surprising how some involuntary patients who initially objected to their commitment later reported they would want to be hospitalized again if they became dangerously ill in the future (Watson, et. al, 2001).
Research on Forced Hospitalization
Researched effects of forced hospitalization on the therapist-client relationship are contradictory. Some research shows that, although forced hospitalization can save lives of some young people with anorexia, it can also have adverse long-term consequences on the patient-therapist alliance and can make the patient abandon therapy4.
Clinical observations point to the opposite, according to other research, which finds compulsory treatment can be an act of compassion and serve as a relief to both patients and family5.
Research reveals other advantages to involuntary hospitalization for those battling anorexia, aside from the obvious life-saving one. Hospitalized patients are normally nutritionally restored, although not necessarily by forced feeding, tube feeding, or other intrusive methods, and as a result, regain some mental stability (Russell, 2001). The patients, under observation, may abstain from eating-disorder-related behaviors, such as excessive exercise and/or self-induced vomiting.
How Compulsory Treatment Can Be Helpful
One study actually found compulsory treatment could erase the guilt and self-torture many people with anorexia feel when receiving the treatment and nutrition they require.
See, if eating isn’t their choice, it may be more acceptable to the eating-disordered self6. This same study contradicts other research by finding the long-term mortality of those involuntarily hospitalized is the same as those hospitalized by choice.
Not only is involuntary hospitalization an extremely contentious topic, it’s a painful decision for anyone to make. If the patient continues to refuse hospital admission, it can become a legal issue. For court-ordered hospitalization, laws are slightly different in each state, but they generally agree someone can be unwillingly hospitalized if he or she is an imminent danger to one’s self and/or to others, and is unable to provide oneself essential needs like food, clothing, etc.
The court, then, is likely to judge in favor of involuntary hospitalization for people who starve to the point of harming themselves. A heartbreaking decision that may save a life.
Community Discussion – Share your thoughts here!
What has been your experience with involuntary hospitalization? What have your learned that you can share with others?
- Brunner, R., Parzer, P., Resch, F. (2005) IInvoluntary hospitalization of patients with anorexia nervosa: clinical issues and empirical findings. Fortschritte de Neurologie Psychiatrie, 73(1), 9-15.
- Watson, T., Bowers, W., & Anderson, A. (2001). Involuntary treatment of eating disorders, American Journal of Psychiatry, 157(11), 1806-10.
- Ramsay, R., Ward, A., Treasure, J., Russel, G. (1999). Compulsory treatment in anorexia nervosa. Short-term benefits and long-term mortality. The British Journal of Psychiatry, 175, 147-53.
- Douzenis, A., Michopoulos, I. (2015). Involuntary admission: the case of anorexia nervosa. International Journal of Law and Psychiatry, 39, 31-5.
- Russell, G. (2001). Involuntary treatment of anorexia nervosa. Psychiatric Clinics of North America 24(2), 337-49.
- University of Haifa. (2015, January 12). Involuntary hospitalization of patients with anorexia nervosa in extreme situations can save their lives. ScienceDaily. Retrieved July 13, 2015 from www.sciencedaily.com/releases/2015/01/150112093051.htm
About the Author:
Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on July 31st, 2015
Published on EatingDisorderHope.com