More threads by David Baxter PhD

David Baxter PhD

Late Founder
Many anorexics admit need for help after admission
2007-01-19
By Amy Norton

NEW YORK (Reuters Health) - Women with eating disorders often deny that they need treatment. But once they are hospitalized and begin therapy, many will realize they need help, a new study suggests.

The findings, according to the study authors, suggest that pressuring eating disorder sufferers into getting treatment might be justified in some cases.

The idea of pressuring people into a therapy is controversial among health professionals. Some believe it will alienate eating disorder sufferers, and ultimately fail because they don't want to get better. Others point out that denial is a hallmark of anorexia and the patient's judgment about whether to seek treatment is impaired.

"Coerced treatment is always controversial because we live in a culture that values autonomy more than paternalism," explained Dr. Angela S. Guarda, director of the eating disorders program at Johns Hopkins University in Baltimore.

"The problem is that patients with anorexia often want treatment, but on their own terms," she told Reuters Health. That means treatment with minimal or no weight gain, which is synonymous with ineffective treatment.

In the new study, Guarda and her colleagues found that women hospitalized for anorexia or bulimia often felt pressured into it. About one third didn't even believe they needed to be in a hospital.

Two weeks into treatment, however, nearly half of those women had changed their minds, the researchers found.

The findings, published in the American Journal of Psychiatry, are based on a study of 139 teenagers and adults who were hospitalized for anorexia or bulimia. Seventy-seven had anorexia, 42 had bulimia, and 20 had an eating disorder that did not completely meet diagnostic criteria.

Most were female (98 percent), Caucasian (92 percent) and the average age was 25.2 years old.

At admission and again 2 weeks later, the patients answered questionnaires that gauged whether they'd felt pressured into treatment and whether they thought they belonged in the hospital.

At admission, the study found, many felt they'd been pushed into treatment, and that hadn't changed 2 weeks later. However, the number who admitted that they needed to be hospitalized did change; 43 percent of patients who initially said they shouldn't be in the hospital changed their minds.

"It does argue," Guarda said, "that we should be talking about whether patients with anorexia are always competent to decide on their own whether they need treatment, and that we should explore whether pressure to enter treatment from others is justified, and if so, in which cases."

SOURCE: American Journal of Psychiatry, January 2007.
 

foghlaim

Member
"It does argue," Guarda said, "that we should be talking about whether patients with anorexia are always competent to decide on their own whether they need treatment, and that we should explore whether pressure to enter treatment from others is justified, and if so, in which cases."
Kendra's law comes to mind here.. is the principal the same? Just wondering.
 

David Baxter PhD

Late Founder
Kendra's law comes to mind here.. is the principal the same?

No, I don't think so. Kendra's Law is about protecting other people from the actions of a mentally ill individual. In this case, the only person at risk would be the person himself or herself.
 

Halo

Member
"It does argue," Guarda said, "that we should be talking about whether patients with anorexia are always competent to decide on their own whether they need treatment, and that we should explore whether pressure to enter treatment from others is justified, and if so, in which cases."

In reading the article I was at first hesitate to think of pressuring someone into getting treatment if it is against their will thinking that being told or forced to do something against someones will (whether it be a good thing or not) may produce more lasting psychological damage (i.e. anger, trust issues etc.). I will say that I was glad to read in the last paragraph of which I quoted above that it is something that should be "explored" and if so "in which cases". I think that it is good that they are looking at exploring this issue instead of just making a quick decision without thinking of the consequences of their decision/actions and the effect that it may have on the individual.

The article mentions that anorexics may not always being competent to decide on their own whether they need treatment, I think the same can be said for a lot of people that suffer mental illnesses. When someone is in the depths of their illness they may not see the light at the end of the tunnel and think that their future is hopeless and therefore not think that treatment or hospitalization will do any good same as what an anorexic may feel. If they do explore this issue and decide that it is good then I have to wonder what is next? Maybe it isn't going to come down to whether you are a danger to yourself or others anymore it is going to be well you are sick and need help so we are going to force you into hospital to get it.

Just my opinion and my rant :eek:
 

David Baxter PhD

Late Founder
Maybe it isn't going to come down to whether you are a danger to yourself or others anymore it is going to be well you are sick and need help so we are going to force you into hospital to get it.

I don't think it will come to that. The law as it stands now specifies that one must be an imminent danger to self or others. Applying that to anorexia would mean the person would have to be on the verge of systemic collapse (death).
 
in some ways i agree with the factthat yes well as an anoreixc myself if i was never forced into treatment i might not have ever went into treatment but then if you think of it in that sence i was weekened by the e-d therefore i was forced to go cause i was so very blinded by my anorexic obsessions but there is some girls that have anorexic behaviors that are able to get better not on there own but with their surroundings there fore i find it a bit tuchy to force someone into treatment if they are not really at risk because i also find that once i was diagnoste with anorexia it helped in my down fall cause i ientifies myself as anorexic there for giving a reason to my behaviros.. and not thinking more along the lines i needed to changethem cause if i did then wel i would lose my anorexic identity .. a name that was givin to the way i was with food.
i donT' know if you understand what i mean but if i hadent been around many of the other girls i was in the hospital with i may not be were i am today as in using the tricks the thignswe told each other .. it is like pro ana sites but live . cause some of those girls really did not want to get better
ashley
 

Halo

Member
I understand your point however that is the law now but if they decide to force anorexics into treatment against their will even if they are not an imminent danger who is to say that other mental illnesses aren't next. Being forced to get help whether they are an imminent danger or not basically just because someone decides that they need help and therefore forcing them into a hospital or treatment.

I guess I just see it as possibly escalating if they were to decide that it would be a good idea to force anorexics into treatment against their will. I just wonder how far they will go?
 

Halo

Member
Ashley-Kate,

I completely understand what you are saying and I agree with you. I too was once in an eating disorder group and I honestly thought that it was going to be a good place to gain support, coping skills and learning tools but to my amazement it ended up to be more like you described. For the anorexics it was learning ways to fool the doctors into thinking that they had gained weight, for the bulimics it was learning ways of hiding their purging after meals from family and friends and well you get the point....

Needlesstosay, I only stayed in the group for about 3 months and then left but I learned more about ways to keep my disordered eating patterns going and hidden then I did to stop them which was the point of the group to start with.

I am not saying that all eating disorder groups are like the one that I attended (as I know there are lots of good ones out there) but I guess I just happened to hit one of the bad ones.
 

David Baxter PhD

Late Founder
I guess I just see it as possibly escalating if they were to decide that it would be a good idea to force anorexics into treatment against their will.

I just do not see that happening - not even anything close to that. Look at how difficult it is to hospitalize individuals who are obviously delusional or irrational. Look at how strong the opposition has been even to the Kendra's Law statutes working their way through various states in the US. In Canada, you pretty much have to commit a crime first - and even then the Community Treatment Order is only an alternative to incarceration - if the individual chooses incarceration for the crime, s/he cannot be compelled to take medication or any other treatment even in prison.
 

Halo

Member
That's true. I guess I just hear about people being forced into treatment and or hospitals and it brings about fear for myself personally and that was how I was reacting to the article.

I do see your point though on how difficult it is even now to get individuals hospitalized who obviously need it not even considering the fact of shortages of beds and facilities these days.
 

Misha

Member
I think that treatment has to be a choice to be effective... in the long term. Forced hospitalization I think is necessary at times for the purpose of refeeding, when the patient's life is at risk. This often provides the 'kick-start" they need to think clearly enough to make a decision to continue in therapy voluntarily.
I can't say I ever wanted to be hospitalized or wanted a tube down my nose but I'm still thankful for the fact that my life was saved by that, and while I don't want it to happen again, I may very well need that again one day. Sure being force-fed makes an anorexic mad, sure being locked up can make them more defiant. But refeeds are necessary and save lives. It's like jump-starting a car.
 
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