Reflections on coercion in the treatment of severe anorexia nervosa.

BACKGROUND The high mortality of severe anorexia nervosa causes clinicians to consider any legal avenues for coercing acutely-ill patients to remain in treatment or refeeding programs, such as mental health laws or adult guardianship laws. METHOD Review of pattern of laws for coercing treatment in various jurisdictions and retrospective file analysis over 4.7 years for a specialist anorexia unit in the State of New South Wales, Australia, to isolate attributes associated with resort to two different avenues of legal coercion. RESULTS Coercion is most likely indicated for patients with more chronic histories (prior AN admissions), already known to the unit, where they present with other psychiatric illnesses and a low BMI. Compared to voluntary admissions, coerced patients were significantly more likely to experience the refeeding syndrome (an indicator of being seriously medically compromised). They were more likely to be tube fed and placed on a locked unit. LIMITATIONS Sample size, limited variables and retrospective analysis method. CONCLUSIONS The study suggests that, where available, clinicians will use legal coercion to help treat severe medical crisis situations, or manage behaviors such as vomiting, excessive exercise/sit-ups, or of absconding to no fixed abode when patients are very young.