Eating Disorders and Obesity: A Comprehensive Handbook

By Christopher G. Fairburn; Kelly D. Brownell | Go to book overview

61
Compulsory Treatment in the
Management of Eating Disorders
JANET TREASURE The law in many countries recognizes that patients have the right to make their own treatment decisions as long as they posses the capacity to do so. Legal definitions of patient capacity require that the patient is able to do the following:
1. Take in and retain information material to the decision and understand the likely consequences of having, or not having, the treatment in question.
2. Believe the information. (Certain disorders and states, for example, intoxication, may interfere with belief in the information.)
3. Weigh the information as part of the process of arriving at a decision.

The clinical concept of competence may be wider than this, taking into account the consistency with which a decision is held.


THE PHENOMENOLOGY OF ANOREXIA NERVOSA

Much of the focus of discussions of the psychopathology of anorexia nervosa is on the abnormal beliefs of these patients (see Chapter 29). In contemporary Western cultures, these beliefs center mainly on the conviction that there is a need to lose weight. As noted in Chapter 47, comparable beliefs in non-Western cultures often center on somatic symptoms (e.g., feeling bloated or full).

The abnormal beliefs of patients with anorexia nervosa are usually classed as overvalued ideas (see Chapter 29). However, the boundary between a delusion and an overvalued idea is blurred. The level of distress, preoccupation, and action associated with the beliefs of patients with anorexia nervosa are similar to those of patients with schizophre-

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