Reflections on Coercion in the Treatment of Severe Anorexia Nervosa

By Carney, Terry; Wakefield, Alison et al. | The Israel Journal of Psychiatry and Related Sciences, July 1, 2006 | Go to article overview

Reflections on Coercion in the Treatment of Severe Anorexia Nervosa


Carney, Terry, Wakefield, Alison, Tait, David, Touyz, Stephen, The Israel Journal of Psychiatry and Related Sciences


Abstract: 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.

Introduction

From a medico-legal perspective it is not the incidence of severe anorexia, but its characteristics and consequences, which distinguish it from other DSM-IV(R) eating disorders like bulimia nervosa (1). Experienced by up to one percent of young women (and occasionally young men) (2), anorexia nervosa differs precisely because it is such a serious, life-threatening condition (3). This feature tests the ethical limits of medicine, the state and the law in deciding whether to coerce patients into treatment (4). It is compounded by questions about whether anorexia is a traditional illness rather than a "syndrome" (5), and whether law should facilitate treatment interventions (6, 7).

In some jurisdictions - such as Israel and, until recently, also the State of New South Wales (NSW) in Australia - anorexia does not qualify as a mental illness warranting involuntary mental health admission and treatment. This outcome mainly hinges on the drafting "model" adopted to express the gateway definition of mental illness, rather than on medical differences of opinion about the condition. There are three main definitional forms (8):

* A "non-definition" (or circular definition) model, where the meaning of "mental illness" is defined by the judiciary. In 1986 the New South Wales Supreme Court ruled that under the then definition in section 4 of its Mental Health Act 1958 anorexia was not a mental illness because this "syndrome" lacked the sharp "diagnostic criteria" of, for instance, a psychosis (5, 9,10).

* A "disorder of function" or consequence-based model, such as that now contained in the NSW Mental Health Act 1990, that defines mental illness as a condition which temporarily or permanently impairs a person's "mental functioning" and which is accompanied by "symptoms" such as delusions, hallucinations, serious disorders of thought form, a severe disturbance of mood, or sustained or repeated irrational behavior. This is a test which covers rather than excludes anorexia (Matter of Ms CS, 1999).

* The third model, like that in the neighboring Australian state of Victoria, combining a functional test with a list of certain conditions, also catches anorexia because mental illness is interpreted to cover a "medical condition characterised by a significant disturbance of thought, mood, perception or memory" (10,11).

The availability of legal coercion hinges not only on the way the law is written, but also its institutions and procedures. When courts decide about mental health committal (as in the U.S.A.) it is utilized less frequently than in Britain, for instance, where medical practitioners make the initial admission subject to tribunal review (12). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Reflections on Coercion in the Treatment of Severe Anorexia Nervosa
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.