Coercion is Coercion? Reflections on Trends in the use of Compulsion in Treating Anorexia Nervosa

Abstract

Objective: This paper explores similarities and differences between formal coercion and other forms of ‘strong persuasion’ in clinical decision-making about medical management of patients with severe anorexia nervosa. Method: The paper builds on findings from analysis of data from 117 successive admissions to an eating disorder facility, where an eating disorder was the primary diagnosis. Results: The study implications of particular interest in this paper are the findings that legal coercion into treatment was associated with three main indicators: the patient's past history (number of previous admissions), the complexity of their condition (the number of other psychiatric comorbidities), and current health risk (measured either by body mass index or the risk of re-feeding syndrome). Conclusions: We conclude that clinicians use legal coercion very sparingly in treating severe anorexia nervosa, distinguishing legal coercion from other forms of close clinical management of patients. While we agree with Monahan et al. and others that there are similarities between legal coercion and other forms of strong clinical management (or power), our results suggest that clinicians recognize the importance of maintaining, rather than blurring that distinction.