Perceived Coercion and Change in Perceived Need for Admission in Patients Hospitalized for Eating Disorders

Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University Hospital, Meyer 101, 600 N. Wolfe St., Baltimore, MD 21287, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 02/2007; 164(1):108-14. DOI: 10.1176/appi.ajp.164.1.108
Source: PubMed


Ambivalence toward treatment is characteristic of eating disorders, and patients are often admitted to inpatient programs under pressure from clinicians, family, friends, educators, or employers. This study evaluated patient perceptions of the admissions process and perceived need for hospitalization and assessed whether these perceptions remain stable in the short term.
A total of 139 patients with eating disorders completed a 13-item self-report scale on the admission experience when they were admitted to a behavioral inpatient specialty program and again 2 weeks into their hospitalization.
Patients with anorexia nervosa reported higher levels of perceived coercion and pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18 (N=35) reported more perceived coercion than did adult patients (N=104), and a trend was noted for them to disagree that they needed hospitalization. Perceptions of coercion, of pressure by others toward hospitalization, and of procedural justice were stable in the short term. However, of the 46 patients (30 of them adults) who initially did not endorse needing admission, 20 patients (17 of them adults) changed their minds by 2 weeks into hospitalization and agreed that they needed hospital admission.
Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these findings suggest a need for studies assessing the long-term outcome and ethics of pressuring patients with eating disorders into treatment.

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Available from: Angela S Guarda, Sep 08, 2015
    • "Given the health-threatening consequences of malnutrition and emaciation, nutritional rehabilitation and weight restoration constitute the first step in the treatment for AN (National Institute for Health and Care Excellence, 2004). However, many patients admitted to inpatient care feel pressured or coerced to do so (Guarda et al., 2007). They are ambivalent about change and often terminate treatment prematurely (Woodside et al., 2004). "
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    ABSTRACT: Background: Patients with Anorexia Nervosa (AN) experience high levels of social difficulties and anxiety. These problems might be underpinned by negatively biased processing of social stimuli. The aim of this study was to examine the feasibility of using a novel Cognitive Bias Modification (CBM) training to target information processing biases in patients with AN. Methods: Twenty-eight patients with AN completed a baseline and end of intervention assessment of mood and social appraisals. The CBM training consisted of 5 sessions and included an attentional probe task to train attention towards positive social stimuli and an ambiguous scenarios task to train benign or neutral interpretations of ambiguous social scenarios. Results: At baseline patients displayed an attention and interpretation bias towards negative social stimuli. At the end of intervention there was a medium sized increase in attention to positive faces and fewer negative interpretations of ambiguous social stimuli. There were also lower levels of anxiety and higher levels of self-compassion in response to a judgemental video clip. Limitations: The lack of a control group is the main limitation to this preliminary study as the changes obtained may have resulted from non-specific aspects of the inpatient treatment. Conclusions: A novel CBM training is associated with more positive processing of social information in AN. It would be of interest to test the hypothesis that reducing cognitive biases towards social stimuli impacts on wider features of an eating disorder.
    Journal of Affective Disorders 09/2015; 188:188-193. DOI:10.1016/j.jad.2015.08.019 · 3.38 Impact Factor
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    • "Their request for admission to hospital was part of a personal process that seems to follow their personal experience of their increasing awareness. This result is the opposite of what has been suggested by earlier studies, which indicated that women agree to be admitted because they give in to pressure from their families or caregivers [24]. "
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    ABSTRACT: Anorexia nervosa is a severe psychiatric disorder mainly affecting women. Its treatment is long and accepted with much difficulty, in particular in-patient treatment. To describe the subjective motives of women with anorexia nervosa for requesting in-patient admission, from a qualitative analysis of application letters. Participants were adult women (18 years and older) with anorexia nervosa who were admitted as in-patients in a referral hospital unit in France from January 2008 to December 2010. The application letters, prerequisites to admission, were studied by the interpretative phenomenological method of content analysis. 63 letters have been analysed, allowing the identification of six themes related to requests for in-patient care: loss of control of behaviour, and of thoughts, mental exhaustion, isolation, inner struggle and fear of recovery. Requests for in-patient admission were motivated by very personal, subjective experiences, unrelated to medical reasons for admission. These results may help improve pre-admission motivational work with individuals, by basing it on their subjective experience.
    PLoS ONE 10/2013; 8(10):e77757. DOI:10.1371/journal.pone.0077757 · 3.23 Impact Factor
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    • "Motivation to change has been found to be especially low in individuals with AN [4-6]. Other studies have reported no differences between these two groups on motivation to change [7,8]. "
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    ABSTRACT: Background Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder. Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change. Results Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%). Conclusions MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
    International Journal of Eating Disorders 08/2013; 1(1):34. DOI:10.1186/2050-2974-1-34 · 3.13 Impact Factor
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