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: 13.56). 02/2007; 164(1):108-14. DOI: 10.1176/appi.ajp.164.1.108
Source: PubMed

ABSTRACT 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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    • "Many service users who are informally admitted to treatment for their AN feel pressured or coerced in doing so (Guarda et al., 2007). Although Guarda et al. (2007) state that perceived coercion lessens in the first two weeks of treatment, no study of this population has looked at how perceived coercion affects the course of treatment and how this mediates treatment outcome. It is nonetheless an important area to consider within the context of treatment for AN, in which the ego-syntonic nature of the illness may heighten experiences of perceived coercion. "
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    ABSTRACT: This study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia. 90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups. The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004). End-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.
    Eating behaviors 04/2013; 14(2):119-23. DOI:10.1016/j.eatbeh.2013.01.007
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    • "One could argue that physically imposed treatment represents the ultimate form of coercion. Alternatively, as some have suggested, coercion may be a spectrum with various forms (Guarda et al., 2007: 108; Polcin & Weisner, 1999: 64; Monohan et al., 1995: 251-252; Galon & Wineman, 2010: 308). In this sense, involuntary treatment could be at one end of the spectrum, while pressure and persuasion would be at the other. "
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    • "One study found that patients with anorexia nervosa experience high levels of 'perceived coercion'—that is, the perception that they are being coerced whether or not formal mechanisms are used. Some of these patients changed their views in hindsight about the coercion that they had received (Guarda et al., 2007). Most research in this area has focussed on using quantitative measures of perception of coercion. "
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    ABSTRACT: The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that patients are often subject to compulsion and coercion even without formal compulsory treatment orders. Research also suggests that patients suffering from anorexia nervosa can change their minds in retrospect about compulsion. Qualitative interviewing methods were used to explore the views of 29 young women concerning compulsion and coercion in the treatment of anorexia nervosa. The participants were aged between 15 to 26years old, and were suffering or had recently suffered from anorexia nervosa at the time of interview. Compulsion and formal compulsory treatment of anorexia nervosa were considered appropriate where the condition was life-threatening. The perception of coercion was moderated by relationships. What mattered most to participants was not whether they had experienced restriction of freedom or choice, but the nature of their relationships with parents and mental health professionals. People with anorexia nervosa appear to agree with the necessity of compulsory treatment in order to save life. The perception of coercion is complex and not necessarily related to the degree of restriction of freedom.
    International Journal of Law and Psychiatry 11/2009; 33(1):13-9. DOI:10.1016/j.ijlp.2009.10.003 · 1.19 Impact Factor
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