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
    • "serious consideration by their treatment teams (Guarda et al., 2007;Svindseth, Nøttestad, & Dahl, 2013). Importantly, these findings on lower and higher perceived coercion link to earlier findings on autonomy and patient-staff relationships, which then link to positive and negative outcomes associated with involuntary confinement and treatment. "
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    ABSTRACT: The authors reviewed and synthesized scholarly literature on the topic of involuntary confinement and treatment for severely mentally ill adults. Objectively, all facets of the issue are reported, including recurrent positive outcomes, negative outcomes, and patient experiences in common. Patient experiences are organized into related subthemes of autonomy, patient satisfaction, relationships with staff, perceived coercion, traumatization, and humiliation. The literature suggests that short-term involuntary hospitalization is sometimes necessary in order to prevent the mentally ill from psychiatrically decompensating or harming themselves or others. Understandably, hospitalization is often experienced by the mentally ill as a demoralizing violation of their rights and tends to lead them to disengage further from the professional help they need in order to recover. In turn, disengagement leads to further decompensation and resulting risk for rehospitalization. In order to intervene in this cycle and instill severely mentally ill patients with hope in the recovery process, the use of coercive tactics must be decreased in favor of cooperative engagement measures to the greatest extent possible. Patients must be empowered to make choices within the limits of their illnesses through positive interactions with staff, particularly in potentially negative, autonomy-compromising situations. Cooperative measures may help to minimize the potentially traumatic and humiliating effects of being involuntarily hospitalized and medicated. In turn, trusting patient-provider relationships may develop. Thereafter, the severely mentally ill may become more likely to seek professional help on their own volition in the future. (Bulletin of the Menninger Clinic, 79[3], 255-280).
    No preview · Article · Sep 2015 · Bulletin of the Menninger Clinic
    • "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.
    No preview · Article · Sep 2015 · Journal of Affective Disorders
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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.
    Preview · Article · Oct 2013 · PLoS ONE
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