Longitudinal investigation of patients receiving involuntary treatment for extremely severe anorexia nervosa.

Abstract

Involuntary treatment may be a life-saving option for extremely severe anorexia nervosa (AN) in the context of life-threatening conditions and refusal of care. The long-term outcomes of patients undergoing involuntary treatment for AN are poorly understood. This study aims to explore quality of life, long-term outcomes and attitudes towards involuntary treatment in patients involuntarily treated for extremely severe AN. 23 patients involuntarily admitted for extremely severe AN (I-AN), and 25 voluntarily admitted patients (V-AN) were compared for body mass index (BMI), residual symptoms, quality of life, and attitudes towards treatment almost four years after discharge. In I-AN, clinical variables were also compared between admission and follow-up. At follow-up, weight restoration was higher in V-AN (p=0.01), while differences in quality of life, BMI, and mortality rates were not significant between I-AN and V-AN (p>0.05). In I-AN, BMI increased and weight-controlling strategies decreased at follow-up (p<0.05). Despite negative experiences of involuntary treatment, the perception of the necessity of treatment increased from admission to follow-up (p<0.01) and became comparable to V-AN (p>0.05). Involuntary treatment for AN does not appear to be a barrier to weight gain and clinical improvement, nor to long-term attitudes towards treatment.