Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

Thomas Blikshavn,Øyvind Rø,Inger Halvorsen

doi:10.1186/s40337-020-00297-1

Thomas Blikshavn, Øyvind Rø + Show 1 more

Open Access

https://doi.org/10.1186/s40337-020-00297-1

Copy DOI

Abstract

BackgroundStudies of the use and effects of physical restraint in anorexia nervosa (AN) treatment are lacking. The purpose of this study was to describe the frequency of physical restraint in a specialized program for adolescents with AN, and to examine if meal-related physical restraint (forced nasogastric tube-feeding) was related to 5-year outcome.MethodThirty-eight (66% of 58) patients with AN (mean age 15.9, SD = 1.9) admitted to a regional, specialized adolescent eating disorders (ED) inpatient unit. Patient data, including restraint episodes, were obtained from hospital records, and outcome was assessed at a 5-year follow-up.ResultsA total of 201 restraint episodes occurred over 5513 days of inpatient treatment, including 109 meal-related episodes and 56 episodes to avoid self-harm. Twelve (32%) patients experienced at least one restraint episode during the admission, of which eight (21%) experienced meal-related restraint. Four patients represented 91% of all restraint episodes, experiencing 10 or more episodes during admission. Meal-related restraint was significantly associated with a higher rate of persisting ED diagnosis, but not with weight gain during admission, EDE-Q global score or BMI at follow-up.ConclusionsRestraint episodes occurred rather infrequently. A small number of patients (n = 4) accounted for a high proportion of episodes (91%). More knowledge is important to reduce the need for restraint in treatment for AN.

Highlights

Involuntary treatment for eating disorders (ED) is utilized as a last resort in cases where there is considerable risk to the patient that cannot be managed in a less restrictive way [1,2,3]
Meal-related restraint was significantly associated with a higher rate of persisting ED diagnosis, but not with weight gain during admission, Eating Disorder Examination Questionnaire 6.0 (EDE-Q) global score or body mass index (BMI) at follow-up
This study describes the frequency of physical restraint in a specialized program for adolescents with anorexia nervosa, and investigates if the use of physical restraint was related to 5-year outcome

Summary

Introduction

Involuntary treatment for eating disorders (ED) is utilized as a last resort in cases where there is considerable risk to the patient that cannot be managed in a less restrictive way [1,2,3]. No quantitative studies until the present have examined the extent to which weight restoration is facilitated by the use of physical restraint, that is, the use of physical force to restrict or control the patient. The general view is that interventions involving physical restraint have no inherent therapeutic effects in the treatment of children and adolescents [5] and may be associated with negative psychological outcomes [6, 7]. The purpose of this study was to describe the frequency of physical restraint in a specialized program for adolescents with AN, and to examine if meal-related physical restraint (forced nasogastric tube-feeding) was related to 5-year outcome

Methods

Results

Discussion

Conclusion