Background
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.
Methods
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 26 years old, and were suffering or had recently suffered from anorexia nervosa at the time of interview.
Results
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.
Conclusions
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.
Anorexia nervosa is a mental disorder which often leads to serious risk of physical harm or even death to the individual, through self-imposed dietary or other behavioural strategies aimed at losing weight and self harm (Harris and Barraclough, 1997 and Harris and Barraclough, 1998). However, there is controversy over whether compulsory treatment for anorexia nervosa is appropriate (Draper, 2000, Giordano, 2003 and Tiller et al., 1993).
Compulsion is not solely achieved through legal measures. Some mental health professionals use not only formal legal powers to compel patients to have treatment, but also the threat of legal orders or other powers as ‘leverage’ to obtain agreement to treatment (Appelbaum and Redlich, 2006, Carney et al., 2008 and Carney et al., 2006). In cases where patients are legal minors, it is common to use other means of compulsion such as parental consent (Ayton, Keen, & Lask, 2009). Psychiatric patients' perceptions of coercion are complex and not directly correlated with the use of compulsory legal orders (Bindman et al., 2005, Rajkumar et al., 2006, Salize and Dressing, 2005 and Watson et al., 2000). 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. There have been few in-depth studies exploring the views of patients who suffer or have suffered from anorexia nervosa, about their experiences of coercion and compulsory treatment.
