SAN DIEGO – Court orders were sought to force 5% of patients admitted for anorexia nervosa disorders to remain involuntarily under hospital care, according to findings from a 4-year study of patients treated at a Colorado clinic.
Nearly all of the patients declined to fight those efforts. However, the orders were withdrawn in about one-quarter of cases because treatment was deemed to be futile.
The study findings point to the importance of seeking civil commitment early in the course of illness in patients with anorexia nervosa when it can do the most good, study author Patricia Westmoreland, MD, attending psychiatrist at the Eating Recovery Center in Denver, said in an interview.
Patricia Westmoreland
Dr. Westmoreland presented the findings at the annual meeting of the American Psychiatric Association, where she contended that anorexia nervosa has the highest mortality of any psychiatric disorder. “If patients are not treated earlier in the course of their illness and when they’re at a younger age,” she said, “they develop severe and enduring eating disorders.”
Anorexia nervosa is estimated to have a prevalence rate of 0.3% in young women. Research suggests that 20% of people with the disease kill themselves (Int J Eat Disord. 2003 Dec;34[4]:383-96), (Arch Gen Psychiatry. 2011;68[7]:724-31).
For the new study, Dr. Westmoreland and her colleagues tracked 2,106 admissions of patients who were treated for two conditions – anorexia nervosa restricting subtype and anorexia nervosa binge purge subtype – at the Eating Recovery Center from April 2012 to March 2016. The ages and genders of the subjects were not available.
Officials sought involuntary care in 109, or 5.2%, of the admissions, including 11 patients who were recommitted at least once.
Of the 109 admissions:
• 85% waived the right to a hearing (94% of those who fought commitment ultimately were committed involuntarily).
• 31% successfully completed treatment.
• 24% had their commitments – also known as certifications – terminated because treatment appeared to be futile.
“These are patients for whom certification is only helpful to a point, beyond which it becomes harmful, i.e., patients harming themselves to leave a locked facility, patients pulling out NG tubes so many times they cause injury, patients who purge continuously despite being tube fed,” Dr. Westmoreland said in an interview. “In other cases, the team evaluated the patient and determined he or she is, in general, being harmed more than helped by trying to attain goal weight. This is where harm reduction may prove useful. And failing that, palliative or hospice care for a patient who has had many treatments over the years and has never recovered for any meaningful period of time.”
Dr. Westmoreland defined harm reduction in this context as “having patient being managed at an agreed-upon weight that is lower than an ideal body weight, but nonetheless a weight at which they can function and have some quality of life, even if that quality of life is not optimal.”
This also means that the patient must regularly check with an outpatient treatment team – dietitian, psychiatrist, and therapist – and be monitored for signs of unacceptable levels of weight loss or abnormal lab results, she said. These problems, she added, will trigger hospitalization.
Dr. Westmoreland reported no relevant disclosures.