Compulsory treatment of anorexia nervosa and the moribund patient

Clinicians may experience ethical and legal dilemmas in the management of patients with severe anorexia nervosa. It has been suggested that weight gain through compulsory treatment is counterproductive and adversely affects the therapeutic relationship. Because of the ethical problems of withholding treatment in patients who may be at significant risk of dying, there is a dearth of outcome studies determining the effects of compulsory treatment. This study considers the legal implications, psychotherapeutic management and follow-up of 11 severely ill patients with a DSM IV diagnosis of Anorexia Nervosa. Preliminary findings suggest that if intervention is pursued in a structured and caring manner, compulsory treatment and/or nasogastric feeding may not adversely affect the therapeutic relationship. The assumption that compulsory treatment is necessarily detrimental is therefore questionable and requires further evaluation.