Perceived coercion in inpatients with Anorexia nervosa: Associations with illness severity and hospital course
Author(s) -
Schreyer Colleen C.,
Coughlin Janelle W.,
Makhzoumi Saniha H.,
Redgrave Graham W.,
Hansen Jennifer L.,
Guarda Angela S.
Publication year - 2016
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22476
Subject(s) - coercion (linguistics) , anorexia nervosa , psychology , specialty , psychiatry , weight gain , clinical psychology , medicine , eating disorders , body weight , philosophy , linguistics
ABSTRACT Objective The use of coercion in the treatment for anorexia nervosa (AN) is controversial and the limited studies to date have focused on involuntary treatment. However, coercive pressure for treatment that does not include legal measures is common in voluntarily admitted patients with AN. Empirical data examining the effect of non‐legal forms of coerced care on hospital outcomes are needed. Method Participants ( N = 202) with AN, Avoidant/Restrictive Food Intake Disorder (ARFID), or subthreshold AN admitted to a hospital‐based behavioral specialty program completed questionnaires assessing illness severity and perceived coercion around the admissions process. Hospital course variables included inpatient length of stay, successful transition to a step‐down partial hospitalization program, and achievement of target weight prior to program discharge. Results Higher perceived coercion at admission was associated with increased drive for thinness and body dissatisfaction, but not with admission BMI. Perceived coercion was not related to inpatient length of stay, rate of weight gain, or achievement of target weight although it was predictive of premature drop‐out prior to transition to an integrated partial hospitalization program. Discussion These results, from an adequately powered sample, demonstrate that perceived coercion at admission to a hospital‐based behavioral treatment program was not associated with rate of inpatient weight gain or achieving weight restoration, suggesting that coercive pressure to enter treatment does not necessarily undermine formation of a therapeutic alliance or clinical progress. Future studies should examine perceived coercion and long‐term outcomes, patient views on coercive pressures, and the effect of different forms of leveraged treatment. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:407–412).