Many anorexics admit need for help after admission

Women with eating disorders often deny that they need treatment. But once they are hospitalized and begin therapy, many will realize they need help, a new study suggests.

The findings, according to the study authors, suggest that pressuring eating disorder sufferers into getting treatment might be justified in some cases.

The idea of pressuring people into a therapy is controversial among health professionals. Some believe it will alienate eating disorder sufferers, and ultimately fail because they don’t want to get better. Others point out that denial is a hallmark of anorexia and the patient’s judgment about whether to seek treatment is impaired.

"Coerced treatment is always controversial because we live in a culture that values autonomy more than paternalism,” explained Dr. Angela S. Guarda, director of the eating disorders program at Johns Hopkins University in Baltimore.

“The problem is that patients with anorexia often want treatment, but on their own terms,” she told Reuters Health. That means treatment with minimal or no weight gain, which is synonymous with ineffective treatment.

In the new study, Guarda and her colleagues found that women hospitalized for anorexia or bulimia often felt pressured into it. About one third didn’t even believe they needed to be in a hospital.

Two weeks into treatment, however, nearly half of those women had changed their minds, the researchers found.

The findings, published in the American Journal of Psychiatry, are based on a study of 139 teenagers and adults who were hospitalized for anorexia or bulimia. Seventy-seven had anorexia, 42 had bulimia, and 20 had an eating disorder that did not completely meet diagnostic criteria.

Most were female (98 percent), Caucasian (92 percent) and the average age was 25.2 years old.

At admission and again 2 weeks later, the patients answered questionnaires that gauged whether they’d felt pressured into treatment and whether they thought they belonged in the hospital.

At admission, the study found, many felt they’d been pushed into treatment, and that hadn’t changed 2 weeks later. However, the number who admitted that they needed to be hospitalized did change; 43 percent of patients who initially said they shouldn’t be in the hospital changed their minds.

“It does argue,” Guarda said, “that we should be talking about whether patients with anorexia are always competent to decide on their own whether they need treatment, and that we should explore whether pressure to enter treatment from others is justified, and if so, in which cases.”

SOURCE: American Journal of Psychiatry, January 2007. 

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