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Release: Nov. 1, 2000

Involuntary treatment of eating disorders can help patients, UI study shows

IOWA CITY, Iowa -- You might question the good of trying to help a person who doesn't want help for a problem. However, in the case of eating disorders, involuntary treatment seems to be as effective in the short-run as voluntary treatment is.

The observation was made by University of Iowa Health Care researchers in one of the largest investigations to date on the subject and the first study of its kind conducted at the UI. The findings will appear in the Nov. 1 issue of the American Journal of Psychiatry.

The UI researchers reviewed the records of 397 patients (351 females and 46 males) who had been admitted to the UI Eating Disorders Program over a seven-year period for anorexia, bulimia or eating disorders not otherwise specified. Sixty-six, or 16.6 percent, of the patients received their treatment after involuntary legal commitment. Individuals in this category have refused hospitalization despite the life-threatening severity of their illness but can legally be required to enter a treatment program.

"We found that once admitted, involuntary patients restored weight and were able to return home," said Tureka Watson, UI researcher in psychiatry and the study's designer and author. "Many of them also said they understood they were sick and needed treatment."

Arnold Andersen, M.D., UI professor of psychiatry and director of the UI Eating Disorders Program, was the study's primary investigator. Wayne Bowers, Ph.D., UI associate professor (clinical) of psychiatry also was on the research team.

Watson added that while involuntary treatment can be controversial, no detained patient took any legal action or registered any type of complaint. Numerous safeguards are also in place within the state to protect the rights of people committed involuntarily for medical treatment.

The involuntary patients, who included 60 females and 6 males, needed to be hospitalized on average for 58 days, about 17 more days than the voluntary patients, due to their lower weights on admission. However, both patient groups gained weight at about the same rate on a weekly basis and were otherwise similar in age, gender ratio and marital status as well as history of substance abuse and depression.

The researchers found that the involuntary group of patients had more previous hospitalizations, an indication of their resistance to treatment. They also scored slightly lower on certain tests that measure how well a person understands what is going on around them and how their actions affect their lives. Watson said the difference could be attributed to the lower body weight of those patients.

"They are so starved, their bodies don't function at full capacity," she said. "Whatever energy the body does get goes to maintaining essential functions such as their heart rate and body temperature. We know it becomes more difficult for them to concentrate, for example."

One drawback to the study, Watson noted, is that the researchers do not know how the patients do in the long-term.

"After five years, do the involuntarily treated patients relapse or even die of something related to the eating disorder?" Watson said. "It's possible some patients may be 'eating their way out' of hospitalization just to go back to their ways."

To help answer that question, the UI is working with researchers from Johns Hopkins University on a long-term study to see how patients do five to 20 years after treatment.

A previous study by other investigators showed about five years after treatment, mortality for involuntary patients was 12.7 percent compared to 2.6 percent for voluntary patients.

The current editor-in-chief of the American Journal of Psychiatry is Nancy Andreasen, M.D., Ph.D., UI professor of psychiatry.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.