CONTACT: BECKY SOGLIN
Iowa City IA 52242
(319) 335-6660; fax (319) 335-8034
Release: Nov. 1, 2000
Involuntary treatment of eating disorders can help patients, UI study
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
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
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
"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.