Forced treatment has been a component of eating disorder treatment since its inception. The concept of a treatment intervention began in substance abuse treatment and transferred primarily to severe cases of Anorexia Nervosa.
The theory behind an intervention is that a central facet of the illness is denial. The person has little if any insight into the problem, minimal desire for change, if any, and significant risk of medical symptoms or even fatality.
Forced hospitalization feels like the only option for families in this situation as they fear for the safety, health and even life of their loved one. With encouragement from professionals, families, often reluctantly, agree to take this drastic step.
The intervention undoubtedly leads to short-term relief. The person is temporarily safe. Their medical and psychiatric conditions improve from nutrition, and the family hopes that the intervention predicts healing and recovery.
However, people with anorexia forced to eat will comply in the short-term, but that nutrition will not change the core beliefs of the disorder about food restriction and weight loss. Rarely, an early intervention can reverse the course of the illness, but much more often this step hardens the eating disorder thoughts and behaviors as a reaction to being trapped to do the action most abhorrent and terrifying to them. Even though families may even not feel like there is a better solution in the moment, interventions are far from a panacea.
One major risk of forced treatment is the traumatic effect on the patient. They will feel as if they are being forced to do the one thing that every part of their being is fighting. The thoughts are so strong to restrict and each bite, each snack, each meal can cause extremely painful emotional responses. For others who don’t have anorexia, the pain caused by forced eating is hard to imagine.
As the person endures the food and weight gain that follows, many feel traumatized by the experience. They feel they are forced to do something extraordinarily painful day after day for months with minimal understanding or compassion. They feel abandoned and betrayed by their loved ones and locked up in a tortured environment for months on end.
The younger the patients, often the more traumatic the responses.
The result is not only hardened eating disorder symptoms but trauma symptoms such as constant reminders of the treatment, nightmares and fear of the people they love most.
Seeing patients years out from their experience still having trauma symptoms certainly makes one question the benefit of forced treatment.
The trauma caused by forced treatment is one the eating disorder treatment community needs to grapple with and needs to stop.
When forced treatment is needed to save someone’s life, then thoughtful steps to mitigate the potential trauma need to be considered. If that means shorter term care to stabilize someone medically rather than months of treatment, that may be a more humane and compassionate step to consider. Any intervention must take into account the risks from the start.
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