Patient and caregiver characteristics and outcomes following compulsory admission for anorexia nervosa treatment

BACKGROUND: A proportion of patients with anorexia nervosa require compulsory admission due to treatment refusal in the context of high medical or psychiatric risk. AIMS: The clinical characteristics and treatment outcomes of patients with anorexia nervosa compulsorily admitted for in-patient care (current and previous) were compared with those of patients admitted voluntarily. The characteristics of their caregivers were also evaluated. METHOD: This is a secondary analysis of the Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise trial. We included 274 patient-caregiver dyads: 62 on compulsory admission ('current compulsory'), 48 on voluntary admission with a history of compulsory treatment ('previous compulsory') and 164 on voluntary admission without a history of compulsory treatment ('voluntary'). Baseline demographic and clinical characteristics, and longitudinal clinical outcomes at 3-6 and 9-12 months, were compared across groups. RESULTS: Patients in the current compulsory group had an earlier age of onset, a higher proportion of obsessive-compulsive disorder comorbidity and less motivation and confidence to change compared with the voluntary group. The previous compulsory group showed a longer illness duration, older age and lower body mass index (BMI) compared with the other groups. All groups showed improvement, with similar outcomes at the end of the study except for depression symptoms and BMI. Caregivers had varying levels of distress and caregiving skills at baseline, which had improved by the end of the study. CONCLUSIONS: People receiving current or previous compulsory treatment presented with diverse clinical presentations. Further studies are needed to determine whether more individualised approaches improve outcomes in these subgroups. TRIAL REGISTRATION NUMBER: Trial registration number and data-set information: ISRCTN14644379.