Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa

Eat Weight Disord. 2022 Dec;27(8):3157-3172. doi: 10.1007/s40519-022-01446-y. Epub 2022 Jul 21.


Purpose: We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment.

Methods: This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)).

Results: Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment.

Conclusions: Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment.

Level of evidence: Level III, cohort study.

Keywords: Anorexia nervosa; Coercion; Compulsory treatment; Eating disorders; Epidemiological factors; Involuntary treatment; Psychopathology.

MeSH terms

  • Anorexia Nervosa* / complications
  • Anorexia Nervosa* / diagnosis
  • Anorexia Nervosa* / therapy
  • Cohort Studies
  • Feeding and Eating Disorders* / complications
  • Feeding and Eating Disorders* / therapy
  • Humans
  • Involuntary Treatment*
  • Psychopathology
  • Retrospective Studies