- Eating disorders have significant health and personal impacts on those living with the illness, as well as family and friends who provide care and support.
- Anorexia nervosa is characterised by a distorted view of body weight and shape. When combined with the physical effects of starvation on cognitive function, it can impact on a person’s capacity to make decisions about treatment.
- Sometimes coercive treatment is necessary to help a person recover from anorexia.
This article outlines the voluntary and coercive treatment of eating disorders under both the Mental Health Act 2007 (‘MHA’) and the Guardianship Act 1987 (‘GA’).
Eating disorders and their treatment
Eating disorders are characterised by disturbances in thinking and behaviour around food, eating, and body weight or shape. Eating disorders are estimated to affect 4 per cent of the population at any one time (i). The three main types of eating disorder are anorexia nervosa, bulimia nervosa and binge eating disorder.
Anorexia is estimated to affect between 0.3 per cent and 0.6 per cent of the population at any one time (ii). The highest incidence is in the 15-19 year age group but can be present at any stage of life. The ratio of female to males with the disorder is estimated to be around 10:1 (3:1 before puberty). Community based studies have found that anorexia is more likely to be under detected in males than females (ii).
All eating disorders have an elevated mortality risk (ii). Medical complications in anorexia can arise from the amount of weight loss, the rapidity of the weight loss and the compensatory behaviours (vomiting, laxative abuse, diuretic abuse, diet tablets and compulsive exercise). Severe starvation can decrease comprehension and concentration. For many people living with an eating disorder, their primary coping strategy is to control their food intake and engage in other disordered behaviours. It is not surprising then that patients frequently refuse to engage in treatment.
People with anorexia can become acutely medically compromised and may require urgent nutritional rehabilitation. The main aim of a hospital admission is to begin weight restoration and interrupt the eating disorder behaviours. While in hospital the patient requires meal supervision, monitoring of the eating disorder behaviours, weighing, and medical monitoring.
Once a person’s cognition has been restored through re-feeding, other therapies can begin. Maudsley Family Therapy is the optimal treatment for children and adolescents. For adults, therapeutic inputs may include psychological therapies, medical monitoring, anti-depressant or anti-anxiety medication and dietetic support.