Watson T L, Bowers W A, Andersen A E
Department of Psychiatry, University of Iowa College of Medicine, Iowa City 52242-1057, USA.
Am J Psychiatry. 2000 Nov;157(11):1806-10. doi: 10.1176/appi.ajp.157.11.1806.
Involuntary treatment of any psychiatric disorder has always been controversial, especially for eating disorders. Patients with an eating disorder of life-threatening severity frequently refuse hospitalization. In this study, the authors compared individual characteristics and treatment outcomes of patients admitted to an inpatient program for voluntary or involuntary treatment of their eating disorder.
This study examined 397 patients admitted to an inpatient treatment program over 7 years. Demographic measures, length of illness, weight history, and treatment response of patients admitted for voluntary treatment and those legally committed for involuntary treatment were compared.
The two groups were similar in age, gender ratio, and marital status, but those legally committed for involuntary treatment had a longer illness duration and significantly more previous hospitalizations. At admission, the patients legally committed for involuntary treatment were lower in weight and required a significantly longer hospitalization to attain a healthy discharge weight. However, there was no statistically significant difference between involuntary and voluntary patients in rate of weight restoration (2.6 versus 2.2 lb/week, respectively). The groups did not differ in history of comorbid substance abuse or clinical depression but did differ significantly on all admission IQ measures. Eating disorder severity, as assessed by the Eating Attitudes Test-26, Eating Disorder Inventory, and MMPI-II, was similar for both patient groups.
This study suggests that a substantial minority of patients with severe eating disorders will not seek treatment unless legally committed to an inpatient program. Despite the involuntary initiation of treatment, the short-term response of the legally committed patients was just as good as the response of the patients admitted for voluntary treatment. Further, the majority of those involuntarily treated later affirmed the necessity of their treatment and showed goodwill toward the treatment process. Only a long-term follow-up study will indicate whether these two populations differ in the enduring nature of their treatment response.
对任何精神疾病进行非自愿治疗一直存在争议，尤其是对于饮食失调症。患有危及生命的严重饮食失调症的患者经常拒绝住院治疗。在本研究中，作者比较了因饮食失调症自愿或非自愿住院治疗的患者的个体特征和治疗结果。
本研究对7年期间住院治疗项目收治的397例患者进行了检查。比较了自愿治疗患者和因法律强制进行非自愿治疗患者的人口统计学指标、病程、体重史和治疗反应。
两组在年龄、性别比例和婚姻状况方面相似，但因法律强制进行非自愿治疗的患者病程更长，既往住院次数显著更多。入院时，因法律强制进行非自愿治疗的患者体重更低，达到健康出院体重所需的住院时间显著更长。然而，非自愿和自愿患者在体重恢复率方面没有统计学上的显著差异（分别为每周2.6磅和2.2磅）。两组在合并物质滥用或临床抑郁症病史方面没有差异，但在所有入院智商测量指标上有显著差异。通过饮食态度测试-26、饮食失调量表和明尼苏达多相人格调查表-2评估的饮食失调严重程度在两组患者中相似。
本研究表明，相当一部分患有严重饮食失调症的患者除非被法律强制住院治疗，否则不会寻求治疗。尽管治疗是被迫开始的，但被法律强制治疗的患者的短期反应与自愿住院治疗患者的反应一样好。此外，大多数接受非自愿治疗的患者后来确认了治疗的必要性，并对治疗过程表现出善意。只有长期随访研究才能表明这两类患者在治疗反应的持久性方面是否存在差异。
