Anorexia Nervosa is a severe mental illness with a high rate of mortality. Ten years post hospitalization, the mortality rate is 10 times greater than that of an age and gender matched population. Half of all deaths occur within the first 3 years after discharge. Medical complications and suicide are the most common causes of death and the average age at death is 34.
Predictors of mortality include chronicity of illness, critically low body weight, and binging and purging behavior. Impaired judgment and delusional beliefs caused by starvation often result in these patients adamantly resisting treatment efforts.
Despite the severity and risk of the illness, providers are often reluctant to initiate involuntary treatment for patients with anorexia. However, this respect for a patient’s autonomy may lead to a fatal outcome in patients with eating disorders.
Recent legal cases are cited in this article suggesting that the court’s role generally is to decide if the patient meets criteria for commitment including having a serious mental illness, being perceived as gravely disabled, and the potential to bring harm to oneself by not taking in the nutrients necessary to sustain life. In one case, the court went so far as to order involuntary medications and tube feedings. However, in most cases, the courts refrained from rulings involving the treatment of anorexia as long as the treatments were believed to be the standard of care. It is important to note that patients who may resist treatment initially, may later realize they needed treatment all along.
Read full article here: http://jaapl.org/content/jaapl/45/4/419.full.pdf