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Cited by 55Eating Disorders and BehaviorsHealthcare Decision-Making and RestraintsDietetics, Nutrition, and Education

The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.

Caring for Patients With Severe and Enduring Eating Disorders (SEED): Certification, Harm Reduction, Palliative Care, and the Question of Futility

WESTMORELAND, PATRICIA, MEHLER, PHILLIP S.·2016·Journal of Psychiatric Practice
DOI 10.1097/pra.0000000000000160
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Abstract

Anorexia nervosa is a serious mental illness with a high mortality rate. The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment. Involuntary treatment may therefore be both life-saving and critical to recovery. Between April 2012 and March 2016, 109 patients (5.2% of patients admitted to the Eating Recovery Center in Denver, CO) were certified, 39% of whom were transferred from the ACUTE Center for Eating Disorders at Denver Health Medical Center. Of these 109 certified patients, 31% successfully completed treatment, and 42% returned for a further episode of care; 24% of the certifications were terminated as involuntary treatment was not found to be helpful. Conclusions supported by these data are that patients with anorexia nervosa who are the most medically ill often require involuntary treatment. In addition, although many patients who are certified successfully complete treatment, involuntary treatment is not helpful approximately 25% of the time. Many of the patients for whom certification is ineffective are those who suffer from a lifetime of illness that is severe and enduring. Patients with severe and enduring eating disorders (SEED) typically undergo cyclical weight restoration and weight loss. Many of these patients question the value of serial treatments, especially when they have few (if any) illness-free intervals. Patients, families, and treating physicians often wish to explore other models of care, including harm reduction and palliative care. In addition, patients with SEED may also contemplate whether a compassionate death would be better than an ongoing lifetime of suffering. In this review, we outline arguments for and against the concept of futility in SEED, and explore whether (or when) patients are competent to make the decision to die.

Overview

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Crossref · 10.1097/pra.0000000000000160

Cites

37 of 37 references verified0 citation errors · 0 not checkable

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Citations

Cites

Research works printed but not linked: 2

  1. Gull, 1874, Anorexia nervosa (apepsia hysterica, anorexia hysterica), Transact Clin Soc London, 7, 22
  2. Nogal, 2009, Analysis of treatment efficacy in girls with anorexia nervosa (III), Neuro Endocrinol Lett, 30, 32

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Metadata

Authors
WESTMORELAND, P., & MEHLER, P. S.
Affiliations
  • Denver Health Medical Center (US)
  • University of Colorado Anschutz (US)
Venue
Journal of Psychiatric Practice
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-07
Volume
22
Issue
4
Pages
313-320
ISSN
1527-4160 (ISSN-L)
DOI
10.1097/pra.0000000000000160
OpenAlex
W2502748109
Cited by
55
References
37
Citations by year
2026: 4 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 8 · 2021: 4 · 2020: 8 · 2019: 3 · 2017: 2
FWCI
0.25
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Psychiatric Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Nursing › Nutrition and Dietetics › Dietetics, Nutrition, and Education
Keywords
anorexia nervosa, involuntary treatment, medical certification, harm reduction, palliative care, futility, treatment refusal, treatment completion, weight restoration, patient competence
MeSH terms
Anorexia Nervosa, Humans, Palliative Care, Medical Futility, Harm Reduction

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