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Perceived Coercion and Change in Perceived Need for Admission in Patients Hospitalized for Eating Disorders
Abstract
OBJECTIVE: Ambivalence toward treatment is characteristic of eating disorders, and patients are often admitted to inpatient programs under pressure from clinicians, family, friends, educators, or employers. This study evaluated patient perceptions of the admissions process and perceived need for hospitalization and assessed whether these perceptions remain stable in the short term. METHOD: A total of 139 patients with eating disorders completed a 13-item self-report scale on the admission experience when they were admitted to a behavioral inpatient specialty program and again 2 weeks into their hospitalization. RESULTS: Patients with anorexia nervosa reported higher levels of perceived coercion and pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18 (N=35) reported more perceived coercion than did adult patients (N=104), and a trend was noted for them to disagree that they needed hospitalization. Perceptions of coercion, of pressure by others toward hospitalization, and of procedural justice were stable in the short term. However, of the 46 patients (30 of them adults) who initially did not endorse needing admission, 20 patients (17 of them adults) changed their minds by 2 weeks into hospitalization and agreed that they needed hospital admission. CONCLUSIONS: Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these findings suggest a need for studies assessing the long-term outcome and ethics of pressuring patients with eating disorders into treatment.
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“In two involuntary admissions where I had received nutritional restoration via nasogastric and nasojejunal feeding, I was retrospectively grateful and recognised that my life had been in grave danger, aligning with reports in the literature [173].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [173]
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Metadata
- Authors
- Guarda, A. S., Pinto, A. M., Coughlin, J. W., Hussain, S., Haug, N. A., & Heinberg, L. J.
- Affiliations
- Johns Hopkins University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2007-01
- Volume
- 164
- Issue
- 1
- Pages
- 108-114
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2073096420
- Cited by
- 152
- References
- 31
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 17 · 2023: 9 · 2022: 11 · 2021: 9 · 2020: 9 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 5 · 2015: 10 · 2014: 11 · 2013: 13 · 2012: 2
- FWCI
- 8.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- 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 › Nutrition, Health and Food Behavior
- Keywords
- eating disorders, anorexia nervosa, bulimia nervosa, perceived coercion, hospitalization, procedural justice, treatment pressure, adolescents, treatment avoidance
- MeSH terms
- Adolescent, Adult, Age Factors, Anorexia Nervosa, Feeding and Eating Disorders, Attitude to Health, Coercion, Female, Health Status, Hospitalization, Humans, Male, Patient Admission, Personality Inventory, Surveys and Questionnaires, Referral and Consultation, Bulimia Nervosa
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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