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Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa

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Abstract

Purpose

We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment.

Methods

This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)).

Results

Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16–5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19–0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05–2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68–9.32), and neutral (HR = 2.92, 95% CI 1.20–7.13) or poor (HR = 3.97, 95% CI 1.49–10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment.

Conclusions

Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment.

Level of evidence

Level III, cohort study.

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Data availability

The data from health records and the Danish national registers are not publicly available. Stata 16 code from Statistics Denmark’s servers is not publicly available.

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Acknowledgements

The authors want to thank Dr. Janne T. Larsen for her support with data management and Mr. Anders H. Carlsen for his support with data management and analyses.

Funding

This research was supported by the National Institute of Mental Health (Dr. Bulik, grant numbers R01MH120170; R01MH124871; R01MH119084; R01MH118278; R01 MH124871); Brain and Behavior Research Foundation Distinguished Investigator Grant (Dr. Bulik); Swedish Research Council Vetenskapsrådet (Dr. Bulik, award 538-2013-8864); the National Institutes of Health (Drs. Bulik and Petersen, grant number R01MH120170); Lundbeckfonden (Drs. Petersen and Bulik, grant number R276-2018-4581); Child & Adolescent Psychiatry, Aarhus University Hospital (Mr. Mac Donald, internal funding without a grant number); and Fru C. Hermansens Mindelegat (Mr. Mac Donald, no grant number available). The funders had no involvement in any aspect of the study.

Author information

Author notes

  1. Liselotte V. Petersen and Loa Clausen contributed equally to the study and share senior authorship.

Authors and Affiliations

  1. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Benjamin Mac Donald & Loa Clausen

  2. Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark

    Benjamin Mac Donald & Loa Clausen

  3. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Cynthia M. Bulik

  5. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cynthia M. Bulik

  6. The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark

    Liselotte V. Petersen

  7. Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark

    Liselotte V. Petersen

  8. Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark

    Liselotte V. Petersen

Authors
  1. Benjamin Mac Donald
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  4. Loa Clausen
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Contributions

BMD was involved in the initial idea of the study, the study design, data management, data analysis, interpretation of results, and was responsible for writing the paper. LVP, CMB, and LC were involved in the study design, interpretation of results, and paper revision. LVP and LC also supervised data analysis. All authors approved the final version of the paper. LVP and LC contributed equally to the study and share senior authorship.

Corresponding author

Correspondence to Benjamin Mac Donald.

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Conflict of interest

Dr. Bulik reports: Takeda (grant recipient, scientific advisory board); Idorsia (consultant); Pearson (author, royalty recipient); Equip Health Inc. (clinical advisory board). Mr. Mac Donald and Drs. Petersen and Clausen have no competing interests to declare.

Ethical approval

The study did not require approval by an ethics committee in Denmark. In accordance with Danish law, permission to access health record data was obtained from the Danish Patient Safety Authority (3–3013-2627/1) and approval for using register-based data was obtained from the Danish Health Data Authority (FSEID-00004078; FSEID-00001107). The study conformed to the Helsinki Declaration except regarding informed consent from patients.

Consent to participate

The data were obtained from health records and the Danish national registers. In accordance with Danish law, permission to access health record data was obtained from the Danish Patient Safety Authority (3–3013-2627/1) and approval for using register-based data was obtained from the Danish Health Data Authority (FSEID-00004078; FSEID-00001107).

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Mac Donald, B., Bulik, C.M., Petersen, L.V. et al. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 27, 3157–3172 (2022). https://doi.org/10.1007/s40519-022-01446-y

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