About this course
Eating disorders remain among the most lethal of mental health conditions; in particular, anorexia nervosa has the second-highest mortality rate (Krug et al., 2025). Despite the severity of these illnesses, individuals with eating disorders often demonstrate low motivation for change, limited engagement in treatment, and poor insight into their condition (Clausen, 2020). As a result, the use of coercive interventions is a recurring consideration in clinical practice--one that raises significant ethical challenges. Treatment providers are frequently faced with competing ethical priorities: protecting patients from serious harm while honoring their autonomy and dignity. This presentation will explore clinical, ethical, legal, and psychological dimensions of coercive interventions and perceived coercion in the treatment of eating disorders. Drawing on both empirical evidence and theoretical frameworks, this session will examine a range of coercive interventions used in the treatment of eating disorders. These include formal measures such as involuntary hospitalization, court-mandated treatment, and the appointment of medical guardians. It will also explore perceived or informal coercion (including pressure from family members or clinicians) and more invasive yet frequently necessary interventions like threats of negative consequences, prescribed feeding, and restrictions on movement, all common in eating disorder treatment (Guarda & Schreyer, 2021). The session will critically examine the risks and benefits of coercive interventions, considering both empirical outcomes and patient perspectives. While the preservation of life is the primary justification for compulsory treatment, as highlighted in several reviews (e.g., Zielinski-Gussen et al., 2023), additional benefits may include symptom stabilization and the restoration of cognitive functioning (Horn et al., 2025). Research indicates that short-term outcomes, such as weight gain, are comparable between patients admitted voluntarily and those admitted involuntarily (Atti et al., 2021). Moreover, some patients later report feeling grateful for receiving care they initially resisted, recognizing in hindsight the necessity of intervention (Touyz et al., 2024). At the same time, coercive care is not without risk. It may damage the therapeutic relationship, erode trust, and undermine long-term engagement in treatment (Douzenis & Michopoulos, 2015). Importantly, coercion is not always effective in achieving sustained recovery (Westmoreland & Mehler, 2016). This session will also address logistical and legal complexities that influence clinical decision-making, including the variability of legal standards across jurisdictions. In addition, it will explore provider distress and emotional responses when faced with these ethical challenges, and examine alternatives to coercion, including the application of harm-reduction principles (Russell et al., 2019). It will consider the risks and benefits of these alternative approaches as well (Birch et al., 2024). Participants will engage with sample case examples to deepen their understanding and apply concepts in a real-world context. Finally, the session will offer practical strategies for managing provider emotions and reducing reliance on coercive practices while still prioritizing safety and clinical effectiveness. Attendees will leave with a nuanced understanding of circumstances in which coercive care can be ethically justifiable, along with tools to promote more autonomy-supportive and collaborative approaches to treatment.
