Tipping the Scales

Unlike patients with other mental health disorders, such as schizophrenia or bipolar illness, for whom a medical physician rarely needs to be involved in care delivery, patients with eating disorders have a litany of significant medical complications that demand close oversight by a medical doctor knowledgeable in treating these disorders. However, prior to the 1980s, little available literature elucidated the best medical practices for these patients, and currently, very few physicians have much medical expertise in this specialized area. This is disconcerting, because these patients are known to be frequent utilizers of the medical system who are often admitted to hospitals and emergency departments for medical complications of their disorders. In addition, anorexia nervosa has the highest mortality rate of any mental disorder except opioid abuse, and the standardized mortality ratio for bulimia nervosa is almost twice that seen in age-matched control subjects. Moreover, much of the excessive mortality rate in AN is attributable to medical complications. Thus, there is an impelling need for this book, which highlights the medicolegal and ethical challenges in treating individuals with EDs. Progress in the medical and psychological treatment of eating disorders over the past half-century has shown us what we can do but sometimes leaves unanswered questions about what we should do in difficult situations, such as the case of a person with a severe and enduring eating disorder who is symptomatic, resiststreatment, and requires repeated involuntary hospitalizations. This book explores the ethical and legal dimensions of these difficult questions.