Robyn P. Thom, MD First-Year Psychiatry Resident Harvard Longwood Program Boston, Massachusetts
Douglas Mossman, MD Professor of Clinical Psychiatry and Director Division of Forensic Psychiatry University of Cincinnati College of Medicine Cincinnati, Ohio
Disclosures The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
To be subject to civil commitment, a person with a substantial mental disorder also must pose a risk of harm to herself or others because of the disorder. That risk can be evidenced via an action, attempt, or threat to do direct physical harm, or it might inhere in the potential for developing grave disability through neglect of one’s basic needs, such as failing to eat adequately. In Ms. Q’s case, if the evidence shows her eating-disordered behavior has placed her at imminent risk of permanent injury or death, she has satisfied the legal criteria that justify court-ordered psychiatric hospitalization.
Bottom Line When a severely malnourished patient with anorexia nervosa does not agree to allow recommended care, an appropriate clinical response should include judgment about the urgency of the proposed treatment, what treatment setting is best suited to the patient’s condition, and whether the patient has the mental capacity to refuse potentially life-saving care.
