Involuntary Treatment of Minors with Severe and Enduring Anorexia Nervosa

Anorexia nervosa is among the most lethal of all psychiatric illnesses and is increasingly prevalent in children and adolescents. There are limited treatment options specifically for youth with severe and enduring illness who decline treatment. Although treatment guidelines increasingly favor outpatient family-based treatments, there is a continued role for inpatient psychiatric treatment and involuntary commitment for high-risk patients. Providers may be reluctant to pursue involuntary treatment given its controversial nature, and differences in state's commitment laws complicate the development of clear guidelines for this approach. If parents also oppose treatment, providers must consider involving the child welfare system while balancing the impact of terminating parental rights upon long-term treatment outcomes. The case example of an adolescent with severe and enduring anorexia nervosa who opposed involuntary treatment, as did the legal guardian, highlights Washington's unique mental health laws for minors, which allow for temporary suspension of patient and guardian decision-making authority without terminating parental rights. The article discusses the ethics of involuntary treatment, the intersection of anorexia nervosa with the child welfare system, legal cases establishing commitment criteria for anorexia nervosa, and Washington's mental health laws for minors to inform the treatment approach for high-risk adolescents with severe and enduring anorexia nervosa.