[How voluntary can treatment of adolescent patients with anorexia nervosa be?]

Patients with anorexia nervosa often refuse therapy and deny their organic and psychological state of disease. In doing so they are often supported by their parents who as well assume an ambivalent attitude towards therapy. If the family still refuses assenting to therapy after having been confronted with the severe consequences of this disease, the therapist has to decide by himself whether he initiates inpatient treatment even against the patient's will - so far as his life is in danger. According to Crisp (1980) anorectic patients have the right to intense and even compulsory treatment, as their refusal has to seen as part of their psychopathology. In 5 out of 85 inpatients we started therapy against the patients' and partly even the parents' will. All these cases had a prehistory of several therapy attempts and dropouts. Despite our compulsory measures it was possible to enter into an alliance with the patient and to initiate a positive course of illness. In any case, compulsory treatment has to be carefully considered. None the less, if the patient is in a life-threatening condition the therapist has to be aware of his responsibility without expecting therapy motivation from patients who are not able to meat this expectation because of their somatic and psychological symptomatology.