Clinicians' Experiences of Providing Compulsory Care for Youth With Anorexia Nervosa: A Qualitative Study

While compulsory treatment is shown to be potentially traumatic for patients, its impact on clinicians has been insufficiently studied. This study aimed to examine clinicians' experiences with providing compulsory nasogastric tube feeding for youth with severe anorexia nervosa, with particular attention to identifying factors contributing to its negative impacts and potential areas for improvement in clinical practice.

Twenty-three clinicians in various roles from four academic child and adolescent psychiatry clinics in the Netherlands shared their experiences and opinions regarding compulsory nasogastric tube feeding for youth with anorexia nervosa in semi-structured interviews. Thematic analysis was conducted after systematic deductive and inductive coding based on a framework of theory and practice.

Three themes were identified. First, clinicians illustrated the immense impact of providing compulsory feeding and how this varied between different roles within a team. Second, the clinicians described myriad situations of highly distressing and potentially traumatic physical, and especially verbal resistance by patients and sometimes their parents. Third, the clinicians underlined the value of an emotionally safe working environment, the need for clear practical guidelines and the necessity of ethical debate.

Providing compulsory nasogastric tube feeding for youth with anorexia nervosa may potentially cross clinicians' moral boundaries, leading to moral injury and potential traumatization, endangering the quality and sustainability of care. The necessity for education, innovation, team building, shared decision-making, practical guidelines and ethical/moral debate is discussed. This study may contribute to ongoing debate and further research on the implications of compulsory feeding for youth with anorexia nervosa.