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Introduction: This Rapid Review (RR) aimed to assess the current literature over the past decade to determine the prevailing evidence regarding compulsory treatment* in eating disorders (ED). It is hoped that the review will help inform a consensus opinion as to whether this course of action confers significant clinical benefit, and importantly, to whom it should apply. The review also explores alternative options to involuntary care. Methods: Four indexing databases (OVID; ProQuest; Web of Science; PubMed/MedLine) were searched using variations of the following keywords: "coercive/detained/involuntary/least restrictive care" "treatment refusal" "incarcerated/forced/compulsory admission" "moral/ethic/legal/mental health act" "eating disorder". Research was restricted to articles published between 2013 and 2023 and included grey literature. Results: Of 9911 articles retrieved, 34 were included for final analyses, exploring ethical, legal, and physical and mental health outcomes of compulsory treatment. Studies comprised review papers, cohort studies, cross sectional research, case series reports, ethnography, commentary papers and grey literature. The majority of studies focused on individuals with anorexia nervosa (AN). Only two papers considered compulsory treatment in individuals with other eating disorders (EDs) Findings largely align with previous reviews suggesting compulsory treatment saves lives but comes at a therapeutic and personal cost. It remains unknown as to who may benefit from compulsory treatment. The decision to invoke compulsory treatment remains with the clinician and is a responsibility that is likely to be faced by most in their care of individuals with EDs. Conclusions: Significant gaps remain in the published literature and a clear road map for a clinician-informed decision on the submission of a compulsory treatment for a person with ED does not yet exist. Further, there is little evidence as to who is most likely to benefit from compulsory treatment. There is consensus that efforts should be concentrated on reducing instances of compulsory treatment and minimising coercion through the development of open, transparent and trusting relationships between individuals and their treating clinician. Co-produced research and the development of clinical guidelines guided by the voices of individuals with lived experience are needed to ensure minimisation of potential harm. Plain English Summary: Eating disorders are complex psychological disorders with numerous significant physical health consequences associated with lethality including heart attack, irregular heartbeat, dehydration, blood clots, and risk of suicide. Without indicated intervention for physical deterioration in the acute stages of illness, individuals are likely at best to develop a chronic course and at worst to lose their life. Despite this, individuals frequently refuse intervention and medical treatment due to fear of weight gain, the interruption of behaviours that are experienced as protective and the effects of past experiences of care. Many report a sense of hopelessness and fear due to past unsuccessful and at times harmful treatments. This presents treating clinicians with a practical and ethical conundrum: should treatment be delivered to an individual against their will? Researchers, policymakers, law professionals and lived experience alike are challenged as to the legal and ethical bounds around which practitioners can act with beneficence when considering compulsory treatment of an individual with an eating disorder. A Rapid Review was commissioned by the Victorian Government Department of Health to summarise the extant literature on the compulsory treatment* of individuals with eating disorders. * Involuntary treatment' and 'compulsory treatment' are synonymous, but we have chosen the term that is best understood by the general public/informed readers. [ABSTRACT FROM AUTHOR]

Objective: Sociocultural factors are believed to play significant roles in predisposing individuals to eating disorders. Accordingly, this study aimed to investigate various sociocultural predictors of body shape and weight concerns among healthy women and those with eating disorders within the Turkish population. Method: Data from 79 patients (41 diagnosed with anorexia nervosa, 31 with bulimia nervosa, and 7 with binge eating disorder) were analyzed alongside 72 healthy controls matched for age and education. Participants provided demographic information and completed several questionnaires, including the Sociocultural Attitudes Towards Appearance Questionnaire - 4 Revised, the Social Comparison through Physical Appearance Scale and the Eating Disorder Examination Questionnaire. Results: Key findings include: 1) Patients exhibited higher scores related to sociocultural factors impacting appearance and engaged in more negative social comparisons than controls; 2) Among both groups, internalization of a thin ideal was a predictor of concerns about shape and weight; 3) In controls, but not in patients, family pressures influenced shape concerns; 4) Parental dieting status influenced weight concerns in both groups. Surprisingly, in controls, paternal dieting was linked to a higher shape and weight concerns, a finding not observed in patients. Conclusion: These findings indicate that sociocultural influences on body image may affect Turkish women with eating disorders (ED) differently from healthy women. The impact of paternal dieting on shape and weight concerns among control women has not been previously reported. This finding suggests that the influence of paternal dieting on daughters' shape and weight concerns may be more pronounced in Turkiye than in Western countries. [ABSTRACT FROM AUTHOR]

The article offers information on caring for psychiatrically healthy individuals at the end of life. Topics discussed include average life expectancies for individuals with psychiatric disorders, characteristics of individuals demonstrating foreseeably foreshortened lives, and factors that underscore the importance of developing palliative and hospice care providers specially trained on issues that might be anticipated in caring for patients with psychiatric disorders and their families.

Mental health providers caring for refugees should be aware that obtaining citizenship is critical to stability and safety for their patients. In the United States (U.S.), obtaining citizenship requires applicants to pass an examination exhibiting working knowledge of English and foundational knowledge of U.S. civics. For refugees with mental health disorders that impair cognition, this may present insurmountable barriers. The United States Customs and Immigration Services (USCIS) offers form N-648 to request exemption from these requirements. However, the form can be difficult to complete in a manner acceptable to USCIS. In this paper, the authors present preliminary data on citizenship-related mental health evaluations and subsequent applications for 40 patients seen in a university-based refugee mental health clinic. We simplify the process into three phases, and present three cases highlighting specific complexities involved. Our experiences and recommendations may help other mental health providers prepare to advocate for their refugee patients. [ABSTRACT FROM AUTHOR]

Some individuals with severe and enduring anorexia nervosa experience dramatically degraded quality of life in the face of refractory illness and compulsory treatment. We propose a palliative care (PC) model for this group of patients that aims to support their unique goals of care, improve social-professional function, reduce physical suffering, and honor the whole person. Far from representing a pre-hospice model, a PC model for those with severe and enduring anorexia nervosa instead provides an alternative to current practices in hopes of meaningfully improving quality of life and outcomes. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Slowing the Slide Down th Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US" by Daryl Pullman which uses a rhetorical device to immediately bias readers toward perceiving the increasing sanctioning of medical assistance in dying (MAiD) in Canada as descent into immoral nether regions. Topics include the MAiD legislation in the U.S. and their agreement with Pullman that decisions concerning MAiD are complicated.

The article presents a guideline from the American Psychiatric Association Practice for the treatment of Eating Disorders including improvement in quality of care and treatment outcomes; statistics of lifetime prevalence of eating disorders in the U.S.; and rating the strength of research evidence and recommendations are also discussed.

Background and objectives: Premature deaths are estimated to occur in 5–20% of patients with anorexia nervosa (AN). Among them, some patients with severe and enduring anorexia nervosa (SE-AN) will die due to the medical complications of malnutrition or to suicide. Almost no literature provides guidance to patients, clinicians, and loved ones regarding clinical characteristics of those with SE-AN who recognize and accept the fact that they will not be able to survive their disease. Consistent with general medical literature on terminal illness and based on the authors' work with patients at this phase of life, we previously described four clinical characteristics of the small group of SE-AN patients who may be considered to have a terminal eating disorder. Following publication of this article, several opinions objecting to these formulations were published. The goals of this article are to respond to the key themes of concern posed by these objections, to extend our discussion of the palliative care and associated needs of these patients and their families, and to suggest ways in which the eating disorder and palliative care fields might develop more definitive criteria and consensus guidelines for the assessment and management of these patients. Methods: Based on a selective narrative review of the literature, our combined experiences with these patients, and clinical reasoning, we address critiques grouped around five major themes: that (1) labels such as terminal AN are dangerous; (2) since AN is a treatable disorder, no SE-AN patients should be considered terminal; (3) a terminal psychiatric condition cannot be defined; (4) the proposed definition is not specific enough; and (5) considerations regarding mental capacity in the proposed criteria do not sufficiently account for the psycho-cognitive impairments in AN. Results: Our analysis responds to the critiques of our original proposed clinical characteristics of those with terminal AN. While refuting many of these critiques, we also appreciate the opportunity to refine our discussion of this complex topic and identify that there are multiple stages of SE-AN that can result in good clinical outcomes. Only when all of these have failed to provide adequate amelioration of suffering do a low number of patients progress to terminal AN. Conclusions: By further refining our discussion of terminal AN, we aim to encourage eating disorders and palliative care specialists to develop expert consensus definitions for terminal AN and to generate authoritative clinical guidance for management of this population. By validating terminal AN as a distinct condition, patients with this subcategory of SE-AN, their families, and their caregivers facing end-of-life concerns may be better able to access palliative and hospice care and related services to help improve their overall experiences at this phase of life. [ABSTRACT FROM AUTHOR]

In this narrative medicine essay, a retired psychiatrist emulates his father who in his sunset years helped many of his friends, family members, and loved ones navigate end-of-life illnesses and death. [ABSTRACT FROM AUTHOR]

Background: Most individuals with eating disorders will either recover, settle into an unrecovered but self-defined acceptable quality of life, or continue to cycle from crisis to relative stability over time. However, a minority of those with severe and enduring eating disorders recognize after years of trying that recovery remains elusive, and further treatment seems both futile and harmful. No level of harm reduction proves achievable or adequately ameliorates their suffering. In this subgroup, many of those with anorexia nervosa will experience the medical consequences of malnutrition as their future cause of death. Whereas anyone who wishes to keep striving for recovery despite exhaustion and depletion should wholeheartedly be supported in doing so, some patients simply cannot continue to fight. They recognize that death from anorexia nervosa, while perhaps not welcome, will be inevitable. Unfortunately, these patients and their carers often receive minimal support from eating disorders health professionals who are conflicted about terminal care, and who are hampered and limited by the paucity of literature on end-of-life care for those with anorexia nervosa. Case presentation: Three case studies elucidate this condition. One patient was so passionate about this topic that she asked to be a posthumous co-author of this paper. Conclusions: Consistent with literature on managing terminal illness, this article proposes clinical characteristics of patients who may be considered to have a terminal eating disorder: diagnosis of anorexia nervosa, older age (e.g. age over 30), previous participation in high quality care, and clear and consistent determination by a patient who possesses decision-making capacity that additional treatment would be futile, knowing their actions will result in death. By proposing the clinical characteristics of terminal anorexia nervosa, we hope to educate, inspire compassion, and help providers properly assess these patients and provide appropriate care. We hope that this proposal stimulates further expert consensus definitions and clinical guidelines for management of this population. In our view, these patients deserve the same attendant care and rights as all other patients with terminal illness, up to and including medical aid in dying in jurisdictions where such care is legal. [ABSTRACT FROM AUTHOR]

Background: For DSM – 5, the American Psychiatric Association Board of Trustees established a robust vetting and review process that included two review committees that did not exist in the development of prior DSMs, the Scientific Review Committee (SRC) and the Clinical and Public Health Committee (CPHC). The CPHC was created as a body that could independently review the clinical and public health merits of various proposals that would fall outside of the strictly defined scientific process. Methods: This article describes the principles and issues which led to the creation of the CPHC, the composition and vetting of the committee, and the processes developed by the committee – including the use of external reviewers. Results: Outcomes of some of the more involved CPHC deliberations, specifically, decisions concerning elements of diagnoses for major depressive disorder, autism spectrum disorder, catatonia, and substance use disorders, are described. The Committee's extensive reviews and its recommendations regarding Personality Disorders are also discussed. Conclusions: On the basis of our experiences, the CPHC membership unanimously believes that external review processes to evaluate and respond to Work Group proposals is essential for future DSM efforts. The Committee also recommends that separate SRC and CPHC committees be appointed to assess proposals for scientific merit and for clinical and public health utility and impact. [ABSTRACT FROM AUTHOR]

Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of intersecting identities that, to varying degrees, complement, assimilate, accommodate, or clash. In these patterns, individuals' relationships to cultures are not necessarily categorically distinct ("multicultural"). Instead, they are often "polycultural," defined as partial and plural; rather than interpreting different cultural traditions as separate and independent, they are, within the lives of individuals and families, better understood as systems that interact with and influence one another. Cultural identity groups extend beyond those traditionally considered by transcultural psychiatry—that is, beyond ethnic, racial, and language groups. They encompass (in alphabetical order) educational, ethnic, extended family, gender-oriented, generational, geographic, language and dialect, organizational, physical or psychiatric disability, political, professional, racial, religious, sect, social class, and vocational identity groups, among others. Simplistic assumptions and generalities about identity groups risk cultural stereotyping that may negatively bias clinical assessments. Therefore, practitioners striving for cultural sensitivity need to adopt nuanced strategies for approaching broad polycultural identity questions in clinical practice. Accordingly, this article suggests frameworks and strategies for (1) assessing and confronting one's own cultural preconceptions and prejudices, and (2) developing etic (objective quantitative data) and emic (insiders' experiential worldviews) perspectives pertinent to clinical anthropathology. Both etic and emic perspectives are necessary for polyculturally nuanced, respectful, comprehensive inquiries pertinent to patients' and family's health beliefs, psychiatric difficulties, and health practices. Supplementary material from the DSM-5 section on cultural formulation is adapted and discussed, along with the implications of polycultural psychiatry for education and training in psychiatry. [ABSTRACT FROM AUTHOR]

The article provides an outlook for the practice of psychiatry in 2500 based on the lessons learned from history. Topics discussed include the possibility that 26th-century psychiatry will consider the biopsychosocial approach in 2021 as simplistic in understanding, knowledge of scientists in 2500 about the impacts of genetic, epigenetic and physical and psychosocial environmental factors, and possible inclusion of cell-specific diagnoses and connectivity patterns in psychiatric diagnoses.

In the article, the author discusses the effectiveness of using harm reduction strategies in treating patients with severe and enduring anorexia nervosa (SEAN). Topics include a study by Andria Bianchi and colleagues on the use of said approaches by physicians to reduce the intensity, frequency and possible lethality of life-threatening or shortening behaviors by SEAN patients, and the six principles of harm reduction like humanism, individualism and pragmatism.

We are pleased that the concept of terminal anorexia nervosa is being considered in serious discussion. Our previous presentations were not intended to assess eating disorders care broadly, but solely to bring attention to the importance of end-of-life care issues for patients with anorexia nervosa. Regardless of differences in ability to access or utilize health care resources, inescapably, individuals contending with end-stage malnutrition due to anorexia nervosa who refuse further nutrition will progressively decline, and some will die as a result. Our description of these patients' last days and weeks as "terminal" and meriting thoughtful end-of-life care is consistent with how the term is used in other end-stage terminal conditions. We clearly acknowledged that precise definitions and guidelines for end-of-life care for these patients should be developed by the eating disorder and palliative care fields. Avoiding the phrase "terminal anorexia nervosa" will not make these phenomena disappear. We are sorry that some individuals are upset by this concept. Our intention is certainly not to demoralize by "triggering" fears of hopelessness or death. But these discussions will inevitably distress some people. Individuals who are adversely affected by considering these issues might well benefit from further explorations, clarifications, and discussions with their clinicians and others. Finally, we clearly applaud expanding treatment options and availability, and we strongly advocate for making every effort to provide every patient every possible option for treatment and recovery at every phase of their struggles. [ABSTRACT FROM AUTHOR]

In this narrative medicine essay, an emeritus professor of psychiatry ponders the preparation for and circumstances of achieving a good death and what burdens or benefits are left behind for loved ones. [ABSTRACT FROM AUTHOR]

Objective: Although efforts have been made to study mechanisms and mediators of posttraumatic growth (PTG - positive sequelae of coping with trauma), little has been done to investigate PTG as a concept in the context of complex PTSD, a disorder recently delineated in ICD11. This article considers PTG in relation to complex PTSD, primarily as associated with childhood sexual abuse. Method: Using clinical case material and available literature, we explore the emergence of PTG in the treatment of patients with complex PTSD and examine factors contributing to its appearance. Results: Despite extensive early traumas, including those associated with histories of ongoing childhood sexual abuse, patients may be capable of PTG. While factors favoring PTG may include temperamental resilience and other as yet ill-defined personality traits, the presence of safe, supportive and enduring therapeutic and extra-therapeutic relationships, appear to address insecure attachments related to trauma and be of considerable importance in fostering possibilities for PTG. Conclusions: While much remains to be learned, encouraging and helping establish varieties of accepting, trusting and nurturing contacts in real world and psychotherapy and introducing and exploring the concept of PTG within therapy, can help patients suffering from complex PTSD address the underlying developmental deficiencies they have endured, facilitate treatment, and promote PTG. [ABSTRACT FROM AUTHOR]

The article discusses the ethical and practical dilemmas confronting psychiatrists on the issue of medical aid in dying (MAiD) or assisted suicide. Also cited are the differences among MAiD, euthanasia and suicide, the countries that passed laws allowing physician-assisted suicide and voluntary active euthanasia as of 2018, as well as the key role played by psychiatrists in the implementation of the laws.