to both RA and AN-BP .
The severity of anorexia is predominantly assessed using the metric of body mass index ( BMI ); a measure that uses a person ’ s weight and height to determine whether their weight is ‘ healthy ’ ( NHS , 2019 ). For example , an anorexic patient with a BMI of 16 to 16.99 would be diagnosed with moderate anorexia ( American Psychiatric Association , 2013 , p . 339 ). It is important to note that using BMI to measure the severity of anorexia is problematic as BMI is not always an accurate indicator of health and can sometimes mean that anorexic individuals whose BMI does not match the severity of their symptoms are limited in their ability to access treatment ( Eiring et al ., 2021 , p . 2 ; Humphreys , 2010 , p . 696 ). The level of severity of anorexia may also be altered in accordance with a patient ' s symptoms , their difficulty in performing basic tasks , and the need for supervision and intervention ( American Psychiatric Association , 2013 , p . 339 ).
Anorexia and the malnutrition that accompanies it have many harmful consequences , both short term and long term . These consequences include : damage to one ’ s ‘ reproductive , cardiovascular , gastrointestinal and skeletal ’ health , decreased concentration and comprehension , and specific health complications such as osteoporosis and infertility ( Meczekalski et al ., 2013 , p . 215 ). Anorexia is also associated with a substantial risk of mortality , with estimates ranging from 5.9 % to 20 % ( Meczekalski et al ., 2013 , p . 216 ; Sullivan , 1995 , p . 1074 ). This is much higher than any other psychiatric disorder and is due to the medical complications associated with anorexia and the increased risk of suicide ( Sullivan , 1995 , p . 1074 ).
1.2 . Treatment Methods
Anorexia is treated using a combination of psychotherapeutic techniques , including cognitive behavioural therapy and family-based therapy , and refeeding methods . ‘ Refeeding methods ’ are treatment strategies which aim to achieve nutritional rehabilitation and weight restoration through ‘ reversing the effects of malnutrition and the associated cognitive impairments ’ ( Matusek and O ’ Dougherty , 2010 , p . 444 ). Specific examples of refeeding techniques include : supplementary feeding ( increasing a patient ’ s food or nutritional intake ), surveillance at meal times and in the bathroom following meal times , movement restriction , pharmacotherapy ( providing a patient with drugs with side effects of weight gain ), nocturnal tube feeding , and nasogastric tube feeding ( Matusek and O ’ Dougherty , 2010 , p . 435 ). Contrary to popular belief , nasogastric tube feeding is used relatively infrequently in the treatment of anorexia as patients are more likely to accept other forms of treatment to avoid the invasiveness of tube feeding ( Russell , 2001 , p . 338 ). My discussion focuses on the coercive use of refeeding methods in the treatment of anorexia . As such , any subsequent reference to ‘ treatment ’ or ‘ treatment methods ’ is a reference to refeeding methods , unless otherwise specified .
1.3 . Defining Coercion
Given the harmful and potentially fatal nature of anorexia , alongside the resistance that many patients demonstrate towards recovery , the use of coercion is sometimes necessary in the treatment of the disorder ( Tan et al ., 2003a , p . 697 ). There is a lack of consistency within mental health literature regarding what constitutes coercion and , as such , establishing a definitive definition of coercion is somewhat
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