regarding their treatment ( Matusek and O ’ Dougherty , 2010 , p . 443 ).
3.4 . Evidence of a Lack of Capacity Relevant to Making Treatment Decisions in Patients with Anorexia
Very few studies have explicitly examined capacity to consent to treatment in patients with anorexia . Apart from the work of Tan et al . ( 2003a , 2006 ), there have not been any studies generating empirical evidence regarding capacity in the anorexic population . Despite the limited amount of research on the matter , we can still observe evidence of a lack of capacity relevant to making treatment decisions in patients with anorexia . For example , evidence demonstrates that organic impairments that affect reasoning and cognitive abilities are often found in patients with anorexia . Organic impairments may include : cerebral pseudoatrophy ( loss of brain volume ), hormonal imbalances , or biochemical changes ( Vitousek et al ., 1998 , p . 393 ). These impairments are caused by the nutritional deficiencies that arise in cases of severe anorexia and can adversely affect a patient ’ s ability to make rational , informed decisions regarding their treatment ( Matusek and O ’ Dougherty , 2010 , p . 442 ).
Further evidence of a lack of capacity relevant to making treatment decisions in patients with anorexia comes from a study conducted by Tan et al . ( 2003a , p . 698 ). In the study , capacity to consent to treatment was assessed in 10 female patients with anorexia ( Tan et al ., 2003a , p . 699 ). The patients were aged between 13 and 21 and had BMIs in the range of 12.57 to 19.62 ( below normal ) ( Tan et al ., 2003a , p . 699 ). The patients were interviewed on a broad range of topics that were relevant to capacity and were asked to complete a psychopathology questionnaire ( Tan et al ., 2003a , p . 700 ).
The results of the study indicated that most participants showed ‘ significant levels of psychopathology ’ as determined by their selfcompleted questionnaires for depression , anxiety , and eating disorders ( Tan et al ., 2003a , p . 701 ). The interview aspect of the study generated clear evidence of compromised capacity in patients with anorexia . For example , many patients described experiencing alterations in their attitudes towards the risk of death and disability following the onset of anorexia , such that the risks of death and disability were less important than losing weight ( Tan et al ., 2003a , p . 702 ). As stated by one patient : ‘ although I didn ’ t mind dying , I didn ’ t really want to , it ’ s just that I wanted to lose weight , that was the main thing ’ ( Tan et al ., 2003a , p . 702 ). A similar attitude that emerged was that death and disability had a certain meaning in the context of anorexia that compromised the perception of these risks . As one patient recalled : ‘ I remember getting some tests back saying how my liver was really damaged […] it really felt like quite an accomplishment !’ ( Tan et al ., 2003a , p . 702 ).
Many patients also described a shift in values following the onset of anorexia . Several participants described valuing anorexia more highly than their familial relationships , friendships , and academic achievements . As one patient put it : ‘ it ’ s awful to admit , but in general it ’ s [ anorexia ] the most important thing in my life […] In comparison with relationships , it ’ s much more [ important ] than that ’ ( Tan et al ., 2003a , p . 702 ). Some participants even went so far as to link anorexia to their personal identity ; one patient expressed the view that if their anorexia ‘ magically disappeared ’, their ‘ entire personality would be different ’ ( Tan et al ., 2003a , p . 702 ).
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