Forced feeding, also known as compulsory feeding or refeeding, is a controversial and complex aspect of treating severe anorexia nervosa. Healthcare professionals may consider trying it if other treatments do not work.

Anorexia is a serious and potentially life threatening eating disorder that can cause an intense fear of gaining weight and a distorted body image.

These perceptions can lead individuals to engage in extreme behaviors to manage their weight and food intake, such as eating very little or exercising excessively.

This article looks at compulsory feeding as a treatment for anorexia, including how it works, how effective it can be, and whether it is ethical. It also describes other available treatment options.

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Forced feeding is the administration of nutrients directly into a person’s gastrointestinal tract. Healthcare professionals use it to deliver essential nourishment, typically through a feeding tube.

It may also involve intravenous (IV) administration, which involves delivering fluids into a vein, bypassing the digestive system altogether. Medical professionals may also refer to this process as parenteral nutrition.

When do doctors use it?

Forced feeding is generally a last resort.

Doctors may use it if a person is refusing to eat voluntarily and their life is in immediate danger due to the following:

Healthcare professionals will usually only use compulsory feeding when all other interventions have not helped or voluntary treatment is not feasible.

Who decides to initiate forced feeding?

The decision to implement forced feeding involves careful evaluation of the person’s medical and psychological condition, considering their capacity to make decisions about their health at that moment due to their illness.

Ethical and legal considerations also play a role in determining whether forced feeding is appropriate. Parents and guardians can request it, but the healthcare team typically makes the final decision.

Learn more about anorexia nervosa.

While forced feeding may address the immediate physical risks of severe anorexia, it does not address the underlying psychological issues that accompany eating disorders.

The primary goal of compulsory feeding is stabilizing the individual’s physical health. However, when the person’s condition is stable, they should receive comprehensive medical and psychological treatment to address the underlying issues contributing to the refusal to eat.

Psychotherapy, including cognitive behavioral therapy (CBT) and family-based therapy, can benefit long-term recovery and help with treating the psychological aspects of the disorder.

Compulsory treatment is controversial, as it raises ethical dilemmas related to autonomy and personal choice.

A fundamental principle of medical ethics is respect for individual autonomy, which means people have the right to make decisions about their medical treatment and provide informed consent.

By its nature, forced feeding infringes upon this autonomy, as it involves medical intervention without the person’s consent.

Considering mortality rates

Anorexia has a high mortality rate among psychiatric disorders. People with anorexia often die due to complications of starvation or by suicide.

In severe cases, people with anorexia may be unable or unwilling to eat, leading to severe malnutrition, electrolyte imbalances, and organ damage, all of which can be fatal. Medical professionals are ethically obligated to intervene when a person’s life is at immediate risk.

Ethical dilemmas arise when there is a conflict between respecting an individual’s autonomy and the medical necessity of providing lifesaving treatment. In such cases, the moral principle of beneficence, which emphasizes doing what is in the person’s best interest, comes into play.

Laws and guidelines around forced feeding vary by country and jurisdiction, and they often require a careful assessment of the person’s capacity to make decisions about their health at that moment.

This means that each case requires individual consideration to determine if force-feeding is the best course of action.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Treatment for anorexia typically involves a multidisciplinary approach.

This involves addressing the physical and psychological aspects of the disorder. Some current treatment approaches include the following:

  • Nutritional rehabilitation: People can work with registered dietitians or nutritionists to develop a balanced meal plan that helps restore and maintain a healthy weight.
  • Education: Healthcare professionals should provide education about nutrition and portion control to help individuals make informed choices about their eating habits.
  • CBT: This form of therapy helps individuals with anorexia identify and adjust thoughts and behaviors about food, body image, and weight.
  • Family-based therapy: This treatment method involves family members in the process. It may be particularly useful for adolescents with anorexia and their loved ones. It focuses on helping families support a person’s recovery.
  • Dialectical-behavior therapy: This form of treatment can address emotional dysregulation that occurs due to eating disorders.
  • Body image therapy: Treatment and counseling often include interventions to address body image dissatisfaction and low self-esteem.

In some cases, doctors may use medication to address co-occurring mental health conditions, such as depression or anxiety.

Learn more about treatment for severe anorexia.

Supporting someone with anorexia through treatment can be challenging, but encouragement and understanding can make a significant difference in the recovery process.

The United Kingdom’s National Health Service (NHS) offers the following tips for parents or caregivers supporting a person with an eating disorder:

  • learn about eating disorders and triggers
  • behave in a nonjudgmental and patient manner
  • avoid commenting on the person’s appearance
  • celebrate small victories
  • avoid promoting diet culture
  • move the focus away from the food during meals
  • adopt a lighthearted attitude during meals, where possible and appropriate
  • encourage seeking professional help
  • participate in family therapy

The NHS suggests it can also be helpful for parents and loved ones to try to be honest about their own feelings to encourage the person with the eating disorder to do the same. However, avoiding saying things that may make the person feel guilty about their illness is important.

Parents and loved ones of a person with an eating disorder can also seek support for themselves through a support group or other methods.

Help is available

Eating disorders can severely affect the quality of life of people living with these conditions and those close to them. Early intervention and treatment greatly improve the likelihood of recovery.

Anyone who suspects they or a loved one may have an eating disorder can contact the National Alliance for Eating Disorders, which offers a daytime helpline staffed by licensed therapists and an online search tool for treatment options.

For general mental health support at any time, people can call the Substance Abuse and Mental Health Services Administration 24 hours a day at 1-800-662-4357 (or 1-800-487-4889 for TTY).

Many other resources are also available, including:

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Healthcare professionals consider forced feeding a last resort they may implement when a person’s life is in immediate danger due to severe malnutrition.

Before considering compulsory feeding in an individual with an eating disorder, doctors will encourage voluntary treatment and support the person’s overall physical and mental well-being.

A compassionate and person-centered approach is essential in the treatment of anorexia.

Healthcare professionals can help and advise people with eating disorders and their loved ones.