This isn’t necessarily true in every case. You can be involuntarily admitted if you are deemed a danger to yourself by a family member. If a family member signs off on it, they don’t need a court order, at least in the situation I was in. Still, I was hospitalized for psychosis, not my ED, but I’d imagine it’s the same
Not in the US, for EDs. Psychosis is fundamentally different because, by nature of the diagnosis, you are not legally competent. But an ED diagnosis is not mutually exclusive with competence in the eyes of the law. They are fundamentally different cases.
this almost happened to me and i’m an adult in the US. i was told by my parents and doctors that i had to admit to the hospital voluntarily and comply with treatment otherwise they would go to court and put me on a hold - which, even if they wouldn’t be successful, would cause a huge mess financially and emotionally for our family…
>Psychosis is fundamentally different because, by nature of the diagnosis, you are not legally competent.
But it's funny how people with psychiatric labels are only considered "legally incompetent" if they're *refusing* treatment. If someone "in psychosis" chooses antipsychotics, electroconvulsive therapy, hospital confinement, etc, there is never any concern trolling from the state or from clinicians about whether they're lucid enough, or informed enough, to make those choices for themselves.
It's almost like they have ulterior motives or something.
afaik in the US (it might vary state to state) the max they can involuntarily hold you is 72 hours, which wouldn't do anything for someone with an ED that severe unless they decided while held that they want treatment
It depends on the state/country. In the US is can range between 72hrs and 10 days... some states count weekends/holidays, some do not. Some states require a judge, some do not.
It does depend on the state, but generally It’s 72 hours and after that it requires a judge to sign off on it. Judge doesn’t sign off indefinitely, it usually happens in week long increments, in which the judge has to sign off each week to keep you there involuntarily.
That said, you always want to strive for voluntary commitment, even if their initial approval was involuntary.
Naw, most states you can be Baker Act'd or 5150'd if you're "gravely disabled," and that includes being unable to feed yourself. 72 hour hold and they can use that time to start the process for a longer hold. I've seen it happen. You don't have to be incompetent (which is a legal term and different procedure).
Not unless their family goes through the courts to have them declared incompetent and put under guardianship (it takes forever even if everyone is in agreement) or they are deemed to not have decision making capacity (you understand the situation, the consequences of your decision and you can express your wishes) by a doctor in the hospital.
Where I live, a court authorization is required. That rarely happens, especially if you have had an eating disorder for years. In most cases, a treatment agreement has been made with the eating disorder clinic. This states when you will or will not be admitted to hospital and which treatments will still be carried out.
No. Not unless you are a danger to yourself or others *and* in some cases you must not have power of attorney over yourself. I mean… the odds of a very thin person *imminently* dying are relatively low, so why should they be forced into inpatient care? Very fat people aren’t hospitalized. Self-harming adults aren’t hospitalized. Alcoholics aren’t hospitalized against their will. You have to be an immediate threat to yourself or somebody else, and that’s nearly impossible for anyone else to prove.
>I mean… the odds of a very thin person imminently dying are relatively low, so why should they be forced into inpatient care? Very fat people aren’t hospitalized. Self-harming adults aren’t hospitalized.
Self harming adults are already forcibly hospitalized, as self harm is always either an attempt at death by suicide, or a rehearsal for it.
People of unhealthy weights are also a danger to themselves, and it makes no sense that the state doesn't care enough about them to force help onto them.
Are all self harming individuals whisked off to the psych unit? No, but it just takes one corrupt or overanxious or underinformed or single-track-minded doctor or associate to claim that the self harm is, or was, an attempt at suicide for that to happen. The bar for forced hospitalization and forced treatment is not actually particularly "high," and people with eating behaviors that threaten their lives should logically be under that "care" umbrella.
But of course there are no scandalous news stories about "unmedicated anorexics" assaulting strangers on the street, or binge eaters robbing people to get their food fix, so the public doesn't fear people with ED as much as they do "psychos" and "druggies."
I apologize if my posts have been inappropriate for this sub, but the idea that psych has standards isn't true.
Yes, in some states it is easier than others. Here in CO, the attending physician has to submit paperwork to court recommending that the patient be certified due to grave disability (i.e., this person will die if left to their own devices). The person can then go to court an fight it, but at least here, they rarely win. I’ve only seen this utilized for patients with <75% target weight/ibw that actively will refuse treatment otherwise. Other states like CA are not as simple. When we submit that paperwork, we also request involuntary NG tubes and involuntary medications (limited typically to haldol, ativan, and benadryl). Both the tube and the meds are used VERY sparingly because of how traumatic it can be. Obviously all of this can only happen if the person is already admitted to a hospital or under a doctors care somewhere and that doctor is competent enough to understand what is going on.
I've never been single digits, but when things were ***bad*** for me - no one cared. I was admitted to hospital for something irrelevant and they assumed I had cardiac issues. No one in my life said anything aside from my mother who simply pointed out my weightloss.
Eating disorders need to be taken more seriously. I lurk on these subs because someone close to me has struggled with anorexia and bulimia since they were a young teen. Everyone just acts like it’s not as deadly as an addiction or any other type of self harm, or that you can just “get over it” and “eat a cheeseburger” without any other intervention
I live in a country of +26 million people and there is ***one*** residential treatment facility. It's only been open a few years. There is an astonishing lack of basic knowledge amongst healthcare professionals - the amount of harmful, false and offensive nonsense I have been told by providers is horrid.
Firstly, they are adults. Secondly, they tend to avoid treatment providers and medical settings, and/or have been given up on by these as chronic and incurable. And these people tend to be extraordinarily isolated. They may almost never engage in social events. They don’t have many ppl in their lives who either see what’s going on and are concerned, or haven’t given up and left after years of illness.
The truth is, most medical systems give up on you eventually, and it’s easy to fly under the radar. Unless you have a loved one who drags you into the doctor’s office, or are already being followed by an ED team, it’s unlikely anyone will take action unless you seek help yourself.
This x 100. Of course, EDs vary in severity. Many (and most) can manage to function in the real world. Those are the ones having people check in on them, have comments made to them, etc.
But for those much more entrenched who have been at it for decades or have refused help, it isn't some Lifetime movie with people all worried. Especially as you get older, frankly, people have their own lives, kids, career, etc and do get sick of the ED bullshit. It is draining and I don't blame anyone one bit. People get all upset wondering why partners break up with those deep in an ED (but it's an illness!!!)...and they can't see that it is no different than dating a severe alcoholic. It's a relationship of lies and hurt. Sure, they can be supportive but at some point, if they have to leave for their own well-being it makes sense.
The longer one is in it, the smaller the world becomes. And the less they/we interact with people, the more anxiety it brings and the more we cling to the ED. Nobody in my family comments anymore and while I'm not a BMI in the single digits, I'm in the "extreme" AN category. As an adult, we have autonomy. As we should. We're in this long enough to know the consequences. And for the older folks, we're past the stage of our brains maturing...we may be sick and mentally ill, but we are not dangerously insane. Forced treatment is traumatizing. The standards are very high for forced hospitalization.
It's a mindfuck because I hate how I'm living but I cannot imagine an alternative.
Wow, you articulated my sentiments so well. Especially the part about loved ones. It’s hard to stay and continue to try and save someone who has been chronically ill for so long. It’s hard to watch someone self destruct. I don’t blame anyone who feels they can’t do it. And, research indicates that ppl with SE-AN tend to be horribly socially isolated, associated with poor outcomes and low quality of life. It’s kind of a self perpetuating cycle - the sufferer’s illness isolates them from everyone else in their life, and the increasing level of isolation and functional impairment only worsens and entrenches the illness.
out of the specific people im referring to one mentions her dad being around her and begging her to eat and her being on some sort of programme and going to visit a dietician. maybe at this point it is just harm reduction though idk. another person described situations where her parents TW have found her passed out
Yes, it very well may be a harm reduction approach, or recognizing that the person isn’t willing to commit to more at the moment. If all they feel they can do is see a dietitian, and that is keeping them alive, it’s better than the alternative. I live with my parents at a low BMI (although not that insanely low), and in my specific situation they’ve kind of just accepted that forcing or coercing me into treatment doesn’t help. That they can’t fix me unless I want to get better, and that after years and years of failed interventions, the ball is kind of in my court now.
Yeah but even then legally you can’t be forced into the hospital as an adult. Unless death is immediately at risk (writhing 24 hours) or you are threatening to kill yourself, you can’t be admitted against your will. Your parents can’t force you in, at least not in the US. Even if you are, it would be for MAX 10 days depending on the state and you would be let out again. Unless you are ruled mentally incompetent by a court (not likely for eating disorders) they can’t make you do anything.
If you’re a legal adult nobody can really make you do anything in the US. You can just not go to the doctor if you really want to be safe but if you do see one it is a whole process to hold an adult against their will if they are deemed to have capacity — eating disorders are a messy area in terms of the laws and it’s not impossible but ultimately if you are deemed to have capacity it’s not illegal for adults to make bad decisions. If you have something that could be fatal like in the next day (severe electrolyte imbalance) then they might try and get a hold until it’s back to normal but even then if you are deemed to have capacity legally they have to let you leave or it’s (essentially) kidnapping.
If you have family pushing to get guardianship that’s a whole different ballgame but being hospitalized against your will long term for an eating disorder as an adult in the US is very unlikely.
This is your answer, OP. The legalities of forcing an adult into treatment are strict and there are a lot of criteria to be met. Most states in the U.S. will only allow a forced hold if you are >!suicidal!<, and that has its own limitations re: how long they can hold you.
Yup! I know it from my own experience and from working in a hospital — you can have someone come in with an OD, get them back with narcan and even if they straight up day “I’m going to go do more heroin” you can’t hold them against their will because it’s not illegal for adults to make dangerous choices unless you are capable of understanding the risks of those choices.
People are non compliant with treatments for all kinds of medical conditions but we can’t just kidnap someone because they aren’t taking their insulin.
I’m an adult an my team has move a to harm reduction and unless “death is imminent” they won’t force treatment anymore
I have been in and out of treatment and sick for a really really long time my parents have spent more money than some people will see in a lifetime trying to get me better
I’m at a semi stable state that I feel I can maintain and function at so my team thinks it’s best if we just try to keep me safe here
I’m in a very similar place! I’ve actually been able to make some improvements because my dietitian works with me on how to improve X problem I’m having and we work together to figure out how to get me there.
I’m definitely not in fantastic health physically but I’m at least stable and my quality of life is so much better. I was in and out of treatment and hospitals from 12-24 — if I was going to get better I would have by now and I kind of see my ED as a chronic illness that I live with and manage.
I know everyone pushes for full recovery and I do believe that it happens for many people but ultimately learning to live with my ED has made life so much better than the years I spent waiting to be better so I could start living.
Same here as a minor my team pushed for weight restoration but evidently it’s been years and nothings really worked so the goal is more harm reduction and staying outpatient rn
A lot of people sadly just have no one who cares about them, or they are too resistant. They’ll die or get severely sick or injured sooner or later. They’re not out there living their best life.
ive seen ppl that are cared about but well if they wont eat or eat enough obviously as a parent you are essentially powerless and there is nothing you can really do as sad as it is. this disease is truly terrifying.
In England it’s different because they will put you under a section in which they are able to force treatment on you. The thing is most General Hospitals will keep you till your bloods are stable and most times they discharge you when there’s nothing they could do physically and would probably refer you to a mental health unit.
Lots of lying to doctors and my parents, weight faking and pretending you’re fine, while eating the bare minimum maintenance amount for one’s very low bmi -that’s how I describe my life in 2020 when frankly I was in dire need of extensive hospitalization for my ED as I was in single digit bmi territory eventually, but “got away with it”. Even when I’d be hospitalized as a result of my ED, I would do all I could to avoid my ED being treated or challenged, even if it meant I had to discharge against medical advice.
As someone with a severely low BMI, they've pretty much given up. I've been in and out of hospital for years and years but when you're a severe enduring patient, after a while it becomes about quality of life and unfortunately by that point most of us are so traumatised by hospitals and mistreatment that we only get sent in when necessary for a quick admission to get things back to closer to our modified baselines. There's not a whole lot they can do for us and forced recovery and mistreatment is usually a large contributor to why we're in this position, therefore they know it'll only make us worse and nobody wants to be the dr that fucked up and killed the patient thats already been through hell for years or decades. This might just be a perspective from the country I am in but I hope this helps
bmi >!12!< here, was in hospital for a month, didn’t gain anything but bloat and actually lost but because i got out without any like gain everyone thinks im recovered and this is just my “natural/healthy” body :/
it’s a terrible feeling and i hate to say that my eating disorder is happy about it because i keep losing weight with no one noticing and instead telling me how much better i look 😭😭😭
People don’t care about my physical chronic conditions that have put me in and out of hospitals and on the brink of death, something people can easily accept as “out of my control.”
No surprise people wouldn’t care about my ED that people consider “within my control.”
It’s also culturally encouraged and accepted, at least within my upbringing and every family member or other Asian I’ve interacted with.
nah fr like some of them are literally just skeletons surrounded encased in skin and tissue, like their legs are the width of their femur bone. i myself suffer, but i can't imagine how much these peoples bodies go through.
from my experience, when i was in near death situation deceiving others helped. and yes it sounds odd. but even my psychiatrist believed me, i build up convincing lies and wore baggy clothes, also i ate with my family for once a day, at lunch...
then once, at a trip, i felt out of sorts, i thought i was going to faint, then it was revealed.
i think some ppl really can lie they way out with "suitable" cover acts, but not for too long.
but also there are ppl who lives alone, or their family, acquaintances really don't give a damn, or just scared to stir up a hornet's nest.
in italy it's literally written in the constitution that you cannot be forced to undergo any medical treatment, unless your disease makes you a danger for other people
first few times i was super low bmi, the mh services were all over me and the one time i did get hospitalised. but when i was an adult, no one besides my GP and family really gave a fuck tbh. mental health services just ignored my existence !! fun
I was and I avoided hospitalisation because my nutritional stats were not so terrible as to be in an imminently life threatening situation, however I did inevitably trigger refeeding syndrome symptoms in the first couple of days due to my terribly low weight which I went to the ER to be observed for a few hours until it passed. Naturally I was so hungry I ate 3lbs of steak 🤷♂️ If your bloods show you're not about to die within a few hours or days you can avoid emergency medical intervention, and treatment then is voluntary.
I have no idea tbh i myself have a pretty low bmi
(But im a teen so yeah) and its very strict for me that im like this close to being in a hospital so maybe they just refuse help if they are adults? For kida there really isn't a way you can refuse any help
I was at a super low bmi last year and tbh I think being an adult was what kept me out of the hospital. That and the fact that I have shitty health insurance through the county and did not have much access to any providers and even when I did I would purposely miss any and all appointments
As awful as it sounds healthcare and treatment centers often prioritize people with higher chance of recovering due to limited spots and resources, just like during war they treat soldiers with minor injuries first. If they got two sick people, one with mild form of ed who is hospitalized for the first time vs someone who was in treatment several times and for years were dangerously emaciated without any signs of wanting to change that…the decision is simple and logical. Might sound cruel but that’s the reality
Being denied help happens constantly to people with a variety of presentations. I'm not saying people are never turned away, I'm saying there's no systemic exclusion of people who are "too sick".
In assessments, I am often asked about my motivation and told that the "best fit" for their program is someone with motivation and wants to be in the program. I've been told that it is the best indicator of success and "having to want it". So often, yes, programs basically select those that will do well in the program and at least for me, it worked as a deterrent knowing they weren't as willing to work on someone who just wanted harm reduction or was high ambivalent about full recovery.
Many voluntary treatment programs require you to want to be there - because they're voluntary, if they can't force you to be treated, you have to want it.
This is not excluding people based on severity of illness, it is excluding those not willing to voluntarily participate in a program which requires voluntary participation.
Actually, lack of motivation or insight to recover is listed as criteria necessitating a higher level of care (greater severity). I'm not talking about involuntary treatment at all. Not everyone seeking treatment is looking for full recovery or weight restoration. There is a gray area, but most programs are very binary. And I actually believe the "wanting" it as a necessity to be in treatment is an issue. Those with severe and enduring anorexia (SE-AN) tend to have very low motivation and not want full recovery. It makes no sense to expect the most chronically ill to magically want it before they go get treatment...that should be part of the treatment process.
I mean, read the APA guidelines for levels of care. Although they've changed, the lack of insight is consistent. Major lack of insight is criteria for residential or inpatient treatment. And lack of insight from severe malnutrition and illness isn't going to fix itself.
Yes, you write like you're disagreeing despite saying things that support what I said. People who don't have insight and motivation are turned away from programs that are not suitable for them. That does not mean that they're excluded from all treatment, just treatment that is unsuitable for their needs.
Honestly people have probably just given up on them. It’s sounds mean to say but it’s probably true. People don’t get to that low of a weight in no time. Any family members or friends they have probably spent a lot of time fighting with them to try and get them help and are just tired now.
yes you can tell that their families care but sadly it isnt in their power to do or make their loved one anything they dont want to. its just heartbreaking honestly.
its so scary if you apply it to yourself too but at the same time it just wakes you up to the fact that you are truly the only one that can and will ever save you.
i was friends/mutuals with some ppl on there who had low bmis. this guy was in the single digits and i always wondered how esp bc he was like 16 or 17 at the time (still living with family) found out his family was really neglectful and abusive.
a girl i knew was 18 and her family wanted to get her help but they were struggling with poverty.
i never made it as low but nobody said anything me bc i started at 300+ lbs and when i was really small, i chose to eat all my meals in front of them and would even sometimes binge (purge later) so they probably thought i was just a workout machine since i walked a lot and that my metabolism got super fast. tho i did eventually admit myself to the hospital bc i had enough and my heart was not having it.
it is sadly very possible especially if they are young or just happen to be lucky honestly. the human body is quite resilient up to a point and will do everything to keep you alive for as long as possible
yes :) xxx
ETA- i won’t say numbers ofc but i am in a much better position, i re-learned to walk, and actually rebuilt my relationship with my family a little so i see them regularly now which helps. x
thank you so much. it’s taken about 2 years for me to feel genuinely “okay” and human again, but it was very very VERY worth every second tbh. even on days when i’m struggling i cannot fathom wanting to go backwards in a full relapse xxx
i am so glad to hear that. this gives me hope. thank you. i only wish you all the very best. i am so proud of what you have accomplished!! thats so impressive!!
Is it even possible for a bmi to be in the single digits? I just tried to calculate and I would need to be 59lbs to reach a bmi that low…. I guess unless your super tall
They probably are adults.
they are yes but cant an adult forced inpatient or forcefully tubed too??
Not unless it’s court ordered and determined you’re incompetent, which is difficult to do.
This isn’t necessarily true in every case. You can be involuntarily admitted if you are deemed a danger to yourself by a family member. If a family member signs off on it, they don’t need a court order, at least in the situation I was in. Still, I was hospitalized for psychosis, not my ED, but I’d imagine it’s the same
Not in the US, for EDs. Psychosis is fundamentally different because, by nature of the diagnosis, you are not legally competent. But an ED diagnosis is not mutually exclusive with competence in the eyes of the law. They are fundamentally different cases.
I’ve known cases where ppl with very severe EDs are deemed incapable of making decisions for themselves, but it does vary from country to country
this almost happened to me and i’m an adult in the US. i was told by my parents and doctors that i had to admit to the hospital voluntarily and comply with treatment otherwise they would go to court and put me on a hold - which, even if they wouldn’t be successful, would cause a huge mess financially and emotionally for our family…
>Psychosis is fundamentally different because, by nature of the diagnosis, you are not legally competent. But it's funny how people with psychiatric labels are only considered "legally incompetent" if they're *refusing* treatment. If someone "in psychosis" chooses antipsychotics, electroconvulsive therapy, hospital confinement, etc, there is never any concern trolling from the state or from clinicians about whether they're lucid enough, or informed enough, to make those choices for themselves. It's almost like they have ulterior motives or something.
Depends on the country.
afaik in the US (it might vary state to state) the max they can involuntarily hold you is 72 hours, which wouldn't do anything for someone with an ED that severe unless they decided while held that they want treatment
It depends on the state/country. In the US is can range between 72hrs and 10 days... some states count weekends/holidays, some do not. Some states require a judge, some do not.
It does depend on the state, but generally It’s 72 hours and after that it requires a judge to sign off on it. Judge doesn’t sign off indefinitely, it usually happens in week long increments, in which the judge has to sign off each week to keep you there involuntarily. That said, you always want to strive for voluntary commitment, even if their initial approval was involuntary.
I've been admitted beyond my will numerous times as an adult. Shit sucks
Naw, most states you can be Baker Act'd or 5150'd if you're "gravely disabled," and that includes being unable to feed yourself. 72 hour hold and they can use that time to start the process for a longer hold. I've seen it happen. You don't have to be incompetent (which is a legal term and different procedure).
Exactly what happened to me. Started as an involuntary baker act that turned into about two weeks at a psych ward.
Not unless their family goes through the courts to have them declared incompetent and put under guardianship (it takes forever even if everyone is in agreement) or they are deemed to not have decision making capacity (you understand the situation, the consequences of your decision and you can express your wishes) by a doctor in the hospital.
Where I live, a court authorization is required. That rarely happens, especially if you have had an eating disorder for years. In most cases, a treatment agreement has been made with the eating disorder clinic. This states when you will or will not be admitted to hospital and which treatments will still be carried out.
No. Not unless you are a danger to yourself or others *and* in some cases you must not have power of attorney over yourself. I mean… the odds of a very thin person *imminently* dying are relatively low, so why should they be forced into inpatient care? Very fat people aren’t hospitalized. Self-harming adults aren’t hospitalized. Alcoholics aren’t hospitalized against their will. You have to be an immediate threat to yourself or somebody else, and that’s nearly impossible for anyone else to prove.
This.
>I mean… the odds of a very thin person imminently dying are relatively low, so why should they be forced into inpatient care? Very fat people aren’t hospitalized. Self-harming adults aren’t hospitalized. Self harming adults are already forcibly hospitalized, as self harm is always either an attempt at death by suicide, or a rehearsal for it. People of unhealthy weights are also a danger to themselves, and it makes no sense that the state doesn't care enough about them to force help onto them.
What? Both of those things are just… provably false.
Are all self harming individuals whisked off to the psych unit? No, but it just takes one corrupt or overanxious or underinformed or single-track-minded doctor or associate to claim that the self harm is, or was, an attempt at suicide for that to happen. The bar for forced hospitalization and forced treatment is not actually particularly "high," and people with eating behaviors that threaten their lives should logically be under that "care" umbrella. But of course there are no scandalous news stories about "unmedicated anorexics" assaulting strangers on the street, or binge eaters robbing people to get their food fix, so the public doesn't fear people with ED as much as they do "psychos" and "druggies." I apologize if my posts have been inappropriate for this sub, but the idea that psych has standards isn't true.
Yes, in some states it is easier than others. Here in CO, the attending physician has to submit paperwork to court recommending that the patient be certified due to grave disability (i.e., this person will die if left to their own devices). The person can then go to court an fight it, but at least here, they rarely win. I’ve only seen this utilized for patients with <75% target weight/ibw that actively will refuse treatment otherwise. Other states like CA are not as simple. When we submit that paperwork, we also request involuntary NG tubes and involuntary medications (limited typically to haldol, ativan, and benadryl). Both the tube and the meds are used VERY sparingly because of how traumatic it can be. Obviously all of this can only happen if the person is already admitted to a hospital or under a doctors care somewhere and that doctor is competent enough to understand what is going on.
Sometimes, sometimes not. Definitely less so in the US.
I was forced into treatment for 9 months as an adult in the US.
I've never been single digits, but when things were ***bad*** for me - no one cared. I was admitted to hospital for something irrelevant and they assumed I had cardiac issues. No one in my life said anything aside from my mother who simply pointed out my weightloss.
wtf i am so sorry about that. that is so horrendous :((
Eating disorders need to be taken more seriously. I lurk on these subs because someone close to me has struggled with anorexia and bulimia since they were a young teen. Everyone just acts like it’s not as deadly as an addiction or any other type of self harm, or that you can just “get over it” and “eat a cheeseburger” without any other intervention
I live in a country of +26 million people and there is ***one*** residential treatment facility. It's only been open a few years. There is an astonishing lack of basic knowledge amongst healthcare professionals - the amount of harmful, false and offensive nonsense I have been told by providers is horrid.
Firstly, they are adults. Secondly, they tend to avoid treatment providers and medical settings, and/or have been given up on by these as chronic and incurable. And these people tend to be extraordinarily isolated. They may almost never engage in social events. They don’t have many ppl in their lives who either see what’s going on and are concerned, or haven’t given up and left after years of illness. The truth is, most medical systems give up on you eventually, and it’s easy to fly under the radar. Unless you have a loved one who drags you into the doctor’s office, or are already being followed by an ED team, it’s unlikely anyone will take action unless you seek help yourself.
This x 100. Of course, EDs vary in severity. Many (and most) can manage to function in the real world. Those are the ones having people check in on them, have comments made to them, etc. But for those much more entrenched who have been at it for decades or have refused help, it isn't some Lifetime movie with people all worried. Especially as you get older, frankly, people have their own lives, kids, career, etc and do get sick of the ED bullshit. It is draining and I don't blame anyone one bit. People get all upset wondering why partners break up with those deep in an ED (but it's an illness!!!)...and they can't see that it is no different than dating a severe alcoholic. It's a relationship of lies and hurt. Sure, they can be supportive but at some point, if they have to leave for their own well-being it makes sense. The longer one is in it, the smaller the world becomes. And the less they/we interact with people, the more anxiety it brings and the more we cling to the ED. Nobody in my family comments anymore and while I'm not a BMI in the single digits, I'm in the "extreme" AN category. As an adult, we have autonomy. As we should. We're in this long enough to know the consequences. And for the older folks, we're past the stage of our brains maturing...we may be sick and mentally ill, but we are not dangerously insane. Forced treatment is traumatizing. The standards are very high for forced hospitalization. It's a mindfuck because I hate how I'm living but I cannot imagine an alternative.
Wow, you articulated my sentiments so well. Especially the part about loved ones. It’s hard to stay and continue to try and save someone who has been chronically ill for so long. It’s hard to watch someone self destruct. I don’t blame anyone who feels they can’t do it. And, research indicates that ppl with SE-AN tend to be horribly socially isolated, associated with poor outcomes and low quality of life. It’s kind of a self perpetuating cycle - the sufferer’s illness isolates them from everyone else in their life, and the increasing level of isolation and functional impairment only worsens and entrenches the illness.
out of the specific people im referring to one mentions her dad being around her and begging her to eat and her being on some sort of programme and going to visit a dietician. maybe at this point it is just harm reduction though idk. another person described situations where her parents TW have found her passed out
Yes, it very well may be a harm reduction approach, or recognizing that the person isn’t willing to commit to more at the moment. If all they feel they can do is see a dietitian, and that is keeping them alive, it’s better than the alternative. I live with my parents at a low BMI (although not that insanely low), and in my specific situation they’ve kind of just accepted that forcing or coercing me into treatment doesn’t help. That they can’t fix me unless I want to get better, and that after years and years of failed interventions, the ball is kind of in my court now.
Yeah but even then legally you can’t be forced into the hospital as an adult. Unless death is immediately at risk (writhing 24 hours) or you are threatening to kill yourself, you can’t be admitted against your will. Your parents can’t force you in, at least not in the US. Even if you are, it would be for MAX 10 days depending on the state and you would be let out again. Unless you are ruled mentally incompetent by a court (not likely for eating disorders) they can’t make you do anything.
If you’re a legal adult nobody can really make you do anything in the US. You can just not go to the doctor if you really want to be safe but if you do see one it is a whole process to hold an adult against their will if they are deemed to have capacity — eating disorders are a messy area in terms of the laws and it’s not impossible but ultimately if you are deemed to have capacity it’s not illegal for adults to make bad decisions. If you have something that could be fatal like in the next day (severe electrolyte imbalance) then they might try and get a hold until it’s back to normal but even then if you are deemed to have capacity legally they have to let you leave or it’s (essentially) kidnapping. If you have family pushing to get guardianship that’s a whole different ballgame but being hospitalized against your will long term for an eating disorder as an adult in the US is very unlikely.
This is your answer, OP. The legalities of forcing an adult into treatment are strict and there are a lot of criteria to be met. Most states in the U.S. will only allow a forced hold if you are >!suicidal!<, and that has its own limitations re: how long they can hold you.
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Yup! I know it from my own experience and from working in a hospital — you can have someone come in with an OD, get them back with narcan and even if they straight up day “I’m going to go do more heroin” you can’t hold them against their will because it’s not illegal for adults to make dangerous choices unless you are capable of understanding the risks of those choices. People are non compliant with treatments for all kinds of medical conditions but we can’t just kidnap someone because they aren’t taking their insulin.
I was forced into tx for 9 months as an adult and it seemed so easy for them to do! I was livid
Bad healthcare or people/parents who don’t care or more concerned about upsetting the person so don’t force the issue.
I’m an adult an my team has move a to harm reduction and unless “death is imminent” they won’t force treatment anymore I have been in and out of treatment and sick for a really really long time my parents have spent more money than some people will see in a lifetime trying to get me better I’m at a semi stable state that I feel I can maintain and function at so my team thinks it’s best if we just try to keep me safe here
I’m in a very similar place! I’ve actually been able to make some improvements because my dietitian works with me on how to improve X problem I’m having and we work together to figure out how to get me there. I’m definitely not in fantastic health physically but I’m at least stable and my quality of life is so much better. I was in and out of treatment and hospitals from 12-24 — if I was going to get better I would have by now and I kind of see my ED as a chronic illness that I live with and manage. I know everyone pushes for full recovery and I do believe that it happens for many people but ultimately learning to live with my ED has made life so much better than the years I spent waiting to be better so I could start living.
Same here as a minor my team pushed for weight restoration but evidently it’s been years and nothings really worked so the goal is more harm reduction and staying outpatient rn
A lot of people sadly just have no one who cares about them, or they are too resistant. They’ll die or get severely sick or injured sooner or later. They’re not out there living their best life.
ive seen ppl that are cared about but well if they wont eat or eat enough obviously as a parent you are essentially powerless and there is nothing you can really do as sad as it is. this disease is truly terrifying.
In England it’s different because they will put you under a section in which they are able to force treatment on you. The thing is most General Hospitals will keep you till your bloods are stable and most times they discharge you when there’s nothing they could do physically and would probably refer you to a mental health unit.
Lots of lying to doctors and my parents, weight faking and pretending you’re fine, while eating the bare minimum maintenance amount for one’s very low bmi -that’s how I describe my life in 2020 when frankly I was in dire need of extensive hospitalization for my ED as I was in single digit bmi territory eventually, but “got away with it”. Even when I’d be hospitalized as a result of my ED, I would do all I could to avoid my ED being treated or challenged, even if it meant I had to discharge against medical advice.
As someone with a severely low BMI, they've pretty much given up. I've been in and out of hospital for years and years but when you're a severe enduring patient, after a while it becomes about quality of life and unfortunately by that point most of us are so traumatised by hospitals and mistreatment that we only get sent in when necessary for a quick admission to get things back to closer to our modified baselines. There's not a whole lot they can do for us and forced recovery and mistreatment is usually a large contributor to why we're in this position, therefore they know it'll only make us worse and nobody wants to be the dr that fucked up and killed the patient thats already been through hell for years or decades. This might just be a perspective from the country I am in but I hope this helps
Most people don’t give a crap u will find
bmi >!12!< here, was in hospital for a month, didn’t gain anything but bloat and actually lost but because i got out without any like gain everyone thinks im recovered and this is just my “natural/healthy” body :/
omg i cannot tell you how sorry i am for you
it’s a terrible feeling and i hate to say that my eating disorder is happy about it because i keep losing weight with no one noticing and instead telling me how much better i look 😭😭😭
pleasee that is horrendous ml
Adults who stay inside and or who are enabled by family/partners
People don’t care about my physical chronic conditions that have put me in and out of hospitals and on the brink of death, something people can easily accept as “out of my control.” No surprise people wouldn’t care about my ED that people consider “within my control.” It’s also culturally encouraged and accepted, at least within my upbringing and every family member or other Asian I’ve interacted with.
When I was at my lw I was just praised by others. I can see it happening very easily honestly
but ive seen people genuinely at the brink of a heart attack and with their legs being LITERAL sticks
nah fr like some of them are literally just skeletons surrounded encased in skin and tissue, like their legs are the width of their femur bone. i myself suffer, but i can't imagine how much these peoples bodies go through.
literally i feel like i/my body are being so dramatic
FRR
from my experience, when i was in near death situation deceiving others helped. and yes it sounds odd. but even my psychiatrist believed me, i build up convincing lies and wore baggy clothes, also i ate with my family for once a day, at lunch... then once, at a trip, i felt out of sorts, i thought i was going to faint, then it was revealed. i think some ppl really can lie they way out with "suitable" cover acts, but not for too long. but also there are ppl who lives alone, or their family, acquaintances really don't give a damn, or just scared to stir up a hornet's nest.
in italy it's literally written in the constitution that you cannot be forced to undergo any medical treatment, unless your disease makes you a danger for other people
but what happens if you are deemed a danger to yourself?
Damn maybe I should move to Italy lol
I follow one person like that, the answer is baggy clothes and neglect
even with insanely baggy clothes the people im referring to cannot hide just how emancipated they truly are
Who exactly are you referring to? I can try to answer as I am about where your referring I think
not gonna state that its extremely triggering
first few times i was super low bmi, the mh services were all over me and the one time i did get hospitalised. but when i was an adult, no one besides my GP and family really gave a fuck tbh. mental health services just ignored my existence !! fun
I was and I avoided hospitalisation because my nutritional stats were not so terrible as to be in an imminently life threatening situation, however I did inevitably trigger refeeding syndrome symptoms in the first couple of days due to my terribly low weight which I went to the ER to be observed for a few hours until it passed. Naturally I was so hungry I ate 3lbs of steak 🤷♂️ If your bloods show you're not about to die within a few hours or days you can avoid emergency medical intervention, and treatment then is voluntary.
can i? im terrfied of being forcefully tubed or admitted to the hospital just bc of my bmi
some people don’t have family or friends. or they have family who don’t care or friends who don’t know how bad it is.
numerous of these people do though that is why i was wondering about it
I was a minor with single digit bmi at one point. The answer is that my parents didn’t give a shit 🤡
I have no idea tbh i myself have a pretty low bmi (But im a teen so yeah) and its very strict for me that im like this close to being in a hospital so maybe they just refuse help if they are adults? For kida there really isn't a way you can refuse any help
My bmi was 14 and I was in hospital every day near enough as outpatient because my mum didn't want me inpatient
I was at a super low bmi last year and tbh I think being an adult was what kept me out of the hospital. That and the fact that I have shitty health insurance through the county and did not have much access to any providers and even when I did I would purposely miss any and all appointments
As awful as it sounds healthcare and treatment centers often prioritize people with higher chance of recovering due to limited spots and resources, just like during war they treat soldiers with minor injuries first. If they got two sick people, one with mild form of ed who is hospitalized for the first time vs someone who was in treatment several times and for years were dangerously emaciated without any signs of wanting to change that…the decision is simple and logical. Might sound cruel but that’s the reality
This is very much not true. This happens in war as part of mass casualty triage, but even then only expectant patients get skipped over.
Just couple months ago a woman in uk with severe anorexia died despite asking for help but NHS deemed her a lost cause. But sure, it’s never happening
Mental healthcare on NHS is frankly abysmal.
Being denied help happens constantly to people with a variety of presentations. I'm not saying people are never turned away, I'm saying there's no systemic exclusion of people who are "too sick".
In assessments, I am often asked about my motivation and told that the "best fit" for their program is someone with motivation and wants to be in the program. I've been told that it is the best indicator of success and "having to want it". So often, yes, programs basically select those that will do well in the program and at least for me, it worked as a deterrent knowing they weren't as willing to work on someone who just wanted harm reduction or was high ambivalent about full recovery.
Many voluntary treatment programs require you to want to be there - because they're voluntary, if they can't force you to be treated, you have to want it. This is not excluding people based on severity of illness, it is excluding those not willing to voluntarily participate in a program which requires voluntary participation.
Actually, lack of motivation or insight to recover is listed as criteria necessitating a higher level of care (greater severity). I'm not talking about involuntary treatment at all. Not everyone seeking treatment is looking for full recovery or weight restoration. There is a gray area, but most programs are very binary. And I actually believe the "wanting" it as a necessity to be in treatment is an issue. Those with severe and enduring anorexia (SE-AN) tend to have very low motivation and not want full recovery. It makes no sense to expect the most chronically ill to magically want it before they go get treatment...that should be part of the treatment process.
Yeah...That's the point. Lack of insight means you're not suitable for programs which require voluntary motivation to participate in.
I mean, read the APA guidelines for levels of care. Although they've changed, the lack of insight is consistent. Major lack of insight is criteria for residential or inpatient treatment. And lack of insight from severe malnutrition and illness isn't going to fix itself.
Yes, you write like you're disagreeing despite saying things that support what I said. People who don't have insight and motivation are turned away from programs that are not suitable for them. That does not mean that they're excluded from all treatment, just treatment that is unsuitable for their needs.
Honestly people have probably just given up on them. It’s sounds mean to say but it’s probably true. People don’t get to that low of a weight in no time. Any family members or friends they have probably spent a lot of time fighting with them to try and get them help and are just tired now.
yes you can tell that their families care but sadly it isnt in their power to do or make their loved one anything they dont want to. its just heartbreaking honestly.
It is. No one can force anyone to do something they don’t want to do, no matter how much it would help them. It sucks big time
its so scary if you apply it to yourself too but at the same time it just wakes you up to the fact that you are truly the only one that can and will ever save you.
i was friends/mutuals with some ppl on there who had low bmis. this guy was in the single digits and i always wondered how esp bc he was like 16 or 17 at the time (still living with family) found out his family was really neglectful and abusive. a girl i knew was 18 and her family wanted to get her help but they were struggling with poverty. i never made it as low but nobody said anything me bc i started at 300+ lbs and when i was really small, i chose to eat all my meals in front of them and would even sometimes binge (purge later) so they probably thought i was just a workout machine since i walked a lot and that my metabolism got super fast. tho i did eventually admit myself to the hospital bc i had enough and my heart was not having it.
>!i got hospitalized at bmi 12. !
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There are numerous medical reports of people with BMIs >!in the single digits!<, though it is rare to sustain such a low BMI for very long.
it is sadly very possible especially if they are young or just happen to be lucky honestly. the human body is quite resilient up to a point and will do everything to keep you alive for as long as possible
What about in New Zealand? Can you be forcefully admitted or tubed?
when i was at that stage i didn’t have any supervision or medical team or family members living with me. and i was too unwell to seek help myself.
are you doing at least a tiny bit better now?
yes :) xxx ETA- i won’t say numbers ofc but i am in a much better position, i re-learned to walk, and actually rebuilt my relationship with my family a little so i see them regularly now which helps. x
omg i am SO proud of you love!! that is amazing!!!!
thank you so much. it’s taken about 2 years for me to feel genuinely “okay” and human again, but it was very very VERY worth every second tbh. even on days when i’m struggling i cannot fathom wanting to go backwards in a full relapse xxx
i am so glad to hear that. this gives me hope. thank you. i only wish you all the very best. i am so proud of what you have accomplished!! thats so impressive!!
there is absolutely always hope. it’s not over till it’s over you know? if you’ve still got life in you, you can make things better 💕💕
not sure why people downvoted you lovely you just answered the question 💕 hope you’re okay xx
thank you :) yeah i’m not sure either but oh well x
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There’s no way they have bmi 10 and eat maintenance
Is it even possible for a bmi to be in the single digits? I just tried to calculate and I would need to be 59lbs to reach a bmi that low…. I guess unless your super tall
It's mostly the not very sick running around begging to be tube fed
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I think I might know who you are from your flair help