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What Can You Do If Someone You Love Refuses Help for an Eating Disorder?

Despite the emotional and physical suffering that results from most eating disorders, many people are often reluctant to begin eating disorder treatment.Like with any kind of mental health disease, an eating disorder is likely to be a source of shame for the person suffering from it, and that can push them into hiding the issue or even denying it exists. This form of denial is often not a conscious choice, and a person’s receptivity to accepting help is often impacted negatively without their knowing it.

Can Someone Be Made to Enter Treatment?

A disclaimer for this answer: all the options discussed below should be absolute last resorts. Respecting someone’s rights and an individual is not only the moral thing to do – it’s important in the therapy that follows as well. A person who chooses to get help, even if convincing them is hard, has a better chance to recover than someone who has no choice.

If someone has an eating disorder deemed life-threatening by a physician, family members may legally be able to force the person into an eating disorder treatment program. As mentioned, involuntary treatment for anorexia nervosa, bulimia nervosa, and binge-eating disorder is controversial because it seems counterproductive to compel uncooperative eating disorder patients into treatment.

Eating disorder treatment centers that admit adolescent patients are often wary of involuntary treatment, for both legal and ethical reasons. Teens are often “coerced” by the parents by getting an ultimatum. Threatening to take away a teen’s cell phone, car, housing, or something else the teen values is one way a parent can avoid forcing their child into an eating disorder treatment program using legal means.

Despite these caveats, if a person you love continues to refuse to get help, there are possible steps that can be taken. Per the National Eating Disorder Association (NEDA), there are possible options to commit someone to treatment if they are above the age of 18. Any of these is an extreme action, which is difficult and time-consuming, involving the legal system as they do. They should only be done after several hospitalizations or when it’s clear the individual in question’s life is in danger if steps are not taken to secure help.

Guardianship and Involuntary Admission

A judge has to be involved in any decision regarding guardianship. They determine if the person in question is incapable of making rational decisions on their own. Medical guardianship can be conferred in such a case. Although medical authority does not grant someone the ability to sign adults into eating disorder treatment centers, it does give them legal authority to decide what should be done regarding an individual’s psychological and physical care.

In most cases, a judge will be reluctant to involuntarily assign guardianship of one adult over another. If your loved one has been struggling with an eating disorder for some time but has not faced severe medical complications, self-harm, suicide attempts, or another psychiatric emergency, the court will likely not be willing to make a guardianship official. Testimony by experts (doctors, psychiatrists, or other mental health professionals) who have worked with the individual in question will be required.

What Is Conservatorship?

A legal arrangement between a conservator and a person incapable of making legal and life decisions, this term has been in the news recently due to the controversial conservatorship f Britney Spears and her father. This arrangement is another ethical line that people trying to help a loved one should be very careful about crossing; a conservatorship is the granting of financial power to another person. A person who has conservatorship over a person with an eating disorder may try to restrict how the subject spends their money – for example, the money they might use to pay for a gym membership and purchasing weight loss aids like diuretics and laxatives.

Be aware that guardianship and conservatorship are regulated under state laws. One, both, or neither may be effective in certain states recognizing these legal measures. If you do manage to obtain guardianship or conservatorship over a loved one with an eating disorder and they wish to seek eating disorder counseling in another state, you may have to get further legal advice and/or modify court orders to accommodate your loved one.

What Is a 72-Hour Hold?

A 72-hour hold is an emergency hold applied to individuals who are legally considered an immediate danger to others or themselves. Hospitals can hold people with eating disorders who are suffering from severe malnutrition, heart failure, and other serious health issues until the courts can assess the physical and mental status of the person held for 72 hours. During a 72-hour hold hearing, the “defendant” is granted a lawyer to represent them. To get someone released from a 72-hour hold, the lawyer must argue to the judge that their client is competent and not incapacitated.

Some people with anorexia nervosa, bulimia nervosa, or binge eating disorder are not truly capable of identifying that they have a life-threatening disorder. Part of their illness is attributed to this (involuntary) lack of insight concerning their health, body dysmorphic disorder, extreme anxiety over the thought of entering eating disorder treatment centers, and obsessive attitudes regarding food, eating, and movement.

Before You Do Anything, Reach Out for Help

We hope it’s been made crystal clear that these involuntary options are nothing to take lightly; a person’s rights to liberty are sacrosanct. Before even considering these options, the loved ones involved in decision-making about eating disorder treatment should exhaust all other options. When the family and friends of an individual showing symptoms f an eating disorder become concerned about their loved one’s eating patterns, there are a few steps they should take before resorting to drastic measures:

  • Research eating disorders and learn what to look for. Eating disorders all have different behaviors and symptoms from one another. You can start here to learn about some of the shared symptoms, and there are myriad awareness sites available from NEDA and other groups. Read up and then examine your loved one’s behavior to see if any of the symptoms line up with what you’ve read about. If you need sudden weight fluctuations, discomfort at mealtimes, frequent complaints about their body size or weight, it’s an indicator that you should be concerned.
  • Have a talk with them. You should find a neutral time (especially NOT around mealtimes) to speak to your loved one. Gently and non-judgmentally raise your concerns – make a special effort not to make accusations or ultimatums. Pressure at this point can harden the person’s resolve not to get help, or if they are in denial about their disordered eating behaviors, make them feel falsely accused or put upon. Also make sure to listen to what they have to say, without being argumentative or getting angry.
  • Ask them to see a doctor. Even if your family practitioner is not an expert in eating disorders, they will be able to make a referral to another doctor or mental health practitioner who does. Medical doctors will be able to determine if a person has a healthy nutritional balance, which is harder for laypeople to detect than disordered behaviors are. Some people might also feel more comfortable opening up with a professional than with their family members or friends.
  • Contact an eating disorder facility. Not only can eating disorder treatment professionals help interpret the symptoms of eating disorders, but they can also speak directly to the potential patient as well. In extreme cases, they may also be able to facilitate an intervention, if speaking to the family is not proving helpful. In any case, admissions specialists at an eating disorder treatment center have experience with reluctant patients and are prepared to make travel, insurance, and placement preparations.

Eating Disorder Treatment Saves Lives

Eating disorders are the most dangerous form of mental health disorder – the rates of death are higher in cases of anorexia nervosa, bulimia nervosa, and binge eating disorder than they are with depression, anxiety, and other mental health disorders. If a person needs professional help, it’s best to convince them to seek it out. However, if their life is in danger and they still refuse to get help, there are steps you can take – as a last resort. Contact Monte Nido today if you’re worried – and help your loved one get started on the path to recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.