{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:20:33Z","timestamp":1787635233451,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Eat Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anorexia nervosa (AN) is an eating disorder affecting many young people. In severe AN, complications associated with profound weight loss and malnutrition can arise, and restrictive measures (e.g., manual force, devices, or medications) may be employed to ensure treatment of patients at imminent risk of harm. This narrative review explores the ethical issues in restrictive practices or coercive treatment for young people with AN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>345 papers were initially retrieved from online databases Ovid Medline, PsycINFO, Embase and PubMed. 247 papers were systematically screened according to established inclusion and exclusion criteria, before being assessed for relevance. 40 papers remained after screening and were included in the review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Only three empirical studies were identified, with the remainder of the papers in the review being non-empirical. Significant arguments supporting restrictive or coercive practices include preservation of life; cognitive immaturity; altered capacity; alleviation of pressure or guilt regarding treatment decisions (particularly for parents or guardians); and retrospective gratitude. Pertinent counterarguments include patient distress; unjust violation of autonomy; harm to others; damage to parent-child relationships; and impacts on the therapeutic alliance. Despite there being widespread agreement on the ethical issues raised, the literature lacks guidance on how to proceed in these situations. Although restrictive or coercive treatment may be considered essential, last-resort management for young people with severe AN, the literature prompts clinicians to consider the associated harms. Future empirical research should be conducted to better understand the benefits and harms of such practices from patient, parent, and clinician perspectives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40337-026-01715-6","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:08:46Z","timestamp":1787634526000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethical issues related to restrictive practices for anorexia nervosa in young people"],"prefix":"10.1186","volume":"14","author":[{"given":"Angela","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Yeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"O\u2019Neill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Gillam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"1715_CR1","unstructured":"Butterfly Foundation, Deloitte Access Economics. Paying the Price, Second Edition: The economic and social impact of eating disorders in Australia. Sydney: Butterfly Foundation; 2004 [cited 2026 Jul 26]. Available from: Butterfly Foundation."},{"key":"1715_CR2","unstructured":"Keski-Rahkonen A, Raevuori AH, Hoek HW. The occurrence of eating disorders: an update. In: Wonderlich S, Mitchell E, de Zwaan M, editors. Annual Review of Eating Disorders: Part 2. New York: Radcliffe Publishing; 2008. p. 66\u201376."},{"key":"1715_CR3","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5)","author":"American Psychiatric Association","year":"2013","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington: American Psychiatric Association; 2013.","edition":"5"},{"issue":"5","key":"1715_CR4","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/j.pcl.2009.06.006","volume":"56","author":"J Fuentebella","year":"2009","unstructured":"Fuentebella J, Kerner JA. Refeeding syndrome. Pediatr Clin North Am. 2009;56(5):1201\u201310.","journal-title":"Pediatr Clin North Am"},{"issue":"6","key":"1715_CR5","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1542\/peds.2010-2821","volume":"126","author":"DS Rosen","year":"2010","unstructured":"Rosen DS, American Academy of Pediatrics Committee on A. Identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126(6):1240\u201353.","journal-title":"Pediatrics"},{"key":"1715_CR6","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.02273","volume":"8","author":"EC Gregertsen","year":"2017","unstructured":"Gregertsen EC, Mandy W, Serpell L. The egosyntonic nature of anorexia: an impediment to recovery in anorexia nervosa treatment. Front Psychol. 2017;8:2273.","journal-title":"Front Psychol"},{"issue":"2","key":"1715_CR7","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1136\/adc.2010.199885","volume":"97","author":"A Norrington","year":"2012","unstructured":"Norrington A, Stanley R, Tremlett M, Birrell G. Medical management of acute severe anorexia nervosa. Archives Dis Childhood-Edu Pract. 2012;97(2):48\u201354.","journal-title":"Archives Dis Childhood-Edu Pract"},{"key":"1715_CR8","first-page":"1","volume":"6","author":"K Faith","year":"2002","unstructured":"Faith K. Addressing issues of autonomy and beneficence in the treatment of eating disorders. Natl Eat Disord Inform Centre. 2002;6:1\u20136.","journal-title":"Natl Eat Disord Inform Centre"},{"issue":"2","key":"1715_CR9","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1192\/bjpo.bp.115.002485","volume":"2","author":"IF Elzakkers","year":"2016","unstructured":"Elzakkers IF, Danner UN, Hoek HW, Van Elburg AA. Mental capacity to consent to treatment in anorexia nervosa: explorative study. BJPsych open. 2016;2(2):147\u201353.","journal-title":"BJPsych open"},{"issue":"6","key":"1715_CR10","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1002\/eat.22715","volume":"50","author":"C Broomfield","year":"2017","unstructured":"Broomfield C, Stedal K, Touyz S, Rhodes P. Labeling and defining severe and enduring anorexia nervosa: a systematic review and critical analysis. Int J Eat Disord. 2017;50(6):611\u201323.","journal-title":"Int J Eat Disord"},{"issue":"1","key":"1715_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40337-014-0029-8","volume":"2","author":"L Clausen","year":"2014","unstructured":"Clausen L, Jones A. A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics. J Eat Disord. 2014;2(1):1\u201310.","journal-title":"J Eat Disord"},{"issue":"1","key":"1715_CR12","first-page":"21","volume":"24","author":"T Carney","year":"2005","unstructured":"Carney T, Tait D, Wakefield A, Ingvarson M, Touyz S. Coercion in the treatment of anorexia nervosa: Clinical, ethical and legal implications. Med Law. 2005;24(1):21\u201340.","journal-title":"Med Law"},{"key":"1715_CR13","doi-asserted-by":"publisher","first-page":"1094222","DOI":"10.3389\/fpsyt.2023.1094222","volume":"14","author":"AE Downey","year":"2023","unstructured":"Downey AE, Richards A, Tanner AB. Linear growth in young people with restrictive eating disorders:Inching toward consensus. Front Psychiatry. 2023;14:1094222.","journal-title":"Front Psychiatry"},{"issue":"10","key":"1715_CR14","doi-asserted-by":"publisher","first-page":"e2441719","DOI":"10.1001\/jamanetworkopen.2024.41719","volume":"7","author":"JM Nagata","year":"2024","unstructured":"Nagata JM, Lee S, Downey AE. Addressing Bone Health in Adolescents With Anorexia Nervosa\u2014No Bones About It. JAMA Netw open. 2024;7(10):e2441719.","journal-title":"JAMA Netw open"},{"issue":"4","key":"1715_CR15","doi-asserted-by":"publisher","first-page":"E298","DOI":"10.1001\/amajethics.2021.298","volume":"23","author":"M Lavoie","year":"2021","unstructured":"Lavoie M, Guarda AS. How Should Compassion Be Expressed as a Primary Clinical and Ethical Value in Anorexia Nervosa Intervention? AMA J Ethics. 2021;23(4):E298\u2013304.","journal-title":"AMA J Ethics"},{"issue":"1","key":"1715_CR16","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S2352-4642(22)00236-X","volume":"7","author":"K Tsiandoulas","year":"2023","unstructured":"Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, et al. Ethical tensions in the treatment of youth with severe anorexia nervosa. Lancet Child Adolesc Health. 2023;7(1):69\u201376.","journal-title":"Lancet Child Adolesc Health"},{"issue":"2","key":"1715_CR17","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1353\/ppp.2021.0022","volume":"28","author":"JH Radden","year":"2021","unstructured":"Radden JH. Food refusal, anorexia and soft paternalism: what\u2019s at stake? Philos Psychiatry Psychol. 2021;28(2):141\u201350.","journal-title":"Philos Psychiatry Psychol"},{"issue":"4","key":"1715_CR18","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1037\/a0021274","volume":"51","author":"K Bell","year":"2010","unstructured":"Bell K. Anorexia nervosa in adolescents: responding using the Canadian code of ethics for psychologists. Can Psychol. 2010;51(4):249\u201356.","journal-title":"Can Psychol"},{"issue":"3","key":"1715_CR19","first-page":"361","volume":"49","author":"RS Ramasamy","year":"2021","unstructured":"Ramasamy RS. Involuntary Treatment of Minors with Severe and Enduring Anorexia Nervosa. J Am Acad Psychiatry Law. 2021;49(3):361\u201370.","journal-title":"J Am Acad Psychiatry Law"},{"issue":"2","key":"1715_CR20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1192\/bjb.2022.11","volume":"47","author":"SJ Fuller","year":"2023","unstructured":"Fuller SJ, Chapman S, Cave E, Druce-Perkins J, Daniels P, Tan J. Nasogastric tube feeding under physical restraint on paediatric wards: ethical, legal and practical considerations regarding this lifesaving intervention. BJPsych Bull. 2023;47(2):105\u201310.","journal-title":"BJPsych Bull"},{"key":"1715_CR21","doi-asserted-by":"crossref","unstructured":"Bowers WA. Civil commitment in the treatment of eating disorders and substance abuse: Empirical status and ethical considerations. Eating disorders, addictions and substance use disorders: Research, clinical and treatment perspectives. New York, NY: Springer-Verlag Publishing\/Springer Nature; US. 2014: 649\u2009\u2013\u200964.","DOI":"10.1007\/978-3-642-45378-6_30"},{"issue":"6","key":"1715_CR22","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1002\/erv.1036","volume":"18","author":"JA Matusek","year":"2010","unstructured":"Matusek JA, O\u2019Dougherty Wright M. Ethical dilemmas in treating clients with eating disorders: a review and application of an integrative ethical decision-making model. Eur Eat Disord Rev. 2010;18(6):434\u201352.","journal-title":"Eur Eat Disord Rev"},{"issue":"4","key":"1715_CR23","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1177\/0011000003031004006","volume":"31","author":"JL Werth","year":"2003","unstructured":"Werth JL Jr., Wright KS, Archambault RJ, Bardash R. When does the duty to protect apply with a client who has anorexia nervosa? Couns Psychol. 2003;31(4):427\u201350.","journal-title":"Couns Psychol"},{"issue":"9391","key":"1715_CR24","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1016\/S0140-6736(03)14534-5","volume":"362","author":"J Tan","year":"2003","unstructured":"Tan J. The anorexia talking? Lancet. 2003;362(9391):1246.","journal-title":"Lancet"},{"issue":"4","key":"1715_CR25","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1353\/ppp.2019.0047","volume":"26","author":"S Giordano","year":"2019","unstructured":"Giordano S. Anorexia nervosa: a case for exceptionalism in ethical decision making. Philos Psychiatry Psychol. 2019;26(4):315\u201331.","journal-title":"Philos Psychiatry Psychol"},{"issue":"4","key":"1715_CR26","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1002\/1098-108X(200012)28:4<470::AID-EAT18>3.0.CO;2-1","volume":"28","author":"M Neiderman","year":"2000","unstructured":"Neiderman M, Zarody M, Tattersall M, Lask B. Enteric feeding in severe adolescent anorexia nervosa: a report of four cases. Int J Eat Disord. 2000;28(4):470\u20135.","journal-title":"Int J Eat Disord"},{"issue":"1","key":"1715_CR27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1176\/ajp.2007.164.1.9","volume":"164","author":"AE Andersen","year":"2007","unstructured":"Andersen AE. Eating disorders and coercion. Am J Psychiatry. 2007;164(1):9\u201311.","journal-title":"Am J Psychiatry"},{"issue":"6","key":"1715_CR28","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/0197-0070(89)90005-3","volume":"10","author":"TJ Silber","year":"1989","unstructured":"Silber TJ. Justified paternalism in adolescent health care. Cases of anorexia nervosa and substance abuse. J Adolesc Health Care. 1989;10(6):449\u201353.","journal-title":"J Adolesc Health Care"},{"issue":"2","key":"1715_CR29","first-page":"283","volume":"22","author":"TJ Silber","year":"2011","unstructured":"Silber TJ. Treatment of anorexia nervosa against the patient\u2019s will: ethical considerations. Adolesc Med State Art Rev. 2011;22(2):283\u20138. x.","journal-title":"Adolesc Med State Art Rev"},{"issue":"3","key":"1715_CR30","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1002\/erv.413","volume":"9","author":"RS Manley","year":"2001","unstructured":"Manley RS, Smye V, Srikameswaran S. Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision-making. Eur Eat Disord Rev. 2001;9(3):144\u201366.","journal-title":"Eur Eat Disord Rev"},{"issue":"2","key":"1715_CR31","first-page":"159","volume":"28","author":"JH Radden","year":"2021","unstructured":"Radden JH. Forced feeding for anorexia: Soft or hard paternalism? Philosophy. Psychiatry Psychol. 2021;28(2):159\u201362.","journal-title":"Psychiatry Psychol"},{"issue":"3","key":"1715_CR32","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1111\/1467-8519.00340","volume":"17","author":"S Giordano","year":"2003","unstructured":"Giordano S. Anorexia nervosa and refusal of naso-gastric treatment: a response to Heather Draper. Bioethics. 2003;17(3):261\u201378.","journal-title":"Bioethics"},{"issue":"8","key":"1715_CR33","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1002\/jclp.22783","volume":"75","author":"F Tury","year":"2019","unstructured":"Tury F, Szalai T, Szumska I. Compulsory treatment in eating disorders: control, provocation, and the coercion paradox. J Clin Psychol. 2019;75(8):1444\u201354.","journal-title":"J Clin Psychol"},{"issue":"4","key":"1715_CR34","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/S1262-3636(07)70284-7","volume":"32","author":"B Vialettes","year":"2006","unstructured":"Vialettes B, Samuelian-Massat C, Valero R, Beliard S. The refusal of treatment in anorexia nervosa, an ethical conflict with three characters: The girl, the family and the medical profession. Discussion in a French legislative context. Diabetes Metab. 2006;32(4):306\u201311.","journal-title":"Diabetes Metab"},{"issue":"1","key":"1715_CR35","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1080\/13218710802553136","volume":"16","author":"T Carney","year":"2009","unstructured":"Carney T, Anorexia. A role for law in therapy? Psychiatry. Psychol Law. 2009;16(1):41\u201359.","journal-title":"Psychol Law"},{"issue":"1","key":"1715_CR36","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijlp.2009.10.003","volume":"33","author":"JO Tan","year":"2010","unstructured":"Tan JO, Stewart A, Fitzpatrick R, Hope T. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. Int J Law Psychiatry. 2010;33(1):13\u20139.","journal-title":"Int J Law Psychiatry"},{"issue":"6","key":"1715_CR37","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.ijlp.2003.09.009","volume":"26","author":"JO Tan","year":"2003","unstructured":"Tan JO, Hope T, Stewart A, Fitzpatrick R. Control and compulsory treatment in anorexia nervosa: the views of patients and parents. Int J Law Psychiatry. 2003;26(6):627\u201345.","journal-title":"Int J Law Psychiatry"},{"issue":"3","key":"1715_CR38","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/1467-8519.00341","volume":"17","author":"H Draper","year":"2003","unstructured":"Draper H. Anorexia nervosa and refusal of naso-gastric treatment: a reply to Simona Giordano. Bioethics. 2003;17(3):279\u201389.","journal-title":"Bioethics"},{"key":"1715_CR39","doi-asserted-by":"publisher","first-page":"533288","DOI":"10.3389\/fpsyt.2020.533288","volume":"11","author":"L Clausen","year":"2020","unstructured":"Clausen L. Perspectives on involuntary treatment of anorexia nervosa. Front Psychiatry. 2020;11:533288.","journal-title":"Front Psychiatry"},{"issue":"5","key":"1715_CR40","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1097\/YCO.0b013e328305e45c","volume":"21","author":"C Thiels","year":"2008","unstructured":"Thiels C. Forced treatment of patients with anorexia. Curr Opin Psychiatry. 2008;21(5):495\u20138.","journal-title":"Curr Opin Psychiatry"},{"issue":"5","key":"1715_CR41","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1097\/YCO.0b013e32832c008d","volume":"22","author":"C Thiels","year":"2009","unstructured":"Thiels C, Curtice M Jr. Forced treatment of anorexic patients: part 2. Curr Opin Psychiatry. 2009;22(5):497\u2013500.","journal-title":"Curr Opin Psychiatry"}],"container-title":["Journal of Eating Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40337-026-01715-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40337-026-01715-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40337-026-01715-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:08:48Z","timestamp":1787634528000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40337-026-01715-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1715"],"URL":"https:\/\/doi.org\/10.1186\/s40337-026-01715-6","relation":{},"ISSN":["2050-2974"],"issn-type":[{"value":"2050-2974","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"assertion":[{"value":"16 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"199"}}