Existing in a Battle Zone – The Lived Experience of Adolescents Subjected to Hospital Compulsory Care Due to Severe Anorexia Nervosa

Abstract When untreated, anorexia nervosa is a life-threatening and disabling condition with the second highest mortality rate of all psychiatric disorders. In this study we undertook an in-depth exploration of adolescent girls’ experience of inpatient compulsory care due to severe anorexia nervosa, aiming to better understand the complexity of the disorder and facilitate improvements in care standards. We used Lindseth and Norberg’s phenomenological hermeneutic approach and conducted in-depth interviews with seven girls with a mean age of 15.3 years who had experienced inpatient psychiatric care in a Swedish context for severe anorexia nervosa. Data analysis took place in three steps: naïve reading, structural analysis and finally comprehensive understanding. The participants experienced a power struggle involving battles on four different fronts, namely fighting against healthcare professionals, the eating disorder, fellow patients and parents. Compulsory inpatient care due to severe starvation included surveillance, weight control and supervised meal situations. In this phase of the illness the girls described being approached as an eating disorder rather than a person, often feeling deprived of their human dignity, inherent value and responsibility for their actions. The fight against the eating disorder was difficult, starting in denial and efforts to understand the condition. The inner perspectives on inpatient care for anorexia nervosa raise clinical considerations encompassing patient empowerment and counselling, psychosocial therapy, guiding while in hospital and patients’ differing ways of learning about their illness. There is a risk that girls with anorexia nervosa are approached as a disorder during compulsory care, thus hampering person-centred processes. The perception of fighting a multi-front battle makes inpatient care extremely challenging for patients, parents and caregivers. Nevertheless, reconciliation is possible, despite the sufferings described during the compulsory care phase of the disorder.