Eating Disorders Are Common in Prisons, Yet Care Guidelines Are Missing

People living in prisons, jails and forensic mental health facilities carry some of the heaviest burdens of psychological distress in society, yet one of the most dangerous and under-recognised forms of that distress has largely escaped scientific attention. A new scoping review published in the Journal of Eating Disorders has systematically mapped the research on eating disorders and disordered eating within forensic and correctional systems, and its findings paint a stark picture: these conditions appear to be strikingly common among incarcerated and forensic populations, especially women, but there are no setting-specific clinical guidelines, no validated screening tools, and almost no research on how to prevent or treat them behind bars.

The review, led by Amy Woods and Sarah Walker of La Trobe University’s School of Psychology and Public Health, together with Daniel Simsion of the Victorian Institute of Forensic Mental Health, Anita Raspovic and Leah Brennan, followed the PRISMA-ScR reporting guideline, with the protocol registered on the Open Science Framework. The team searched five major databases, MEDLINE, PsycINFO, Scopus, CINAHL and ProQuest, for peer-reviewed studies reporting on eating disorders or disordered eating among individuals with any forensic or correctional involvement. From 1,314 articles screened, only 29 met the inclusion criteria: 27 quantitative studies, one case study and one ethnography. That small body of evidence, spread across decades and jurisdictions, is what constitutes virtually the entire published record on the topic.

The risk factors that make this population vulnerable are well established in the broader eating disorder literature. Eating disorders and disordered eating occur at disproportionately high rates among people with elevated psychosocial risk, including Indigenous people, LGBTQIA individuals, and those with histories of trauma or mental illness. Each of these groups is overrepresented in prisons and forensic settings. Trauma and substance use, in particular, are strongly linked to disordered eating, and both are endemic in correctional populations. The review found that past trauma and past substance use frequently co-occurred with eating pathology in the studies it examined, reinforcing the picture of a population in which multiple vulnerabilities converge.

Prevalence figures varied across the included studies, but the overall trend was clear and concerning: rates of eating disorders and disordered eating trend high in forensic and correctional settings, particularly in women’s prisons. This aligns with community data showing that women experience eating disorders at higher rates than men, but the correctional context adds unique pressures, including restricted food access, loss of control over eating routines, body-focused stigma and the psychological strain of confinement, that may shape or exacerbate disordered eating behaviours in ways community research does not capture.

Perhaps the most alarming gaps concern who is missing from the evidence. The reviewed studies focused mostly on women in prisons, with limited data on men and, remarkably, no studies at all on transgender or gender-diverse individuals. Given that LGBTQIA people face elevated eating disorder risk in the community and are also overrepresented in the justice system, this absence represents a substantial blind spot. The review also found a lack of consistent data collection tools across studies, making it difficult to compare prevalence estimates or build a coherent epidemiological picture, and little research exploring the lived experience of incarcerated people with eating pathology or the perspectives of correctional and health staff who work alongside them.

The clinical consequences of this evidence vacuum are concrete. In community settings, eating disorders are typically supported through stepped levels of care, engagement with evidence-based treatments such as cognitive behavioural therapy or family-based approaches, and adjunct recovery supports. These services remain largely inaccessible to people who are incarcerated, who made up the majority of individuals considered in the studies reviewed. Instead, the review found that eating disorder behaviours in institutional settings are being responded to through suicide and self-harm protocols, including seclusion and restraint. Such responses treat the visible symptom, food refusal or self-harm, without addressing the underlying disorder, and may in fact worsen distress in vulnerable individuals.

The authors highlight that no forensic or correctional specific eating disorder guidelines or validated screening tools exist anywhere in the literature they reviewed. This leaves correctional health services without an evidence base for identifying who needs help, deciding what treatment to provide, or training staff to recognise the often-hidden signs of disordered eating. The review’s recommendations are correspondingly direct: routine screening for eating disorders and disordered eating on entry and during incarceration, the development of evidence-based, eating-disorder-targeted interventions adapted to secure environments, and staff training so that correctional officers and health professionals can recognise and respond appropriately.

There is also a rehabilitation dimension that extends beyond individual suffering. The review notes a limited understanding of the links between eating pathology and criminal behaviour, and of how untreated eating disorders might influence criminogenic needs or rehabilitation outcomes. Because eating disorders carry among the highest mortality rates of any psychiatric illness, and because disordered eating intertwines with trauma, substance use and self-harm, leaving them unaddressed in custodial settings may undermine the broader goals of correctional health and rehabilitation. The authors argue that targeted research and the development of prevention and treatment protocols for forensic and correctional settings are urgently needed.

The review, conducted in partial completion of a Doctorate of Public Health at La Trobe University and supported by the Australian Eating Disorder Research and Translation Centre Publication Support Project, ultimately serves as both a map and a warning. It confirms that eating disorders and disordered eating are prevalent among people in the forensic and correctional system, that the evidence base is thin, fragmented and demographically narrow, and that the systems responsible for the health of incarcerated people currently lack the tools to respond. Until screening, inclusive research, trauma-informed care and setting-specific treatment protocols are developed, hundreds of thousands of people in custody worldwide with eating pathology will continue to go unidentified and untreated, their illness managed only through crisis protocols never designed for it.

Subject of Research: Prevalence and management of eating disorders and disordered eating among people in forensic and correctional settings

Article Title: Eating disorders and disordered eating in the forensic and correctional system: a scoping review

Article References: Woods, A., Walker, S., Simsion, D., Raspovic, A., & Brennan, L. (2026). Eating disorders and disordered eating in the forensic and correctional system: a scoping review. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01761-0

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01761-0

Keywords: eating disorders, disordered eating, forensic mental health, correctional health, prison, incarceration, scoping review, trauma, substance use, screening, women's prisons, rehabilitation