The stakes of the question are high. Untreated anorexia nervosa is life-threatening and disabling, carrying the second highest mortality rate of all psychiatric disorders, exceeded only by opioid use disorder, with deaths driven both by medical complications and by suicide. Lifetime prevalence reaches up to four percent among females and 0.3 percent among males, and incidence in adolescents appears to be rising. Roughly half of those affected have psychiatric comorbidity, and depression and high anxiety are linked to poor long-term prognosis. Although outpatient care, particularly family-based treatment, is the recommended first line for adolescents, the most severely ill patients, those with life-threatening weight loss, physiological instability or deterioration despite maximal outpatient efforts, often require inpatient admission, sometimes under Sweden’s Compulsory Psychiatric Care Act, which permits treatment without patient consent.

The researchers recruited participants from the child and adolescent psychiatric emergency unit at University Hospital in Malmö, the only such unit in a region of 1.4 million people, which maintains eight inpatient beds dedicated to severe eating disorders. Of 28 potentially eligible adolescents admitted between January 2021 and December 2023, seven agreed to participate. Their average stay had lasted 18 weeks, ranging from four to 38 weeks, six had experienced multiple treatment periods, and six had been admitted involuntarily, some more than once. On average they had been ill for about ten months before their first admission, and by the time they arrived they could no longer attend school or after-school activities. Interviews, averaging 90 minutes, took place 13 to 24 months after discharge, when all participants were stabilized and in full or partial remission.

The analysis followed three steps: a naïve reading of the transcripts, a structural analysis dividing the text into meaning units and themes, and a final comprehensive understanding discussed by the whole team. To guard against bias, the researchers explicitly discussed their pre-understanding of eating disorders and compulsory treatment, and two participants were invited to review and confirm the structural analysis, which both did. What emerged was a powerful central metaphor: the girls described existing in a power struggle, a battle zone with four distinct fronts. They were fighting, simultaneously, against the healthcare professionals, against the eating disorder itself, against fellow patients, and against their parents.

The battle with staff was the most visible front. Compulsory care for severe starvation involves surveillance, weight control and supervised meals, and the participants described feeling restricted, oppressed and stripped of all autonomy. Some recalled being threatened with feeding tubes and experiencing nutritional support as punishment rather than therapy. They reported mixed signals from staff about rules and restrictions, producing profound insecurity, and they felt mistrusted and monitored while eating. Most painfully, many described being approached as an eating disorder rather than as a person, feeling deprived of their human dignity, inherent value and responsibility for their own actions. One participant put it bluntly: care cannot fight the eating disorder, only she could, and for that she needed personalized treatment rather than a focus on pathology alone.

Uncertainty compounded the distress. The girls said staff did not always explain the rationale behind decisions, leaving them confused and lonely, and in retrospect they recognized that starvation itself had limited their cognitive capacity, deepening their despair. Some described suicidal thoughts during this period. Yet the analysis also identified a theme of surrendering, in which some participants came to accept that total autonomy was not an option while medically unstable, and a few even appreciated being disburdened from the pressure of managing the illness alone. This ambivalence, resentment of coercion alongside recognition of its necessity, runs through the entire study and captures the paradox clinicians face when treating patients who lack insight into their own condition.

The second front, the fight against the disorder itself, began in denial. Participants initially rejected the idea that they were sick and struggled to understand the condition. Staff encouraged them to view the anorexia as an external entity separate from the self, a technique known as externalization that is common in eating disorder treatment. But the girls experienced this dualistically: they felt simultaneously identical to the disorder and subjected to it, and when staff focused narrowly on weight, food intake and forced nutrition, the part that constituted their self went unconfirmed, producing a profound sense of fighting an entirely solitary battle. They endured acute somatic consequences such as hypoglycaemia, nausea and vomiting, and while they accepted somatic care as necessary, they wished staff would support their psychological fight rather than attempting to fight the disorder for them.

The two remaining fronts were quieter but no less corrosive. Among fellow patients, the girls described a silent war of constant observation, monitoring each other’s portions, movements around the ward and feeding tubes, comparisons that triggered panic and, disturbingly, normalized extreme thinness. At the same time they felt empathy and a kind of communion with peers in the same boat. The battle with parents was shaped by the unit’s structure: mothers, who were the primary accompanying caregivers in six of seven cases, slept in the same room, shared meals and participated in monitoring eating, producing situations filled with tension and conflict that eroded trust within the mother-daughter relationship. Fathers were largely absent, and the daughter-father dynamic was described as tense and distanced, suggesting the family, potentially the strongest resource for recovery, was drawn into an unnecessary battle of its own.

Despite the suffering described, the study’s comprehensive understanding is not a condemnation of compulsory care. Within six months to two years after discharge, all participants had become reconciled with the experience, recognizing that the involuntary hospital treatment had been a necessary turning point for their survival, even if the methods remained problematic. They recovered by eventually finding inner motivation and strength, and all had returned to school, friends and family activities. The authors argue that this reconciliation is possible precisely because clinicians can learn from the four-front framework: by acknowledging the power struggle openly with patients and families, confirming the patient’s suffering to restore dignity, strengthening parents to carry out family-based treatment components, and providing the psychological support and peer support that participants repeatedly requested, wards may be able to reduce iatrogenic harm without compromising medical safety.

The authors acknowledge limitations: only girls were included, limiting generalizability to male patients, and the sample was small, though the participant-driven interviews were extensive and the study was judged to have sufficient information power. Recall bias is also possible given the 13-to-24-month interval, although the authors considered this distance valuable for reflection. Methodologically, the study distinguishes the outside, professional perspective on disease from the inside, personal perspective, arguing both are valid and essential for person-centred care, which Swedish national guidelines mandate for all care processes including compulsory psychiatric treatment. The clinical significance of the findings lies in concrete implications for patient empowerment and counselling, psychosocial therapy, in-hospital guidance and the differing ways adolescents learn about their illness. For a disorder whose treatment demands cooperation from patients who cannot yet see why they need it, listening to the narrative and establishing a partnership, the essence of person-centred care, may be the difference between a battle zone and a turning point.

Subject of Research: Adolescents' lived experience of compulsory inpatient care for severe anorexia nervosa

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

Article References: Henningsson, H., Forsberg, A., Eberhard, S., Johansson, B. A., & Rask, O. (2026). Existing in a Battle Zone – The Lived Experience of Adolescents Subjected to Hospital Compulsory Care Due to Severe Anorexia Nervosa. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-026-02101-8

Image Credits: AI Generated

DOI: 10.1007/s10578-026-02101-8

Keywords: anorexia nervosa, adolescents, compulsory care, inpatient treatment, eating disorders, qualitative research, phenomenological hermeneutics, person-centred care, psychiatry, family-based treatment, Sweden, mental health

The review, registered prospectively on PROSPERO and updated through repeated searches in June 2024, April 2025 and May 2026, cast a deliberately wide net. The researchers included quantitative intervention studies involving adults with longstanding and severe eating disorders, with no restrictions on diagnosis, type of intervention or treatment setting. After screening, they identified seventeen main empirical studies, reported across twenty publications, together with eight additional case reports or case studies. The dominant participant profile was female, and the dominant diagnosis was anorexia nervosa, reflecting the composition of the severe and enduring eating disorder population as it presents in specialist services. Crucially, most of the included studies reported real-world clinical data drawn from actual treatment services rather than from tightly controlled trial environments, which gives the synthesis an unusually strong ecological validity even as it exposes the fragility of the underlying evidence base.

The interventions examined spanned the full breadth of modern practice. Specialist inpatient treatment programs, high-calorie re-alimentation protocols, integrated pathways built around enhanced cognitive behavioral therapy, standalone outpatient care, digital and virtual transition support, pharmacological treatments, neuromodulation and even neurosurgery all came under scrutiny. Yet despite this breadth of therapeutic activity, the review found only two level II randomized controlled trials in the entire literature. One of those trials tested whether adding a low-intensity digital self-management program after intensive treatment could sustain recovery, and found no added benefit. The other, conducted in a small inpatient sample of patients with eating disorders and comorbid post-traumatic stress disorder, reported preliminary benefits from adjunctive infra-low frequency neurofeedback. The scarcity of randomized evidence for one of psychiatry’s highest-morbidity populations is itself one of the most striking findings of the review.

Against that limited trial evidence, the level III cohort studies told a more coherent story. Specialist inpatient treatment and intensive integrated care pathways were consistently associated with improvements in body mass index, eating disorder psychopathology, broader psychological symptoms, day-to-day functioning and, where it was assessed, quality of life. The clearest signal of benefit, the authors report, emerged from integrated pathways that combined collaborative psychological treatment, weight restoration into the normal range, and continuity of care across different levels of the health system, from inpatient admission through to supported outpatient follow-up. In other words, it was not any single therapeutic ingredient but the combination and the continuity that appeared to drive recovery in this hardest-to-treat group.

Perhaps the most consequential clinical insight from the synthesis concerns what does and does not predict outcome. Duration of illness, long treated as a proxy for hopelessness, was not a consistent predictor of how patients fared. What mattered far more was discharge body mass index within the healthy range, which was associated with good outcomes at follow-up. That single observation carries an enormous practical weight: it reframes the therapeutic goal from simply managing an incurable condition toward actively achieving and maintaining physiological restoration as the foundation for psychological recovery. Standalone outpatient treatment and low-intensity digital transition support, by contrast, showed only limited benefits in this population, suggesting that severely unwell adults may require more intensive, structured and supervised care than routine community services typically provide.

The less conventional arms of the evidence base were far less encouraging. Studies of pharmacological interventions, neuromodulation techniques and neurosurgical procedures were small, largely uncontrolled, and produced inconsistent effects on the core outcomes that matter in eating disorders, such as weight restoration, reduced food-related anxiety and normalized eating behavior. For a field in which deep brain stimulation and experimental pharmacotherapy occasionally generate dramatic headlines, the review’s sober verdict functions as an important corrective: the most reliable gains currently come from well-organized, multidisciplinary clinical care, not from technological interventions that remain at an experimental stage.

The authors are candid about the limitations of the literature they synthesized. This is a heterogeneous patient group with high rates of psychiatric and medical comorbidity, yet many studies provided little information on ethnicity, socioeconomic background, comorbid conditions or the legal treatment status of participants. Definitions of what constitutes longstanding or severe eating disorder varied across studies, making direct comparison difficult. Observational designs dominated, follow-up periods were generally short, and reporting of outcomes that patients and families prioritize, including quality of life, relapse, readmission and treatment acceptability, was inconsistent. These weaknesses do not undermine the central conclusion that improvement is possible, but they do mean clinicians and policymakers must interpret the magnitude and durability of those improvements with appropriate caution.

The implications reach well beyond academic debate. In several countries, including the United Kingdom, insurers and health systems have at times restricted access to intensive eating disorder treatment for patients judged to have chronic, unremitting illness, on the reasoning that prolonged disease duration predicts poor response. By showing that illness duration alone does not forecast outcome, while achieving a healthy weight and sustained psychological support does, the review provides an evidence-based argument for expanding rather than rationing access to integrated care. It also aligns with the growing involvement of people with lived experience in eating disorder research; the author team itself includes a peer researcher with lived experience, and the authors call for future studies to prioritize lived-experience perspectives alongside comorbidity, legal status and continuity of care.

The review’s agenda for future research is explicit. The authors call for standardized definitions and outcome reporting so that studies can be compared and pooled, for implementation research that examines how integrated pathways can be scaled in real health systems, for longer follow-up periods that capture relapse and sustained recovery, and for trials that deliberately include the comorbidities and legal complexities that characterize real clinical populations. Until that evidence arrives, the message for patients, families and clinicians is one of qualified hope. Adults whose eating disorders have endured for years are not beyond help. The treatment that works best is demanding, multidisciplinary and continuous, combining nutritional rehabilitation to a healthy weight with evidence-based psychotherapy and seamless support after discharge, and the review makes clear that the real barrier to recovery for many patients may not be their diagnosis or its duration, but the assumption that treatment is futile.

Subject of Research: Treatment interventions for adults with longstanding and severe eating disorders

Article Title: Treatment interventions for longstanding and severe eating disorders: an updated systematic review and narrative synthesis

Article References: Ayton, A., Kumar, A., Downs, J., Boniface, S., & Treasure, J. (2026). Treatment interventions for longstanding and severe eating disorders: an updated systematic review and narrative synthesis. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01722-7

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01722-7

Keywords: eating disorders, anorexia nervosa, systematic review, CBT-E, nutritional rehabilitation, weight restoration, inpatient treatment, treatment outcomes, integrated care, digital interventions, continuity of care, Journal of Eating Disorders

Substance use disorders represent one of the most formidable public health burdens in the Americas, where they stand as the leading cause of premature death and disability. The scale of the problem is stark: substance use is implicated in a substantial share of deaths among the world’s adult population, and effective treatment remains one of the most powerful tools available for reducing that toll. Yet treatment only works if people stay in it. Dropout is a persistent and corrosive weakness across virtually every model of addiction care, shortening exposure to interventions, undermining therapeutic momentum, and returning patients to the very environments that may have fueled their substance use in the first place. Understanding who drops out, and when, has therefore become a central question for researchers and clinicians alike.

The new research, published in Addiction Science & Clinical Practice, turned to an unusually rich source of evidence: Chile’s national registry of patients receiving publicly funded treatment for substance use disorders between 2010 and 2019. The investigators focused on emerging adults, those aged 18 to 29, a developmental window marked by instability, identity formation, and heightened vulnerability to both substance use and treatment disengagement. From the registry they assembled a retrospective cohort of 23,979 young adults and classified each person’s living arrangement at the moment they entered treatment into three categories: living alone, living with family of origin, or living with a partner and children. The question was deceptively simple. Did the shape of a patient’s household predict how long they stayed in treatment?

Answering it rigorously required sophisticated statistical machinery. People who live alone are not randomly different from those who live with family; they may differ in age, severity of addiction, employment, education, mental health, and a host of other characteristics that independently influence retention. To disentangle these threads, the researchers used inverse probability of treatment weighting, a technique built on multinomial logistic propensity scores that statistically balances the comparison groups on observed baseline differences. Survival analysis methods, including weighted Kaplan–Meier estimation, were then applied to track how the probability of remaining in treatment evolved over time. The team also computed the restricted mean survival time, a measure that captures the average duration of retention within a defined window and offers an intuitive summary of the survival curves that complements traditional hazard-based approaches.

Crucially, the analysis was stratified by treatment setting, separating outpatient programs from inpatient and residential care, because the two environments place very different demands on patients. The results painted a consistent picture. Young adults living with their family of origin or with a partner and children had a higher probability of remaining in treatment than those living alone, and the gap was widest in inpatient programs. At six months, the probability of still being in treatment was 0.54 for those living with family of origin and 0.57 for those living with a partner or children, compared with just 0.41 for those living alone. At twelve months, the pattern held: 0.43 and 0.44 for the cohabiting groups against 0.33 for those living solo. In other words, nearly six in ten socially connected patients were still engaged at the six-month mark in inpatient care, while fewer than half of those living alone remained.

The restricted mean survival time analysis reinforced the message. Among inpatient participants, the one-year RMST reached 0.60 for those living with family of origin and 0.62 for those living with a partner or children, but only 0.49 for those living alone, a retention gap that translates into weeks of additional engagement over the first year of care. Notably, the two cohabiting groups did not differ from each other in the inpatient setting; whether the anchor was parents, siblings, or one’s own partner and children, the protective effect of shared living appeared comparable. Outpatient programs told a subtler story. There, the differences between living arrangements were modest, and the most consistent contrast emerged between those living with family of origin and those living with a partner and children, suggesting that the protective architecture of the household may interact with the intensity and structure of the treatment modality itself.

Why would a shared household buffer against dropout? The authors point to the central role of social bonds. Family members and partners can provide practical scaffolding, transportation to appointments, reminders, financial support, a stable place to sleep, as well as emotional accountability, the diffuse but powerful sense that someone notices when you fail to show up. For emerging adults, whose ties to education, employment, and institutions are often still fragile, these bonds may carry particular weight. Residential and inpatient treatment, which requires a deliberate withdrawal from daily life, may be especially difficult to sustain without a household invested in one’s return and recovery. Conversely, young adults living alone may face treatment environments that inadvertently ask them to be their own support system, a demand that substance use disorders themselves make harder to meet.

The study’s implications reach well beyond Chile. Many national treatment systems, including those in high-income countries, collect detailed clinical data on substance use severity, psychiatric comorbidity, and treatment modality, yet rarely capture living arrangements as a structured variable at intake. This research suggests that a single intake question, who do you live with, could help identify patients at elevated risk of early disengagement and trigger targeted supports, from peer outreach and case management to deliberate family involvement in treatment planning. The findings also resonate with systems and family therapy traditions that view addiction not merely as an individual pathology but as a condition embedded in relational networks. Interventions that strengthen those networks, or that compensate for their absence, may hold untapped value for the youngest and most precarious patients.

Certain caveats deserve emphasis. As a retrospective cohort study, the analysis can establish association but not causation; unmeasured characteristics, such as motivation for recovery, quality of family relationships, or neighborhood context, could partly explain the observed differences. Living arrangements were assessed at treatment entry and may have changed during follow-up. The study also examined public-sector treatment in a single country, and Chile’s specific service configuration may shape how household context interacts with care. Nevertheless, the sheer size of the cohort, the decade-long observation window, and the rigor of the statistical design give the findings unusual credibility for observational research in this field, and Chile’s advanced monitoring infrastructure makes the dataset one of the strongest of its kind in Latin America.

The broader lesson is one that clinicians and policymakers are increasingly being asked to internalize: recovery is not enacted in a vacuum. For young adults, the developmental crucible in which identities, careers, and relationships are forged, the presence of a stable relational anchor may be the difference between a treatment episode that endures and one that dissolves within months. As the authors conclude, effective strategies for substance use disorders must take social support into account, recognizing the potential positive impact of familial and relational bonds during the critical phase of emerging adulthood. In a decade of data from nearly 24,000 patients, the signal is difficult to ignore: the people waiting at home may be among the most powerful, and least expensive, therapeutic assets a treatment system has.

Subject of Research: The association between living arrangements and time to dropout from substance use disorder treatment among emerging adults in Chile.

Article Title: Association between living arrangements and time to drop out in patients between 18 and 29 years of age, under treatment for substance abuse disorders in Chile, 2010–2019

Article References: Association between living arrangements and time to drop out in patients between 18 and 29 years of age, under treatment for substance abuse disorders in Chile, 2010–2019. (n.d.). https://doi.org/10.1186/s13722-026-00721-y

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00721-y

Keywords: substance use disorders, treatment dropout, living arrangements, emerging adults, treatment retention, social support, inpatient treatment, outpatient treatment, Chile, survival analysis, family bonds, public health