Behavioral Consequences of Force-feeding

  • Malgorzata StarzomskaEmail author
  • Marek Smulczyk


Food refusal may occur for a variety of reasons. For example, it may be used as a method of ­exercising control over others (either at family or society level), as a method of self-harm, or even as a way of committing suicide. It is sometimes a symptom of mental illness. Thus, management of self-starvation depends on the motivation behind it, and consequently, on specification of the extent to which incompetence influences the decision to refuse food. Forcible feeding is the most frequent behavioral intervention in the case of severely emaciated individuals but is it the only way in which they can be helped? Clearly, each case is very specific but it is important to try to analyze the unique character of food refusal and the difficulties involved in forcible feeding of emaciated individuals, at least on several examples. The author has chosen hunger strikes and anorexia nervosa to illustrate, among other things, the consequences of forcible feeding and the practical implications for therapy.


Palliative Care Anorexia Nervosa Eating Disorder Bulimia Nervosa Tube Feeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Motto The Good Samaritan deserves sympathetic support, officious intermeddling must be discouraged (Anon. 1974). Abbreviation


Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision



Malgorzata Starzomska and Marek Smulczyk are very grateful to professor Helena Yanet Grzegolowska-Klarkowska for her invaluable assistance.


  1. Anon. BMJ. 1974;2:737–8.Google Scholar
  2. Beumont P, Carney T. Aust N Z J Psychiatry. 2004;38:819–32.PubMedCrossRefGoogle Scholar
  3. Brockman B. J Med Ethics. 1999;25:451–6.PubMedCrossRefGoogle Scholar
  4. Castro J, Deulofeu R, Gila A, Puig J, Toro J. Int Eat J Disord. 2004;35:169–78.CrossRefGoogle Scholar
  5. Corcos M, Guilbaud O, Paterniti S, Chambry J, Chaouat G, Consoli SM, Jeammet P. Psychoneuroendocrinology. 2003;28:229–49.PubMedCrossRefGoogle Scholar
  6. Draper H. Bioetics. 2000;14:120–33.CrossRefGoogle Scholar
  7. Dresser R. Wis L Rev. 1984;2:297–374.Google Scholar
  8. Dyer C. BMJ. 2000;320:731.PubMedCrossRefGoogle Scholar
  9. Finfgeld DL. Arch Psychiatr Nurs. 2002;16:176–86.PubMedCrossRefGoogle Scholar
  10. Gans M, Gunn WB. Int J Law Psychiatry. 2003;26:677–95.PubMedCrossRefGoogle Scholar
  11. Gowers SG, Weetman JSA, Hossain F, Elvins R. Br J Psychiatry. 2000;176:138–41.PubMedCrossRefGoogle Scholar
  12. Griffiths RA, Beumont PJV, Russell J. Aust N Z J Psychiatry. 1997;31:525–31.PubMedCrossRefGoogle Scholar
  13. Harris, WA, Wiseman, CV, Wagner, S, Halmi, KA. In: Dewan MJ, Pies RW, editors. The difficult-to-treat psychiatric patient. Washington: American Psychiatric Publishing, Inc.; 2001. p. 243–271.Google Scholar
  14. Higginson I, Bruera E (ed). Cachexia-anorexia in cancer patients. Oxford: Oxford University Press; 1996.Google Scholar
  15. Holtkamp K, Hebeband J, Mika C, Grzella I, Heer M, Heussen N, Herpertz-Dahlmann B. J Psychiatr Res. 2003;37:165–9.PubMedCrossRefGoogle Scholar
  16. Kenny M, Silove D, Steel Z. Med J Aust. 2004;180:237–40.PubMedGoogle Scholar
  17. Lemma-Wright AL. Starving to live. The paradox of anorexia nervosa. London: Central Book Publishing; 1994.Google Scholar
  18. Levens M. Eating disorders and magical control of the body. Treatment through art therapy. London: Routledge; 1995.CrossRefGoogle Scholar
  19. Lewey L. Can Med Assoc J. 1977;116:416–9.PubMedGoogle Scholar
  20. MacDonald C. Can J Psychiatry. 2002;47:267–70.PubMedGoogle Scholar
  21. Malan D. Anorexia, murder, and suicide. What can be learned from the stories of three remarkable patients. Oxford: Butterworth Heinemann; 1997.Google Scholar
  22. Manley RS, Leichner P. Crisis. 2003;24:32–6.PubMedCrossRefGoogle Scholar
  23. Mehran F, Leonard T, Samuel-Lajeunesse B. Eur Eat Disord Rev. 1999;7:111–20.CrossRefGoogle Scholar
  24. Melamed Y, Mester R, Margolin J, Kalian M. Int J Law Psychiatry. 2003;26:617–26.PubMedCrossRefGoogle Scholar
  25. Nicholl DJ, Atkinson HG, Kal J, Hopkins W, Elias E, Siddiqui A, Cranford RE, Sacks O. Lancet. 2006;367:811.PubMedCrossRefGoogle Scholar
  26. Oguz NY, Miles SH. J Med Ethics. 2005;31:169–72.PubMedCrossRefGoogle Scholar
  27. Patton GC. Psychol Med. 1988;18:947–51.PubMedCrossRefGoogle Scholar
  28. Review of the Mental Health Act 1983 (Report of the Expert Committee). 1999. Available at: Accessed 30 May 2009.
  29. Robb AS, Silber TJ, Orrell-Valente JK, Valadez-Meltzer A, Ellis N, Dadson MJ, Chatoor I. Am J Psychiatry. 2002;159:1347–53.PubMedCrossRefGoogle Scholar
  30. Serpell L, Treasure J. Int J Eat Disord. 2002;32:164–70.PubMedCrossRefGoogle Scholar
  31. Serpell L, Teasdale JD, Troop NA, Treasure J. Int J Eat Disord. 2004;36:416–33.PubMedCrossRefGoogle Scholar
  32. Sheldon T. BMJ. 1997;315:327–32.PubMedCrossRefGoogle Scholar
  33. Strauss SA. ML. 1991;10:211–18.Google Scholar
  34. Su JC, Birmingham CL. Eat Weight Disord. 2003;8:76–9.PubMedGoogle Scholar
  35. Tan J, Hope T, Steward A. Int J Law Psychiatry. 2003a;26:697–707.PubMedCrossRefGoogle Scholar
  36. Tan J, Hope T, Steward A, Fitzpatrick R. Int J Law Psychiatry. 2003b;26:627–45.PubMedCrossRefGoogle Scholar
  37. Tan J, Hope T, Steward A. Int J Law Psychiatry. 2003c;26:533–48.PubMedCrossRefGoogle Scholar
  38. The Declaration on Hunger Strikers (Declaration of Malta). 1991. Available at: Accessed 29 May 2009.
  39. Treasure J, Ramsay R. Maudsley Discussion Papers. 2002;3:1–20.Google Scholar
  40. Wilks M. BMJ. 2006;332:560–1.PubMedCrossRefGoogle Scholar
  41. Williams Y. MYCY. 2001;40:285–96.Google Scholar
  42. Wynia MK. MGM. 2007;9:5.Google Scholar
  43. Zerbe KJ. Bull Menninger Clin. 1993;57:161–77.PubMedGoogle Scholar
  44. Zuercher JN, Cumella EJ, Woods BK, Eberly M, Carr JK. J Parenter J Enteral Nutr. 2003;27:268–76.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.The Maria Grzegorzewska Academy of Special EducationInstitute of Applied PsychologyWarsawPoland

Personalised recommendations