Psychiatric Holds and Eating Disorders: Understanding the Process and When It’s Necessary
Safety, Stabilization, and the Role of Involuntary Intervention in Eating Disorder Care
Eating disorders are serious, life-threatening illnesses. While they are often treated in outpatient or residential settings, there are times when someone becomes medically or psychiatrically unstable to the point that emergency intervention — including a psychiatric hold — becomes necessary to preserve life and safety.
The idea of a psychiatric hold can be frightening for individuals and families. It can raise questions like:
“Will my child be taken against their will?”
“What qualifies someone for a hold?”
“Does this mean they’re ‘crazy’?”
“How does this relate to eating disorder treatment?”
This blog will break down what psychiatric holds are, when they’re used in the context of eating disorders, and how to approach the process with compassion, clarity, and advocacy.
What Is a Psychiatric Hold?
A psychiatric hold (also known as an involuntary hold, civil commitment, or 5150/1013 depending on the state) is a legal process that allows medical or mental health professionals to temporarily detain someone in a hospital or psychiatric facility when they are deemed a danger to themselves or others, or unable to care for themselves due to a mental illness.
Each state in the U.S. has specific criteria and time limits, but most emergency holds last 72 hours, during which a full evaluation is conducted.
How This Applies to Eating Disorders
While eating disorders are mental health conditions, they often present with complex medical and psychiatric risk factors. A person may be placed on a psychiatric hold if their condition meets criteria such as:
1. Medical Instability Due to Malnutrition or Purging
Critically low heart rate (bradycardia)
Low blood pressure or temperature
Risk of cardiac arrest due to electrolyte imbalances (especially in purging disorders)
Inability or refusal to take in nourishment despite life-threatening risk
These cases may be framed as “grave disability” or “imminent risk to self,” even if the individual denies suicidal intent — because malnutrition can cause death, and the brain is compromised in its ability to assess danger.
2. Active Suicidal Ideation or Self-Harm
Eating disorders are highly comorbid with depression, self-injury, and suicidal thinking. If a person expresses intent or has a plan to harm themselves, a psychiatric hold may be required to ensure safety and provide stabilization.
3. Extreme Behavioral Risk
Some individuals with severe eating disorders may engage in:
Repeated refusal of food, hydration, or medication
Attempts to remove feeding tubes or leave the hospital
Severe agitation, psychosis, or delusional thinking related to body image
In these cases, a hold may be considered to interrupt dangerous patterns long enough to assess psychiatric needs and develop a safer treatment plan.
What Happens During a Psychiatric Hold
While protocols vary by state and hospital, here is a general outline of what to expect:
Evaluation: A physician, licensed mental health provider, or emergency department team determines whether criteria for a hold are met.
Initiation: If a hold is placed, the individual may be transferred to a psychiatric unit or medical stabilization unit.
Observation and Treatment: Over the next 72 hours (or longer if extended), the patient receives:
Medical monitoring
Psychiatric evaluation
Crisis intervention and safety planning
Determination of next steps (voluntary treatment, step-down care, or legal proceedings)
In some cases, families are involved in discharge planning or court hearings if the hold is extended (e.g., a 14-day involuntary treatment stay).
When a Hold May Be Necessary — but Also Complex
What Makes This Especially Difficult in Eating Disorders
Lack of insight: Malnutrition can impair brain function and judgment, leading individuals to deny the severity of their illness.
Fear of weight gain: Refeeding in hospitals may feel terrifying, even if medically necessary.
History of trauma or invalidation: Involuntary treatment can feel retraumatizing or coercive, especially without trauma-informed care.
Legal and ethical tensions: The balance between autonomy and safety is delicate — and sometimes, saving a life requires urgent action.
How to Approach a Hold with Compassion
For Families and Loved Ones
Know that a hold is not a punishment — it’s a medical crisis response.
Stay informed about your child’s rights, treatment, and next steps.
Be present as a supportive, non-judgmental advocate during and after the hold.
Consider involving legal or clinical professionals to help with appeals or care transitions if needed.
For Providers
Explain clearly and calmly why a hold is being considered.
Use trauma-informed language, emphasizing care and safety rather than control.
Ensure that gender-affirming, culturally competent, and respectful care is prioritized in any holding facility.
When possible, transition to voluntary care as soon as safety is restored.
What Happens After a Hold?
A psychiatric hold is a short-term stabilization tool, not a long-term treatment plan. Most patients will need follow-up care that may include:
Medical stabilization in a specialized eating disorder unit
Inpatient or residential eating disorder treatment
Intensive outpatient (IOP) or partial hospitalization (PHP) programs
Psychiatric and nutritional care coordination
Ongoing therapy and family support
Rebuilding trust after an involuntary hold is essential. Many individuals feel confused, angry, or ashamed — especially if they don’t fully understand what happened. Processing the experience with a trauma-informed therapist is critical for long-term recovery.
Final Thought
Psychiatric holds are complex, emotionally charged, and sometimes lifesaving interventions. In the context of eating disorders, they are rarely the first choice — but they can be an important step toward survival when the illness overtakes a person’s ability to choose care for themselves.
With compassion, education, and proper follow-up, individuals can emerge from a psychiatric hold into a treatment path that offers not just safety — but true healing.
References
Golden, N. H., Katzman, D. K., Sawyer, S. M., et al. (2015). Position paper of the Society for Adolescent Health and Medicine: Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 56(1), 121–125.
Guarda, A. S., Schreyer, C. C., Boersma, G. J., Tamler, A., & Lymperopoulos, Y. (2019). Intensive treatment for severe and enduring eating disorders: Outcomes and predictors of treatment response. International Journal of Eating Disorders, 52(8), 956–963.
Redgrave, G. W., Coughlin, J. W., Schreyer, C. C., Martin, L. M., Leonpacher, A. K., Seide, M., ... & Guarda, A. S. (2015). Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines. International Journal of Eating Disorders, 48(7), 866–873.
Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P., & Zerbe, K. J. (2006). Guideline watch: Practice guideline for the treatment of patients with eating disorders. American Psychiatric Association.
