Exploring restrictive practices in inpatient eating disorder services: a scoping review.

Abstract

Restrictive practices (RPs) encompass interventions that limit an individual's freedom, such as restraint, seclusion, and enforced treatment. While widely studied in acute mental health settings, their use within inpatient eating disorder services remains underexplored despite evidence of high prevalence. In addition to these formal restrictive interventions, eating disorder inpatient wards commonly employ structured behavioural rules as part of nutritional rehabilitation programs, including enforced rest periods, supervised meals, locked bathrooms, and limits on fluids or activity. A scoping review methodology following a five-step framework was implemented. Four databases (CINAHL, MEDLINE, Embase, and PsycInfo) were searched. The analysis involved both numerical and narrative synthesis in line with the framework. Thirty-six studies were included. Most originated from the UK, focused on anorexia nervosa, and used quantitative designs, with a substantial proportion conducted in child and adolescent inpatient settings. Common RPs included nasogastric tube feeding under restraint, involuntary admission, and physical restraint. Prevalence varied widely, with a small subset of patients accounting for most RP episodes. RPs were primarily applied in response to medical or nutritional risk rather than aggression, differentiating them from acute psychiatric contexts. Evidence regarding outcomes such as weight restoration, length of stay, and mortality was inconsistent, and RPs were frequently described by patients and staff as distressing, coercive, and potentially traumatic. Findings highlight the distinct nature of RP use in eating disorder settings and the need for context-specific policies, ethical guidance, and intervention strategies to minimize harm while ensuring patient safety.