[Introduction] The number of eating disorder (ED) patients in Japanese correctional facilities has increased in recent years, creating difficulty for their on-site staff, especially those working at women's prisons. Patients in severe condition who cannot be dealt with adequately in regular prisons are transferred to a medical prison. Kitakyushu Medical Prison started accepting ED patients in severe condition who need intensive treatment in May of 2012. Most of them were suffering from anorexia nervosa (AN). Up to June of 2021, we treated 100 female prisoners with AN. [Purpose] To deepen our understanding of the pathology of the disease, we classified female AN patients by their history of ED and methamphetamine abuse. [Methods] The patients were classified into four groups by their history of ED and methamphetamine abuse before their first imprisonment: (i) the "ED (+) Methamphetamine (-)" group consisted of patients with a history of ED without methamphetamine abuse; (ii) the "ED (-) Methamphetamine (-)" group consisted of patients without a history of ED without methamphetamine abuse; (iii) the "Methamphetamine (+) ED (+)" group consisted of patients with a history of ED with methamphetamine abuse; and (iv) the "Methamphetamine (+) ED (-)" group consisted of patients without a history of ED and with methamphetamine abuse. Data were collected for comparison of various demographic, clinical, and psychosocial factors. [Results] The majority of our patients were in the "ED (+) Methamphetamine (-)" group (n=74). They generally developed typical ED at a young age, their ED was of very long duration, and they had the most serious severe and enduring AN. For the "ED (-) Methamphetamine (-)" group (n=13), the onset of ED was in middle-age and older in the wake of arrest or imprisonment. The "Methamphetamine (+) ED (-)" group (n=9) had their first ED symptoms after imprisonment and showed them almost only during incarceration. The members of the "ED (-) Methamphetamine (-)" and "Methamphetamine (+) ED (-)" groups showed non-typical ED features and their desire to be thin was comparatively mild. Although the "Methamphetamine (+) ED (+)" group (n=4) had a small number of patients, they had a pathological condition that was more deeply related to eating disorders than the "Methamphetamine (+) ED (-)" group. The rate of history of receiving ED treatment before the first imprisonment was low, even for patients of the "ED (+) Methamphetamine (-)" group. [Discussion] Our results suggest that female AN prisoners are not homogenous thus, treatment regimens and how patients are dealt with must be individualized to fit the features of each patient. These classifications will be useful in creating more effective interventions. The "ED (+) Methamphetamine (-)" group is especially of clinical importance because of the number of patients and the comparatively typical features and severity of their ED. We plan to do a systematic, multifaceted study of the pathology and treatment of AN patients in medical prisons.
Authors' abstract
Anorexia Nervosa of Female Patients in a Medical Prison: First Report: Classification into Characteristic Groups
1 Kitakyushu Medical Prison
2 Department of Psychosomatic Medicine, Kyushu University Hospital
3 Center for Clinical and Translational Research, Kyushu University Hospital
2 Department of Psychosomatic Medicine, Kyushu University Hospital
3 Center for Clinical and Translational Research, Kyushu University Hospital
Psychiatria et Neurologia Japonica
124: 601-622, 2022
Accepted in revised form: 12 April 2022.
Accepted in revised form: 12 April 2022.
<Keywords:anorexia nervosa, eating disorders, theft, methamphetamine abuse, medical prison>