Anorexic patients 'sabotage weigh-ins' to falsely elevate what is shown on the scales
Anorexic patients use sabotaging tactics, including wearing hair accessories, to falsely add to their weight, a study found.
The anorexic patients also concealed food, and did not go to the toilet as often on days they were weighed by medical staff.
Other tactics can include hiding batteries in sanitary towels on weighing days, weights in the hems of clothing, and gripping of scales with toes.
They can engage in vigorous page turning, or animated talking, asking for a window to be opened so they can shiver, and even tried to use up energy by repeatedly hitting computer keys.
The behaviour was observed among a group of anorexic patients who were being treated at a "pop-up" eating disorder unit at Sligo Hospital, the 'Irish Medical Journal' reported.
The unit was set up at the hospital in response to a number of acute presentations, mainly by women who suffered from eating disorders.
Anorexia nervosa affects around 0.5pc of the population with 90pc of those affected being female.
The death rate from anorexia is the highest of any psychiatric illness, although doctors said there were no deaths among the group.
Since the service started in 2014, the Sligo team have admitted 20 acutely ill patients - and all but two of the patients were female, commonly in their early 20s.
The report said multidisciplinary co-operation and communication is essential for successful outcomes. Collaboration, appropriate clinical skills and patience are the keys to success with this group of patients, it said.
The Sligo team is made up of a consultant psychiatrist, physician, clinical nurse specialist in eating disorders, senior dietician, and ward clinical nurse manager.
Patients are placed in a special ward where they are continuously supervised and get complete bed rest. When they are admitted they are weighed.
But the doctors report that "in our experience the admission weight can be falsely elevated with intentional water and bowel loading and objects cached in pockets".
They said that "in our cohort there was a significant drop in weight on the designated ward compared to the initial weight in the acute assessment on it, likely to represent some degree of faecal/water loading, or heavy clothing".
The pop-up unit's weighing protocol involves random unannounced weighing with minimal clothing and patients facing away from the digital dial. The unit provides a commode by a patient's bedside, but no bathroom trips are allowed, as it is a vulnerable point for sabotage.