Eating disorders and disordered eating in the forensic and correctional system: a scoping review

Abstract

Eating disorders (EDs) and disordered eating (DE) occur at disproportionately high rates among populations with elevated psychosocial risk factors, such as Indigenous people, LGBTQIA individuals and those with trauma or mental illness, all of whom are overrepresented in forensic and correctional settings. Despite these risks, research on ED/DE in these contexts remains limited. This review maps literature on ED/DE in forensic and correctional settings, summarising research on prevalence, co-occurring factors, criminogenic needs, guidelines and treatment approaches. Following PRISMA-ScR guidelines, the protocol was registered on Open Science Framework (registration DOI https://doi.org/10.17605/OSF.IO/BR8QU). Five databases were searched (MEDLINE, PsycINFO, Scopus, CINAHL, ProQuest), identifying peer-reviewed studies reporting on ED/DE among individuals with any forensic or correctional involvement. Of 1,314 articles, 29 met inclusion criteria: one case study, one ethnography, and 27 quantitative studies, focusing mostly on women in prisons with limited data on men, and none on transgender or gender-diverse individuals. Findings show high ED/DE prevalence with frequent co-occurrence of past trauma and past substance use. No management guidelines were found and lived experience perspectives were largely unexamined. Despite ED/DE being prevalent among those in forensic and correctional settings, no setting-specific guidelines exist, leaving a critical gap in evidence-based care in mental health and rehabilitation. This review revealed a lack of consistent data collection tools, lack of diversity in samples and limited understanding of links to criminal behaviour. It highlights the urgent need for targeted research and development of interventions for ED/DE in forensic and correctional settings. People in prisons and other forensic and correctional settings frequently experience high rates of mental illness, trauma, and substance use difficulties, all of which are linked to ED/DE risk, yet little is known about ED/DE in forensic and correctional settings. This review identified 29 studies exploring ED/DE in these settings and found they are common, especially among women, however there is limited information on men, and no information on trans or gender diverse people. There are no clear guidelines for identifying or treating ED/DE in these environments and little research has explored lived experience and staff perspectives. In the community, eating disorders are often supported through access to multiple levels of care, engagement with evidence-based treatments and adjunct recovery supports, however these services remain inaccessible to people who are incarcerated, the majority of individuals considered in the studies reviewed. The review highlights a major gap in understanding and responding to ED/DE in forensic and correctional settings and calls for better screening, inclusive research, trauma-informed care, and development of appropriate prevention and treatment protocols. Without further research, it remains unclear how eating disorders affect people in the forensic and correctional systems, what forms of support may be most beneficial, and how these factors might influence rehabilitation. ED/DE prevalence rates vary, but trend high in forensic and correctional settings, particularly in women’s prisons. No forensic or correctional specific ED/DE guidelines or validated screening tools exist. ED/DE behaviours are being responded to in institutional settings by implementing suicide/self-harm protocols (such as seclusion and restraint). Recommendations include routine ED/DE screening, evidence-based eating disorders targeted intervention and staff training. Further research on prevention and treatment for ED/DE in forensic and correctional settings is required.