Avoidance and refusal of treatment by patients with anorexia nervosa are eminent features of the disorder. A subgroup of severely ill patients are affected by involuntary hospitalizations. Based on empirical studies, this review analyzes whether patients with involuntary hospitalization differ from patients with voluntary treatment with regard to clinical characteristics and treatment outcomes. Furthermore, reasons for treatment refusal and diminished treatment motivation are outlined based on a selective review of the literature. Patients who where admitted involuntarily had significantly more previous hospitalizations and a longer duration of illness. Other predisposing factors for an involuntary admission were a history of childhood abuse and self-mutilative behavior, whereas a history of comorbid substance abuse or clinical depression was not predictive. Empirical findings suggest that weight restoration was similarly effective for both patient groups. Because catamnestic studies of patient groups with involuntary admissions are insufficient, it is presently difficult to assess the treatment response and the risk of mortality in the long-term. Future research is mandatory to identify risk factors in this special group of patients in order to establish specific interventions.