Schizophrenia and Eating Disorders

At first glance, schizophrenia and eating disorders might seem to be odd bedfellows. However, according to one group of clinicians, many patients with schizophrenia have disturbances in eating behaviors that cover the entire spectrum of eating disorders (Psychiatr Clin N Am. 2009. 32:809). Dr. Sun Young Yum and colleagues, note that these eating disorders occur concurrently and independently from the severity of the schizophrenic symptoms.

According to the researchers, who presented a series of cases of schizophrenic patients with disordered eating patterns ranging from ritualistic night eating with purging to rituals relating to eating and body image, it is not uncommon to meet a patient whose first psychotic episode was immediately preceded by preoccupation with body weight/image and periods of fasting. This period is extremely distressing to patients; for some, obsessive-compulsive reactions appear to offer a certain level of comfort.

According to the authors, one of the differences between eating disorder patients without schizophrenia and those with schizophrenia is that while patients with eating disorders alone generally provide “smokescreen” reasons for their behaviors, only a few patients with eating disorders plus schizophrenia can offer any rational-sounding explanations (although they may occasionally offer bizarre delusional ideas). For schizophrenic patients who experience the psychopathology, the combination of schizophrenia and eating disorders is distressing and demoralizing, Repeated past failures in psychiatric treatment or self-attempts of control often leave a sense of demoralization for patients and the treating physician alike.