Psychotic symptoms in a woman with severe Anorexia Nervosa

Abstract

With this paper we aimed to describe a case of a woman affected by Anorexia Nervosa Restricting subtype (AN-R) with delusional symptoms, visual hallucinations and severe body image distortion. We discussed the main AN diagnosis and whether delusional symptoms could be related to severity of AN describing also the use of olanzapine in such a severe clinical condition. The use of olanzapine was found to be effective to reduce both delusions and body distortions, and to improve compliance to treatments. We found a severe delusional symptomatology with mystic, omnipotence and persecution features. The psychotic structure seemed preceding the eating disorder and was also found to be worsened by emaciation. The use of antipsychotic helped reducing delusional symptoms and improving compliance to treatments. Finally, the dynamically oriented therapeutic relationship helped the patient to gain weight and to achieve a full recovery from psychotic symptoms.

Delusion‐like beliefs in anorexia nervosa: An interpretative phenomenological analysis

“…For example, it was reported that some participants in the denial category expressed conviction that their low weight was due to the manipulation of scales (Espeset et al, ). This appears consistent with the paranoid beliefs noted in the previously reported case studies (Delsedime et al, ). Importantly, whilst participants’ lived experiences were not directly explored, such depth of detail highlighting their attempts to make sense of their experience would not have been uncovered in a quantitative research paradigm.…”

“…For example, Mehler et al (2001) described a patient who believed that touching food or refrigerators would lead to immediate weight gain. Reported paranoid and persecutory beliefs include that hospital scales were tampered with (Delsedime et al, 2013), that hospital food was poisoned, and that medical professionals and family were attempting to intentionally harm patients (Kelly, Kamali, & Brennan, 2004).…”

Anoreksja – jadłowstręt psychiczny

“…Zaburzenia dotyczące wyglądu sylwetki i wagi są zazwyczaj pierwszymi symptomami, które można obserwować u osoby w początkowej fazie anoreksji. Zauważono, iż mogą się one pojawić już 6 miesięcy przed postawieniem diagnozy ostatecznej, dlatego tak ważne dla dalszego postępowania jest wczesne wykrycie symptomów rozwijającego się zaburzenia [17,18,19].…”

“…Objawy psychotyczne mają zazwyczaj charakter urojeń o treści depresyjnej, rzadziej można zaobserwować u chorych na anoreksję obecność halucynacji wzrokowych. Dość często natomiast stwierdza się dysmorfofobię, co określane jest jako nasilone uczucie lęku związane z przekonaniem o nieestetycznym wyglądzie lub budowie własnego ciała [17,18,19]. W świetle przeprowadzonych badań zauważono również związek między zaburzeniami odżywania a zdiagnozowanymi zaburzeniami osobowości bądź też cechami osobowości nieprawidłowej.…”

Neurobiological Correlates of Core Symptoms in Anorexia:Abnormal Spatiotemporal Structure in the Resting-StateActivity and Troubles of the Self

“…These new evidences give room to a new conceptualization of dysmorphic symptoms in anorexia nervosa. Some authors argue that in the most severely disturbed anorectic subjects a possible deficit in the structure of the Self may be strictly related to a perception of the body with delusionary characteristics (Delsedime et al, 2013) [3]. It is thus possible that a common basis for the expression of the psychotic-like symptoms in anorexia nervosa and the psychotic symptoms in the major psychosis may reside in deficits related to the structure of the Self.…”