Diagnostic and management challenges of a patient with schizophrenia and comorbid anorexia nervosa

The prevalence of comorbid schizophrenia in patients with eating disorders is between 3 and 10% while symptoms of anorexia nervosa has been observed in 1–4% of patients with schizophrenia. However, there is a lack of comprehensive studies available to better understand and manage this complex dual diagnosis at present.

Here, we present a case of treatment-resistant schizophrenia and comorbid anorexia nervosa in a young woman in a long-stay ward of a tertiary psychiatric hospital requiring 1-1 nursing care. She exhibited disordered eating behaviors, a distorted body image, and persistent food refusal. A diagnostic dilemma presented due to the overlap in symptomatology between her eating disorder-related restrictive behaviors and psychosis-driven food refusal. Efforts to engage her in various therapies for her anorexia nervosa has been hampered by her regressed and disorganized behavior, with concerns of the metabolic side effects of anti-psychotics potentially worsening her eating disorder cognitions. She required constant monitoring of her bloods and vitals due to her severely low body mass index (BMI). Different combinations of psychotropics, neurostimulation and psychotherapies were trialed with limited efficacy. The diagnostic overlap and treatment challenges highlights the need for interdisciplinary approaches and tailored management strategies for complex comorbid cases of schizophrenia and anorexia nervosa.