Schizophrenia and Disordered Eating: When Your Loved One is Suffering from a Co-Occurring Eating Disorder

There are several diagnosable eating disorders, but some are more common as secondary disorders of schizophrenia. These include:

• Anorexia nervosa. Anorexia is characterized by a fear of gaining weight, severely restricted calorie intake, distorted perceptions of one’s own body and size, and unhealthy low body weight.
• Bulimia nervosa. Bulimia causes cycles of binging on food and then purging. Binging means eating far too much food at once and in a manner that is out of control. Purging may take the form of vomiting, using laxatives, restricting food intake, or extreme exercising.
• Binge eating disorder. Someone with this disorder binges and loses control but does not purge afterward. But they do feel intense guilt, shame, and disgust after binging.
• Night eating syndrome. Mental health professionals categorize this type of disordered eating as an “other specified feeding or eating disorder.” The signs are eating a lot at night, up to 25 percent of the day’s calories, after dinner or throughout the night. Some people with schizophrenia struggle with insomnia, which increases the risk for night eating.

The prevalence of disordered eating is higher in people with schizophrenia than in the general population. So if you have a loved one diagnosed with schizophrenia, or who you believe may have this condition, any signs of an eating disorder are important to note and share with doctors.

The relationship between disordered eating and schizophrenia is not always straightforward. This is why a differential diagnosis is so important. This is when mental health experts determine the best possible diagnosis in a patient with symptoms similar to more than one condition.

With schizophrenia and anorexia, there are a few possible diagnoses that require different approaches to treatment. For instance, an individual may have anorexia first and then develop schizophrenia. An eating disorder may develop as a secondary condition to schizophrenia. And in some cases, a person with anorexia will develop psychotic symptoms but doesn’t necessarily have schizophrenia.

A differential diagnosis with anorexia is especially challenging as compared to other eating disorders because of the distorted perceptions it causes. Someone with anorexia sees their body as fat or overweight, when in reality it is very thin. This kind of psychosis could be a symptom of schizophrenia or independently caused by anorexia.

Distinguishing among all these possibilities is important for guiding treatment. If your loved one can be diagnosed with schizophrenia, treatment will focus on this condition while still addressing disordered eating. There is a chance that by alleviating psychotic symptoms, unhealthy eating behaviors will begin to disappear.

A good residential treatment facility will give your loved one the best possible differential diagnosis. This will be the first step in planning treatment, because it informs what comes next. For patients with schizophrenia and secondary anorexia or another eating disorder, treatment must focus on the psychotic condition with an emphasis on disordered eating.

It’s not easy to get this integrated care outside of a residential setting. Schizophrenia alone is a serious condition that requires long-term care in a safe and supervised place. The most effective treatment will address all mental health issues at the same time, especially when they are so interconnected.

Your loved one will get an individualized plan for treatment, but the center of care will be therapy and medical treatment. Both of these are essential for symptom management. Antipsychotic drugs can help reduce symptoms and psychotic episodes, but therapy will help your loved one learn to manage their illness over the long-term.

Therapy for schizophrenia may include behavioral interventions that help your loved one change their thought patterns and behaviors. It may also involve social skills training, relationship and family counseling, and group support. In a residential setting, your loved one will also have access to a wide variety of other types of supplemental care like alternative therapies, holistic medicine, vocational training, and life skills training.

Your loved one can also benefit from including disordered eating in the treatment plan. It is important to address an eating disorder in therapy, to learn and practice coping strategies to prevent unhealthy eating behaviors. Additionally, treatment can include the development of healthy lifestyle habits like regular exercise and a healthy diet.