Nexus of Delusions and Overvalued Ideas: A Case of Comorbid Schizophrenia and Anorexia in the View of the New ICD-11 Classification System

Patient: Female, 44-year-old Final Diagnosis: Schizophrenia and anorexia nervosa Symptoms: Overweight belief • restriction in food intake • auditory hallucinations • insomnia • delusions Medication: — Clinical Procedure: — Specialty: Psychiatry OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Schizophrenia and anorexia nervosa are challenging mental disorders. In cases in which the cognitive-affective drivers eliciting abnormal eating behaviors strongly influence diagnostic accuracy and treatment planning, it is important to be extremely thorough in differentiating between the phenomenology of delusions, obsessions, and overvalued ideas. CASE REPORT: Here we present an unusual relationship between anorexia nervosa and schizophrenia and also an update on diagnosing them according to the new ICD-11 classification system. The case illustrates a 44-year-old Romanian woman who had met the criteria for eating disorder from the age of 15 to 22 years, subsequently developed a psychotic break, and ultimately had schizophrenia from the age of 22 to 44 years (present time). This case report focuses on the dual diagnosis of a psychotic disorder and an eating disorder, with discussions based on the literature available on the topic. CONCLUSIONS: Schizophrenia can be considered a disabling mental disorder, but in association with a diagnosis of anorexia nervosa, the patient usually requires immediate admission and medical care in a coordinated and sustained manner. Symptoms of anorexia nervosa might manifest in the active phase of psychosis, precede psychosis, or, less commonly, manifest during the residual phase of the illness. Nevertheless, when these 2 disorders are combined, we can assume that the treatment plan is even more difficult to handle, requiring a multi-disciplinary team. Therefore, to provide adequate clinical care, a proper diagnosis must be made. The complex nature of the interrelationship between psychotic disorders and eating disorders requires further research.