Comorbid Eating Disorders and Schizophrenia
Understudied: Eating Disorders in Patients with Schizophrenia
Eating disorders in patients with schizophrenia have been largely understudied and, therefore, understood. At times they are recognized, they are reasoned to be a symptom of psychosis that will disappear when the psychosis has ceased or as part of schizophrenia induced inability to comply with healthy living habits.1 However, according to the article “Eating Disorders in Schizophrenia” by Sun Young Yum, M.D. and colleagues, it is understood that patients with schizophrenia may suffer from independent eating disorders, due to underlying preoccupation with body image.1 Therefore, determining whether or not there is an independent comorbid condition or just symptoms of schizophrenia itself is important for treatment purposes, as well as long-term outcomes.1
Disordered Eating Historically A Symptom of Schizophrenia
Comorbid schizophrenia and eating disorders has been observed for many years.1 Approximately a century ago, Kraepelin and Bleuler stated that disorganized and uncontrolled food intake was simply a characteristic of schizophrenia. We now know this is not always the case. Recently, molecular examinations have reported that there are in fact differences in hunger, satiation, and satiety mechanisms in persons with schizophrenia when compared to persons without.1 Researchers believe that this is due to either the specific disease itself or the psychotropic medicines used to treat it.1 However, this is not the reason for all cases. In fact, distorted body images and low self-esteem are widely recognized as common features of schizophrenia. These features predispose persons to developing eating disorders.1 Many patients with schizophrenia often are dissatisfied with their body and attempt drastically to change the imperfections, either through restrictive eating, long-term dramatic dieting, or through cycles of binging and fasting or purging.1
Patients who eat large amounts of food after a period of restrictive dieting are viewed as having a loss of control over their food intake; however, this is not typical DSM-IV “binging”.1 In fact, this lack of insight is often seen as a sign of psychosis, but awareness is not present, similar to the lack of awareness seen in eating disorders.1 Therefore, the disordered eating is viewed as a separate diagnosis.1 However, whether or not disordered eating is a separate diagnosis or part of schizophrenia itself, it always influences the patient’s metabolic health.1 It is directly associated with increased triglyceride levels and fluctuation in body mass index (BMI).
Treating Eating Disorders in Patients with Schizophrenia Difficult
According to Yum and colleagues, addressing the disordered eating is not always easy.1 They state: “Healing words are valuable remedies. Conversely, inconsiderate words can be as wounding as any physical insult.”1 Therefore, people who turn to food in times of anxiety and depression are more likely to feel further depressed and anxious when forced to diet.1 Lectures on dieting rarely help in these situations.1 Addressing patients with schizophrenia should take into consideration the patient’s emotional frailties.1 Yum and colleagues state that focusing on self-acceptance, health, and eating behaviors in group therapy sessions has been a successful way of addressing disordered eating.1 Praising good attempts to change for the better is extremely important, even in the absence of change in body weight.1 The praise will eventually lead to change.
Eating behaviors in patients with schizophrenia are complex, and often require specific assessment and treatment. Further research regarding patterns and distinctions are needed to help clarify the spectrum of eating disorders seen in schizophrenia and those that are independent of the disease.
 Yum, S.Y.; Hwang, M.Y.; and Halmi, K.A. (2006, June 1). Eating Disorders in Schizophrenia. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/childhood-feeding-and-eating-disorders/content/article/10168/51311
 Kraepelin E. Dementia Praecox and Paraphrenia. Edinburgh: Thoemmes Press; 2002:87 [original published 1919].
 Bleuler E. Textbook of Psychiatry. New York: Macmillan Co; 1924:149 [original published 1911].
 Weckowicz TE, Sommer R. Body image and selfconcept in schizophrenia. J Ment Sci. 1960;106:17-39.
 Yum SY, Hwang MY. Eating behaviors and associated psychopathology in patients with schizophrenia. In: Program and abstracts of the Annual Meeting of the American Psychiatric Association; May 23, 2005; Atlanta. Abstract NR54. Schizophrenia.