Schizophrenia and Anorexia Nervosa: The Dopamine Connection

24-year-old Alice Smith* is not unlike most students at Monash University in Victoria, Australia. Like most young twenty somethings in Victoria, Alice enjoys hanging out with her friends, watching movies at the local cinema, and relaxing with a cup of cappuccino in her favorite spot, the Carpark Cafe.

Alice is also a schizophrenic with an eating disorder.

Although it sounds rare, schizophrenia and eating disorders occur more often than people think. According to the Psychiatric Times, eating disorders―specifically, anorexia nervosa―are characteristically similar to schizophrenia, and its underlying features are actually considered schizophrenic symptoms.

Schizophrenia and anorexia nervosa also share another bond―a different in dopamine output, one of the main factors that causes both illnesses. But there are currently no existing treatments for both illnesses.

Schizophrenia with Anorexia Nervosa: Causes

Though schizophrenia and anorexia nervosa are completely different illnesses, they share a similar cause.

According to several studies, excess dopamine production in the brain can cause schizophrenia―and anorexia nervosa.

It is not clear what causes excess dopamine production, but science suggests excess stress during fetal or childhood development can contribute to it.

Alice's childhood was marked with numerous tragedies, including the death of her best friend, a very sick father, the estrangement of her older brother, and an abusive teacher. By the time she entered Year 7, she was having a nervous breakdown.

Soon the symptoms started. Alice began thinking she had magical powers and could read other people's minds. She also began restricting her caloric intake.

"I was very secretive," says Alice,"[I] hid food, exercised compulsively, pretended to eat. It was a very intense preoccupation."

By the time she turned 16, she had limited her intake to vegetables, rice, chicken, fish, and wholemeal bread, taking in only 400 calories per day. At 5'9'', Alice was only a meager 107.8lbs, with a dangerously low body mass index (BMI) of 15.9. During this time she was diagnosed with anorexia nervosa.

Her anorexia was not her only problem, however. Her schizophrenic symptoms also became worse.

I had voices telling me to kill myself," she recounts,"And that the neighbors were putting little cameras in the kitchen, lounge room and my bedroom to watch everything I did."

Her symptoms grew worse and worse until she was finally diagnosed and treated in 2007, after having several psychotic episodes.

Schizophrenia and Anorexia Nervosa: Treatment Issues

Alice's case is not the only documented occurrence of schizophrenia and anorexia nervosa. There are numerous cases of anorectics, both male and female, who have developed schizophrenia in the beginning or in the midst of their eating disorder.

One study showed six anorectics developed schizophrenia after their anorexia nervosa diagnosis.

But the medical community, both in Australia and the United States, has not made any attempts to find treatments for both illnesses.

Despite the fact that schizophrenia and anorexia nervosa was first documented in 1913, many physicians consider them separate medical conditions that should be treated separately.

Treatment for both illnesses can become difficult―some cases show schizophrenics' symptoms became worse after treatment. The same study reports one anorectic became psychotic after being treated with schizophrenia medications and a high calorie diet.

In Alice's case, her psychiatrist treated her schizophrenia with numerous drugs, including Abilify and Ziprasidone, which worsened her symptoms and caused her to become depressed. He did not treat her existing eating disorder.

Says Alice: "On Abilify, I couldn't sit still and was constantly agitated. There was a persistent anxiety that wouldn't go away. I felt like I was watching a movie and I slept for most of the day."

Ziprasidone, according to Alice, caused more significant side effects. It caused her to develop symptoms similar to Parkinson's disease, including uncontrollable shaking in her legs, arms, and head. It also made her lethargy worse, causing her to fall asleep at work.

Her weight also dramatically increased during her Ziprasidone treatment.

Alice, who normally weighed 120lbs due to brief stints in self-recovery, shot up to 165lbs.

"They told me the weight gain had nothing to do with the medication," she says,"My self esteem hit rock bottom as a result."

She began restricting again to lose the weight, which worsened her anorexia and depression.

Schizophrenia and Anorexia Nervosa Treatments: Is There Hope?

Like Alice's case, many schizophrenics with anorexia nervosa are being thrown into treatments that only treat one part of the issue, often causing significant side effects. Even when schizophrenic and anorexic treatments are combined, they cause unwanted and sometimes severe side effects, including psychosis.

Because physicians do not know about the correlation between both illnesses, schizophrenics are forced to use traditional treatments that do not address their eating disorder.

Although Alice has not had success with her schizophrenia treatment, she hopes her eating disorder treatment―she recently entered an eating disorder outpatient program―is more successful. She hopes to learn how to become spiritually, mentally, and physically healthier.

Alice's views on schizophrenia treatment-more specifically, treatment only involving anti-psychotic medications-are not as positive, however.

"For other Schizophrenics, I would advise them to stay away from psych meds, because they are evil, destructive, and create more problems than they solve," she says,"I would recommend investigating unorthodox techniques such as orthomolecular therapies or seeing a therapist who is well-versed in Jungian Analysis and Psychology, who can help interpret symbols, dreams, and visions."

Although schizophrenia and anorexia nervosa are often lifelong illnesses, people who have it are not cursed. Furthermore, schizophrenics with anorexia nervosa are not sick or psychotic-their brains simply work in different ways not familiar to doctors, psychiatrists, or the general public.

*This name has been changed to protect the person's identity.

Sources:

Sun Young Yum, M.D., Michael Y. Hwang, M.D., Katherine A. Halmi, M.D., "Eating Disorders in Schizophrenia" (PsychiatricTimes.com)

Barton J. Blinder, M.D., "Anorexia Nervosa in Neuropsychiatric Disorders" (ltspeed.com)