Anorexia nervosa is a multiply determined disorder of unknown aetiology. Restriction of food intake culminating in profound emaciation is considered to be pathognomic (Kaye et al, 1999). One of the diagnostic criteria for anorexia nervosa is body image disturbance that is characterised by feeling and judging oneself to be fat and by claiming to ‘see’ oneself as fat despite being underweight. The bizarre body self-image in anorexia nervosa can be regarded as a psychotic way of thinking. We tried to treat anorexia nervosa as a psychotic disorder with olanzapine. Hansen (1999) has previously reported a case of treatment of anorexia nervosa with olanzapine ; here we report three further cases.
A 50-year-old woman with anorexia nervosa since she was 17 years old applied for treatment in our clinic with an initial weight of 34 kg and height of 157 cm. By that time she had already been treated with antidepressants, traditional neuroleptics and psychotherapy, without success. She was commenced on olanzapine, 5 mg daily. The first 2 months were difficult because she had to accept the side-effects of hunger and weight gain. After 2 months she stopped talking about being overweight ; according to her drawings, her body self-image changed towards normality. Now she weighs 53 kg and feels herself completely healthy. She still receives 5 mg olanzapine daily.
A 30-year-old woman with anorexia nervosa since she was 18 years old additionally developed bulimia nervosa 5 years before presentation to our clinic. She was treated traditionally for many years without significant positive results. When she applied to our clinic her weight was 44 kg, height 167 cm. Mental state examination revealed severe body self-image disturbance. We commenced her on 5 mg olanzapine daily. In 9 months her weight was 53 kg, and she recovered from symptoms of both anorexia nervosa and bulimia nervosa. According to her drawings her body self-image changed from a fat little girl to an attractive grown-up woman. She still receives 5 mg olanzapine daily.
A 34-year-old woman had been suffering from anorexia nervosa and borderline personality disorder since puberty. When she came to our clinic her weight was 60 kg, height 180 cm. She complained of confusion, having too many thoughts in her head at one time. She had a seriously disturbed body image - in her drawings she looked like a little fat girl without hands and secondary sexual signs. She was started on olanzapine 5 mg, and after 2 months her body image has improved (she now sees herself as a grown-up woman) and she feels healthy.
In all three cases olanzapine was well tolerated. Our patients restored their body weight and appetite as well as their body self-image. They now think of themselves as normal, mature adults. The problem is to convince the patient to start and to continue with olanzapine therapy within the first 2 months, because it takes a few weeks before a full antipsychotic effect is achieved. We think that further investigations in this area should take place.
- © 2000 Royal College of Psychiatrists