PSYCHOTIC SYMPTOMS IN ANOREXIA NERVOSA

Abstract

Background: Recent studies suggest an overlap and mutual influence between Anorexia Nervosa (AN) and psychotic symptoms, with the anorexic voice proposed as a clinically significant marker within this spectrum. This cross-sectional observational study aimed to assess the prevalence and characteristics of psychotic symptoms, focusing on the anorexic voice, in patients with AN. Secondary objectives included exploring associations with dissociation, body image disturbance (BID), sociodemographic and clinical factors.

Subjects and methods: Forty-three patients were recruited from specialized outpatient and inpatient Services. Anamnestic history was collected, participants completed psychometric assessments, including Positive and Negative Syndrome Scale (PANSS), Brown Assessment of Beliefs Scale (BABS/BABS-A), Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI-3), Body Uneasiness Test (BUT), Body Shape Questionnaire (BSQ), Symptom Checklist-90 Revised (SCL-90-R), Dissociative Experience Scale (DES/A-DES), Community Assessment of Psychic Experiences (CAPE-42), Multidimensional Assessment of Interoceptive Awareness (MAIA).

Results: The anorexic voice was significantly associated with clinically relevant dissociation, not with BID. Subthreshold psychotic symptoms were common and significantly linked to body dissatisfaction, eating psychopathology and dissociation. Psychoticism was associated with BID, higher psychiatric comorbidity (especially personality and anxiety disorders), lower ideal BMI and greater general psychopathology. Adolescents showed higher levels of persecutory ideation, interpersonal alienation and general psychopathology.

Conclusions: Psychotic-like symptoms are highly prevalent in AN. The anorexic voice appears more closely related to dissociative processes than psychotic phenomena. Conversely, BID may play a significant role in the onset of predominant ideation about body shape and weight. Larger longitudinal studies are needed to clarify these relationships and their prognostic implications.

Keywords: anorexia nervosa; anorexic voice; psychiatric comorbidity; psychotic symptoms; socio-demographic.