When I read the article on anorexia nervosa (Morris and Twaddle BMJ
28 April 2007), I was reminded of something which has bothered me for a
long time. Namely, why is anorexia nervosa not classified as a psychotic
illness and treated as such?
After all, there seems to be a primary somatic delusion - a fixed
unshakeable belief that the person is overweight. It might be said that a
delusion needs to be out of keeping with the local culture - but this does
not really apply - even though we all recognise the media and peer
pressure that people are under to be thin. The fact is, the belief that
the person is overweight is not shared by the vast majority of our culture
when we see the emaciatation that the illness causes.
I don't understand what is essentially different from, for example,
nihilistic somatic delusions when the person believes they are empty
inside or even dead. If anorexia nervosa was seen as a psychotic illness,
then antipsychotics would be worth using in their own right - not just for
their weight gain side effects.
I would be very interested to see a debate about this - perhaps
through the pages of the British Medical Journal.
Yours sincerely
Dr Joss Bray
Gateshead,
Tyne and Wear
Competing interests:
None declared
Competing interests:
No competing interests
07 May 2007
Joss A Bray
GP
Birtley Medical Centre, Durham Road, Birtley, DH3 1AD
Rapid Response:
Is Anorexia Nervosa a Psychotic Illness?
Dear Editor,
When I read the article on anorexia nervosa (Morris and Twaddle BMJ
28 April 2007), I was reminded of something which has bothered me for a
long time. Namely, why is anorexia nervosa not classified as a psychotic
illness and treated as such?
After all, there seems to be a primary somatic delusion - a fixed
unshakeable belief that the person is overweight. It might be said that a
delusion needs to be out of keeping with the local culture - but this does
not really apply - even though we all recognise the media and peer
pressure that people are under to be thin. The fact is, the belief that
the person is overweight is not shared by the vast majority of our culture
when we see the emaciatation that the illness causes.
I don't understand what is essentially different from, for example,
nihilistic somatic delusions when the person believes they are empty
inside or even dead. If anorexia nervosa was seen as a psychotic illness,
then antipsychotics would be worth using in their own right - not just for
their weight gain side effects.
I would be very interested to see a debate about this - perhaps
through the pages of the British Medical Journal.
Yours sincerely
Dr Joss Bray
Gateshead,
Tyne and Wear
Competing interests:
None declared
Competing interests: No competing interests