The hidden intersection of eating disorders and psychosis
by Mary Iellamo, M.Ed. // March 27, 2026
Each year, the last week of February is recognized as Eating Disorder Awareness Week. In the days leading up to it, my inbox typically floods with reminders of deadly statistics, awareness events, and calls for legislative action. As a clinician who has worked for several years in eating disorder treatment, I am relieved to see this increase in messaging; however, as a clinician also treating individuals with psychosis, I believe we must expand our conversation to include those whose symptoms often go unreported and misunderstood.
The Reality in Vermont
Research from the past several years has highlighted how eating disorders are even more nuanced than we have ever realized. The Academy for Eating Disorders reminds us that nearly 30 million Americans will experience an eating disorder at some point in their lives, and the Vermont Department of Mental Health noted in 2023 that 55,000 Vermonters will face this illness in their lifetimes.
While our understanding of anorexia and bulimia has grown over decades, along with our more recent awareness of binge eating disorder, we now recognize that many disorders do not fit neatly into these boxes. Some take on unique forms when they appear among individuals with schizophrenia spectrum disorders. These are conditions that involve changes in the way someone experiences reality, often involving hallucinations or delusions, which we commonly refer to as psychosis.
A High-Risk Connection
Scholars have noted that eating disorders are actually more common in those experiencing psychosis than in the general population. Reports suggest that anywhere from 4% to 30% of people who have schizophrenia spectrum illness also experience binge eating or night eating symptoms, and 1 to 4% experience anorexia nervosa. There are several reasons for this increased risk. For some, the eating disorder exists independently. For others, the psychosis is a direct driver. Someone experiencing command auditory hallucinations may restrict food because a voice is giving them specific instructions to do so. A person with delusions involving paranoia may restrict their intake due to a terrifying belief that someone has tampered with their food. Additionally, people who experience psychosis are more likely to face socioeconomic insecurity, leading to challenges with food access that can trigger disordered eating symptoms.
The Danger of Overlooking Symptoms
It is particularly concerning that many people with psychosis never receive care for disordered eating. Because symptoms of psychosis can be so blatant, they often receive immediate attention while an eating disorder remains less obvious. Clinicians may mistakenly believe disordered eating is simply “apathy,” a common experience in schizophrenia, or the patient may not readily report the distress associated with their eating behaviors.
The relationship goes both ways. People with eating disorders are at an increased risk of psychosis, with recent research from 2026 noting they are more likely to receive schizophrenia spectrum diagnoses. Furthermore, electrolyte disturbances and medical complications from an eating disorder can lead to psychotic symptoms that typically subside once the medical issues are treated.
Breaking the Silence
While awareness events and legislative calls are vital, we also need careful assessment. Healthcare providers can use evidence-based screening to assess symptoms of both eating disorders and psychosis, breaking the myth that these struggles are unrelated. Screening measures are a great start, but we can also simply try talking about it. Nothing gets addressed in silence, and for the 55,000 Vermonters facing eating disorders in their lifetime, a louder conversation could be life-saving.
Mary Iellamo, M.Ed., is the Inpatient Psychology Specialist for Adult Inpatient Programs at the Brattleboro Retreat.
