At first glance, you probably don’t quite find any obvious relationship between Anorexia (irrational fear of gaining weight, food restriction, distorted body perception) and Psychosis (“loss of contact with reality”) in my title, but with some explanation in the brackets I hope it does make it a bit obvious…

This young boy came with his parents that day. He seems a bit underweight when we were told that he’s already 13 years old. The mother said he was above 60 kgs, much bigger size than most of his peers, but now he has lost almost half of his size, and is still losing.

He was the target of bully, his schoolmates made jokes about his size and weight. He made no friends and had very low self-esteem and confidence. Then he started to avoid taking meals. The parents have to persuade, convince, force him with all kind of methods. Still, he continues to lose weight.

He’s also obsessed with cleanliness (yet another OCD case), very fear of contamination and infection. Though one very different thing from the other obsessors, is that he can’t take off his shoes, as he thinks if his feet have any contact with the floor, the dirt and dust will be “transmitted” into his body, causing him fat! causing him fat! causing him fat! (Something’s wrong with my writing style, I think I’m also obsessed with repeating when I talk about OCD cases).

Although we can’t really be sure chicken or egg which came first, here it seems likely that he first became anorexic, then only led to obsessions with cleanliness. But being highly fear about things on the floor causing him gaining weight, he is so close to delusional and psychotic. Guess what’s happening right now? He thinks the medicine will make him fat and so is refusing the medicine…

It seems that anorexia is also a kind of obsessions and compulsions, but it can also be so serious and appear like psychosis. Just like how they see themselves in the mirror, completely distorted, different from how we see them, isn’t that “losing contact with reality”?