Narrative Review of Catatonia in Psychosis and Eating Disorders: Common Intersections and Treatment Considerations

Eating disorders (ED) and psychosis/psychotic-spectrum disorders (PSD) have overlapping symptoms and may co-occur in a variety of presentations. Due to its debilitating and life-threatening risk, it is important for clinicians to be aware of how catatonia may present within these co-occurrences.

A narrative review was conducted of catatonic presentations in individuals with co-occurring EDs and psychosis, using the databases Google Scholar, ScienceDirect, PubMed, ProQuest and PsychInfo.

This article reviews and summarises the 10 cases found in the literature, and explores critical considerations within ED-psychosis co-occurrence, including the author's lived experience insight into experiencing catatonia within co-occurring ED-psychosis. In 9 out of 10 cases, catatonia occurred during adolescence (ages 13-24). Fifty percent of cases involved stressful or traumatic events as a precipitant to catatonia emergence. Autistic individuals with EDs may be particularly vulnerable to catatonic symptoms. In most cases, catatonic symptoms responded to lorazepam treatment or a combination of lorazepam and other medications such as antipsychotics, although tube-feeding was also required in some cases.

This review discusses key factors and intersections that are highly relevant to individuals vulnerable to EDs and psychosis (i.e., malnutrition, trauma, autism, bipolar disorder, OCD). Catatonic symptoms may be mistaken for ED symptoms, delaying early treatment in individuals with ED. Consideration of catatonic presentations and trauma-informed and neurodivergent-affirming treatment practices are recommended.