Dr. Herre is an MD candidate, Tri-Institutional MD-PhD Program, Weill Cornell Medical College, New York, New York.
Mr. Yang is an MD candidate, University of California San Diego School of Medicine, San Diego, California.
Dr. Francois is Associate Professor of Clinical Psychiatry, New York-Presbyterian Hospital, Weill Cornell Medical College, White Plains, New York.
Disclosures
The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
How do we approach the pharmacologic treatment of patients with co-occurring eating, somatic symptom, and anxiety disorders? Olanzapine facilitates recovery in children and adolescents with ARFID by promoting eating and weight gain, and decreasing symptoms of depression and anxiety.16 Patients with orthorexia nervosa also may benefit from treatment with olanzapine, which has decreased food-related fixations, magical thinking, and delusions regarding food.17 Further, orthorexic patients with ARFID have also been shown to respond to SSRIs due to those agents’ efficacy for treating intrusive thoughts, obsessions, and preoccupations from OCD and SSD.18,19 Thus, treating Ms. L’s symptoms with olanzapine and fluoxetine targeted the intersection of several diagnoses on our differential. Olanzapine’s propensity to cause weight gain is favorable in this population, particularly patients such as Ms. L, who do not exhibit body dysmorphia or fear of gaining weight.
OUTCOME Weight gain and fewer fears
Ms. L is prescribed olanzapine 5 mg/d and fluoxetine 20 mg/d. She gains 20.6 pounds in 4 weeks. Importantly, she endorses fewer fears related to foods and expands her palate to include foods she previously considered to be unhealthy, including white bread and farm-raised salmon. Further, she spends less time thinking about food and says she has less anxiety regarding the recurrence of GI symptoms.
