Schizophrenia poses challenges in diagnosis and treatment strategies when the predominant clinical features represent another spectrum of disorder like eating disorders. Nevertheless, symptoms of eating disorder in schizophrenia are not entirely uncommon although never included in the diagnostic criteria. We reported a case of a woman who first presented at seventeen years old with food refusal and underlying psychosis resulting in severe weight loss, but defaulted treatment for almost a decade. In 2009, she presented again with sinus bradycardia and secondary amenorrhoea. In this report, we discussed about the patient’s vulnerability for psychosis and its psychodynamic drive which led to a complex symptoms manifestation. Our aim is to highlight its diagnostic dilemma and suggestions to treatment strategies unique to this presentation.