With this paper we aimed to describe a case of a woman affected by Anorexia Nervosa Restricting subtype (AN-R) with delusional symptoms, visual hallucinations and severe body image distortion. We discussed the main AN diagnosis and whether delusional symptoms could be related to severity of AN describing also the use of olanzapine in such a severe clinical condition. The use of olanzapine was found to be effective to reduce both delusions and body distortions, and to improve compliance to treatments. We found a severe delusional symptomatology with mystic, omnipotence and persecution features. The psychotic structure seemed preceding the eating disorder and was also found to be worsened by emaciation. The use of antipsychotic helped reducing delusional symptoms and improving compliance to treatments. Finally, the dynamically oriented therapeutic relationship helped the patient to gain weight and to achieve a full recovery from psychotic symptoms.