Celiac disease

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Celiac disease is an immune-mediated disorder triggered by gluten exposure, causing chronic inflammation and villous injury of the small intestinal mucosa with potential multisystem manifestations.

It can present with psychiatric features such as depression, anxiety, irritability, cognitive difficulties (“brain fog”), mood disturbance, and, less commonly, psychosis.

Other characteristic features include neurological manifestations such as peripheral neuropathy, headache, cognitive impairment, cerebellar ataxia, and seizures. Neuropsychiatric manifestations are thought to arise through immune-mediated mechanisms, nutritional deficiencies, and associated metabolic or autoimmune factors rather than a primary CNS antibody-mediated encephalitis. Distinctive features include gluten-sensitive enteropathy with malabsorption, which may lead to nutritional deficiencies and associated systemic manifestations.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Gastrointestinal: chronic diarrhoea, abdominal pain, bloating, nausea, weight loss, malabsorption, and symptoms related to nutrient deficiencies are characteristic.

  • Hematologic: iron deficiency anaemia is common and may occur due to impaired intestinal iron absorption; other nutritional deficiencies may contribute to cytopenias.

  • Musculoskeletal: bone pain, osteopenia, osteoporosis, and increased fracture risk may occur due to impaired calcium and vitamin D absorption.

  • Dermatologic: dermatitis herpetiformis, a pruritic vesicular rash associated with gluten sensitivity, is a characteristic extraintestinal manifestation.

  • Endocrine: associated autoimmune endocrine disorders, particularly autoimmune thyroid disease and type 1 diabetes mellitus, may occur as part of autoimmune clustering.

Early diagnosis is important to enable initiation of a gluten-free diet and correction of nutritional deficiencies, prevent complications such as osteoporosis, malignancy risk associated with chronic intestinal inflammation, and persistent neurological symptoms, and improve prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.