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A 22-year-old woman, known to have a BMI of 12 kg/m2 and a personality disorder, developed urinary retention on a normal dose of quetiapine. She had earlier tolerated a dose of 800 mg quetiapine without complications. The daily dose was 600 mg in combination with oxazepam and zolpidem. Reduction had no effect. The patient intervened with intermittent urinary catheterization the next 19 months. Normal urinary function returned three days after the last dose of quetiapine 25 mg. This case report shows that patients with a low BMI may be more receptive of the anticholinergic effects of quetiapine.