Acute intermittent porphyria (AIP) is caused by an inborn error of heme metabolism; it is characterized by the accumulation of neurotoxic heme intermediates, particularly aminolevulinic acid (ALA) and porphobilogen (PBG). Though classically described as a triad of abdominal pain, peripheral neuropathy, and neuropsychiatric disturbance, AIP has been known to present in a multitude of ways with both psychiatric and somatic complaints. Here we present a case of an acute porphyric attack manifesting exclusively as psychosis without any accompanying somatic features. We further review the neuropsychiatric manifestations of the disease and detail the importance of obtaining a comprehensive history and physical examination in order to identify the psychosomatic manifestations of this puzzling disease.