Ellis later wrote that people assumed that American Psycho would end his career.[6] It was originally to have been published by Simon & Schuster in March 1991, but the company withdrew from the project because of "aesthetic differences". Vintage Books purchased the rights to the novel and published the book after the customary editing process. The book was not published in hardcover in the United States until 2012, when a limited hardcover edition was published by Centipede Press,[20] although a deluxe paperback was offered.[21] Before its publication, Roger Rosenblatt of The New York Times approved of Simon & Schuster canceling the "worthless" book in a review called "Snuff This Book! Will Bret Easton Ellis Get Away With Murder?".[22] Ellis received numerous death threats and hate mail after the publication of American Psycho.[23][24] The Los Angeles Times's review[18]—"the one good review in the national press", he said—resulted in "a three-page letter section of all these people canceling their subscriptions".[6]

In Germany, the book was deemed "harmful to minors" and its sales and marketing severely restricted from 1995 to 2000. In Australia, the book is sold shrink-wrapped and is classified "R18" under national censorship legislation. The book may not be sold to those under 18 years of age. Along with other Category 1 publications, its sale is theoretically banned in the state of Queensland and it may only be purchased shrink-wrapped.[25] In Brisbane, the novel is available to those over 18 from all public libraries and can still be ordered and purchased (shrink-wrapped) from many book stores despite this prohibition.[26] Bret Easton Ellis has commented on this, saying "I think it's adorable. I think it's cute. I love it."[27][28] In New Zealand, the Government's Office of Film & Literature Classification has rated the book as R18. The book may not be sold or lent in libraries to those under 18 years of age. It is generally sold shrink wrapped in bookstores. During the trial of Canadian serial killer Paul Bernardo, a copy was discovered in Bernardo's bedroom. The Toronto Sun reported that Bernardo "read it as his 'bible'",[29][30][30] though it turned out it actually belonged to his wife and accomplice Karla Homolka; it is unlikely Bernardo ever read it.[29]

Feminist activist Gloria Steinem was among those opposed to Ellis' book because of its portrayal of violence toward women.[31][6] Steinem is the stepmother of Christian Bale, who played Bateman in the film. This coincidence is mentioned in Ellis' mock memoir Lunar Park.

Phil Collins, whose solo career is referenced in the book, recalled: "I didn't read it. At the time, I just thought, 'That's all we need: glorifying all this crap. I'm not interested.' Then the film came out and I thought it was very funny."[32]