bstract

We examine the impact of Axis II personality disorders (PDs) on body weight.

PDs are psychiatric conditions that develop early in life from a mixture of
genetics and environment, are persistent, and lead to substantial dysfunction
for the affected individual. The defining characteristics of PDs conceptually
link them with body weight, but the direction of the relationship likely varies
across PD type. To investigate these links, we analyze data from Wave II of the
National Epidemiological Survey of Alcohol and Related Conditions. We
measure body weight with the body mass index (BMI) and a dichotomous
indicator for obesity (BMI ≥ 30). We find that women with PDs have
significantly higher BMI and are more likely to be obese than otherwise
similar women. We find few statistically significant or economically
meaningful effects for men. Paranoid, schizotypal, and avoidant PDs
demonstrate the strongest adverse impacts on women's body weight while
dependent PD may be protective against elevated body weight among men.
Findings from unconditional quantile regressions demonstrate a positive
gradient between PDs and BMI in that the effects are greater for higher BMI
respondents.

Abstract
BACKGROUND:
The prevalence of individuals who are overweight or obese has increased dramatically over the past
decades, especially in high-income countries. However, the success rates of conservative therapies
in morbidly obese patients are poor. Consequently, bariatric surgery is the treatment of choice for
morbid obesity. Because many obese individuals who seek professional help show a high co-
morbidity of mental disorders, including eating disorders, and psychosocial problems, a
psychological evaluation before bariatric surgery is deemed.
METHODS:
The patient cohort included 547 morbidly obese subjects (389 females, 158 males). All patients were
recruited from the Department of Surgery, Medical University of Innsbruck. An exact psychological
evaluation, using a semi-structured interview and the Structured Clinical Interview for Mental
Diseases (SCID), was carried out at the Department of Psychosomatic Medicine.
RESULTS:
The results of the preoperative psychiatric-psychotherapeutic evaluation of the morbidly obese
patients revealed that more than half suffered from one or more mental disorders; these included in
particular depression and adjustment disorders, as well as personality disorders, in particular Cluster
C personality disorders. A majority of the patients showed one or more disordered eating patterns.
Females showed a markedly higher rate of a "binge-eating"-disorder than males, while males tended
to be classified as "overeaters" in many cases.
CONCLUSIONS:
An exact preoperative psychological evaluation can make an important contribution in identifying
those patients who, on one hand, are not ideal candidates for bariatric surgery, or, on the other
hand, need additional psychiatric and/or psychotherapeutic treatment to cope with the new demands
postoperatively.
Borderline personality disorder (BPD) is characterized by inherent difficulties with self-regulation. While a
number of studies have examined the relationship between BPD and body mass index
(BMI)/overweight/obesity, findings have been mixed. In this cross-sectional study of a consecutive sample
of 238 participants presenting for cardiac stress testing, we investigated the relationship between
borderline personalitysymptoms, according to two self-report measures, and BMI. Compared to
participants who were negative on both measures of borderline personality symptoms, participants who
were positive on either measure of borderline personality symptoms demonstrated no differences in
current BMI or highest BMI in adulthood. These results in a unique study population mirror the findings of
other studies in medical and community populations.

Objective

This study investigated self-reported levels of depression, anxiety

and neuroticism in obese patients waiting for bariatric surgery. The patients
who indicated that they might have eating disorders (ED) or
subthreshold binge eating disorders (SBED) were compared with those
without.

Method

The design was cross sectional. Obese patients (n = 160, 117 women, 43 men)
returned self-report questionnaires: Eating Disorders in Obesity (EDO)
indicated eating disorder status; Hospital Anxiety and Depression
Scale (HADS) assessed symptoms and caseness of depression and anxiety;
and the Eysenck Personality Questionnaire (EPQ-12) captured neuroticism.
Age, BMI and gender were also recorded.

Results

Patients with ED (n = 28) presented significantly higher levels of depression,

anxiety and neuroticism as well as more HADS-cases for depression and
anxiety than those without ED (n = 109). Patients with sub-diagnostic binge
eating disorders (SBED, n = 23) also reported significantly more depression
symptom levels, and number of HADS-cases of depression, than those without
ED. In addition, the SBED group showed significantly more neuroticism than
patients without ED. No significant differences were found between men and
women, for high/low age, or for high/low BMI.

Conclusion

The data displayed that obese pre-surgery patients with eating disorders have
more psychological problems than those without. Patients with SBED were
more similar to those with full scale eating disorders in their level of
depression and neuroticism than those without ED. Clinically, obese patients
with SBED should probably be regarded as those who have full scale ED.

Abstract
Anxiety disorders are the most prevalent mental disorders in developed countries. On the other
hand, obesity is recognized to be one of the greatest public health problems worldwide.The
connection between body weight and mental disorders remains an open issue. Low body weight has
been studied enough (anorexia nervosa is a typical example) but high body weight has not been
addressed sufficiently. It is known that obesity has been related with depression. Although moderate
level of evidence exists for a positive association between obesityand anxiety disorders, the exact
association between these two conditions is not clear yet.The studies about this subject are quite
few and they follow different methodology. Furthermore,anxiety disorders share some common
elements such as anxiety, avoidance and chronicity, but they also present a great deal of differences
in phenomenology, neurobiology, treatment response and prognosis. This factor makes general
conclusions difficult to be drawn. Obesity has been associated with anxiety disorders as following:
most of the studies show a positive relationship with panic disorder, mainly in women, with specific
phobia and social phobia. Some authors have found a relationship with generalised anxiety disorder
but a negative relationship has been also reported.Only few studies have found association
between obesity and agoraphobia, panic attacks and posttraumatic stress disorder. There has not
been reported a relationship between obesity and obsessive-compulsive disorder. The causal
relationship from obesity to anxiety disorders and vice versa is still under investigation.
Pharmacological factors used for obesity treatment, such as rimonabant,were associated with
depression and anxiety. Questions still remain regarding the role of obesity severity and subtypes of
anxiety disorders. Besides, it is well known that in the morbidly obese patients before undergoing
surgical treatment, unusual prevalence of psychopathology, namely depression and
anxiety disorders, is observed. Anxiety is also a common trait in personality disorders.There is no
single personality type characteristic of the morbidly obese, they differ from the general population
as their self-esteem and impulse control is lower. Obese patients present with passive-dependent
and passive-aggressive personality traits, as well as a trend for somatization and problem denial.
Their thinking is usually dichotomous and catastrophic. Obese patients also show low
cooperativeness and fail to see the self as autonomous and integrated. When trying to participate in
society roles they are subject to prejudice and discrimination and should be treated with concern to
help alleviate their feelings of rejection and guilt.

PMID:
22271843