Is morbid obesity a psychosomatic disorder?

A study published in the current issue of Psychotherapy and Psychosomatics has applied diagnostic criteria for psychosomatic syndromes to a sample of patients with morbid obesity.

The Diagnostic Criteria for Psychosomatic Research (DCPR) consist of 12 clusters representing different abnormal illness behaviour and psychosocial factors with prognostic and therapeutic implications in medical settings . Obesity is a major worldwide health concern, given the substantial health and economic burden associated with excess weight . The DCPR could enhance the decision-making process aimed at managing obesity by providing important clinical information that DSM or ICD-10 does not capture . The investigators predicted that DCPR diagnoses would be more frequent in obese than in normal weight controls and that the former would show lower levels of psychological well-being (PWB). We also expected that the DCPR diagnoses would be independent of the ICD-10 mental disorders in obese patients and that a higher number of DCPR syndromes would be related to lower PWB.

39 outpatients (29 females; age: 35.8 ± 11.8 years) with morbid obesity (BMI: 45.7± 10.3; weight: 127 ± 28.5 kg) consecutively referred to the Community Mental Health Centre in the area of Malaga (Spain) for psychological assessment over a 12-month period before bariatric surgery. The controls were 36 normal weight subjects (25 females; age: 30.7 ± 10.4 years; BMI: 23.3 ± 3.2; weight: 64.8 ± 12.5 kg) recruited from students at the University of Malaga and from the general population.

The percentage of subjects with at least one DCPR diagnosis was similar across the groups (cases: 92%; controls: 89%). Health Anxiety and Demoralization occurred, respectively, in 21 and 23% of the patients, while they did not occur among the controls. Illness Denial (cases: 80%; controls: 72%) and Alexithymia (33% in both groups) were also frequently but similarly represented in the two groups. A total of 13 patients (33%) fulfilled the DCPR criteria for one diagnosis, 13 (33%) for two, and 10 (26%) for three or more DCPR diagnoses. Patients with more than two DCPR diagnoses were younger (27.6 ± 6.1 years) than those in the other subgroups (one DCPR diagnosis: 40.7 ± 12.9 years; two DCPR diagnoses: 38.8 ± 11.7 years;). The patients yielded lower scores than the controls in several PWB dimensions. The patients with more than two DCPR diagnoses showed lower Autonomy and Self-Acceptance than those with one or two DCPR diagnoses. A total of 14 (35.9%) patients had one ICD-10 diagnosis. The most frequent ICD-10 diagnoses were Mixed Anxiety-Depressive Disorder (15.4%), Obsessive-Compulsive Disorder (5.1%) and Borderline Personality Disorder (5.1%). Only 1 patient (2.6%) met the criteria for Binge Eating Disorder. All patients with an ICD-10 diagnosis also met the criteria for at least one DCPR diagnosis.

This is the first study identifying specific DCPR syndromes which could affect obesity: Health Anxiety and Demoralization were more frequent in the than in the controls. Our findings suggest that the experience of may trigger feelings of hopelessness and health-related concerns, which, in turn, may hamper efforts to manage excess weight. Illness Denial and Alexithymia emerged as the most frequent diagnoses and occurred in a similar percentage in both groups. The results suggest that these syndromes are not specifically linked to obesity and that they also deserve attention in general population samples. Indeed, both Illness Denial and Alexithymia may reflect a generalized avoidant coping style which may inhibit the adoption of healthy lifestyles . The cases showed lower PWB than the controls and a higher number of DCPR diagnoses were associated with lower Autonomy and Self-Acceptance. These results are consistent with previous research and support the criterion validity of the DCPR in obesity.

More information: Venditti F., Cosci F., Bernini O., Berrocal C. Criterion Validity of the Diagnostic Criteria for Psychosomatic Research in Patients with Morbid Obesity. Psychother Psychosom 2013;82:411-412

add to favorites email to friend print save as pdf

Related Stories

Physician's weight may influence obesity diagnosis and care

Jan 26, 2012

A patient's body mass index (BMI) may not be the only factor at play when a physician diagnoses a patient as obese. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, the diagnosis ...

Imaging may unlock new mental illness diagnosis options

Oct 11, 2013

(Medical Xpress)—Imagine suffering from a mental illness and waiting up to a decade to get a proper diagnosis, all the while taking the wrong medications. This is an unfortunate reality for some patients suffering from ...

Recommended for you

Toddlers copy their peers to fit in, but apes don't

6 hours ago

From the playground to the board room, people often follow, or conform, to the behavior of those around them as a way of fitting in. New research shows that this behavioral conformity appears early in human ...

Sadness lasts longer than other emotions

7 hours ago

Why is it that you can feel sad up to 240 times longer than you do feeling ashamed, surprised, irritated or even bored? It's because sadness often goes hand in hand with events of greater impact such as death ...

Can parents make their kids smarter?

7 hours ago

Reading bedtime stories, engaging in conversation and eating nightly dinners together are all positive ways in which parents interact with their children, but according to new research, none of these actions ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.