Is morbid obesity a psychosomatic disorder?

December 6, 2013

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.

Explore further: How can psychological stress be determined in chronic cardiovascular disease?

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

Related Stories

How can psychological stress be determined in chronic cardiovascular disease?

March 19, 2013
An investigation in one of the last issue of Psychotherapy and Psychosomatics addresses the evaluation of psychological stress in the setting of chronic cardiovascular disease. In a number of circumstances allostatic systems ...

Physician's weight may influence obesity diagnosis and care

January 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 ...

Following bariatric surgery, use of opioids increases among chronic opioid users

October 1, 2013
In a group of patients who took chronic opioids for noncancer pain and who underwent bariatric surgery, there was greater chronic use of opioids after surgery compared with before, findings that suggest the need for proactive ...

Imaging may unlock new mental illness diagnosis options

October 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 ...

Weight at time of diagnosis linked to prostate cancer mortality

October 29, 2013
Men who are overweight or obese when they are diagnosed with prostate cancer are more likely to die from the disease than men who are of healthy weight, according to a Kaiser Permanente study published today in the journal ...

Large prospective study finds long-term obesity is associated with poorer pancreatic cancer survival

October 21, 2013
New results from a prospective study published in the Journal of Clinical Oncology show that patients with a body mass index (BMI) in the obese range live on average two to three months less after a pancreatic cancer diagnosis, ...

Recommended for you

Many kinds of happiness promote better health, study finds

July 21, 2017
A new study links the capacity to feel a variety of upbeat emotions to better health.

Study examines effects of stopping psychiatric medication

July 20, 2017
Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according ...

Study finds gene variant increases risk for depression

July 20, 2017
A University of Central Florida study has found that a gene variant, thought to be carried by nearly 25 percent of the population, increases the odds of developing depression.

In making decisions, are you an ant or a grasshopper?

July 20, 2017
In one of Aesop's famous fables, we are introduced to the grasshopper and the ant, whose decisions about how to spend their time affect their lives and future. The jovial grasshopper has a blast all summer singing and playing, ...

Perceiving oneself as less physically active than peers is linked to a shorter lifespan

July 20, 2017
Would you say that you are physically more active, less active, or about equally active as other people your age?

Old antibiotic could form new depression treatment

July 19, 2017
An antibiotic used mostly to treat acne has been found to improve the quality of life for people with major depression, in a world-first clinical trial conducted at Deakin University.


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.