Prevalence of borderline personality symptoms in two groups of obese subjects

Are physical activity and nutrition linked to personality disorders? Health habits and personality disorders: A scoping review

Individuals with personality disorders (PDs) have a decreased life expectancy compared with the general population in part due to physical illnesses. Many hypotheses have been suggested to explain those physical illnesses such as hormone imbalance, medication, lack of physical activity, and unhealthy diet. However, little is known about the relation between lifestyle and PDs. The purpose of this scoping review is to regroup the available information on this topic. We searched the literature up to February 2021 using four databases and found 21 articles analyzing the relation between lifestyle and PDs in observational studies including 153,081 participants from diverse populations going from general population to adults in psychiatric care. Most studies used measures of lifestyle as control variables or did not use lifestyle variables at all. Moreover, the instruments used to measure lifestyle variables lacked precision at best. Two studies demonstrated a relation between early malnutrition and further development of PDs, but those results may be influenced by confounding variables and cannot indicate a clear link between nutrition and personality disorder. The lack of solid evidence we observed is surprising, considering the multiple benefits individuals with PDs could get from a healthy lifestyle. More studies are needed to thoroughly analyze the impact of lifestyle on PDs and vice versa.

Personality disorders and obesity: a systematic review

BACKGROUND

Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have investigated the association between personality disorders (PDs) and obesity.

OBJECTIVE

The present review summarizes through a comprehensive and critical evaluation the results of 68 studies identified by database research (PubMed and PsycINFO) covering the last 35 years that investigated the association between PDs, overweight and obesity as well as the predictive value of PDs for the development of obesity and the effectiveness of weight reduction treatments.

RESULTS

Adults with any PD have a higher risk of obesity. In the female general population, there is an association between avoidant or antisocial PD and severe obesity. Further, women with paranoid or schizotypal PD have a higher risk of obesity. Clinical studies including foremost female participants showed a higher comorbidity of PDs, especially borderline PD and avoidant PD, in binge-eating disorder. Regarding both genders, patients with PD show less treatment success in conservative weight-loss treatment programmes for obesity than patients without PD.

CONCLUSIONS

In prevention and conservative weight-loss treatment strategies, more care should be taken to address the special needs of patients with comorbid PDs.

The relationship between borderline personality symptoms and body mass index in a consecutive sample of cardiac stress test patients

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 personality symptoms, 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.

Psychiatric and neurophysiological predictors of obesity in HIV/AIDS

The objective of the study was to identify predictors of obesity. One hundred eleven nonobese and 48 obese HIV-1 seropositive patients provided information on medical history and other characteristics. They were then asked to detect the passage of 2-s time intervals while the contingent negative variation (CNV) was recorded. Obese patients were healthier, more likely to be receiving Highly Active Antiretroviral Therapy, and less likely to be substance dependent. Obese patients also exhibited a greater CNV slope and responded prematurely. A path model suggested that CD4+count and protease inhibitor use directly predicted obesity. Depression had no direct effect. However, when incorporated into a hypothetical construct, "mood dysregulation," that also included childhood conduct problems and stimulant dependence, the shared variance among the indicators did predict obesity. This relationship was mediated through premature response preparation (anterior scalp CNV amplitude) and its hypothesized association with impatience/impulsivity.

The prevalence of binge eating disorder and borderline personality symptomatology among gastric surgery patients

In this study, we examined the prevalence of binge eating disorder (BED) and borderline personality disorder (BPD) in a sample of 121 candidates seeking surgery for obesity. In this predominantly female sample (85.9%), according to the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R), the prevalence of BED was 6.5%. As for the prevalence of BPD, 14.0% exceeded the clinical cut-off score on the Self-Harm Inventory (SHI), 14.0% exceeded the clinical cut-off score on the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4), and 7.4% exceeded the clinical cut-off score on the McLean Screening Inventory for Borderline Personality Disorder (MSI-BPD). Overall, 24.8% of the sample exceeded the clinical cut-off on at least one measure of BPD whereas only 3.3% exceeded the clinical cut-off on all three measures. In addition, there was a significant inverse relationship between the discrepancy between highest and lowest adult body mass index, and scores on the PDQ-4 and the MSI-BPD. The authors discuss the implications of these findings.

Panic-agoraphobic spectrum in obese binge eaters

OBJECTIVE

This study investigated the frequency of the panic-agoraphobic spectrum symptoms in a sample of obese subjects affected by Binge Eating Disorder (BED) vs controls.

METHOD

Fifty obese with BED were matched by age, sex and marital status to twenty-five normal weight controls. The Structured Clinical Interview For Panic-Agoraphobic Spectrum--SCI-PAS was administered to all participants.

RESULTS

Obese subjects with BED presented significantly higher frequencies of typical and atypical panic symptoms (82% vs 8%, p<0.0001), agoraphobia (58% vs 12%, p=0.002) and reassurance orientation (56% vs 8%, p=0.001) than controls.

DISCUSSION

BED frequently co-occurs with other major psychiatric disorders, traditionally assessed using categorical methods of classification of mental disorders. The spectrum of the subthreshold, atypical and partial symptoms of full-blown mental disorders, often neglected by categorical approach, may also affect subjective well-being and functioning as full-blown disorders. The identification of the subthreshold symptomatology may have relevant implications for the response to treatment and the outcome of the eating disorder.

The Eating Disorder Inventory in a UK National Health Service Obesity Clinic and its response to modest weight loss

OBJECTIVE

Using the Eating Disorder Inventory (EDI-2) to identify a normative range in a UK obese population referred to a specialist hospital obesity clinic and to assess the response of the scale to the nonsurgical treatment of obesity.

METHODS

A total of 100 obese (BMI>30) patients attending an obesity clinic completed the EDI-2. In a separate sample, 45 obese patients participated in a dietary weight loss program consisting of an acute (10 weeks) and a long-term (2 year) weight maintenance phase. The EDI-2 was administered at baseline and at the end of the acute weight loss phase.

RESULTS

Most obese subjects showed elevated scores for body dissatisfaction (BD), which improved with weight loss. Eight percent had EDI scores suggesting psychological traits central to eating disorders.

CONCLUSION

Most obese subjects do not have a trait central to an eating disorder as defined by the EDI-2, but do have high scores for BD that respond to weight loss. A few patients show scores suggesting an eating disorder that may benefit from psychological evaluation.

Reported sexual abuse and cognitive content in the morbidly obese

This study investigated whether a reported history of childhood sexual abuse (CSA) in morbidly obese adults is associated with a higher level of negative core beliefs (unconditional, schema-level representations regarding the self, the world, and others), and whether those beliefs are significantly associated with weight levels and weight fluctuation. A cross-sectional design was used, with comparative and correlational elements. The participants were 30 morbidly obese patients (age range=27-61years; body mass index [BMI] range=40.8-73.5), awaiting surgical intervention. Each completed standardized self-report measures of childhood traumatic experiences, core beliefs, and weight history. BMI was obtained from clinical interview. In terms of weight variables, the individuals with a reported history of sexual abuse (n=10) did not differ from those with no such history (n=20). However, those with a reported abuse history had higher levels of specific negative core beliefs. This group also showed more extensive associations between their BMI and their core beliefs than the nonabused group. Core beliefs, which are often associated with personality disorder pathology, were associated with the reported presence of a history of sexual abuse among the morbidly obese. The group differences (in levels of core beliefs and in their association with weight variables) suggest that there might be different mechanisms to explain weight levels in those obese patients who do or do not have a history of CSA. When psychological interventions are used in support of other treatments (e.g., surgery), they might be most productively targeted on those with such an abuse history.

The prevalence of borderline personality disorder among individuals with obesity: a critical review of the literature

Through a MEDLINE and PsycLIT database search, all US studies relating to the prevalence of borderline personality disorder (BPD) among obese individuals were reviewed. The highest rates of BPD among these individuals were found in samples recruited from psychologically oriented settings (i.e., eating disorders program, mental health setting). Lowest rates were found among those seeking weight loss in non-psychological programs or those in primary care settings. Among those studies examining individuals with binge-eating disorder (BED), all indicated a higher-than-community prevalence of BPD. These data suggest that the prevalence of BPD appears increased among those obese individuals seeking psychological care or who have BED.

Depressive disorders as psychiatric complications after obesity surgery

Three case reports of morbidly obese patients (two women and a man) who underwent vertical banded gastroplasty and who subsequently fell into depression, are presented here. The psychiatric diagnosis according to DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised), the eating pattern before obesity surgery, the past history of mental disorder, social adaptation before surgery, psychological gain from their obese state, and the presence of unrealistic expectations of obesity surgery were investigated. Case 1 was diagnosed postoperatively as having a major depressive episode without a personality disorder. Case 2 was diagnosed post-operatively as having a major depressive episode. Case 3 had a depressive disorder not otherwise specified. Cases 2 and 3 had a social phobia with comorbidity of personality disorders. Binge eating disorder was confirmed in all patients before obesity surgery. There were differences between case 1 and cases 2 and 3 based on the presence of personality disorder and the time of onset of depression. When some psychiatric characteristics are confirmed in obese patients, obesity surgery should be undertaken more prudently because the patients may manifest depression postoperatively. The pre-operative psychiatric assessment is essential for a decision on indication of obesity surgery.

The comorbidity, relationship and treatment implications of borderline personality and obesity

Studies indicate that a significant minority of obese individuals in clinical studies meet criteria for borderline personality. Although the relationship between obesity and borderline personality remains unexplained, the following article discusses the implications of treating obesity among individuals with this personality disorder. Longitudinal intervention, normalizing or regulating eating patterns, and reframing weight plateaus are emphasized.