BackgroundObese patients who apply for bariatric surgery reveal an higher prevalence of psychiatric disorders than both general population and obese patients not seeking treatment. Some psychiatric conditions represent an absolute contraindication to surgical treatment. Personality disorders (PD) are not part of this group but their presence can indirectly affect surgical outcome. Different studies demonstrated that cluster A (Schizoid, Paranoid, Schizotypal) and B (Antisocial, Borderline, Narcissistic, Histrionic) are the most represented PD in obese population. Bariatric patients show different characteristics. In three recent different studies, cluster C (Avoidant, Dependent, Obsessive-Compulsive) disorders appear to be prevalent in bariatric population, with frequencies from 18.8% to 24%.

MethodsOur sample consisted of 113 patients, 70 female and 43 male, who underwent psychiatric consultation as part of the bariatric surgery program in Trieste, from 2010 to 2015. They were aged between 18 and 66 years old. BMI was in the range of 30.47 to 77.64. In order to assess personality disorders we used the Temperament and Character Inventory (TCI), a questionnaire which measures four dimensions of temperament (Novelty Seeking, Harm Avoidance, Reward Dependence, Persistence) and three dimensions of character (Self-Directedness, Cooperativeness, Self-Transcendence). Character’s scales allow to determine the presence or absence of a PD. Temperament’s scales permits differential diagnosis between PD. We applied a descriptive statistic to our results, comparing different sub-population of our sample.

ResultsOverall 63% of participants had a personality disorder: the most represented was obsessive PD (21.23%), followed by passive-aggressive PD (14.15%) and dependent PD (9.73%). In our study, as in literature, bariatric population showed higher prevalence of PD than general population (10%), with preponderance of cluster C PD. In the sub-population of 88 patients who received the psychiatric assent for surgical intervention, 43.3% showed the absence of PD. The most represented PD in this group was obsessive PD (20.45%), followed by passive-aggressive PD (11.36%) and dependent PD (10.20%). In the sub-group of 19 patients who required a re-evaluation, 15,8% didn’t have a PD. The more recurrent disorders were, also in this case, obsessive PD (26.3%) and passive-aggressive PD (21%). Between the 5 patients of the dissent sub-population, the 60% had a PD, in particular passive-aggressive PD (40%). In our research, the presence of PD seemed to have just little influence on the access to bariatric surgery. A high percentage (56.7%) of subjects, who received the psychiatric approval for surgery, had some PD. Men showed higher frequency of PD (69.77%), in comparison with women (58.58%). In both sub-populations the most represented PD was the obsessive one (23.25% for men and 25% for women). Men seemed also to suffer frequently from passive-aggressive PD (16.27%) and borderline PD (11.62%). Women were more affected by dependent PD (14.28%) and passive-aggressive PD (12.85%). This results are similar to literature findings. The PD frequency increases with increasing BMI. Class I obesity group, composed of 12 patients, showed 50% of PD, with higher frequency of passive-aggressive PD (25%). Class II and III obesity groups, made up of 29 and 71 patients, had respectively 62% and 64.79% of PD. Obsessive PD was the most represented disorder in both sub-groups, with 31.03% and 19.71% of frequency. These results support the presence of a positive correlation between BMI and PD, already highlighted by literature. 23 subjects of the sample showed impulsive food behavior (binge eating and purging). In this sub-population we found 78.27% of PD, in particular passive-aggressive (30.43%) and obsessive PD (21.73%). Borderline PD, that is considered to be associated with impulsive food behavior, had a frequency of 8.7%, consistent with research findings.

Personality disorders in bariatric population

Peresson G, Arimondi C, Bonavigo T, Sandri F, Pascolo-Fabrici E Clinica Psichiatrica, Università degli Studi di TriesteClinica Psichiatrica, Università degli Studi di Udine

Conclusions Personality disorders seem to be very frequent in bariatric population. They appear particularly represented in men, in individuals with higher BMI and in subjects with impulsive food behaviors. Cluster C disorders are prevalent, in particular obsessive PD is very common in our study. The presence of a personality disorder should therefore be carefully assessed for the eligibility to bariatric surgery. Further studies could be done to better understand the consequences of a personality disorder on surgery outcomes.

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