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Although the health risk of overweight and obesity is widely acknowledged, weight loss treatments are often unsuccessful in the long term due to several factors. Binge eating (BE) might explain some of the reduced benefits from the treatments. In this study, we investigated whether impulsivity and BE may interact decision processes among outpatients with overweight or obesity, and we looked at their underlying brain activity. Patients with BE tended to be more impulsive and to prefer sooner rewards compared to later ones. In all patients, α oscillations in the parietal lobe have been observed to play a dominant role during reward choice processes. A preference for immediate rewards might help to explain the low long-term success of weight loss treatment plans. The study may also provide useful information for clinicians working with patients with overweight or obesity.

Purpose: It is well known that body mass index (BMI) affects how individuals perceive their well-being and that obese individuals tend to report poorer levels of subjective health status. The aim of this study was to compare subjects with and without FSD and to examine the direct and indirect impact of BMI on female sexual dysfunction (FSD) in overweight/obese and normal-weight women. Methods: A cross-sectional study was conducted on 186 overweight/obese and 233 normal-weight women. FSD assessed with the Female Sexual Function Index (FSFI) was investigated in relation to body satisfaction assessed with the Body Uneasiness Test (BUT-A) and self-esteem assessed with the Rosenberg Self-Esteem scale (RSE). Results: No difference in the prevalence of FSD was found between overweight/obese (44.4%) and normal-weight women (55.6%), even though significant between-group differences in body image were found. Structural Equation Modelling (SEM) showed that BMI contribute to FSD only through the mediating role of body dissatisfaction and self-esteem. Conclusions: The present results support the notion that sexual functioning is not related directly to BMI in women but to a more complex interactions of body weight, satisfaction with one’s own body image, and levels of self-esteem. Clinicians should take into account that for women having a good sexual life seems not related to body weight but to the way their body weight is perceived within the context of self-image. Level of evidence: Level III, case–control analytic study.

Purpose: Alexithymia, a personality trait characterized by difficulties in emotional processing, has been associated with unhealthy behaviors and chronic medical conditions. This study aimed to further develop our understanding of this complex relationship by investigating whether alexithymia increases the risk of metabolic syndrome (MetS) in participants with obesity or overweight through the mediating role of binge eating (BE). Methods: A consecutive sample of 238 treatment-seeking patients with obesity or overweight were recruited. Alexithymia (TAS-20), binge eating symptoms (BES), body mass index (BMI), and depression and anxiety symptoms (HADS) were concurrently assessed. Results: Almost half of the participants met the criteria for MetS (44.12%). Compared to patients without MetS, those with MetS were older, had a longer duration of overweight, and had a higher BMI (p< 0.01). Individual with MetS also had higher HADS, BES, and TAS-20 scores, particularly difficulty identifying and describing feelings. The structural equation modeling (SEM) analysis revealed that BES levels exerted a significant direct effect on MetS (p< 0.01), and that TAS-20 levels exerted a significant direct effect on BES (p< 0.01), anxiety (p< 0.001) and depression (p< 0.001). Moreover, psychological distress (anxiety, p= 0.01, and depression, p= .05) indirectly affected MetS through the mediating effect of BES, and TAS-20 (p= 0.01) indirectly affected MetS through the mediating effect of HADS and BES. Finally, age had a significant direct effect on MetS (p< 0.001). Conclusion: Our findings indicate that alexithymia is a concurrent causative factor to the development of MetS through the mediating role of BE and psychological distress. Level of evidence: Level III, case–control analytic study.

Purpose: The aim of this longitudinal study was to examine the extent to which improved levels of binge eating (BE) behaviors, alexithymia, self-esteem, and psychological distress would predict a reduction in body mass at 9-month follow-up, following a lifestyle modification program for weight loss in obese or overweight patients. Methods: A convenience sample of 120 obese or overweight patients were recruited. Body mass index (BMI), binge eating (BES), levels of alexithymia (TAS-20), perceived stress (PSS), depressive symptoms (SDS), and self-esteem (RSE) were assessed during their first medical examination (T1), and after a weight-loss treatment period of 9 months (T2). Results: Compared with unimproved patients, improved patients reported a significant decrease in binge eating (p= 0.04) and perceived stress symptoms (p= 0.03), and a significant improvement in self-esteem (p= 0.02) over time. After controlling for gender, self-esteem, depressive symptoms, and perceived stress, baseline BMI (OR = 1.11, 95% CI  [1.04,1.19]), ΔBES (OR = 0.99, 95% CI  [0.98,0.99]), and ΔTAS-20 (OR = 1.03, 95% CI  [1.01,1.05]) significantly and independently predicted a ≥ 5% reduction in body mass from baseline. Conclusions: Our finding supports the suggestion to consider psychological outcomes such as emotional aspects and dysfunctional eating behaviors when planning a weight loss programs to prevent a negative outcome.

The aim of this study was to explore the prevalence and characteristics of anniversary reactions (somatic symptoms occurring at the anniversary of specific events) in a large sample of 1498 medical patients from different medical settings who underwent the Structured Clinical Interview for DSM-IV(SCID) and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), which provide definition of anniversary reactions. In 54 (3.6) of the 1498 patients for whom anniversary reaction was identified, 61.1 had a concurrent DSM-IVdiagnosis. Other syndromes related to somatization, abnormal illness behavior, irritable mood, demoralization, and alexithymia were present in 9 of 10 cases. Symptoms of the conversion syndrome were found in 6 (0.4) patients with the SCID and in 67 (4.5) patients with the DCPR, 20 of whom also had anniversary reaction. The results should alert physicians to enquire about the timing of symptoms in relation to meaningful personal events.

Electroencephalographic wave suppression was investigated using all 10 static, ambiguous Rorschach stimuli. In an earlier study using four Rorschach stimuli, the two stimuli that elicited feelings of movement were associated with suppression. In this study, we replicated this relationship using all 10 Rorschach stimuli while overcoming a number of other earlier limitations. The results strongly support the hypothesis that internal representation of the feeling of movement is sufficient to suppress the rhythm even when minimal external cues are present. This outcome increases the generalizability and ecological validity of this approach and gives support to the traditional interpretation of the Rorschach human movement responses as being associated with cognitive functioning, empathy, and social cognition.

Somatization is a widespread clinical phenomenon that cuts across diagnostic categories, both psychiatric and medical.

Psychological distress has been frequently reported in the setting of skin disorders. The Diagnostic Criteria for Psychosomatic Research (DCPR) have been found to yield valuable integrative information, in addition to DSM–IV nosology, in a variety of medical diseases. The aim of this study was to verify whether this integration could also be helpful in dermatology. A consecutive series of 539 inpatients with various skin conditions was evaluated by means of structured interviews for DSM–IV and DCPR diagnoses. The prevalence of DSM–IV conditions was 38% (mostly depressive disorders and anxiety disorders), whereas that of DCPR clusters (mostly demoralization and somatization secondary to psychopathology) was 48%. Overall, DCPR diagnoses were significantly more frequent than DSM–IV categories, regardless of the presence or absence of a psychiatric disorder. Psychological assessment of patients with skin diseases needs to incorporate both clinical (DSM–IV) and subclinical (DCPR) methods of classification. The health status of these patients can be improved if their psychological problems are appropriately assessed and recognized.

AbstractBackground: Alexithymic features are close to anhedonia, blunted affect, and alogia that are also characteristics of the negative symptoms of schizophrenia. This study aimed to evaluate whether alexithymia is associated with negative symptoms and is related to the change of schizophrenic symptoms over time. Sampling and Methods: A consecutive sample of 29 schizophrenic outpatients was evaluated at baseline and at 3, 6, and 12 months during appropriate treatment. They completed the Positive and Negative Syndrome Scale, the Montgomery and Asberg Depression Rating Scale, the Global Assessment of Functioning Scale, and the 20-item Toronto Alexithymia Scale at any time points. Results: The psychiatric scale scores showed significant symptom improvement over time but were unrelated to the alexithymia score that was instead stable over time. Hierarchical regression showed that the 20-item Toronto Alexithymia Scale at baseline was the sole predictor of alexithymia at 12 months, after controlling for psychopathology and psychological functioning. Conclusions: Alexithymia was unrelated to negative symptoms, suggesting it is an independent and separate construct from schizophrenia. As expected, the negative symptoms were associated instead with illness-related aspects of depression and psychosocial functioning. Caution should be expressed in generalization mainly because this study is limited by the small sample size.Copyright © 2005 S. Karger AG, Basel

The construct validity of Rorschach Comprehensive System (CS) variables theoretically linked to alexithymia was evaluated in 92 outpatients with inflammatory bowel disease, 32 of whom were categorized as alexithymic, 15 as indeterminate-alexithymic, and 45 as nonalexithymic, on the basis of Toronto Alexithymia Scale scores. Six sets of Rorschach CS marker variables were selected for analysis: fantasy, affect, adaptive resources, cognition, social adaptation, and projection. Most variables significantly differentiated the three groups. Compared with the other groups, alexithymic subjects were more likely to show an impoverished fantasy life, poorly adapted emotional expression, poor coping resources, concrete and stereotypical thinking, and social conformity with compromised relationships.

Background:Because of criticism made against psychiatric assessment of somatization, alternative Diagnostic Criteria for Psychosomatic Research (DCPR) have been proposed by an international group of psychosomatic investigators. One of these criteria concerns the alexithymia construct. The main aim of the present study was to investigate the criterion-related validity of the DCPR for alexithymia syndrome (DCPR-A). A secondary aim was to explore the relationship between alexithymia and depressed mood. Method:The study included 190 consecutive outpatients with functional gastrointestinal disorders. Alexithymia was assessed by means of the DCPR-A and the 20-item Toronto Alexithymia Scale (TAS-20). Depressed mood was assessed on the basis of the Depression subscale of the Hospital Anxiety and Depression Scale (HDS) and the DSM-IV criteria. Results:The sensitivity of the DCPR-A together with the TAS-20 was 70.2%, specificity was 81.6%, positive predictive power 88.9%, negative predictive power 66.0% and overall hit rate 46.8%. DCPR-A positives scored significantly higher than DCPR-A negatives on the TAS-20 scores (t = 9.86, p < 0.001). The TAS-20 was not associated with any measure of depression, while the DCPR-A was significantly associated with the HDS and DSM-IV criteria. Conclusions:The DCPR-A had adequate sensitivity, specificity and accuracy, thus proving that the criterion has good validity. The differences in association found between alexithymia and depression suggest that they may be due to differences in the methods of investigation rather than to the constructs per se.

Background:Psychiatric assessment of somatization (the tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for them) currently rests on DSM criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. The aim of this study was to compare these new criteria (Diagnostic Criteria for Psychosomatic Research, DCPR) with DSM-IV in a population where a high prevalence of psychosocial problems is expected (functional gastrointestinal disorders, FGID). Method:One hundred and ninety consecutive patients with FGID in a tertiary care center were assessed according to DSM-IV and DCPR criteria. Results:The number of the 12 DCPR diagnoses was almost double that of DSM diagnoses. Only 9% of the patients were not identified by DCPR criteria, whereas this occurred in 25% of patients using DSM criteria. While patients who were given a DSM diagnosis frequently had additional DCPR diagnoses, many patients with DCPR syndromes did not fulfill any DSM criteria. Four DCPR syndromes appared to be particularly frequent and accounted for almost three quarters of the total diagnoses (alexithymia, persistent somatization, functional symptoms secondary to a psychiatric disorder, demoralization). Conclusions:The joint use of DSM and DCPR criteria was found to improve the identification of psychological factors in FGID. The results may pave the way for changes in DSM classification of somatoform disorders.

Background:Although the alexithymia construct was derived from observations of patients with classical psychosomatic diseases, empirical studies have found only a moderate association between alexithymia and inflammatory bowel disease (IBD). Indeed, there is some evidence that alexithymia may be associated more strongly with functional somatic symptoms than with the psychosomatic diseases. The present study examined the relationship between alexithymia and functional gastrointestinal disorders (FGIDs) in a group of 121 FGID patients, and compared the results with findings from a group of 116 IBD patients and a group of 112 healthy subjects. Method:The subjects completed the 20-item Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale. Results:The FGID group was significantly more alexithymic than the IBD group, and the two gastrointestinal groups were more alexithymic than the normal healthy group. These differences remained even after controlling for the influence of education, gender, anxiety, depression and gastrointestinal symptoms. Conclusions:The finding of a high rate of alexithymia (66%) in the group of FGID patients is consistent with the propensity of these patients to somatization and to high levels of poorly differentiated psychological distress.

Nonfearful panic disorder (NFPD) is a panic condition masked under the appearance of somatic symptoms only, without the component of fear, and it represents a challenging diagnostic task.

Gastroenterologists are often faced with the diagnostic problem of differentiating acute symptoms of ulcerative colitis from functional intestinal disorders. Bowel obsession syndrome (BOS) is an OCD-like, functional syndrome characterized by fear of fecal incontinence and compulsive behaviors of evacuation-checking. Only sparse case studies on treatment of BOS with antidepressants have been published. This is the first study on successful psychotherapy of a male patient with ulcerative colitis overlapping functional bowel symptoms and marked symptoms of BOS. Clinical recognition of BOS may help clinicians in differential diagnosis, prevent unnecessary investigations, and give patients the most appropriate treatment.

Irritability may be a mood state independent of other moods and anxiety disorders, even though it may be symptomatic of several psychiatric disorders, such as major depression. The aims of this exploratory study were to verify the presence of irritable mood in a group of medical outpatients with a variety of clinical conditions (functional gastrointestinal disorders, cardiovascular disorders, endocrine diseases and cancer) and to examine its relationship with major depression. A total of 609 consecutive outpatients recruited from different medical settings were assessed according to DSM-IV and Diagnostic Criteria for Psychosomatic Research using semistructured research interviews. Irritable mood was identified in 163 (27%) patients, while major depression was present in 113 (19%) patients. Even though there was a considerable overlap between the two diagnoses, 76 (67%) patients with major depression were not classified as irritable, and 126 (77%) patients with irritable mood did not satisfy the criteria for major depression. The findings suggest a high prevalence of irritability in the medically ill, which in most cases is independent of mood disorder. Further research may determine whether irritability, alone or in association with major depression, entails prognostic and clinical implications.