Simple obesity is not included among the eating disorders in DSM-IV. However, when there is evidence that psychological factors play a substantial etiological role in a specific case, this may be documented by noting “psychological factors affecting physical condition” in the diagnosis.
Symptoms & Signs
Despite the absence of clear-cut psychological and behavioral profiles associated with the development of obesity, there is a subgroup of obese individuals that manifests emotionally based patterns of overeating. Between 25% and 50% of participants in weight control programs report severe problems with binge eating, with women 11/2 times more likely to report this pattern than men. The eating binges are related to emotional stresses, and these individuals are more likely than nonbingers to have coexisting psychiatric disorders. DSM-IV established research criteria for diagnosing these individuals as having binge-eating disorder. This diagnosis is differentiated from bulimia nervosa only by the absence of compensatory behavior such as purging, fasting, or excessive exercising.
As many as one-third of obese patients have severe disparagement of body image. They feel that their bodies are grotesque and that others view them with hostility and contempt. Such feelings are reinforced by social attitudes, since fat people are often discriminated against and viewed by others as lazy, weak, self-destructive, and responsible for their condition. They also manifest low self-esteem and a negative self-concept.
Although many obese individuals tend to eat in response to emotional cues such as feelings of anxiety, fear, loneliness, boredom, and anger, so do many persons of normal weight. Obese individuals tend to chew less and eat more rapidly than other people, but both groups are strongly influenced by the eating behaviors of those around them.
Obese adults are usually physically less active than others, but this may be a consequence rather than a cause of obesity. Obese children are not less active than their normal-weight peers.
Dieting itself can be a significant biological and psychosocial stress factor. Dieting may cause feelings of frustration, agitation, irritability, and heightened emotional reactivity in otherwise normal persons. Thus, some of the emotional features traditionally attributed to obese persons may be a consequence of attempts to lose weight by dieting rather than a cause of their condition.
Revision date: July 6, 2011
Last revised: by Sebastian Scheller, MD, ScD