Abstract
Background: Personality pathology does not have to be a contraindication to a bariatric surgery if a proper pre-surgical assessment is done. Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes.Objectives: Using the Alternative DSM-5 model for personality disorders (AMPD) and the ICD-11 model for PDs to detect subgroups of patients with obesity based on a specific constellation of maladaptive personality traits and the level of overall personality impairment.Methods: 272 consecutively consented patients who underwent a standard pre-surgical psychological assessment. The majority were women (58.0%), age range was 22–79 years (M = 48.06, SD = 10.70). Patients’ average body mass index (BMI) was 43.95 kg/m2. All participants were administered the Personality Inventory for DSM-5 (PID-5) from which Level of Personality Functioning Scale-Self Report (LPFS-SR) and Standardized Assessment of Severity of Personality Disorder (SASPD) scores were gained using the “crosswalk” for common metric for self-reported severity of personality disorder. The k-means clustering method was used to define specific subgroups of patients with obesity and replicated for equality testing to the samples of non-clinical respondents and psychiatric patients.Results: The cluster analysis detected specific groups in the sample of patients with obesity, which differed quantitatively from the samples of non-clinical respondents and psychiatric patients. A vast majority of patients with obesity showed above-average values in most of the PID-5 facets compared to the United States representative general community sample. In two out of the three clusters defined, patients demonstrated moderate (> M + 1.5 × SD) to severe (> M + 2.0 × SD) personality psychopathology within the Detachment and Negative Affectivity domains according to PID-5, which in one of the clusters corresponded to the mild overall impairment in both, LPFS-SR (M = 2.18, SD = 0.27) and SASPD (M = 8.44, SD = 2.38). Moreover, higher levels of psychopathology prove to be associated with higher age and use of psychiatric medication.Conclusions: The dimensional DSM-5 and ICD-11 trait models are suitable procedures for defining specific “characters” of patients in a pre-bariatric setting. As such, they help to identify subgroups of patients with obesity who are different from general population and psychiatric patients. Implications for clinical practice and further research are discussed.
Highlights
The level of personality pathology and mental disorders including personality disorders (PDs) is discussed in regard to obesity treatment, especially when the risks and profits of bariatric surgery are in question (Walfish et al, 2007; Chalopin et al, 2020)
The lowest average values of the Personality Inventory for DSM-5 (PID-5) facet scores were achieved in the range from M = 0.27 (SD = 0.23) for callousness to M = 1.15 (SD = 0.70) for separation insecurity
In line with the first goal of the current investigation based on the k-means clustering method, we defined three clusters with a specific distribution of the Alternative DSM-5 model for personality disorders (AMPD) maladaptive personality traits and varying degrees of psychopathology within Sample 1
Summary
The level of personality pathology and mental disorders including personality disorders (PDs) is discussed in regard to obesity treatment, especially when the risks and profits of bariatric surgery are in question (Walfish et al, 2007; Chalopin et al, 2020). Studies address personality variables by various tools, which may cause inconsistencies in the presented findings (Rowe et al, 2000; Guisado et al, 2002; Tsushima et al, 2004; De Panfilis et al, 2006; Leombruni et al, 2007) Another problem is that there is no clear consensus among psychologists as to whether (Larsen et al, 2004) and how to assess the overall personality psychopathology in pre-bariatric evaluations (Bauchowitz et al, 2005; Fabricatore et al, 2006). Borderline personality problems along with anxiety-related disorders and higher proneness to stress have been associated with less optimal BMI and weight outcomes 5 years after bariatric surgery in a recent study using the Personality Assessment Inventory (PAI) in a representative sample of bariatric patients (Oltmanns et al, 2020). Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes
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