• Psychopathology
• Lipodystrophy

Aim of the study: Lipodystrophy is a collection of disorders defined by complete or partial loss of adipose tissue, due to abnormal adipocyte production, function, or distribution; it shares the main metabolic complications (insulin resistance and type II diabetes, hypertriglyceridemia and hepatic steatosis) with obesity. Although lipodystrophic patients can report psychopathological distress, little is known about these aspects. The aims of the present study were to investigate the psychiatric diagnoses obtained from non-HIV lipodystrophic patients and to evaluate the psychopathological rating scales of patients with non-HIV lipodystrophy in comparison with a group of obese patients, a group of patients affected by oncologic chronic illness and a control group of healthy subjects.
Methods: All participants were female: 16 lipodystrophic women (mean age 42±12 yrs), 20 women with breast cancer (adenocarcinoma with a positive sentinel lymphnode in outpatients awaiting chemotherapy, mean age 44±5 yrs), 20 obese women (mean age 40±3 yrs), 20 healthy women (mean age 40±2 yrs). Each lipodystrophicpatient received a psychiatric assessment, following the diagnostic criteria for DSM-5. Patients from all four groups received a battery of self-report instruments measuring general psychopathology, body image concerns, eating habits and food craving, pain concerns. The following psychopathological rating scales were used:
- SCL-90-R (Symptom Check-List) for general psychopathology
- BUT (Body Uneasiness Test) for body image
- FCQ-T (Food Cravings Questionnaire Trait) for food craving
-WHYMPI (West Haven Yale Multidimensional Pain Inventory) for multidimensional pain inventory
Results: The psychiatric assessment of the 16 lipodystrophic patients allowed to recognize the following diagnostic categories: 3 lifetime mood disorder, 6 current mood disorder, 3 lifetime anxiety disorder, 5 current anxiety disorder, 4 current Somatic Symptom Disorder with Predominant Pain, 6 current Binge Eating Disorder, 11 Eating disorder not otherwise specified, 2 Borderline personality disorder, 1 Obsessive-compulsive personality disorder, 1 Avoidant personality disorder, 5 Personality disorder not otherwise specified.
In the psychopathological scale SCL-90-R, the subscale Sensitivity showed a significantly higher score in the lipodystrophic and oncologic groups versus healthy subjects. The subscale Paranoid ideation showed a significantly higher score in the lipodystrophic group versus all the other groups. The total score of BUT scale was significantly higher in the lipodystrophic and in the obese groups versus healthy subjects. Furthermore, it was higher in obese subjects than in lipodystrophic patients. With regard to WHYMPI scale, the scores of Pain Interference and family Support were significantly higher in the lipodystrophic group versus healthy subjects, as much as in the oncologic group and in obese subjects. The scores of Negative Responses (to subject’s perception when she complains to the others about her pain) were significantly higher in the lipodystrophic group versus healthy subjects. The scores of Solicitous Responses were significantly lower in the lipodystrophic and healthy groups versus obese subjects. In FCQ-T scale, the score of Cues dimension in lipodystrophic patients was significantly lower as compared with all the other groups.
Discussion and Conclusions: An almost widespread prevalence of mood, anxiety and eating disorders was observed in our cohort of lipodystrophic patients. It is interesting to note that about 25% of them display a current Somatic Symptom Disorder with Predominant Pain. Regarding the pain evaluation in WHYMPI scale, the interference of pain on personal and social activity is markedly disabling in lipodystrophic subjects, as much as in oncologic and in obese subjects.
Although a good family support is reported, lipodystrophic subjects receive more negative and less thoughtful responses from those to whom they complain of their own pain. With regard to SCL-90-R scale, Sensitivity dimension expresses the feelings of personal inadequacy and inferiority, while Paranoid ideation is expression of discomfort for a chronic, disabling and impelling disease like lipodystrophy, and for being observed and misjudged by others. In BUT scale subjects from lipodystrophic and obese groups are more disturbed by body image concerns, although obese subjects to a greater extent compared to lipodystrophic patients. In FCQ-T scale, the mean score of Cues dimension in lipodystrophic patients was significantly lower compared to the other groups, suggesting that the external cues triggering food craving have a lower influence in inducing the voracious appetite about which they often complain. Internal stimuli are more important than external food cues in eliciting food craving in subjects with disordered eating behaviours. Among the various internal stimuli potentially involved in provoking food craving, we can hypothesize the role of leptin. Therefore, being lipodystrophic patients hypoleptinemic, they show an increased appetite independently of external cues. In conclusion, lipodystrophic patients suffer from a chronic, disabling and impelling disease that needs a careful psychiatric evaluation and may benefit from psychological support or psychopharmacotherapy.