• affective temperaments
• bariatric patients
• emotional dysregulation
• impulsivity
• mood disorders
• obesity
• psychiatric comorbidity

The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic proportions. Obesity is a chronic, relapsing, progressive disease process presenting a multifactorial etiopathogenesis with the role of both eating behaviour and psycho(patho)logical factors. Evidence shows an important relationship between metabolic disorders and psychopathological dimensions such as emotional dysregulation, impulsivity, executive dysfunction and affective temperamental instability. In particular obesity and mood disorders are both highly prevalent in the general population and frequently associated.
This study aims to evaluate psychiatric comorbidities, affective temperamental dimensions, emotional dysregulation and deficits of executive functions in a sample of obese bariatric patients. Moreover we explore the differences between obese patients with and without mood disorders, in terms of emotional dysregulation, executive function deficits and their clinical correlates.
Fifty-nine obese patients, candidates for bariatric surgery, were consecutively enrolled between March and November 2019 at the Obesity Centre of the U.O. Endocrinology 1 of the AOUP. Inclusion criteria were: to be candidate for bariatric surgery, age ≥ 18 years, BMI ≥ 35 kg/m2 (class II obesity). Patients unable to complete the self-questionnaires or with unstable and/or severe medical or psychiatric condition were excluded from the recruitment. All subjects provided written informed consent for the study participation. In a single consultation, socio-demographic variables along with several clinical variables were recorded by the participating psychiatrists. Current and/or lifetime psychiatric comorbidity according to the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5) criteria was assessed trough the Mini-International Neuropsychiatric Interview (MINI). The assessment of clinical features of Attention Deficit Hyperactivity Disorder (ADHD) in adults was carried out through the Wender - Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). The clinical assessment was conducted by administering the following self-questionnaires: the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-M (Brief TEMPS-M), the Barratt Impulsiveness Scale, Version 11 (BIS-11), the Affective Lability Scale - Short Form (ALS-SF), the Reactivity, Intensity, Polarity, Stability Questionnaire (RIPoSt) and the Difficulties in Emotion Regulation Scale (DERS). Epidemiological and clinical variables, as well as psychometric scale scores, were compared in patients with and without mood disorders (i.e., Bipolar Disorder and Major Depressive Disorder). Comparisons between the two subgroups were conducted by Student’s t-test for the dimensional variables and chi-square analysis for the categorical ones.
Our obese patients showed low levels of education and employment while the majority of the sample was married. Obese patients portrayed high rates of psychiatric comorbidity (74.6%) and psychiatric treatment (32.2%) in their medical history. Among psychiatric comorbidities, Bipolar disorder (37.3%), Major Depressive Disorder (11.9%), Anxiety Disorders (45.8%), BED (47.5%) and Neurodevelopmental disorders (16.9%) were the most represented. Obese patients also reported high rates of medical comorbidities, in particular of OSAS, hypertension and type II diabetes mellitus.
In the comparison between obese patients with (MD) and without mood disorders (N-MD) emerged that MD patients obtained higher scores in the affective lability and emotional over-reactivity WRAADDS subscales. Regarding the subdimensions of emotional dysregulation, in the affective instability, negative emotionality and emotional impulsivity RIPoSt subscales; in the subscales of the DERS related to the difficulty of engaging in goal-directed cognition and behaviour when distressed (goals), difficulties of impulse control and regulation of behaviour when distressed (impulse), and limited access to emotion regulation strategies for feeling better when distressed (strategies); then in the affective lability measured through ALS-SF. Concerning impulsivity MD patients obtained higher scores in the attentional and motor impulsivity BIS-11 subscales. Regarding the temperaments, in the cyclothymic, depressive and anxious temperaments measured through the Brief TEMPS-M scale. MD-comorbid patients exhibited also higher rates of psychiatric comorbidities.
In our sample, obese individuals present more frequently social impairments along with a significant rate of medical and psychiatric comorbidities. MD-comorbid obesity is associated with more severe psychiatric comorbidity, emotional dysregulation and impulsivity compared to N-MD obesity. Our results indicate that obese people commonly exhibit elevated levels of emotional dysregulation, suggesting it may play a crucial role in the psychopathology of obesity. The correlation, between temperament-related psychopathology and obesity, deserves a deeper investigation, considering that further studies can impact on the clinical interventions, that should take into account the psychiatric aspects.