Obesity and borderline personality symptomatology: comparison of a psychiatric versus primary care sample.

This study explores the relationship between obesity and borderline personality symptomatology in two clinical settings: a psychiatric vs primary care setting. The body mass indices (BMI) of 48 women from a psychiatric outpatient setting and 83 women from a primary care setting were calculated. Each participant completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). While BMI and PDQ-R were moderately related in the psychiatric sample (r=0.43, P<0.01), there was a lack of association between these variables in the primary care sample (r=0.04, P>0.05). In conclusion, women's increasing body weight appears to have some degree of correlation to borderline personality symptomatology among psychiatric patients, whereas it apparently does not among primary care patients.

Adult somatic preoccupation and its relationship to childhood trauma.

Somatic preoccupation has been associated with a variety of comorbid psychiatric conditions including childhood trauma, personality disorder, and depression. The current study was undertaken to simultaneously explore the inter-relationship of these psychiatric variables as conceptualized in a path model. Participants (N = 120), both men and women, seen for nonemergent health care in a resident-staffed internal medicine clinic, were given questionnaires exploring the presence of childhood trauma, borderline personality symptomatology, current depression, worry, and somatic preoccupation. With one exception, all simple correlation coefficients among study variables were relatively substantial. By sequencing variables into an a priori model and using a path analytic approach, several indirect and direct relationships among variables were evident. Most important, childhood trauma exhibited a direct effect on somatic preoccupation as well as indirect effects through borderline personality disturbance and current depression. These data suggest that childhood trauma may be a precursor for somatic preoccupation during adulthood.

Childhood trauma and adult somatic preoccupation by body area among women in an internal medicine setting: a pilot study.

OBJECTIVE: This study was designed to explore the relationship between three types of abuse in childhood and their relationship to somatic preoccupation, in general and by body area, in adulthood. METHOD: Eighty-five women in an internal medicine clinic completed self-report measures of childhood sexual, physical, and emotional abuse as well as the Bradford Somatic Inventory. RESULTS: Using simple correlations, all three types of abuse were positively related to current somatic preoccupation. Using multiple regression analysis that included demographic variables (education and age) and the three forms of childhood abuse, only the demographic variables and sexual abuse were uniquely predictive of somatic preoccupation. To determine the relationship between childhood abuse and somatic symptoms based on body area (head, chest, stomach, throat) and fatigue, a series of multiple regression analyses were performed. The chest and throat areas were significant, but no abuse variable was uniquely predictive. CONCLUSIONS: Among females in adulthood, all studied forms of abuse in childhood appear to contribute to general somatic preoccupation, as well as specific somatic symptoms in the chest and throat areas. Sexual abuse, specifically, is a unique predictor for general somatic preoccupation, but not necessarily specific body areas.

Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples.

The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with chi(2) analyses indicated that "overdosed" and "hit self" were significantly more common in the mental health subsample whereas "abused laxatives" was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that "overdosed" and "hit self" remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.

Perceptions of parents' health status and relationship to somatic preoccupation.

OBJECTIVES: This study was designed to examine the potential relationship of family factors to somatic preoccupation. METHOD: A total of 116 internal medicine patients completed research booklets exploring perceptions of parents' health, childhood trauma, borderline personality symptomatology [Personality Diagnostic Questionnaire-Revised (PDQ-R)], and somatic preoccupation (Bradford Somatic Inventory). RESULTS: Simple correlations revealed that most of the relationships between somatic preoccupation and remaining study variables were statistically significant (e.g., poor parental health status correlated to somatic preoccupation). Using path analysis, poor perception of mother's health demonstrated an indirect effect on somatic preoccupation via borderline personality symptomatology, whereas, poor perception of father's health demonstrated an indirect effect on somatic preoccupation via childhood trauma. Neither parents' health status demonstrated direct effects on somatic preoccupation. CONCLUSIONS: There appear to be parent gender differences in the mediation of the relationship between poor parental health status and somatic preoccupation in the offspring. The implications of these findings are discussed.

The prevalence of borderline personality disorder among individuals with obesity: a critical review of the literature.

Through a MEDLINE and PsycLIT database search, all US studies relating to the prevalence of borderline personality disorder (BPD) among obese individuals were reviewed. The highest rates of BPD among these individuals were found in samples recruited from psychologically oriented settings (i.e., eating disorders program, mental health setting). Lowest rates were found among those seeking weight loss in non-psychological programs or those in primary care settings. Among those studies examining individuals with binge-eating disorder (BED), all indicated a higher-than-community prevalence of BPD. These data suggest that the prevalence of BPD appears increased among those obese individuals seeking psychological care or who have BED.

Physician mental health and substance abuse. What are state medical licensure applications asking?

OBJECTIVE: To summarize and characterize the questions on initial applications for medical licensure (nonosteopathic) as they relate to applicants' mental health and substance abuse. DESIGN: Collection and analysis of applications for initial medical licensure (nonosteopathic) from 50 states and the District of Columbia. PARTICIPANTS: Nonosteopathic medical licensure applications of 47 states and the District of Columbia (N = 48). INTERVENTION: None. MAIN OUTCOME MEASURES: Number of questions per application relating to mental health problems and substance abuse, in addition to time qualifiers (e.g., current difficulty, specified number of years in the past, ever) and impairment qualifiers (e.g., functional impairment, treatment, hospitalization) per question or set of questions for each area. RESULTS: Of 48 applications analyzed, 41 (85%) inquired about mental health problems and 43 (90%) inquired about substance abuse. Most explored periods between the past 10 years and the present; functional impairment was the most common inquiry. CONCLUSIONS: Applications for nonosteopathic medical licensure most often inquire about physicians' recent history of mental health and substance abuse problems as well as related functional impairment. Variation of items across state applications may have important implications for some physician applicants.

Obesity among sexually abused women: an adaptive function for some?

In an attempt to explore the possibly adaptive function obesity may serve for some women with histories of sexual trauma, we examined relationships among sexual abuse history, body dissatisfaction, and maximum weight fluctuation among obese (n = 38; Body Mass Index > or = 27.3) and nonobese (n = 112; Body Mass Index < 27.3) women sampled from a primary care medical setting. History of sexual abuse was unrelated to current body weight within the entire sample, as well as the nonobese and the obese subsamples. However, the interaction between obesity and sexual abuse was statistically significant in the prediction of both current/ideal body-weight discrepancy (i.e., body dissatisfaction) and maximum weight fluctuation during adulthood. Among nonobese women, history of sexual abuse was unrelated to current body dissatisfaction but was related to greater maximal weight fluctuation during adulthood. Among obese women, those with a history of sexual abuse reported relatively less current body dissatisfaction and less weight fluctuation during adulthood compared to nonsexually-abused obese women. Results are discussed with regard to the potential adaptive function obesity may play for some sexually abused women and the need for additional research using larger, more diverse samples and more elaborate measures.

The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder.

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non-mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation.

Panic disorder: the ultimate anxiety.

Panic disorder, an intense exacerbation of anxiety accompanied by a variety of physical symptoms, is twice as common among women as among men. Onset is bimodal (teens/20 s and mid-30 s/40 s), 50% of cases are accompanied by agoraphobia, and the etiology is probably multifactorial. Treatment in the primary care setting includes pharmacologic (selective serotonin reuptake inhibitors) and cognitive-behavioral intervention. Medication is initiated at low doses, and the drug-evaluation trial is of 6 weeks duration. Psychiatric referral is helpful in nonresponders and in those with comorbid psychiatric conditions. Outcome varies, with most patients experiencing relief with treatment. For some people, however, the disorder is chronic, with ongoing exacerbations and remissions.

Use of psychological measures in primary care.

OBJECTIVE: To determine the use of psychological measures among primary care physicians. DESIGN: Survey. SETTING: Primary care practices in Ohio. SUBJECTS: Active members of the Ohio Academy of Family Physicians. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Subjects' use "ever" and "during the past 12 months" of 11 psychological measures encountered in primary care settings. RESULTS: Approximately 80% of 521 respondents acknowledged having used 1 or more of the listed psychological measures in clinical practice. Of the measures listed, each was endorsed by some proportion of respondents. The majority of physicians who had ever used a particular measure had done so in the preceding 12 months. Compared with respondents who did not use psychological measures in practice, unique predictors for those who did were being relatively younger, female, and practicing in more densely populated areas. CONCLUSION: Most family physicians have used psychological measures in clinical practice.

History of trauma and attempted suicide among women in a primary care setting.

The results of past research have demonstrated apparent links between suicidality and a history of sexual abuse or physical abuse. However, the relative predictive power of such abuse histories in explaining sucidality remains unknown, as does the potential relationship between sucidality and emotional abuse, physical neglect, and witnessing violence. In the current study, 151 women who presented for nonemergent medical care indicated whether they had experienced each of five types of abuse and whether they had ever attempted suicide. Similar to past research, increased rates of having attempted suicide were evident among women who had been sexually or physically abused. Rates of past suicide attempts were also higher among those who had experienced emotional abuse or had witnessed violence. However, many women indicated having experienced multiple forms of trauma. In a multivariate analysis, only sexual abuse and physical abuse were uniquely predictive of having attempted suicide. Results are discussed with regard to the potential importance of bodily intrusiveness during abuse as most predictive of subsequent suicidality.

Borderline personality symptomatology, experience of multiple types of trauma, and health care utilization among women in a primary care setting.

BACKGROUND: This project was designed to explore the relationship between recollected trauma history, borderline personality symptomatology, and health care utilization among women in a primary care setting. METHOD: Women (N = 116) consecutively recruited during routine gynecological appointments were given a set of questionnaires that explored 5 types of trauma (i.e., sexual, physical, and emotional abuse; physical neglect; witnessing violence) as well as borderline personality symptomatology. The preceding 12 months of participants' medical records were blindly reviewed to determine several measures of health care utilization (i.e., number of telephone contacts to the facility, physician visits, ongoing and acute prescriptions, specialist referral). RESULTS: Multiple forms of trauma were related to increased telephone contacts, physician visits, acute prescriptions, and ongoing prescriptions. Borderline personality symptomatology was related to physician visits and ongoing prescriptions. Neither was related to the number of specialist referrals. Total number of types of trauma and borderline personality symptomatology scores were moderately related to each other (r = .36, p < .01). CONCLUSION: With the exception of specialist referrals, the experience of multiple types of trauma and borderline personality symptomatology contribute to higher health care utilization among women in a primary care setting, but not to a substantial degree. The experience of trauma and borderline personality symptomatology appear partially related to each other. This relationship has several implications.

The relationship between obesity and medical utilization among women in a primary care setting.

OBJECTIVE: This project was designed to explore the utilization of specific health care resources by obese compared with nonobese women in a primary care setting. METHOD: Eighty-three obese women, consecutively identified during nonemergent appointments in a primary care health maintenance organization (HMO) setting, were compared with 111 nonobese women with regard to several parameters of health care utilization. All participants' medical records were reviewed for the preceding 12 months for the number of diagnoses, combined telephone and physician contacts with the facility, different physicians seen, and prescriptions. RESULTS: Increasing body mass index (BMI) was predictive of a greater number of diagnoses, contacts with the facility, total number of prescriptions, and number of different physicians seen. After controlling for the number of diagnoses, BMI remained predictive of the number of different physicians seen. DISCUSSION: Our findings indicate that increasing BMI is associated with greater health care utilization, primarily through greater morbidity. Additionally, there may also be particular psychosocial and illness factors which contribute to obese women's patterns of physician contact.

An investigation of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors.

OBJECTIVE: To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment. STUDY DESIGN: A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review. METHODS: Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment. RESULTS: On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record. CONCLUSIONS: Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate.

The comorbidity, relationship and treatment implications of borderline personality and obesity.

Studies indicate that a significant minority of obese individuals in clinical studies meet criteria for borderline personality. Although the relationship between obesity and borderline personality remains unexplained, the following article discusses the implications of treating obesity among individuals with this personality disorder. Longitudinal intervention, normalizing or regulating eating patterns, and reframing weight plateaus are emphasized.

Sabotaging one's own medical care. Prevalence in a primary care setting.

This study determines the prevalence of medically self-sabotaging behaviors reported by patients in a primary care setting. A 19-item self-report survey was completed by patients on-site at the Family Medicine Clinic, University of Oklahoma College of Medicine-Tulsa. Four hundred eleven consecutive male and female patients were seen for nonemergent care. Each of the 19 items was endorsed by at least 1 respondent. The most commonly endorsed self-sabotaging behaviors were not seeking medical care when needed (37.2%) and not taking a prescribed medication (25.1%). Significantly more women (26.4%) than men (17.5%) reported not taking a prescribed medication (P < .05). After excluding these 2 commonly endorsed items, 27 (6.6%) of the respondents reported at least 1 other self-sabotaging behavior, with most indicating 1 (63.0%) or 2 (22.2%); the remaining 4 individuals reported 4 to 12 behaviors. Significantly more men (4.8%) than women (0.6%) reported not following instructions from a physician or nurse to prolong illness (P < .05). A few patients (6.6%) seen in a primary care university outpatient clinic acknowledged the active and intentional sabotage of their medical care, beyond not taking a prescribed medication or seeking medical care when needed. This is probably a conservative estimate and indicates that medical care is actively compromised by a few patients.