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AUTHOR: JON K. MILLS

TITLE: A Note on Interpersonal Sensitivity and Psychotic Symptomatology in Obese Adult Outpatients With a
History of Childhood Obesity

SOURCE: The Journal of Psychology v129 p345-8 My '95

The magazine publisher is the copyright holder of this article and it is reproduced with permission.
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PUBLISHER ABSTRACT AB The Symptom Checklist 90-Revised (Derogatis,

1975) was administered to 37 obese adults in outpatient treatment for obesity.
Individuals who had become obese during childhood showed greater
interpersonal sensitivity and exhibited more psychotic symptoms than those
who had become obese later in life. The findings support the belief that
morbid obesity is characteristically associated with elevated levels of internal
psychological conflict.
A NUMBER OF RESEARCHERS have examined the psychological and personality characteristics
of obese individuals (Leon & Roth, 1977; McReynolds, 1982; Mills, 1994; Slochower, 1987). Several
findings have associated personality characteristics of the obese with passive dependency, self-
consciousness, low assertiveness, and low self-esteem (Jacobs & Wagner, 1984; Klesges, 1984;
Mattlar, Salminen, & Alanen, 1989; McReynolds, 1982; Stein, 1987). Researchers have consistently
asserted that obese people have more internal anxiety and depression than nonobese individuals
((Garetz, 1973; Hafner, Watts, & Rogers, 1987; Klesges, 1984; Kornhaber, 1970; Lowe & Fisher,
1983; Mattlar et al., 1989; Scott & Baroffio, 1986; Slochower, 1987). Several studies have reported
that obese individuals also show a propensity toward somatic disorders and neurotic trends leading to
maladjustment (Hafner et al., 1987; Hjordis, Gunnar, & Daisy, 1989; Scott & Baroffio, 1986; Stein,
1987). This study was conducted to explore these assumptions as well as to examine the relationship
between childhood-onset obesity and the severity of psychotic symptoms.

METHOD
The Symptom Checklist 90-Revised (SCL-90-R) was administered to a sample of 37 obese adults
(27 women and 10 men) in outpatient treatment for obesity. The SCL-90-R is a 90-item self-report
symptom inventory developed by Derogatis (1975) and designed primarily to determine patterns of
psychological symptoms in psychiatric and medical patients. Participants were recruited from a
university-affiliated outpatient eating disorders clinic where they were receiving multidisciplinary
treatment, including dietary, medical, behavioral, and psychological interventions.
The participants were diagnosed using clinical standards for obesity. They ranged from 25 to 365
pounds over their ideal body weight according to standard height and weight tables (M = 115.4 lb, SD
= 75.1); ages ranged from 20 to 62 years (M = 41.3 years, SD = 10.9). The participants were
administered the SCL-90-R during the initial assessment process.

RESULTS AND DISCUSSION

Pearson product-moment correlation coefficients yielded statistically significant results between
age of onset and levels of psychopathology. Age of onset was significantly correlated with greater
interpersonal sensitivity (r = -.36, p < .05) and psychoticism (r = -.33, p < .05) as measured by the
Interpersonal Sensitivity and Psychoticism clinical subscales of the SCL-90-R. Participants with early-
onset obesity showed greater vulnerability to criticism, displayed a greater need for social
acceptance, and exhibited more mild psychotic symptoms than participants with late-onset obesity.
Age of onset was also significantly correlated with greater frequency (r = -.46, p < .01) and higher
levels of psychological distress and psychotic symptoms (r = -.40, p < .01) as measured by two global
scales of the SCL-90-R, the Positive Symptom Total (PST) index and the Global Severity Index (GSI;
Mills & Andrianopolous, 1993). The PST index reflects the frequency and number of patient-reported
symptoms, and the GSI reflects the degree and severity of current psychotic symptoms. Participants
who had early-onset childhood obesity showed a greater frequency of psychotic symptoms as well as
higher levels of psychological distress than those who became obese during adolescence or adulthood.
The finding that obese individuals experience greater interpersonal sensitivity was not surprising.
Body image disturbance, self-esteem concerns, lack of confidence in social situations, and the
perpetual social stigma of obesity all contribute to a heightened sensitivity related to conflicted needs
for social acceptance, inclusion, and self-validation. In addition, the depressive tendency to withdraw
and isolate oneself from interpersonal environments may explain the high scores on the Psychoticism
subscale. Obese individuals may be more prone to develop various psychotic symptoms and personal
adjustment problems than individuals who are not obese.
These findings support the view held by several other researchers that psychotic symptoms and
emotional distress are associated with obesity, and that individuals who became obese during
childhood have more psychiatric and psychological problems than those who become obese later in
life. Thus, it appears that childhood obesity could be a predictor variable for future psychological
distress in obese people. Overall, these findings lend support to the belief that morbid obesity is
characteristically associated with high levels of internal conflict and psychotic symptoms.
Added material

JON K. MILLS
Department of Philosophy
Vanderbilt University
Address correspondence to Jon K. Mills, Vanderbilt University, Department of Philosophy, 111
Furman Hall, Nashville, TN 37240.

REFERENCES
Derogatis, L. D. (1975), The SCL-90-R. Baltimore, MD: Clinical Psychometric Research.
Garetz, F. K. (1973). Socio-psychological factors in overeating and dieting with comments on
popular reducing methods. Practitioner, 210, 671-686.
Hafner, R. J., Watts, J. M., & Rogers, J. (1987). Psychological status of morbidly obese women
before gastric restriction surgery. Journal of Psychosomatic Research, 31(5), 607-612.
Hjordis, B., Gunnar, E., & Daisy, S. (1989). Personality traits related to eating behavior and
weight loss in a group of severely obese patients. International Journal of Eating Disorders, 8(3), 315-
323.
Jacobs, S. B., & Wagner, M. K. (1984). Obese and nonobese individuals: Behavioral and
personality characteristics. Addictive Behaviors, 9(2), 223-226.
Klesges, R. C. (1984). Personality and obesity: Global versus specific measures? Behavioral
Assessment, 6(4), 347-356.
Kornhaber, A. (1970). The stuffing syndrome. Psychosomatics, 11, 580-584.
Leon, G. R., & Roth, L. (1977). Obesity: Psychological causes, correlations, and speculations.
Psychological Bulletin, 84(1), 117-139.
Lowe, M. R., & Fisher, E. B. (1983). Emotional reactivity, emotional eating, and obesity: A
naturalistic study. Journal of Behavioral Medicine, 6(2), 135-149.
Mattlar, C. E., Salminen, J. K., & Alanen, E. (1989). Rorschach findings for the extremely obese:
Results from a two-year reducing programme. British Journal of Projective Psychology, 34(1), 2-27.
McReynolds, W. T. (1982). Toward a psychology of obesity: Review of research on the role of
personality and level of adjustments. International Journal of Eating Disorders, 2, 37-57.
 Mills, J. K., & Andrianopolous, G. D. (1993). The relationship between childhood onset obesity and
psychopathology in adulthood. The Journal of Psychology, 127(5), 547-551.
Mills, J. K. (1994). The obese personality: Defense, compromise, symbiotic arrest, and the
characterologically depressed self. Issues in Psychoanalytic Psychology, 16(1), 67-80.
Scott, R. L., & Baroffio, J. R. (1986). An MMPI analysis of similarities and differences in three
classifications of eating disorders: Anorexia nervosa, bulimia, and morbid obesity. Journal of Clinical
Psychology, 42(5), 708-713.
Slochower, J. (1987). The psychodynamics of obesity: A review. Psychoanalytic Psychology, 4(2),
145-159.
Stein, R. F. (1987). Comparison of self-concept of nonobese and obese university junior female
nursing students. Adolescence, 22, 77-90.

WBN: 9512102188009