Obesity and social anxiety

Researchers at Rhode Island Hospital have shown that obesity is a major cause of social anxiety disorder. There are two reasons for this. The first is that the severe obesity itself may cause anxiety. The second is that there is social anxiety associated with the consequences of being obese.

Interestingly enough the Diagnostic and Statistical Manual (DSM edition 4) suggested that social anxiety disorder was only to be diagnosed if anxiety was not connected to any underlying medical condition.

But the working group proposed for the 5th edition of the Diagnostic and Statistical Manual said that the criteria for diagnosis of social anxiety disorder could be modified. Now, people with conditions such as stuttering, obesity, and Parkinson’s disease could also be diagnosed with social anxiety disorder. This would be the case when their anxiety was excessive or not related to the medical condition.

You see the thing is this: at the time of writing the DSM 4th edition, information about anxiety among individuals with conditions like obesity was lacking. This study from Rhode Island Hospital was one of the first to investigate anxiety levels among obese patients whose obesity was so serious that they were seeking to have bariatric surgery (better known as gastric band surgery).

Amongst these patients were 135 individuals who had social anxiety disorder according to the Diagnostic and Statistical Manual 4th edition. There were another 40 individuals who were diagnosed as having modified social anxiety disorder associated with obesity. And then there were another 600+ individuals who seemed to have no history of emotional or psychiatric disorder.

The study revealed that both the obese patients and the individuals diagnosed with social anxiety disorder in its own right had poor social functioning when they were adolescents when compared to the 600 control individuals. However, there was no difference between the people with obesity and the people with social anxiety disorder in its pure form in this respect.

The effect of losing weight fast on social anxiety disorder is not reported in this study. But investigations revealed that people with obesity had experienced similar social functioning over a five-year period before the study.

Also, the group of individuals defined with what we might call “pure” social anxiety disorder had far more time out of work in the previous five years due to emotional disorders and psychopathology than the other two groups did.

So there are two kinds of anxiety here: the anxiety, and the distress about social anxiety disorder, experienced by people with a formal diagnosis of social anxiety. And the anxiety reported by those people who are obese.

Yet it transpires that the levels of disruption of social life and distress about the social anxiety were far higher in the obese group than they were in the formally diagnosed social anxiety disorder group.

Perhaps,  for a person with obesity, the change in anxiety and social life functioning is distressing because it occurs later in life (i.e. as their weight changes). By contrast, the people who experience social anxiety disorder in a generalized way for a very long period of their lives have it worse.

The results aren’t completely clear, but it does seem to suggest that social anxiety related to weight or obesity has significant consequences. This is when compared to individuals who have social anxiety disorder according to the definition in DSM-IV.

Perhaps, therefore, such people could potentially benefit hugely from treatment of some kind that could reduce their anxiety.

But it’s no use investigating obesity as an isolated condition; anxiety related to weight gain can hinder the identification of social anxiety disorder. As a result it seems sensible that such a proposal for DSM 5th edition should indeed be implemented.

Video – anxiety and eating disorders