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ABSTRACT: To determine the effectiveness of a structured multidisciplinary non-surgical obesity therapy program on the basis of a temporary low-calorie-diet for 12 weeks, and additional intervention modules to enhance nutritional education, to increase physical activity and to modify eating behavior.
Prospective multicenter observational study in obese individuals undergoing a medically supervised outpatient-based 52-week treatment in 37 centers in Germany.
A total of 8296 participants with a body mass index (BMI) of >30 kg m(-2) included within 8.5 years.
Main outcome measures were body weight loss, waist circumference (WC), blood pressure, quality of life and adverse events.
In females, initial body weight was reduced after the 1-year-intervention by 19.6 kg (95% confidence intervals 19.2-19.9 kg) and in males by 26.0 kg (25.2-26.8) according to per protocol analysis of 4850 individuals. Intention-to-treat (ITT) analysis revealed a weight reduction of 15.2 kg (14.9-15.6) in females and 19.4 kg (18.7-20.1) in males. Overall, the intervention resulted in mean reduction in WC of 11 cm; it reduced the prevalence of the metabolic syndrome by 50% and the frequency of hypertension from 47 to 29% of all participants (ITT, all P<0.001). The beneficial effects could be documented for up to 3 years and comprised significant improvement of health-related quality of life. The incidence of adverse effects was low; the only event repeatedly observed and possibly related to either the intervention or the underlying disease was biliary disorders.
The present non-surgical intervention program is a highly effective treatment of obesity grades I-III and obesity-related diseases, and therefore, could be a valuable basis for future weight maintenance strategies required for sustained success.
International journal of obesity (2005) 06/2011; 36(4):614-24. · 4.34 Impact Factor
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ABSTRACT: Child and adolescent psychiatry and adult psychiatry have important common research and working fields, in particular the diagnostics and treatment of disorders with onset in childhood or adolescence and persistence over the life span. Other important aspects in common are the treatment of families (e.g., special wards for children and their parents, children of mentally ill parents), in medical teaching and postgraduate education as well as representative functions in societal and political issues.
Der Nervenarzt 11/2010; 81(11):1298, 1300, 1302, passim. · 0.68 Impact Factor
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M C T Slof-Op 't Landt,
I Meulenbelt,
M Bartels,
E Suchiman,
C M Middeldorp,
J J Houwing-Duistermaat,
J van Trier,
E J Onkenhout,
J M Vink,
C E M van Beijsterveldt, [......], S Herpertz,
S Ehrlich,
A A van Elburg,
R A H Adan,
S Scherag,
A Hinney,
J Hebebrand,
D I Boomsma,
E F van Furth,
P E Slagboom
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ABSTRACT: Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self-induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71-91% of the common variance in candidate genes, stathmin (STMN1), serotonin receptor 1D (HTR1D), tryptophan hydroxylase 2 (TPH2) and brain-derived neurotrophic factor (BDNF), with AN and EDs characterized by regular SV. The first allele frequencies of all the SNPs were compared between a Dutch case group (182 AN, 149 EDs characterized by SV) and 607 controls. Associations rendering P-values < 0.05 from this initial study were then tested for replication in a meta-analysis with two additional independent ED case-control samples, together providing 887 AN cases, 306 cases with an ED characterized by SV and 1914 controls. A significant effect for the minor C-allele of tryptophan hydroxylase 2 rs1473473 was observed for both AN [odds ratio (OR) = 1.30, 95% CI 1.08-1.57, P < 0.003] and EDs characterized by SV (OR = 1.52, 95% CI 1.28-2.04, P < 0.006). In the combined case group, a dominant effect was observed for rs1473473 (OR = 1.38, 95% CI 1.16-1.64, P < 0.0003). The meta-analysis revealed that the tryptophan hydroxylase 2 polymorphism rs1473473 was associated with a higher risk for AN, EDs characterized by SV and for the combined group.
Genes Brain and Behavior 10/2010; 10(2):236-43. · 3.48 Impact Factor
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ABSTRACT: Autism spectrum disorders (ASD), are pervasive developmental disorders, which are defined by qualitative impairment in reciprocal social interaction and communication as well as by stereotyped repetitive behaviour. Newer epidemiological studies report a prevalence of 1 %. However, parents and self-help organisations report a considerable lack of diagnostic services, especially in the university hospital setting. In order to receive funding for adequate treatment at an "autism therapy centre", a Consultant psychiatrist has to diagnose ASD.
We assessed the diagnostic and therapeutic facilities for adults with ASD by sending out questionnaires to 33 German university hospitals. Furthermore, we evaluated the demographic data of the first 74 patients that presented at the specialist clinic for adults with ASD at the Department for Psychiatry and Psychotherapy, RWTH Aachen University.
At the time of the evaluation, only 9 university hospitals in Germany offered a specialist clinic for diagnostics and/or treatment for adults with ASD. A comorbid psychiatric disorder was diagnosed in 52.9 % of the patients presenting at the specialist clinic for adult ASD. These were mostly mental retardation and affective disorders. The most common differential diagnosis for the patients presenting at the service were affective and personality disorders.
There is still great need of specialist services at university hospitals in Germany for adults with ASD, although more services have been established over the past few years. Over half of the patients with ASD had other psychiatric comorbid disorders, which were mostly mental retardation and affective disorders. The most common differential diagnosis for patients presenting at the clinics were personality disorders and depression.
Fortschritte der Neurologie · Psychiatrie 07/2010; 78(7):402-13. · 0.74 Impact Factor
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ABSTRACT: Anorexia nervosa and Bulimia nervosa are the main types of eating disorders described in the International Classification of Diseases ICD-10. The main features are eating patterns such as refusal to eat enough food or loss of control, followed by counter-regulatory measures. In addition, preoccupation with body shape and weight and with food is an important feature of eating disorders. Severe medical conditions may occur as a result to starvation, malnutrition and purging. Binge eating disorder has been included as an additional variant of disturbed eating in the American classification system of mental disorders (DSM-IV). The main characteristic of the binge eating disorder is binge eating, but without counter-regulatory measures. Patients with anorexia nervosa are foremost underweight (BMI < 17.5 kg/m2), those with a bulimia nervosa are usually in the normal weight range. On the other hand, patients with the binge eating disorder are overweight or obese. Etiological models are multifaceted and include predisposing and sustaining factors as well as triggers for the onset of the disorder. The course is variable and marked by changes between remission and clinically relevant symptoms. Psychotherapy is the treatment of choice.
DMW - Deutsche Medizinische Wochenschrift 05/2008; 133(18):961-5. · 0.53 Impact Factor
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ABSTRACT: The classification of personality disorders (PD) according to ICD-10 and DSM-IV has been critisized for several reasons. For example, those who have attempted to validate the presence of a non-arbitrary distinction between normal and abnormal personality functioning have suggested that no such distinction exists. Furthermore, PDs frequently co-occur with a number of Axis-I conditions and other Axis-II disorders leading to multiple diagnoses. Therefore, many have suggested classifying PDs dimensionally, rather than categorically. However, there are only a few studies that have investigated the applicability of these models with respect to PDs, and most of these studies used the Big Five. In this study we investigated the applicability of the Seven-Factor model of temperament and character for the classification of PDs. Our results show that the Seven-Factor model discriminates well between PDs and healthy controls, as well as between PDs and Axis-I disorders. We discuss our findings and present a modified scheme to diagnose PDs.
Fortschritte der Neurologie · Psychiatrie 01/2007; 74(12):706-13. · 0.74 Impact Factor
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ABSTRACT: Adolescent and young women with type 1 diabetes mellitus demonstrate a more than random coincidence with bulimia nervosa. However, the prevalence of eating disorders that do not fulfil the criteria of bulimia nervosa is also raised in women of this age group yet without diabetes mellitus. The comorbidity of type 1 diabetes and an eating disorder poses a risk factor in the development of diabetic follow-up diseases. Patients with an eating disorder and type 1 diabetes are characterized by an insufficient metabolic control and the early development of diabetic complications such as a retinopathy. The binge eating disorder, according to research aspects initially a new eating disorder entity, may especially be observed in overweight and obesity. Even if a binge eating disorder in persons with a type 2 diabetes does not occur more frequently than in those metabolically healthy persons, it does depict a risk factor for an accelerated weight gain which as rule involves an increase of insulin resistance.
Therapeutische Umschau 09/2006; 63(8):515-9.
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ABSTRACT: Many studies have shown that psychophysiological parameters of processing emotional stimuli are associated with different personality traits in children, adolescents, and adults. Individuals with low autonomic baseline arousal, low orienting reaction, accelerated habituation, and reduced excitability particularly to punishing stimuli are characterised by a reduced experience of anxiety, decreased behaviour inhibition, and increased sensation seeking. These characteristics seem to raise the likelihood of dis-social behavior and are perceived as prognostically favourable for the development of antisocial personality disorders in childhood and adolescence. In contrast, an increased disposition towards anxiety, which is associated with increased autonomic reactivity, is recognised as a protective factor. Current data have shown that through special training, child and adolescent autonomic reactivity could be enhanced. Due to its versatility, this biological marker might be used for prevention in children at greater risk of developing antisocial behaviour.
Der Nervenarzt 08/2006; 77(7):782-90. · 0.68 Impact Factor
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ABSTRACT: In zahlreichen Studien mit Kindern, Jugendlichen sowie Erwachsenen konnten psychophysiologische Parameter der emotionalen Reizverarbeitung mit interindividuell unterschiedlichen Persnlichkeitsmerkmalen assoziiert werden. Dabei sind besonders Personen mit einem niedrigen autonomen Ruhearousal, schwach ausgeprgter Orientierungsreaktion, beschleunigter Habituation und verminderter Reaktion auf Strafreize durch Eigenschaften wie reduziertes Angsterleben, verminderte Verhaltenshemmung sowie gesteigerte Reizsuche charakterisiert. Dies scheint insgesamt die Wahrscheinlichkeit fr das Auftreten dissozialen Verhaltens zu erhhen und ist besonders im Kindes- und Jugendalter als prognostisch ungnstig im Hinblick auf die Entwicklung einer dissozialen Persnlichkeitsstrung anzusehen. Im Gegensatz dazu ist vermehrte Angstbereitschaft, die mit einer entsprechend erhhten autonomen Reagibilitt assoziiert ist, als protektiver Faktor zu werten. Aktuelle Daten zeigen, dass durch spezielle Frderung von Kindern und Jugendlichen eine Steigerung der autonomen Reagibilitt erreicht werden konnte. Eine solche Plastizitt dieses biologischen Markers knnte bei Kindern mit erhhtem Risiko fr die Entwicklung dissozialen Verhaltens u. U. prventiv genutzt werden.Many studies have shown that psychophysiological parameters of processing emotional stimuli are associated with different personality traits in children, adolescents, and adults. Individuals with low autonomic baseline arousal, low orienting reaction, accelerated habituation, and reduced excitability particularly to punishing stimuli are characterised by a reduced experience of anxiety, decreased behaviour inhibition, and increased sensation seeking. These characteristics seem to raise the likelihood of dissocial behaviour and are perceived as prognostically favourable for the development of antisocial personality disorders in childhood and adolescence. In contrast, an increased disposition towards anxiety, which is associated with increased autonomic reactivity, is recognised as a protective factor. Current data have shown that through special training, child and adolescent autonomic reactivity could be enhanced. Due to its versatility, this biological marker might be used for prevention in children at greater risk of developing antisocial behaviour.
Der Nervenarzt 06/2006; 77(7):782-790. · 0.68 Impact Factor
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ABSTRACT: The objective of this study was to present a systematic review of psychological and psychosocial predictors of weight loss and mental health after bariatric surgery. This systematic review included all controlled and noncontrolled trials of the last 2 decades with either a retrospective or prospective design and a follow-up period of at least 1 year.
The relevant literature was identified by a search of computerized databases. All articles published in English and German between 1980 and 2002 were reviewed.
Using the above inclusion/exclusion criteria, 29 articles were identified focusing on psychosocial predictors of weight loss and mental health after obesity surgery.
Personality traits have no predictive value for the postoperative course of weight or mental state. Apart from serious psychiatric disorders including personality disorders, psychiatric comorbidity seems to be of more predictive value for mental and physical well-being as two essential aspects of quality of life than for weight loss postsurgery. However, depressive and anxiety symptoms as correlates of psychological stress with regard to obesity seem to be positive predictors of weight loss postsurgery. The severity of the symptoms or the disorder is more relevant for the outcome of obesity surgery than the specificity of the symptoms. It is also not solely the consumption of distinct "forbidden" foods, such as sweets or soft drinks, but rather a general hypercaloric eating behavior, either as an expression of the patient's inadequate compliance or a dysregulation in energy balance, which is associated with a poor weight loss postsurgery.
Obesity research 10/2004; 12(10):1554-69. · 4.95 Impact Factor
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J Hebebrand,
F Geller,
A Dempfle,
M Heinzel-Gutenbrunner,
M Raab,
G Gerber,
A-K Wermter,
F F Horro,
J Blundell,
H Schäfer,
H Remschmidt, S Herpertz,
A Hinney
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ABSTRACT: Recently, Branson and coworkers reported a strong association between binge-eating disorder (BED) and variants in the melanocortin-4 receptor gene (MC4R). In the current study, we compared the eating behavior of 43 obese probands with functionally relevant MC4R mutations and of 35 polymorphism carriers (V103I or I251L) with wild-type carriers. The module for eating disorders of the Composite International Diagnostic Interview was used to identify binge-eating behavior. The Three-Factor Eating Questionnaire and the Leeds Food Frequency Questionnaire were used to assess restrained eating, disinhibition, hunger and percent total energy intake as fat. No significant differences between carriers of MC4R variants and wild-type carriers were detected. In particular, we found no evidence for an increased rate of binge-eating behavior in obese carriers of MC4R variants. Our findings do not support the strong association between BED and MC4R carrier status.
Molecular Psychiatry 09/2004; 9(8):796-800. · 13.67 Impact Factor
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ABSTRACT: Epidemiological studies suggest that adiposity in children may be associated with a reduced level of physical activity. Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are physically hyperactive as of early childhood and have been shown to exhibit higher levels of motor activity than normal. The aim of our study was to assess if the prevalence of overweight and obesity is lower in a population of boys with ADHD in comparison with the German healthy male reference population of the same age.
Patients were investigated from 1999 until 2001 upon referral to the inpatient and outpatient unit of the Department of Child and Adolescent Psychiatry of the University of Aachen.
A total of 97 male patients (mean age 10+/-2 y) with a diagnosis of ADHD according the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), who were free of potentially orexigenic medication and who had no further comorbid diagnosis apart from conduct disorder.
BMI standard deviation scores (BMI-SDS) were calculated and compared to age-adapted reference value of the German population.
Patients' mean BMI-SDS was significantly higher than the age-adapted reference values of the German population (P=0.038). Our sample included significantly more subjects than expected with a BMI > or =90th percentile (19.6%, P<0.001) and > or =97th percentile (7.2%, P=0.007).
Surprisingly, being 'hyperactive' in the sense of the DSM-IV diagnosis of ADHD does not prevent the development or persistence of overweight and obesity in children. The examination of these children might be a helpful approach in the investigation of the relationship between obesity and its contributing psychological and behavioural factors.
International Journal of Obesity 05/2004; 28(5):685-9. · 4.69 Impact Factor
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ABSTRACT: The objective of this study is to present a review of the psychosocial outcome of bariatric surgery with special consideration of psychiatric comorbidity, psychopathology, psychosocial functioning, econometric data, and general quality of life (QoL).
A review of all (non-) controlled trials of the last two decades both with a retrospective and prospective design and a follow-up period of at least 1 y.
The relevant literature was identified by a search of computerized databases. All articles published in English and German since 1980 were reviewed. Based on the requirements of the evidenced-based guidelines of the Agency for Health Care Policy and Research and the Scottish Intercollegiate Guidelines Network, each study was rated by a level of evidence.
In all, 171 publications were reviewed. Using the above inclusion/exclusion criteria, 63 articles including two systematic reviews were identified. A total of 40 studies focused on psychosocial outcome after obesity surgery.
Mental health and psychosocial status including social relations and employment opportunities improve for the majority of people after bariatric surgery thus leading to an improved QoL. Psychiatric comorbidity, predominantly affective disorders, and psychopathologic symptoms decrease postsurgically. A substantial percentage of bariatric surgery patients suffer from binge eating disorder or binge eating symptoms. The effect of bariatric surgery on the outcome of binge eating symptoms largely depends on the type of operation. With the exception of patients with a severe psychiatric comorbidity, the concern that obesity surgery will reinforce psychic symptoms and lead to a reduction in the QoL seems to be unfounded.
International Journal of Obesity 12/2003; 27(11):1300-14. · 4.69 Impact Factor
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ABSTRACT: We analysed two aspects of personality abnormality detected before the disorder became diagnostically apparent: potential genetic disposition, assessed using family and adoption studies, and premorbid constitution, which we outlined using retrospective and prospective studies. Current continuum models of the schizophrenic spectrum suggest that genetic disposition and premorbid constitution overlap to some extent, an area which ought to be better defined psychopathologically. In this overview, we determined a group of symptoms-bizarre behaviour, alogia, social withdrawal, and subclinical thought disorders-which are relevant for both schizotypal personality disorders and early schizophrenia. The topic of so-called reactive psychoses is examined to find an interface between personality abnormality and psychosis.
Der Nervenarzt 10/2003; 74(9):740-7. · 0.68 Impact Factor
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E M Steinmeyer,
J Klosterkötter,
H J Möller,
H Sass, S Herpertz,
A Czernik,
J T Marcea,
F Matakas,
J Mehne,
H Bottländer,
W Hesse,
I Steinbring,
R Pukrop
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ABSTRACT: The 'Dimensional Assessment of Personality Pathology - Basic Questionnaire' (DAPP) measures 18 traits to provide a systematic representation of the overall domain of personality disorders (PD). The present study investigated the relationships between DAPP personality profiles and dimensional assessments of DSM-IV PD in general population subjects (n = 156), and a sample of 220 nonpsychotic psychiatric patients (including n = 67 PD patients). Using nonmetric multidimensional scaling models the similarities between the 18 DAPP-factors and the dimensional scores of the 12 DSM-IV PD (inclusive appendix) were graphically represented in a 2-dimensional similarity-system. Here each DSM-IV PD dimension could be described by a distinct profile of DAPP-factors. Overall results support the assumption that PD can be represented by a dimensional system of personality traits with sufficient sensitivity and specificity.
Fortschritte der Neurologie · Psychiatrie 01/2003; 70(12):641-6. · 0.74 Impact Factor
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E M Steinmeyer,
J Klosterkötter,
H J Möller,
H Sass, S Herpertz,
A Czernik,
J T Marcea,
F Matakas,
J Mehne,
H Bottländer,
W Hesse,
I Steinbring,
R Pukrop
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ABSTRACT: A dimensional diagnostic system for personality disorders (PD) postulates continuous transitions from normal to disordered personalities (continuity hypothesis) and universal validity of basic personality dimensions (universal hypothesis). In the present study three dimensional personality models that claim to provide a systematic representation of the overall domain of personality disorders were compared: the Big-Five model proposed by Costa and McCrae, the psychobiological model proposed by Cloninger and colleagues, and the "Dimensional Assessment of Personal Pathology (DAPP)" model proposed by Livesley and colleagues.
The "Six Factor Test" (SFT) measuring the Big-Five factors of personality, the "Temperament and Character Inventory (TCI)" measuring 4 temperament and 3 character dimensions, and the DAPP measuring 18 basic traits and 4 second ordered factors were administered to general population subjects (n = 156), and a clinical sample (n = 220) including a subsample of 69 patients with at least one diagnosis of DSM-IV PD. Group comparisons, regression analyses, and facet theoretical analyses were conducted.
The nonmetric similarity analyses of the three personality models show a nearly identical radex-representation of the second ordered factors in the non-clinical and clinical sample reflecting an universal validity of 4 basic personality dimensions and confirming the universal hypothesis. In comparison with the BIG-Five concept and the psychobiological model the DAPP model seems to be more sensitive to differentiate PD patients from controls with a reclassification rate of 94.5 %.
The Big-Five model, the DAPP and the TCI represent a substantially similar domain despite their different conceptualization. However, the DAPP was more sensitive to differences between PD patients and controls, offered a more comprehensive account of PD, and could differentiate the two groups more effectively.
Fortschritte der Neurologie · Psychiatrie 01/2003; 70(12):630-40. · 0.74 Impact Factor
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ABSTRACT: There is increasing evidence that the coexistence of diabetes and eating disorders (ED) leads to poor glycemic control and an increased risk of long-term complications.
In a questionnaire- and interview-based study, a sample of 36 out of originally 38 (94.7%) diabetic patients with an ED (type-1: n=13, type-2: n=23) was assessed after a period of about 2 years in order to determine the course of EDs, body mass index (BMI), glycemic control, and psychiatric symptomatology.
Five patients (13.9%) of the total sample showed full remission for at least 12 consecutive weeks. Twenty-two patients (61.6%) showed no change in the diagnosis of the ED. Four patients (11.1%) shifted from subclinical to clinical EDs and five patients (13.9%) vice versa. Of the eight patients who went on to psychotherapy, only one patient (12.5%) showed full remission. Emotional distress of type-2 diabetics was considerably higher compared to type-1 diabetics, which was rather low at baseline. Except interpersonal distrust as one ED-related variable, no significant change of any psychological variable could be observed in the type-1 diabetic sample during follow-up. Of the 13 type-1 diabetic patients with an ED, five patients deliberately omitted insulin in order to lose weight. These patients showed a more serious psychopathology with regard to each measured psychological variable, a higher BMI, and worse metabolic control compared to those without insulin omission. Type-2 diabetics showed a significant increase in drive for thinness and body dissatisfaction. No considerable change could be observed with regard to BMI, glycemic control, and depressive and global psychiatric symptomatology in either diabetic subsample during follow-up.
EDs tended to persist over time with a considerable shift within the different types of EDs. Insulin-purging in type-1 diabetics was associated with enhanced psychopathology, higher BMI, and worse metabolic control. Both mean body mass and ED-related symptoms such as "drive for thinness" and "body dissatisfaction" increased in the average obese type-2 diabetic sample, illustrating the vicious circle of low self-esteem, enhanced restraint eating, and binge eating in weight control measures.
Journal of Psychosomatic Research 12/2001; 51(5):673-8. · 3.30 Impact Factor
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ABSTRACT: The aim of the present study was to follow up the long-term course of adolescent-onset anorexia nervosa by repeated assessment, to analyze the association between the course of the eating disorder and psychiatric comorbidity, and to evaluate psychosocial outcome. The sample consisted of 39 inpatients who were reinvestigated 3, 7, and 10 years after discharge. The patients and 39 controls matched for age, gender, and occupational status were assessed with structured interviews on DSM-III-R eating disorders, additional axis I and axis II psychiatric disorders, and psychosocial functioning. Results showed that 69 % of the original subjects met the criteria for full recovery at the 10-year follow-up. One patient (3%) still exhibited the full syndrome of restrictive anorexia nervosa, two patients (5%) the full syndrome of bulimia nervosa. None of the patients had died. Of the subjects, 51% currently had an axis I psychiatric disorder and 23% met the full criteria for a personality disorder. Apart from the eating disorder, anxiety disorders and avoidant-dependent and obsessive-compulsive personality disorders were the most common psychiatric diagnoses. There was a significant association between psychiatric comorbidity and the outcome of the eating disorder and between outcome and psychosocial adaptation. With regard to psychiatric morbidity and psychosocial functioning, long-term recovered patients did not differ significantly from normal controls. It is concluded that in most patients adolescent anorexia nervosa takes a prolonged course, although it seems to be more favorable than in adult-onset forms. Those who achieve complete recovery from the eating disorder have a good chance of overcoming other psychiatric disorders and to adapt to social requirements.
Journal of Child Psychology and Psychiatry 08/2001; 42(5):603-12. · 4.28 Impact Factor
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ABSTRACT: BACKGROUND: The prevalence of obesity has distinctly increased in almost all industrial countries in the past decades and is considered today to be one of the most important health problems. In Germany, between 12 and 18% of the adult population is obese. Besides the known risk factors such as arterial hypertension, lipometabolism disorders and type-2 diabetes mellitus, obesity is connected to severe psychosocial burdens. The genesis of obesity is multifactorial, besides genetic factors environmental ones such as an increase in hypercaloric food and at the same time a reduction of physical activity play a decisive role. PSYCHOGENESIS: Whereas earlier mainly psychic factors were discussed in the genesis of obesity, and here especially the question as to which personality variables are most frequently associated with obesity, the discussion in the past decades has increasingly shifted towards psychosocial consequences. It does, however, seem justified to adhere to a "psychogenesis" of obesity in a subgroup of obese people. Psychosomatic/psychiatric disorders lead to a change in eating behavior and physical exercise, the result being a sustained positive energy balance with overweight and obesity. PSYCHOSOCIAL PROBLEMS AND TREATMENT CONCEPTS: This paper describes the psychosocial problems of obese people with an emphasis on the question of psychiatric co-morbidity in general and eating disorders in particular. The results of mainly behavioral therapeutically oriented treatment concepts are presented and school-overlapping concepts discussed.
Herz 06/2001; 26(3):185-93. · 0.92 Impact Factor
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ABSTRACT: In the long term anorexia nervosa has after toxicomania the second highest lethality of all psychiatric disorders. The genesis of this eating disorder may be found in a combination of biological, cultural, familial and intrapsychic factors. Long-term investigations have not only verified the seriousness of the prognosis of lethality but have also demonstrated that depressive illness, compulsive behaviour and addiction quite often supersede anorexia nervosa. It therefore seems justified to assume biological pathomechanisms as co-factors both in triggering the disease as well as in the chronification of this illness. Besides the discussion on a genetic disposition based on results of twin- and family research, psychobiological models of appetite and satiation behavior based on known neuropeptides and neurotransmitters are presented with regard to the development of anorexia nervosa.
Zeitschrift fur Psychosomatische Medizin und Psychotherapie 02/2001; 47(2):179-204. · 1.30 Impact Factor
