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Obesity and Social Anxiety: A Real Problem

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According to the DSM-IV, people suffering from a medical condition should only be diagnosed with social anxiety disorder (SAD) if the anxiety is unrelated to the medical condition. Questions have been raised about what this means for people who experience social anxiety related to a medical problem like stuttering or obesity. A new study from researchers at Rhode Island Hospital is the first to look at obese individuals with severe anxiety related only to their weight.

The researchers looked at a group of individuals seeking approval to undergo bariatric surgery. They found that 135 of the individuals were diagnosed with SAD according to the DSM-IV criteria; 40 were classified as "modified SAD," with social anxiety related specifically to their weight; and 616 had no history of mental disorders. The researchers discovered that those in the modified SAD group, who experienced social anxiety due to their obesity, had significant impairment that was at least as severe as that found in the traditional SAD group.

Lead researcher Dr. Kristy Dalrymple notes, "We found it particularly interesting that the modified SAD group reported greater levels of disruption in social life and distress about their social anxiety compared to the DSM-IV SAD group. This suggests that although our modified SAD group had social anxiety that was related to obesity only, their level of impairment was significant." Dalrymple goes on to say that obesity-related social anxiety should be included in the DSM-5, allowing for the diagnosis of SAD when a medical condition is involved if the anxiety is excessive: "These individuals could potentially benefit from treatment of this disorder and therefore, excluding the diagnosis of SAD in obese individuals who experience anxiety related only to their weight may hinder the identification of the disorder. We believe the results of this study support adoption of the proposed change to the medical exclusion for SAD criterion in the DSM-5."

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