Psychiatric aspects of massive obesity: observations on the concept of alexithymia and on the mental representation of the body-self

It is generally admitted that, among the symptomatic manifestations of psychosomatic diseases, massive obesity might be included. The fact that such a condition was not specifically accepted as a fully independent pathology from the psychiatric viewpoint induced us to take into account the concept of alexithymia and to make use of the Rorschach test for estimating the symbolizing capacity of such patients, particularly in connection with the correlation between the somatic elements and their projection at mental level. Our investigation involved 60 patients submitted to specific treatment - either medical or surgical - for reduction of their weight. The results of our study showed that alexithymia should not be included in the wide set of psychopathological characteristics of massive obesity and that a fat body is considered by these patients as a protecting interspace between the outside world and themselves. This brought us to considerations involving therapy mainly at psychological level.