Personality Disorders Linked to Increased Risk of Fatty Liver Disease

Summary: Non-alcoholic fatty liver disease (NAFLD), the most prevalent cause of chronic liver disease in affluent societies, is intrinsically linked with personality disorders.

The research uncovers a tri-fold higher likelihood of personality disorders in NAFLD patients, not correlating with other liver diseases or common mental health issues like anxiety and depression. While the knowledge and necessity of dietary control and exercise among NAFLD patients are prevalent, their adherence to such lifestyles is significantly impacted by unregulated eating behaviors and potentially external locus of control (LoC).

The study thereby accentuates the exigency of scrutinizing attitudes toward diet and exercise, aiming for motivational analysis and efficacious treatment in NAFLD management and post-transplant care.

Key Facts:

  1. Personality Disorders Prevalence: NAFLD patients are approximately three times more prone to have a personality disorder, unrelated to anxiety or depression, compared to those without the disease.
  2. Awareness vs. Action: Although NAFLD patients acknowledge the importance of diet and exercise for disease management, frequent uncontrolled eating behaviors and potentially a high external LoC hinder successful adherence to beneficial lifestyles.
  3. Transplantation and Recurrence: Even post liver transplantation due to NAFLD, a substantial two-fifths of patients exhibit signs of disease recurrence within five years, illuminating a crucial need for effective lifestyle change management.

Source: University of Birmingham

Researchers also discovered that, whilst NAFLD patients know that they need to watch their diet and exercise to keep the disease in check, they frequently exhibit uncontrolled eating behaviors.

NAFLD has become the most common cause of chronic liver disease in wealthy societies – responsible for a significant rise in liver-related deaths.

Up to one in three people in the UK has fatty liver disease. Whilst in its early stages there may be few symptoms, the disease can progress to cirrhosis and liver failure in at risk individuals such as diabetics.

This shows an outline of a man.
NAFLD patients are aware of the beneficial effects of lifestyle modifications, yet frequently cannot make the necessary changes to an improved lifestyle is poor. Credit: Neuroscience News

Non-alcohol steatohepatitis – a more serious form of NAFLD, where the liver has become inflamed – is the most common cause of cirrhosis in industrialised countries where deaths from liver disease have increased fourfold over the last 50 years.

Publishing their findings in BMC Gastroenterology, researchers from the University of Birmingham reveal that NAFLD patients are around three times more likely to have a personality disorder than those people without the disease.

The scientists call for NAFLD patients to be screened for personality disorders – if identified, these mental health disorders should be treated before the patients begin trying to control their diet and exercise more.

Co-author Dr Jonathan Catling, from the University of Birmingham, commented: “Finding an increased prevalence of personality disorders in NAFLD patients is particularly striking – signifying that it’s not an issue associated with all liver disease, but just those with NAFLD.

“Importantly, it appears not to be a general mental health issue, as neither anxiety nor depression were found to be significantly different between the groups – despite both psychiatric disorders often being associated with chronic liver disease.”

The scientists note that, although simple measures such as changes in diet and increased exercise are proven to prevent disease progression in NAFLD, it is often difficult to persuade patients to follow dietary and exercise programmes. This may reflect the fact that such patients are often encouraged to boost their protein and calorie intake to reverse nutritional declines commonly seen in chronic liver disease.

NAFLD patients are aware of the beneficial effects of lifestyle modifications, yet frequently cannot make the necessary changes to an improved lifestyle is poor. Even amongst patients transplanted for NAFLD two-fifths of patients showed signs of the disease recurring within five years of transplantation.

Dr Catling added: “Our findings suggest an urgent need to examine attitudes towards diet and exercise so that we can better understand how to motivate NAFLD patients and deliver more effective treatment – preventing disease recurrence after liver transplantation.”

One factor determining a patient’s attitudes towards weight loss is their internal and external ‘locus of control’ (LoC) – or how much control they believe they have over their life events. Patients with a high internal LoC perceive life events to be a result of their own actions and are more likely to be successful in losing weight.

NAFLD sufferers, rather like individuals with substance abuse disorders, may have increased external LoC – seeing life events as out of their control and struggling to make and maintain

the necessary changes to their diet and exercise regime that prevent disease progression into the more serious, irreversible stages of the disease.

In 2011, NAFLD was reported as prevalent in up to 25% of the global adult population. The disease is a metabolic disorder characterised by the presence of lipid droplets in the liver with the absence of excessive alcohol consumption.

NAFLD is a global health problem and multi-faceted disease, with the main risk factors being obesity and insulin resistance. Because of the close relationship with obesity, NAFLD’s prevalence continues to be a major public health challenge as western societies battle with rising rates of obesity-related disease.

About this health and personality disorder research news

Author: Tony Moran
Source: University of Birmingham
Contact: Tony Moran – University of Birmingham
Image: The image is credited to Neuroscience News

Original Research: Open access.
Behaviour regulation and the role of mental health in non-alcoholic fatty liver disease” by Jonathan Catling et al. BMC Gastroenterology


Behaviour regulation and the role of mental health in non-alcoholic fatty liver disease

Background and aims

Non-alcoholic fatty liver disease (NAFLD) has become the most common cause of chronic liver disease in wealthy societies, and is responsible for a significant rise in liver morbidity and mortality. Current treatments prioritise lifestyle interventions, predominantly diet and exercise management, but patients frequently fail to make the necessary behavioural adjustments. The current study seeks to identify those factors which influence patients’ behaviour with respect to adherence to treatment regimes.


Novel areas of interest were investigated; locus of control, behavioural regulation and a range of mental health measures, due to their links to either poor lifestyle choices or abnormal eating as identified in previous literature. Data was gathered using self-report questionnaires, from 96 participants, who were split into three groups, NAFLD patients, non-NAFLD liver disease patients and healthy controls


Data was analysed using a MANOVA, and followed up with a Tukey post-hoc test. Three factors were found to be significant by group; cognitive restraint, uncontrolled eating and SAPAS score (a measure of personality disorders). An association between personality disorders and NAFLD was identified.


It is suggested that NAFLD patients are screened for personality disorders and, if identified, treated prior to the commencement of diet and exercise management.

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