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A Pre-Bariatric Surgery Psych Evaluation

Mental Health

Pre-Bariatric Surgery Psych Evaluation

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My Psychiatrist physicians and allied health professionals recognize that a bariatric surgery is life-changing. Your surgeon requires an evaluation of your psychological and physical health because they impact the operation’s success, healing, and adjustment post-surgery. Additionally, understanding the impact of the procedure is vital for mental and physical preparedness.

Psychologists analyze:

  • Your motivation for the surgery
  • Your psychological preparedness for the surgery and healing journey
  • Behavioral challenges before surgery
  • Emotional factors 

Although the notion of getting a pre-bariatric surgery psych evaluation comes with considerable resistance, it is a crucial aspect of the surgical procedure. Many things can go wrong during and after surgery when your mental frame is not well. Typical psychological effects in bariatric surgery include:

Increased Susceptibility to Depression

People with obesity have high insulin levels because of consuming foods rich in carbohydrates (simple sugars). The presence of insulin stimulates and sustains serotonin secretion. Serotonin inhibits anxiety and mediates happiness, satisfaction, and optimism in the brain.

However, the post-operation diet limits carbohydrate overconsumption, reducing insulin levels drastically. Serotonin levels also plummet in the process. The drop stimulates the release of stress hormones which activate the stress response, commonly referred to as anxiety. A persisting anxious state makes the internal environment conducive for depression. Vulnerability to depression is higher for patients with a history of this mood disorder.

Mood Dysregulation

Insulin fluctuation is also an expected outcome of bariatric surgery. The body adjusts gradually to dietary changes. Therefore, the pancreatic insulin-producing cells will sometimes release more insulin than needed because of increased sensitivity.

Obesity normalizes body operations in the presence of high sugar concentration. The brain becomes conditioned to this default setting for optimum performance. Unfortunately, insulin stimulates positive moods. Low insulin levels cause anxiety, mental fatigue, mental fog, and depression. When insulin concentrations fluctuate from dietary changes, mood swings become rampant.

Eating Behavior Disorders

Bariatric surgery increases vulnerability to maladaptive eating. Research shows people with preoperative eating disorders like emotional eating or food addiction have a higher likelihood of post-operation weight struggle. Thus, screening patients for eating disorders is vital to maintaining post-operative health and behavior.

Additionally, patients learn some destructive eating behaviors from post-operation adjustments. For instance, vomiting certain foods is a side effect for 40% of patients who have had their stomach pouch plugged. However, some patients may voluntarily induce vomiting by eating the problematic food as a weight-loss measure.

Personality Disorders

Psychiatric conditions like borderline personality disorder and multiple personality disorder are higher in people with obesity. The disorders can either cause or result from obesity. Unconstraint, impulsivity, and self-regulation difficulties exacerbate overeating behavior and eating disorders triggering obesity. Post-surgery, these characteristics continue to overpower weight-loss strategies.

Research shows an increasing number of people with personality disorders were former bariatric surgery patients. Onset for the disorders begins post-surgery and interferes with weight control.

Body Dysmorphia

Changes in body weight post-surgery can also be hard to grasp. Patients have normalized seeing their overweight body for so long it feels strange seeing a thin frame. The bodyweight transformation induces mental distress in some patients, causing them to avoid mirrors. For others, their mind still perceives them as obese, and this may push them toward self-starvation, self-induced purging, and so forth.

The Significance of A Psych Evaluation

A psychological assessment before bariatric surgery enables you to get treatment for any mental conditions before the surgery to improve outcomes post-operation. Furthermore, when your doctor knows you are a high-risk patient for depression, eating disorders, or personality disorders, they will ensure you get the required care before the situation gets out of hand post-surgery.

A psych evaluation is not primarily to qualify or disqualify patients for surgery. On the contrary, it is a preparation phase of the surgery. The assessment only disqualifies candidates for bariatric surgery when they have not received any intervention for their psychological illness pre-operation.

Bariatric surgery only addresses the symptom of an underlying psychological condition. Therefore, a diagnosis requires psychotherapy before surgical intervention to address the root cause of the problem.

  • Counseling enables you to identify and understand the main reason behind your mental condition.
  • You also learn how to manage, avoid or deal with triggers in therapy.
  • The therapist teaches you techniques to help regulate your thoughts and emotions.
  • You gain insights into your wrong mindset, influencing your thoughts, emotions, mood, and behavior in therapy. Your therapist also guides you on how to replace them through reasoning and logic.
  • Counselors have strategies and resources to equip you to form positive habits and embrace adaptive behavior.

What to Expect in A Psych Evaluation

Everything shared in the clinical interview remains confidential between you and the psychologist. Your doctor and surgeon only get to know what is significant for your bariatric surgery.

The psych evaluation focuses on your behavior, psychological symptoms, and understanding of the surgery. For instance, the psychologist may ask about substance use to identify the risk of food and substance addiction post-surgery.

The psychologist may ask about your depression history or food relationship to determine what triggered your weight gain. Additionally, the psychologist also needs to know your motivation behind the surgery. Sometimes the reason is much more problematic, making the intervention dangerous.

There are different psych evaluations assessing aspects of your life linked to surgery. The psychologist wants to know if you can handle surgery, recovery, and maintain a healthy lifestyle after surgery. All these depend on your mindset, attitude, mental resilience.

What Disqualifies You From Surgery?

  • Suicide attempts – if you have attempted suicide five times or more, it is advisable to focus on psychological intervention before going for surgery. Find out why you have suicidal tendencies and solve that problem because the surgery may worsen your condition.
  • Active psychosis – if you have had an episode of psychosis one year before surgery, you cannot have the procedure. Antipsychotic medication is lethal when it interacts with anesthesia.
  • Active substance use disorder – if you abuse substance or were recently addicted to alcohol or drugs, you cannot qualify for bariatric surgery. Substance abuse use interferes with post-operation healing and weight control. You need to show evidence of psychotherapy to qualify for surgery.

If you’re struggling with obesity and have been told that before taking the surgery, a psych evaluation is needed, we can help! My Psychiatrist’s Board-Certified psychiatrists and clinicians offer pre-surgery evaluation, which will bring you one step closer to being healthier physically AND mentally!

For your convenience, My Psychiatrist is proud to offer top outpatient psychiatric care at four Florida locations. My Psychiatrist Oakland Park, My Psychiatrist Sheridan, My Psychiatrist South Miami and My Psychiatrist Boca Raton, FL are here for you!