Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews.

Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. This paper (1) reviews the results of the published studies using the structured interviews to assess psychopathology in bariatric surgery candidates; (2) compares the prevalence rates of psychiatric disorders across these studies with the data from other population samples; and (3) assesses whether sociodemographic variables appear to affect these prevalence rates. We searched online resources, PubMed, PsychINFO and reference lists of all the relevant articles to provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. The prevalence estimates in the non-treatment obese group did not appear to differ substantially from the general population group in the US or the Italian population samples, although they were relatively higher for the German population. However, the rates of psychopathology in the bariatric surgery candidates were considerably higher than the other two population groups in all the samples. Overall, the most common category of lifetime Axis I disorders in all the studies was affective disorders, with anxiety disorders being the most common category of current Axis I disorders. Certain demographic characteristics are also associated with higher rates of psychopathology, such as, female gender, low socioeconomic status, higher BMI. Overall, methodological and sociodemographic differences make these studies difficult to compare and these differences should be taken into account when interpreting the results.

Examining duration of binge eating episodes in binge eating disorder.

OBJECTIVE: The primary goal of this article is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. METHOD: Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (<2 h) versus long (≥ 2 h) average binge duration. Study 2 utilized an ecological momentary assessment design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. RESULTS: Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 min, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. DISCUSSION: Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in bulimia nervosa. This study contributes to the existing literature on characteristics of binge eating in BED.

Possible risk factors for increased suicide following bariatric surgery.

OBJECTIVE: There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved. DESIGN AND METHODS: The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions. RESULTS: First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed. CONCLUSIONS: A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.

Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study.

BACKGROUND: Current and previous psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates often wish to appear psychiatrically healthy when undergoing psychiatric evaluation for approval for surgery. Also, structured diagnostic assessments have been infrequently used. METHODS: The present report concerned 199 patients enrolled in the longitudinal assessment of bariatric surgery study, who also participated in the longitudinal assessment of bariatric surgery-3 psychopathology substudy. The setting was 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. All the patients were interviewed independently of the usual preoperative psychosocial evaluation process. The patients were explicitly informed that the data would not be shared with the surgical team unless certain high-risk behaviors, such as suicidality, that could lead to adverse perioperative outcomes were reported. RESULTS: Most of the patients were women (82.9%) and white (nonwhite 7.6%, Hispanic 5.0%). The median age was 46.0 years, and the median body mass index was 44.9 kg/m2. Of the 199 patients, 33.7% had ≥1 current Axis I disorder, and 68.8% had ≥1 lifetime Axis I disorder. Also, 38.7% had a lifetime history of a major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence. All these rates were much greater than the population-based prevalence rates obtained for this age group in the National Comorbidity Survey-Replication Study. Also, 13.1% had a lifetime diagnosis and 10.1% had a current diagnosis of a binge eating disorder. CONCLUSION: The current and lifetime rates of psychopathology are high in bariatric surgery candidates, and the lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Finally, binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates.

The relationship among compulsive buying, compulsive internet use and temperament in a sample of female patients with eating disorders.

The aim of the present study was to investigate the association among compulsive buying (CB), compulsive internet use (CIU) and reactive/regulative temperament in a sample of 60 female patients with eating disorders. All patients were assessed by means of the Compulsive Buying Scale, the CIU scale, the Eating Disorder Inventory-2, the Behavioral Inhibition System/Behavioral Activation System scales, the Dimensional Assessment of Personality Pathology and the effortful control scale of the Adult Temperament Questionnaire. The results showed a positive association between CB and CIU, both categorized as impulse control disorders, not otherwise specified. Both CB and CIU showed significantly positive correlations with emotional lability, excitement seeking and lack of effortful control (more specifically lack of inhibitory and lack of activation control). The implication of these findings for the treatment of both disorders will be discussed.

Personality prototypes in individuals with compulsive buying based on the Big Five Model.

Personality prototypes based on the Big Five factor model were investigated in a treatment-seeking sample of 68 individuals with compulsive buying (CB). Cluster analysis of the NEO Five-Factor Inventory (NEO-FFI) scales yielded two distinct personality clusters. Participants in cluster II scored significantly higher than those in cluster I on neuroticism and lower on the other four personality traits. Subjects in cluster II showed higher severity of CB, lower degree of control over CB symptoms, and were more anxious, interpersonally sensitive and impulsive. Furthermore, cluster II was characterized by higher rates of comorbid anxiety disorders, and cluster B personality disorders. The two personality prototypes did not differ with respect to obsessive-compulsive features. Finally and of considerable clinical significance, participants in cluster II reported lower remission rates after undergoing cognitive-behavioral therapy. Implications of the results for treatment are discussed.

Predictors of response to cognitive behavioral treatment for bulimia nervosa delivered via telemedicine versus face-to-face.

OBJECTIVE: This study presents the results of a receiver operating characteristics (ROC) analysis to evaluate response to cognitive behavioral treatment (CBT) for patients with bulimia nervosa (BN), delivered via telemedicine (TV-CBT) or face-to-face (FTF-CBT). METHOD: Data were gathered on 116 adults treated with CBT for BN. Response to treatment (i.e., percent reduction in binge eating and purging behavior) were examined at weeks two, four, six, and eight. ROC analysis was completed to predict abstinence at end of treatment (EOT) as well as 3-month and 1-year follow-up for the entire sample and by treatment group (TV-CBT versus FTF-CBT). RESULTS: ROC analyses revealed that abstinence at EOT and 1-year follow-up was predicted by percent reduction in binge eating behavior whereas abstinence at 3-month follow-up was predicted by percent reduction in purging behavior. Results showed differences in predictors of treatment response when ROC analyses were completed for the entire sample and by treatment group. DISCUSSION: Results suggest that evaluating percent reduction in binge eating and purging at weeks two, four, six, and eight of treatment is a clinically useful tool for predicting treatment response at EOT, 3-month, and 1-year follow-up.

Eating behavior and other distracting behaviors while driving among patients with eating disorders.

The current study sought to better characterize eating behavior, binge-eating behavior, and other potentially problematic, distracting behaviors while driving in patients with eating disorders. Forty patients with eating disorders who reported eating in their car at least once per week were included. Thirty subjects with eating disorders reported binge-eating while driving. A surprisingly high number of subjects reported engaging in a variety of distracting behaviors, including changing clothes, reading, applying make-up, and combing/brushing their hair while driving. Potentially problematic behaviors such as binge-eating while driving should be inquired about during assessment, and if found should be addressed in treatment planning.

Dental practitioners and eating disorders.

To better understand how dental practitioners identify, counsel, and refer patients with eating disorders. A questionnaire was mailed to 625 dental practitioners, 54 (19%) of the dentists and 69 (20%) of the dental hygienists responded. Most dental practitioners were aware of eating disorder patients in their practices and most discussed their findings with their patients or parents. However, one of the suggestions most commonly given to patients, to brush immediately after vomiting, may be counter therapeutic, and a few offered referral for more health services. Collaboration between dental practitioners and mental health practitioners who work with eating disorder patients should be improved.

Predictors of disordered eating in a sample of elite Division I college athletes.

OBJECTIVE: The present study sought to investigate the relationship between a number of areas of elite student-athletes' lives and disordered eating. METHOD: We surveyed 1445 elite Division I athletes at 11 different institutions and in 11 different sports. Hierarchical regression was used to indicate specific areas of the participants' collegiate experience that may be associated with disordered eating attitudes and symptomatology. RESULTS: Results demonstrate that the variables entered into each model predicted between 40.5% and 46.4% of the variance for the restriction of food, body dissatisfaction, and drive for thinness. Categories of variables that generally predicted the most variance for each dependent measure were demographics, athletic involvement, and personality. Of the 11 sports included in the analysis, wrestling and gymnastics demonstrated elevated levels of drive for thinness, food restriction, and purging behavior compared to other athletes. DISCUSSION: Findings suggest that in elite athletes gender, ethnicity, sport, and self-esteem are associated with several behaviors and attitudes indicative of disordered eating.

The relationship between compulsive buying and eating disorders.

OBJECTIVE: Compulsive buying has received increased research attention in the last decade. The disorder has high rates of comorbidity for other disorders, including eating disorders. This study explored the possible relationship between compulsive buying and eating disorders. METHOD: Twenty women who scored in the pathological range on a measure of compulsive buying and 20 controls were recruited via the media. Various measures of psychopathology and eating disorder symptoms were administered to both groups. RESULT: Compulsive buyers were significantly more likely to have a higher lifetime history of substance abuse or dependence. No differences existed between normal controls and compulsive buyers in prevalence of current or lifetime eating disorders, nor were there differences in scores of eating-related psychopathology. DISCUSSION: This work failed to demonstrate an increased risk for eating disorder in compulsive buyers, although a higher rate of substance dependence or abuse and higher scores on pathological personality dimension scales were seen.