Obesity as a defense mechanism

As the rate of obesity and bariatric surgery rise, various psychosocial etiologies contributing to obesity are being explored, and it is not uncommon to discover that a patient has been a victim of past abuse.

A 37-year-old female was hospitalized for intractable nausea and vomiting following a laparoscopic Roux-en-Y gastric bypass performed a month and a half prior. After ruling out all medical etiologies, psychiatry was consulted due to a history of panic attacks, and to evaluate for a psychosomatic etiology.

During the initial consultation, it was elicited that the patient had been the victim of a date rape as a teen, which resulted in dramatic weight gain and obesity. Following a comprehensive medical workup, brief psychodynamic psychotherapy, and the initiation of pharmacotherapy, the patient had a resolution of her symptoms, and at a 2 month follow-up, remained asymptomatic.

Prior to surgery, patients should be questioned about any history of abuse by utilizing a structured diagnostic questionnaire, such as the Weight and Lifestyle Inventory (WALI). To prevent minimization, individuals with a history of abuse should be screened more thoroughly, and psychiatric involvement should be an intrinsic component of the follow-up care as abused patients may also be more sensitive to complaints as they lose weight. Psychiatric involvement can be a useful adjunctive treatment while medical etiologies are being ruled out, rather than after they have been ruled out.