Citation

Leduc C, Gault C, Gheorghiev C. Ann. Med. Psychol. (Paris) 2017; 175(10): 856-861.

Copyright

(Copyright © 2017, Societe Medico-Psychologique, Publisher Elsevier Publishing)

DOI

10.1016/j.amp.2016.11.014

PMID

unavailable

Abstract

Our practice in our hospital of the psychological evaluation in preoperative consultations and of the follow up of patients after bariatric surgery is based on the consensus of the national recommendations (HAS). Beforehand, the aim is to evaluate a risk, particularly of acting out, and afterwards, to propose therapy to help the patient make subjective the effects of surgery. Addictive disorders, serious eating disorders or unstabilized psychiatric symptoms can constitute a contraindication. Body-image, motivation and an ability of understanding are also very important to consider. The decision is made during a multi-disciplinary meeting with surgeons, endocrinologists and dietitians. Since 2012, 128 patients have entered the bariatric surgery protocol and 62 have been operated. We have received 43 of them in consultations after surgery. Seven of them have encountered psychological problems after surgery. Bariatric surgery leads to an important and fast physical transformation, particularly after gastric bypass. Orality and the body are often central for these patients regarding to their subjective issue. We note that they are still preoccupied by these questions after surgery. Even though surgery provides a physical limit to eating, patients still have to subjectivate a loss and this limit afterwards. This can be understood thanks to the stakes highlighted by S. Freud about oral phase, and J. Lacan about "sevrage complex", and to some cases of patients of our practice. It is also a new body image that the subject will have to assume and its implications in its relationship with others. Some difficulties related to body image can commonly appear after surgery. Furthermore, recent studies and literature have also emphasized the increase of suicides after surgery, even if the operation has been successful, and the importance to understand its causes. We did not encountered such cases in our small practice, but the analysis of interactions between physical changes and their psychic impact underlines the importance of psychological follow-up of these patients. Either physical changes can accompany psychical changes in some cases or it can be more complex in other cases. The relationship to the Other, an ability to limit oral jouissance and to accept a loss are important aspects to reckon when it comes to bariatric surgery. © 2017 Elsevier Masson SAS

Language: en

Keywords

Body image; Gastroenterology; Obesity; Orality; Psychiatric pathology; Psychological counseling; Subjectivation; Surgery; Therapeutic accompaniment