Bariatric Surgery Psych Eval: Why, What, & How

So, you are considering bariatric surgery and you’ve learned of the need for a pre-surgery psychological evaluation. Patients often have questions about why a psych eval is part of the plan for weight loss surgery, what an assessment is like, and how they may “pass” the testing. Patients sometimes feel irritated by having to complete a bariatric surgery psych eval, as though the need for a preoperative assessment means their doctor thinks they are “crazy.” But a pre-surgical psych eval is a standard part of any weight loss surgery screening.

Why Require a Psych Eval for Weight Loss Surgery?

If you are considering weight loss surgery, you are likely aware that there are many reasons for carrying extra weight. Some of those reasons are physical, like health conditions and genetics. Other reasons are mental or emotional, like binge eating patterns or eating to cope with stress or emotions. Just as the decision for weight loss surgery is deeply personal, the factors that led to weight gain are individual.

A bariatric surgery psych eval can give your medical team (and you) insight into:

• Why you are seeking surgery – your motivation

• The food and health habits you have

• Your understanding of the surgery

• Your emotional and psychological readiness for surgery

• What, if any, anxieties you may have about surgery

• What your expectations of surgery are (and how realistic they are)

• Your support system

• Your understanding of what you will need to do after surgery, including major lifestyle and behavior changes

Weight loss surgery is a major medical procedure with strict post-surgical requirements. It is common to have emotional challenges in adjusting to a new way of life as well as your changing body and reactions from other people. Because of this, a pre-surgery psychological evaluation is an important part of the preparations.

What Happens During a Bariatric Surgery Psych Eval?

A psych eval for weight loss surgery consists of meeting with a psychologist for a clinical interview, and often a few questionnaires designed for pre-surgery psychological evaluations. This means the psychologist will ask many questions about you and your history, including:

• Current and past behaviors related to eating and exercise

• Previous attempts to lose weight

• Any mental health history

• Childhood experiences, including any trauma

• Current and past alcohol and drug use

• Medical problems and medications

• Social support

The goal of the interview and questionnaires is not to invade your privacy, but to gather the information needed to foresee any potential complications. For example, if you have a history that includes depression, you may be at higher risk of developing depression after surgery. If your team knows this, it’s easier to have support in place, like psychotherapy or medication to help manage your mood as you adjust to the changes in your lifestyle and body.

How Do I “Pass” a Bariatric Surgery Psych Eval?

It is natural to have anxiety about testing, especially when you have made the decision to pursue bariatric surgery and a psych eval seems like a roadblock in the way of that goal. But psychological assessment is not a pass/fail endeavor. Most people seeking weight loss surgery have areas of risk. Some common examples:

• Many efforts to lose weight that have ended with returning to old habits and regaining weight. This does not mean you “fail” the psych evaluation. It means this will be an area for you and your medical team to be aware of and an area in which to offer extra education and support so you have the best chance of successful surgery.

• A previous mental health history. Mental health diagnoses do not automatically mean you are not a good candidate for surgery. You and your team will need to plan for the support you need before and after surgery.

Part of the evaluation is a feedback session with your psychologist, who will discuss areas of concern, and offer recommendations. For example, if you’re a smoker, it is a good idea to quit before a major surgery, since nicotine gets in the way of wound healing. A psychologist might refer you to a smoking cessation program to give you the best chance of healing well.

Why might A Psychologist not recommend surgery

Rarely, there are serious concerns that would cause a psychologist to recommend against surgery right now. Some examples include:

• Uncontrolled/untreated severe psychiatric symptoms

• Suicide attempts or psychiatric hospitalization within the past year

• A history of not following medical recommendations

• Active substance or alcohol abuse

If you do have a serious mental health issue, it is important to treat that before considering any surgery, and particularly weight loss surgery, which can be a challenging adjustment accompanied by many emotions. If a psychologist recommends that you wait for surgery until another mental health concern is treated, it is because this will give you the best odds of having a successful weight loss surgery.

The most important thing to do during a bariatric surgery psych eval is to be honest. Your psychologist wants you to succeed, and they are well-equipped to provide you with support, education, and information about your areas of risk, to help you prepare and go on to a successful surgery.

Get A Bariatric Surgery Psych Eval in Los Angeles, CA

Dr. Reger offers assessments at several locations throughout Los Angeles and Southern California. If you are preparing for a weight loss surgery follow these steps to get your pre-surgery psychological evaluation:

1. Reach out to speak with a Los Angeles Psychologist

2. Schedule your bariatric surgery psych eval

3. Get the answers you need for a successful weight loss surgery

Other therapy & Assessment Services Offered by dr. reger in Los Angeles, CA

There are several different types of assessments that Dr. Reger provides as a Los Angeles Psychologist. She can provide assessments for workers comp, med-legal situations, dementia, and cognitive decline. Besides evaluations and assessments, she also offers counseling for older adults, public speaking, and consultations.

Workers Compensation for Depression and Anxiety in Los Angeles

WORKERS’ COMPENSATION FOR DEPRESSION AND ANXIETY

When we think of workers’ comp, we often picture a physical injury, like a broken limb. However, emotional symptoms can result from workplace injuries as well. In California’s Worker’s Compensation system (the Division of Workers’ Compensation, or DWC), there are certain types of psychological injuries that are covered.

Psych Claims for Workers’ Compensation

Trauma & Posttraumatic Stress Disorder

The most obvious type of psychological harm that can happen at work is a traumatic event. For example, if someone survives violence in the workplace, that can cause great distress, which can evolve into posttraumatic stress disorder (PTSD). However, PTSD is not the only mental health problem that can happen on the job.

Depression

Depression involves intense feelings of sadness and can include several other symptoms, such as:

• changes to appetite or sleep

• getting stuck thinking about problems

• feeling exhausted

• feeling hopeless

• even thinking about hurting yourself

The word “depression” is used incorrectly in pop culture all the time, and it does not mean a passing bad mood, sadness over something trivial, or disappointment. Depression can last for weeks or months and can make it difficult to do simple daily activities. Often times people feel like there is “no good reason” for them to feel down.

Anxiety

Anxiety is a mental health diagnosis that involves symptoms of extreme or constant worry, feeling on edge, muscle tension, feeling panicky, and other problems. People with anxiety often worry over seemingly “minor” things, or worry about possible bad things happening that are very unlikely to happen. Anxiety can get in the way of doing day-to-day activities and can prevent people from feeling able to enjoy their lives.

How do depression and anxiety relate to workers’ compensation?

Symptoms of depression and anxiety can develop from a few different experiences at work. For example, a worker may have a physical injury that causes chronic pain, problems with doing daily tasks and activities, or a major change to their lifestyle. The adjustment to pain and disability can be very challenging and can cause depressed mood, hopeless feelings, and anxiety about things like recovery or finances. Other times, things like a strained relationship with a co-worker or harassment by a manager can result in a low mood or stress that gets worse.

Since the worker has to face that relationship very often, other symptoms can develop, like feelings of hopelessness, crying spells, anxiety about going to work, extreme worry about criticism at work, and more. It’s not hard to see how this type of situation could turn into depression and anxiety over months or years of a stressful relationship at work.

Getting Workers’ Compensation for Depression and Anxiety

If you are experiencing depression or anxiety related to a work situation, you may want to consider filing a workers’ compensation claim. In California, and in many other states, psychological diagnoses that are caused by workplace problems are often covered by workers’ compensation.

This usually means that if a qualified medical evaluator (QME; in some states called an independent medical evaluator or IME) determines that you have a mental health diagnosis that was caused mostly or completely by your job, the workers’ comp system may pay for your psychotherapy or medication management with a psychiatrist, if these treatments are recommended to help you. It can be hard to recognize or tell others that you are depressed or anxious, but receiving treatment for your symptoms and resolving a workplace situation that is causing distress can get you back on track to feeling like yourself and doing your best work.

Get Evaluated for Workers’ Compensation for Depression and Anxiety in Los Angeles

Dr. Reger is a Los Angeles Qualified Medical Examiner who provides assessments for PTSD, depression, anxiety, and stress. You can receive your QME report for workers’ compensation for depression and anxiety at several locations throughout Los Angeles and Southern California. To start the process follow these steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Move forward with your workers’ compensation case

Other mental health Services in Los Angles, CA

Dr. Reger offers psych and neuropsychological assessments for situations besides workers comp. She also provides evaluations for cognitive decline, dementia, med-legal capacity, and pre-surgical assessments. Additionally, she offers individual therapy and counseling for older adults.

Deciding on the Right Therapist

It can be intimidating to find a therapist once you've made the decision to seek professional support.  There is no perfect, cookie-cutter algorithm for choosing a therapist; however, there are a few useful things to think about as you decide.

Gender

Choosing a male versus a female therapist may seem like no big deal to some people, and it may seem like a dealbreaker to others.  Even if it doesn't seem like a major factor to you on the surface, think about the problems and concerns in your life.  Would you feel completely comfortable talking about these things with someone of your same sex?  What about the opposite sex?  Do you have an immediate reaction to imagining one or the other of those scenarios?  For example, some people have a hard time discussing a divorce with someone of the same sex as their former spouse.  Think about how your therapist's sex may or may not influence your experience in treatment, and how much this matters to you.

Theoretical Orientation

"Theoretical orientation"is a fancy way of saying "approach to treatment."  All therapists approach therapy from their own unique perspective, and every client responds differently to a given approach.  Some therapists stick closely to one theory that informs treatment (e.g., Cognitive Behavior Therapy, Dialectical Behavior Therapy, Psychodynamic psychotherapy), but many therapists pull from several theoretical orientations to shape the way they approach therapy.  A good way to find out about a potential therapist's theoretical orientation is to ask how she believes change happens in therapy.  Listen carefully to the answer, and think about how this does or does not fit with your own ideas and comfort zone.  If you are someone who prefers less structure, and your potential therapist tells you he makes an agenda at the beginning of each session and assigns homework at the end, you have something to consider when making your decision.  Also remember that sometimes it can be good for us to stretch a bit beyond what we're used to.  So if the agenda and homework really appeal to your rigid streak, consider how it might be immensely helpful for you to find a therapist who pushes you to become more comfortable going with the flow.  Therapy is about change, after all!  You may be getting the sense that there is no "one size fits all" therapist, and you're right.  Feel free to ask many questions about how your potential therapist's orientation will play to your own strengths and vulnerabilities.

Specialty

Although many therapists have what's called "generalist" training (meaning they have experience and training working with many ages and problems), most therapists do have a particular area of specialization.  For example, there are many therapists who work a lot with children and adolescents.  Although many of those same therapists are also trained in working with adults, you may decide to seek someone who works more often with adults than with children to help you improve your relationship with your supervisor at work.  As with gender, this may be more or less of a factor for you, but it is worth considering.  There are also many different areas of specialization.  Some therapists are really experts at working with anxiety, some with depression, some with grief, some with trauma, and so on.  There is often a fair amount of overlap with psychiatric problems (for example, many people with anxiety also deal with depression), and most therapists treat a diverse range of problems,  so looking for someone who sees only people exactly like you is probably going to leave you with very few options.  However, you do want someone who has familiarity and experience with what you are dealing with, and you should ask about this in your search for a good fit.

Practical Stuff

This seems pretty straightforward, but it's worth saying explicitly!  Therapy is an investment of time, money, and energy, and it is important to think about the reality of how a particular therapist will fit into your life.  Does she have a schedule that is compatible with your own?  Does this therapist take your insurance, or will your insurance reimburse you for some number of sessions?  If not, can you afford to pay out-of-pocket?  If it's a financial stretch, is it worth it to work with this particular person because of specialization, theoretical orientation, or recommendation?  Is his office close enough to your work or home to be convenient?  Can you arrange with your supervisor to take a late lunch or leave a few minutes early to make a therapy appointment during the work day?  Think carefully about the practical realities of your resources, and what's most important to you in fitting therapy into a balanced life.

Don't Let the Rules Hold You Back

After thinking about all of the above things, plus whatever else is important to you, you may feel it is an insurmountable task to find the right person with the perfect combination of features. Remember that sometimes the best outcomes in our lives are the result of surprises.  When searching for  a therapist, you may find that you connect very well with someone who does not fit your list of "must-haves," or who is someone you were skeptical about at the start.  As with many things in life, it's about finding the balance between narrowing it down to choices that make practical sense for you, and being open to finding something outside your expectations.

Bottom Line

Only you know the factors that will allow you really to invest in and stick with therapy for long enough to make meaningful change.  Effective therapy that results in lasting change does not happen overnight, and does not happen with just any fit between patient and therapist.  Meaningful change in therapy requires dedication of resources from you.  If there are things that make it especially difficult with a particular therapist, keep looking for the right fit.  Improving your relationships, psychological well-being, and self-esteem is worth the effort and time it takes to find the right therapist!  And remember, when in doubt, ask lots of questions and pay attention to your own gut feelings.