scared to death

I have my Psychological evaluation coming up on june 18th and i am afraid of this appointment. I guess i just do not know what to expect and that is making me scared. Can anyone tell me what happens and what they really want to know, and what to expect?? I know there is stuff in my head that does not need to be brought out, it is not as if i am going to kill or hurt myself -- i am to afraid of pain -- lol. If i have anything in my head that has to do with hurting someone it will not be me that gets hurt- lol. Now i know we all have stuff in our heads that does not need to be brought out in the real world. Can anyone help me to figure out what to expect and how not to be so scared??
Thank you all for any information you can give me.
Margaret

Hello Margaret W!

Welcome to the NY board!
It is common to have fear around the unknown! The whole process is new and can be daunting! When I feel fear creeping up sometimes it is best if I try and readjust my mindset to one of exploration and excitement at the newness and what I may learn! :-)

The best advice be HONEST! Make a connection and stay in therapy AT LEAST a year postop!!!
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The purpose of the psychological consultation (IMHO) is to ensure that there is no severe psychological issue that would compromise your chances for success on the program, and to ensure you'll have adequate personalized support as you begin your post-operative life.  This psychological service is an important and required portion of many weight loss surgery programs.

HI! I can tell you what *I* look for in a psych eval. I happen to be a psych nurse practitioner who does them (several hundred now)..(also a 61/2+ yr postop wlser!) I see people 1-1 1/2 hrs...BUT your mileage may vary as with anything. I have heard of the 15 min eval where a provider says yup you are ok, and others *****quire the MMPI psychological testing and yet others who use a standard 3 session etc. No right or wrong I suppose. For me the proper use of psychology postop is a key in long-term success. Those who embrace this part of the journey may do better and IMHO maintain if they work on any preexisting issues ESPECIALLY emotional eating!

This is what I look at based on my experience and review of the literature.
Possible Exclusion Criteria:
1. Current drug & alcohol dependence/abuse (needs to be in remission 1 year).
2. Untreated and/or unstable mental illnesses: Depression, Bipolar disorder, Anxiety disorder, severe personality disorders or Thought disorders, need to be in treatment with minimal symptoms.
3. A history of near lethal or repetitive suicide attempts may require further evaluation.
4. Current eating disorders: anorexia, bulimia, severe compulsive/binge eating with no ability to control intake. (*If a history may necessitate further eval and intervention)
5. Noncompliance issues & concerns (unwillingness to diet, exercise, or follow treatment recommendations).
6. Inability to give informed consent for treatment.
7. Inability to make lifestyle changes (ex. financially, psychosocially).
8. Unwillingness to follow post-surgical care.
9. Unrealistic surgical expectations, ambivalence about surgery or impulsiveness in decision-making regarding surgery.
10. Inadequate family supports or family hostility toward surgery. *does not disqualify but the need to explore this and develop coping strategies is imperative.
11. Presence of unresolved severe situational stress that may interfere with patient’s success/compliance: current divorce, job stress, financial issues or family issues. May require some work and time to be best prepared.

I also discuss:
diet history, eating issues & insight into...Knowledge of surgery, risks, complications, outcomes..lifestyle needed for f/up etc!
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Your welcome also look at:
http://www.obesityhelp.com/morbidobesity/information/wlsjour ney/getting+authorization.php

http://www.obesityhelp.com/morbidobesity/information/wlsjour ney/your+psychiatrist.php

What your psychiatrist needs to cover

Print out these instructions and send/take to your psychiatrist!
http://www.obesityhelp.com/morbidobesity/information/wlsjour ney/psych+instructions.php

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Psychosocial Evaluation of Bariatric Surgery Candidates: A Survey of Present Practices
Andrea U. Bauchowitz, PhD, Linda A. Gonder-Frederick, PhD, Mary-Ellen Olbrisch, PhD, Leila Azarbad, MEd, Mi-Young Ryee, MEd, Monique Woodson, BA, Anna Miller, RN and Bruce Schirmer, MD

Psychosomatic Medicine 67:825-832 (2005)
© 2005 American Psychosomatic Society ORIGINAL ARTICLES
http://www.psychosomaticmedicine.org/cgi/content/full/67/5/8 25

 

Hey, this s a slightly different angle on psycholoigiscal prep to WLS, I post it often here it is!



The single BEST piece of advice I can offer being ~6+ yrs out is this to anyone:
***Disclaimer some may consider this a no-brainer, others a downer, some a new view, psychobabble, whatever thought it is just my opinion, so take it for what it is worth, and it is meant to be helpful/insightful and thought provoking at a time so many of us are caught up with the right vitamin to take, amount of water to drink, etc.. it is meant to challenge beyond those tasks to see the small stuff matters but that there is a larger and more global view as well to consider!!!***

Establish your mindset to accept that weight loss surgery is not a cure/quick fix for morbid obesity, it's a very effective/powerful/wonderful tool that can be used lifelong to combat the chronic/lifelong disease of morbid obesity that has NO *current* CURE (*So at 1 yr out when many say 100# gone forever I sometimes shudder, it is never gone forever it is gone for now but the work has just started at 1 yr out IMHO). The tool is flawed and can be defeated as well (emotional eating, grazing, drinking calories, eating/drinking together, alcohol use, high calorie dense foods, too many simple carbs, overfilling pouch, carbonation, no consistent exercise routine). Considered WLS as part of a life-long process & commitment to challenge your personal awareness/responsibility/consistency/accountability and that a life-long requirement to follow up with physicians, a regular exercise program, and healthy eating. Accept it will come w/ potential challenges & imperfections (risks, side-effects, complications, challenges such as plateaus, not meeting goal, regain, possible depression, grief over the loss/safety of food/obesity may of offered/invisibility it offered although may of been unwanted at the time/the new attention you get, possible anger or anxiety w/o comfort of food as it used to be/limits it may impose, effort it requires to be healthy etc.) that these frustrations are part of the process to make you healthier see them as challenges not difficulties, positive self talk helps!. Your mindset will be the most important tool for success, as all the challenges of traditional diets/exercise plans for health will be present after WLS as well *Yup so many say I will never diet again, well let me say diets don't work *because people go off them* correct but you will have to be mindful of food and pay attention to intake and exercise for life, so in a sense your dieting for life! Even after WLS.... The surgery won't make a person change, but the beauty is YOU HAVE COMPLETE control over those changes/choices needed after surgery for success, the choices are there and the best use of the mind/psychology will harness those. Surgery is such a drastic choice that so many are successful due to a recommitment to healthy living and choices that is one reason it works and we say it is a 'rebirth'.

Changing habits pre -wls is the mindset that will keep you going, the surgery is a piece, the easiest/smallest IMHO. *It is however the milestone/landmark we set to focuses on. But truly the afterlife is the most challenging, the ever evolving challenges from things like getting in enough liquids to food introduction to vitamin taking, new ways of eating/drinking, introduction of exercise consistently to battling with the scale obsessions & disappointments as well as all the wonderful WOW moments. Have the support system needed to create the healthiest environment as well, willpower fades, the tools robust effects fades as well as the honeymoon closes...Harness your enthusiasm and mind for 6 months doing all you can to influence (not only wt loss) but the healthy lifestyle you want to adopt for maintenance, that elusive animal no one has mastered pre-wls. Exercise can become more routine after 6 months as well. Again the mind is just as/more useful than the pouch...it is the operator of the tool! Stress inevitable, so see each issue/stressful time as an opportunity to use your new tool/mindset! (Like I say use things as excuses or opportunities because holidays come and go each year as do parties, office food/celebrations, hurt feelings, sadness, losses, etc)


I know this isn't one message it is a million crammed into one right! Anyone who knows me knows I am never brief, this is my PASSION (giving back), WLS saved me from myself. It isn't easy or fair, but accepting life is imperfect just as the world we live in, embracing that imperfection and controlling what I can has helped me get thru many issues. There is no perfection, I work on that daily. So what to do about all of this babble?

Get a good journal, start writing today all the reasons you are COMMITTED to this change, what your expectations are (hopefully realistic for wt loss 50-80% of excess not an ideal body wt) and that the goals are not wt related alone, the functional ones how you can integrate into life easier, (clothes fitting, less medical co morbidities or risk of, less meds, less pain (physical/emotional) the benchmarks you are setting, take measurements and photos each month along w/ weights to document the journey. the mind is powerful but may be challenging to change so the photos/measurements help when the HUNKAMETAL doesn't register a loss. We are much more than a number on a scale, free from the numbers and see how much you are more than that as a person, your abilities etc....The journey is full of hills and valleys, some bumps and many more pleasures to see, it can be an awesome ADVENTURE!

The letter you may write/journal entry today may save you from backsliding at your first plateau or at 1 yr out, a recommitment to those thoughts, and how you have grown over time. These are the things I recommend. I think everyone else has you covered w/ the 'physical items you need'. These are the ever-elusive psychological things you need LOL!
OK if you have read this far thanks for hearing me out! I wish you well.

Hiya, Margaret!

I understand that you're scared--I am always uncomfy when I don't know what to expect! I always fear thr worst!

As Jamie said, this appointment is really to exclude any severe issues and to see if you have an acceptable idea about what the surgery will do for you and what you will get out of it. Also, they want to know that you are willing to comply with the rules and even that you know the rules. And, they want to see what kind of support system you have in place to help you along the way--see if you've prepared at all for all these changes! =)

Basically, thery want to know that you have some sort of rational idea that your new life will be much different and that you are ready and willing to make those changes.

If you've had mental issues in the past..or "thoughts in your head" like you mentioned, it probably won't even come up. I do agree you should be honest, but they really want to know stuff related to the surgery. They'll ask all kinds of questions about your personality. Like how often do you____ or do you ever feel ____.

So, I am sure the appointment will be fine. And, maybe when you get there, let the doc know you're feeling a bit anxious. I am sure they will make you feel at ease!

Best of luck with everything! All these appointments are sooooo worth it! This surgery will change your life!!!!

Hugs, Heather =)