Psycological Eval
They want to make sure you are having the surgery for all the right reasons. For example you are having the surgery for "YOU" not to please someone else. That you have realistic expectations, like this is only a tool and you still have to eat right and exercise for life. You have to have it worked out why you never eat, address the head issues. If not, the surgery is not going to work...long term.
We have a saying, get it right between your ears before you re-arrange your plumbing. Good Luck!
HW:330 - GW:150 - MW:118-125
RW:190 - CW:130
I thought some of the questions they asked were kind of silly but I had to do it so I dealt with it. I'm going to paste the questions I got for my psych eval...it's a few pages so I hope it works:
What are the main issues/concerns in your life right now?
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Describe any significant events (past, recent or current) that might have contributed or be contributing to
your current issues?
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How long have these problems been affecting your life?
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Have you ever sought help for these issues? Yes _____ (describe below) No _____
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What did you find most helpful about your treatment?
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Please indicate if you are currently experiencing any greater than usual stress in your life relating to the
following:
a. Work: Yes____ No_____
b. Health: Yes____ No_____
c. Relationships (spouse or significant other): Yes____ No____
d. Children: Yes____ No____
e. Parents: Yes____ No____
f. Finances/legal issues: Yes____ No____
g: School: Yes____ No_____
h: Moves: Yes____ No____
i: Other: __________________________________________________________
If you responded yes to any of the above, please explain:
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Some people turn to substances or activities to deal with stress or problems in their lives. Describe your
use of the following:
Caffeine:
Cigarettes:
Alcohol:
Food:
Soda:
Marijuana:
Cocaine:
Methamphetamines:
Computer/Electronic Devices:
Television:
Family History
What was it like to grow up in your family? __________________________________________________
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What is your birth order? ________________________________________________________________
What was your relationship like with your mother? ___________________________________________
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What was your relationship like with your father? _____________________________________________
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What have your relationships been like with significant others? __________________________________
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Were your parents (or any other family members) ever threatening? (i.e. discipline) __________________
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List family members treated for substance or mental disorders (depression, anxiety, alcoholism, eating
disorders) and indicate treatment received (psychotherapy, medication, hospitalization, etc.).
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Developmental History (Birth to Present)
How would you describe your temperament growing up? Did you suffer from excessive shyness or
aggression? Attention problems? __________________________________________________________
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Did you ever feel rejected as a child? _______________________________________________________
Did any adult or peer harm you verbally, emotionally, or physically? _____________________________
When did you start puberty and what was your reaction? _______________________________________
As a child, what did you do when you were upset? What would your parents do? __________________
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Were there any significant issues/events you had to deal with in childhood (i.e. frequent moves, deaths,
losses, accidents, illness)? _______________________________________________________________
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Relationships/Coping Skills
Describe your current relationship with your:
Family of origin (i.e. parents) __________________________________________________________
Spouse/partner ______________________________________________________________________
Child(ren) __________________________________________________________________________
Friends ____________________________________________________________________________
Describe any issues, if any, you think you have in developing and keeping relationships:
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Has there been any violence (verbal, emotional, physical abuse or threats) in your current family/significant
relationship? __________________________________________________________________________
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During the coming months, what support systems are available to you?
____Friends ____Relatives ____Neighbors ____Church ____Other (Specify)_______
Personal Summary
What do you do for fun/recreation (include hobbies, social activities, clubs, special interest groups, etc.)?
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What are your strengths (include skills and talents that it takes to be good at the activity/hobby and other
qualities you possess such as patience, quick thinking, persistence, attention to detail, etc.)?
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What areas in your life are most satisfying to you (career, parenting, friendships, etc.)?
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What gives your life meaning?
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Is spirituality or religion a significant part of your life?
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What changes would you like to see occur in your life? ________________________________________
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