Hi guys! I'm scheduled for my psych eval this week. Any words of wisdom to share on this or can you just give me an idea of what I'm in for and how long it will take???

Did you ask the office your are going to what it entails? It will vary greatly. I've seem some say they have to answer an extensive questionnaire. Some required multiple visits to get cleared. I called a few places and got a few different descriptions of how it would be.

o went with a guy who did basic 'talk' therapy. Told him about my family history, support network, eating habits, prior therapy etc. he cleared me in that one visit.

My experience was similar. He also did a basic depression / anxiety screening.

I had a 277 question T/F test asking all kinds of entertaining statements like:

• I am worthy of love
• I hate myself
• There's a green man who lives on top of the fridge that tells me what to do

Along with the test, I had a conversation with the therapist where I was asked to explain why I was there, what I was prepared for and how I planned to go forward after my surgery. This was billed as three events according to the shrink's practice, and the third was a phone call where he revealed the results of the test and his own evaluation giving me the all-clear.

One thing that will ease your mind is that he rarely advised against surgery for anyone who physically needs it, but would recommend continued therapy for those who might benefit from it.

"

• There's a green man who lives on top of the fridge that tells me what to do"

That would be funny if it werent so insulting.

Mine asked whether I eat dessert a) with every meal b) daily c) almost always and d) frequently.

Since I have PCOS I RARELY eat dessert but THAT WASNT AN OPTION. I found the correlation of "she is fat therefore she eats desserts at some unreasonable frequence" to be REALLY offputting. These are medical professionals, they should know better.

They would have done better if they asked me about the amount of cheese I consume...or cheetos...

I was very anxious about this eval because I had some mental health issues I was dealing with at the time and didn't want to be denied WLS because of them.

It was completely fine. I had three visits. The first was basically an introduction and she told me she rarely advised against surgery. She also said that I didn't look heavy enough for the surgery, which was a "nice" thing to say, but filled me with anxiety and some embarrassment.

The second visit was a long true/false test that is designed to detect mental health issues. Also a depression/anxiety questionnaire.

The final visit she went over the results of the tests. They determined I was suffering from depression and PTSD. I had explained that I was already being treated for these at the first visit. She cleared me for surgery.

Mine was a cakewalk. Basically I went into stuffy dude's office, he asked me some super basic questions that took about 10 minutes, and then approved me for surgery.

I went back to him, three years later, to see if he could manage my Vyvanse prescription and he was a complete and utter asshole. He actually used air quotes when referring to "binge eating disorder." So, hey, I'm glad I got what I needed from him in 2014 at least. :P

This was way longer than I intended...sorry for the novel, heh.

At any rate, when any pre-surgical evaluation is done, basically the provider is looking to determine a few things: whether compliance post-operatively can be maintained, and whether or not the surgery is ultimately being done with logical, rational, and realistic expectations. What does that mean?

One of the primary purposes I'd argue is to determine executive function. This is the fancy way of saying how people make decisions and whether or not they are good and healthy decisions. Say you are getting a lung transplant - can you take your meds every day? Do you have the cognitive ability to 1) remember to take them and 2) understand what happens if you don't? Does someone understand that they have to change what they eat and that surgery will do nothing if this doesn't occur?

Mood disorders and lability can also cause someone to not be able to follow a post-op regimen. They also mean we might be more prone to impulsive and compulsive behaviors, too, which can also be dangerous post-op. A mood disorder doesn't automatically exclude you, however if it's severe enough (say, severe bipolar vs. mild bipolar disorder) it might, particularly if it isn't well-treated. Mania can be very dangerous post-op for any surgery, never mind bariatric surgery. The good news is that it is very treatable, too. Many people have suffered with mental illness for a long time without treatment, and sometimes surgery evaluations help them get the assistance they need after decades of nothing. I've seen a lot of people see so much benefit in this regard from the psych evaluations.

Eating disorders are another complex thing, and it is my opinion that these are very poorly screened for. Being a clinician with an eating disorder gives me a benefit in this regard, as I look at differential factors rather than literal ones. What I mean, is that eating disorders are literal control addictions, and often have impulsive and compulsive factors. When we are impulsive, we do things without thinking about it. Like, have you ever gone to Target to spend $5 and wound up spending $100? My life right there, hahaha. Kidding aside, if that, say, happened constantly, that would be an example of moderate to high impulsivity. Conversely, a compulsive behavior is something we feel we cannot control. Binge eating disorder, as an example, has both these features - we eat without really wanting to, on impulsve, and we feel a loss of control. I.e., we cannot help it.

Also, some disorders are automatic rejections. Uncontrolled psychosis (and in many cases anything other than exceptionally mild psychosis), and a congenital disorder known as Praeder-Willi Syndrome come to mind. Pronounced intellectual or developmental disabilities are also typically rejected, as we often see very poor executive function in these individuals which would prevent positive surgical outcomes.

There is no one standard test for bariatric evaluations. Rather, you are given the choice of what you'd like to do. Who can sign off on an eval is typically determined by insurance. The office should tell you how long; they can be anywhere from 1-3 hours depending on the test. Don't forget to request a copy of the report after - it's your right to get a copy, and it is also a part of your medical record. The same is true of your surgical report as well.

At any rate, often there will be a clinical interview, which means the provider will basically ask you questions in a conversational format, paired with some more objective testing. You might be asked to fill out a form about anxiety or depression, or do a long multiple choice test. This really varies on who is doing the testing. Some will do the MMPI, which is a personality inventory that is several hundred questions. This takes a few hours to do for most. The MMPI determines pathological traits. I feel this is overkill unless personal history indicates otherwise, however it can be very useful for people who have 1) complex histories of trauma and the like which confuse how we present to others 2) higher IQ peeps or people with neurodevelopmental disorders (Autism, ADHD) to rule out stuff.

More typically you will do the shorter inventories, and many answer a bunch of questions about eating. You'll also have a conversational interview.

Hope this helps a bit. :)

"and whether or not the surgery is ultimately being done with logical, rational, and realistic expectations."

-And this is where I have seen the medical community fall short. How many of us have heard the term "you will lose 80 % of your excess weight" and thought that sounded great.

How many of us have had surgeons that then followed up with "there will be 20 % excess weight remaining" And then done the math for a stereotypical 300 lbs or 400 lb person? What one would find is after the 80% excess is gone, the average MO person will be in the overweight and obese categories.

I have seen/talked to/read so many people that never got to their goal weight or a "normal" BMI. They STILL felt like they were failures (despite the massive weight lost). All I can say is "NO! If someone would have done the math for you, you would have seen that you very likely would NOT have had a normal BMI unless you were on the furthest edge of the bell curve".

Surgeons/psychs/the industry/post-op patients need to be transparent and frank to the new patients coming in just so they know EXACTLY what they are getting into

It depends. I'm always brutally honest, and my surgeon and their staff were, as well. It also really depends on the person to a large degree, and if I note signs that they may not be successful, I say so. I have seen far more good bariatric practices than bad, however I am near a huge hub of some of the best in the world (Chicago) and my surgeon was trained at the University of Chicago.

Part of that is our due diligence as patients. I chose my surgeon for his directness, and for the fact he probably spent about 45 minutes talking to me during my first pre-op visit. I was ready to go straight to the University of Chicago, however this impressed me. He is an impressive surgeon.

I've also seen surgeons tell people their BMI likely won't be normal, and this is repeatedly documented (and I have witnessed it), however the individuals do not recall this. I mean, I see people eat all sorts of crazy stuff a week after surgery and still expect to lose 300 pounds, and that just will never happen if you do that.

So, it's complicated. Definitely medical staff should be more accurate, however I think many of us do get surgery having had varying degrees of behavioral pathology, and that this is a significant factor in success as well, which we also don't discuss.

I dislike how psychiatric evaluations are done at this time, and find most inadequate. However, I am one of the rarer people doing them who has gone through the process myself, in addition to being trained to do assessments, so I see it from a far different perspective. I am very meticulous and picky.