Skip to main content
Log in

Does Post-operative Psychotherapy Contribute to Improved Comorbidities in Bariatric Patients with Borderline Personality Disorder Traits and Bulimia Tendencies? A Prospective Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Borderline personality disorder (BPD) and eating disorders may affect the outcomes of bariatric surgery. This study was aimed to evaluate the influence of a post-operative dialectical behavioral therapy (DBT) intervention on weight loss and comorbidities in a sample of comorbid obese Italian patients with BPD traits and bulimia tendencies who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB).

Methods

One hundred fifty-four LRYGB or LAGB patients showing BPD and bulimia traits and type II diabetes, hypertension, and/or sleep apnea (OSAS) voluntarily adhered to DBT (n = 72) or treatment as usual (n = 82) for 12 months after surgery. Total weight loss (%TWL) and remission/improvement of comorbidities were considered as outcomes. Differences between treatment groups and between LRYGB and LAGB subgroups were evaluated through Student’s t test for TWL and chi-square test for comorbidities.

Results

DBT was more effective than treatment as usual (TAU) in reducing weight loss (p < .001). Reduction of comorbidities was higher in patients treated with DBT, as for diabetes (p = .68), hypertension (p = .02), and OSAS (p = .03). LRYGB outcomes seem to be significantly better than those of LAGB, mainly in TAU group.

Conclusion

Our findings confirm the effectiveness of DBT in enhancing post-bariatric weight loss and reduction of comorbidities in patients showing BPD traits and bulimia tendencies. Further in-depth investigations and a longer follow-up are needed to strengthen these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847–50.

    Article  CAS  PubMed  Google Scholar 

  2. Haslam DW, James WP. Obesity. Lancet. 2005;366:1197–209.

    Article  PubMed  Google Scholar 

  3. Finkelstein EA. How big of a problem is obesity? Surg Obes Relat Dis. 2014;10:569–70.

    Article  PubMed  Google Scholar 

  4. McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139:933–49.

    Article  PubMed  Google Scholar 

  5. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.

    Article  PubMed  Google Scholar 

  6. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8.

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  8. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  10. Crémieux PY, Ledoux S, Clerici C, et al. The impact of bariatric surgery on comorbidities and medication use among obese patients. Obes Surg. 2010;20(7):861–70.

    Article  PubMed  Google Scholar 

  11. Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts. 2008;1(1):52–9.

    Article  PubMed  Google Scholar 

  12. Società Italiana di Chirurgia dell’Obesità e delle malattie metaboliche (SICOB). Linee guida e stato dell’arte della chirurgia bariatrica e metabolica in Italia. Napoli: EDISES; 2008.

    Google Scholar 

  13. Medical Advisory Secretariat. Bariatric surgery for people with diabetes and morbid obesity: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9(22).

  14. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149:275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    Article  PubMed  Google Scholar 

  16. Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.

    Article  PubMed  Google Scholar 

  17. Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164(2):328–34.

    Article  PubMed  Google Scholar 

  18. Yen YC, Huang CK, Tai CM. Psychiatric aspects of bariatric surgery. Curr Opin Psychiatry. 2014;27(5):374–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peterhänsel C, Wagner B, Dietrich A, et al. Obesity and co-morbid psychiatric disorders as contraindications for bariatric surgery? A case study. Int J Surg Case Rep. 2014;5:1268–70.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89.

    Article  PubMed  Google Scholar 

  21. Marcus MD, Kalarchian MA, Courcoulas AP. Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry. 2009;166(3):285–91.

    Article  PubMed  Google Scholar 

  22. Kinzl JF. Morbid obesity: significance of psychological treatment after bariatric surgery. Eat Weight Disord. 2010;15:275–80.

    Google Scholar 

  23. Beck NN, Johannsen M, Støving RK, et al. Do postoperative psychotherapeutic interventions and support groups influence weight loss following bariatric surgery? A systematic review and meta-analysis of randomized and nonrandomized trials. Obes Surg. 2012;22(11):1790–7.

    Article  PubMed  Google Scholar 

  24. Rizvi SL, Linehan MM. Dialectical behavior therapy for personality disorders. Curr Psychiatry Rep. 2001;3(1):64–9.

    Article  CAS  PubMed  Google Scholar 

  25. Verheul R, Van Den Bosch LM, Koeter MW, et al. Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry. 2003;182:135–40.

    Article  PubMed  Google Scholar 

  26. Himes SM, Grothe KB, Clark MM, et al. Stop regain: a pilot psychological intervention for bariatric patients experiencing weight regain. Obes Surg. 2015;25(5):922–7.

    Article  PubMed  Google Scholar 

  27. Safer DL, Telch CF, Agras WS. Dialectical behavior therapy adapted for bulimia: a case report. Int J Eat Disord. 2001;30(1):101–6.

    Article  CAS  PubMed  Google Scholar 

  28. Associazione Medici Diabetologi (AMD), Società Italiana di Diabetologia (SID). Standard italiani per la cura del diabete mellito. 2014. Available at http://www.standarditaliani.it/file/allegati/STANDARD_2014_Ott30_15.pdf. Last accessed 15 October 2016.

  29. World Health Organization. A global brief on hypertension. WHO press, Geneva 2013—the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31:1281–357.

    Article  Google Scholar 

  30. Iber C, Ancoli-Israel S, Cheeson A, et al. The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.

    Google Scholar 

  31. Linehan MM, Comtois KA, Murray MA, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63:757–66.

    Article  PubMed  Google Scholar 

  32. Wisniewski L, Kelly E. The application of dialectical behavior therapy to the treatment of eating disorders. Cogn Behav Pract. 2003;10(2):131–8.

    Article  Google Scholar 

  33. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.

    Article  PubMed  Google Scholar 

  34. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.

    Article  PubMed  Google Scholar 

  35. Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931–40.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pontiroli AE, Zakaria AS, Mantegazza E, et al. Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patients undergoing gastric banding: a controlled study. Cardiovasc Diabetol. 2016;15(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25.

  38. Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA. 2016;315(2):150–63.

    Article  CAS  PubMed  Google Scholar 

  39. Mitchell JE, King WC, Courcoulas A, et al. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord. 2015;48(2):215–22.

    Article  PubMed  Google Scholar 

  40. White MA, Kalarchian MA, Levine MD, et al. Prognostic significance of depressive symptoms on weight loss and psychosocial outcomes following gastric bypass surgery: a prospective 24-month follow-up study. Obes Surg. 2015;25(10):1909–16.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kalarchian MA, King WC, Devlin MJ, et al. Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med. 2016;78(3):373–81.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cassin SE, Sockalingam S, Wnuk S, et al. Cognitive behavioral therapy for bariatric surgery patients: preliminary evidence for feasibility, acceptability, and effectiveness. Cogn Behav Pract. 2013;20(4):529–43.

    Article  Google Scholar 

  43. Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? JADA. 2007;107(1):92–9.

    Article  Google Scholar 

  44. Capoccia D, Monaco V, Coccia F, et al. Axis II disorders, body image and childhood abuse in bariatric surgery candidates. Clin Ter. 2015;166(4):E248–53.

    CAS  PubMed  Google Scholar 

  45. Sansone RA, Sansone LA. Borderline personality disorder in the medical setting: suggestive behaviors, syndromes, and diagnoses. Innov Clin Neurosci. 2015;12:39–44.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the staff of the Evangelical Hospital “Villa Betania” for the support they received throughout the study and the study participants.

Authors’ Contributions

GL, PM, and EG conceived and designed the study.

FG, AC, and PB participated to the organization of the activities and to the collection of the data.

GL revised the manuscript critically for important intellectual content.

FG analyzed and interpreted the data, and drafted the article.

All authors read and approved the final article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesca Gallé.

Ethics declarations

Funding

None.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed were in accordance with the ethical standards of the University of Naples Parthenope and of the hospital Villa Betania and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gallé, F., Maida, P., Cirella, A. et al. Does Post-operative Psychotherapy Contribute to Improved Comorbidities in Bariatric Patients with Borderline Personality Disorder Traits and Bulimia Tendencies? A Prospective Study. OBES SURG 27, 1872–1878 (2017). https://doi.org/10.1007/s11695-017-2581-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2581-1

Keywords

Navigation