Binge Eating: Hiding an Eating Disorder
Technically, those with diagnosable eating disorders are not advised to undergo weight-loss procedures, but because each hospital and insurance company has different psychological screening requirements, many patients with mental health problems slip through the cracks.
In some cases, psychological screenings consist of asking only a couple of basic questions that don't even address eating disorders or mental health concerns, says Dr. Leslie Seppinni, a therapist who specializes in treating obesity. "Then after the surgery, most doctors fail their patients in terms of follow-up. There are some group sessions with other patients, but that's about it."
In Turner's case, however, her health insurance had relatively rigorous requirements for surgery approval, including an eating disorder screening and a letter from her therapist. But for those who are desperate to get the surgery at all costs, she says it's relatively easy to get around these requirements by answering the questions "right," as she did.
Because of insufficient screening or deception, Lilenfeld says about a third of all patients who undergo weight-loss procedures are believed to have "severe binge eating disorder" going into surgery, though not all of these patients will go on to develop other eating disorders post-op.
Anorexia/Bulimia After Surgery: Medical or Emotional?
One of the reasons that true anorexia and bulimia may not be recognized after bariatric surgery is that the symptoms of these eating disorders can mimic some of the expected adverse affects of the surgery.
In the months following surgery, the stomach has to heal and slowly expand, which makes eating difficult and sometimes painful. Patients who eat too much will sometimes throw up because it's the only way to relieve the pain in their stomach, not because they are compulsively trying to get rid of calories. Similarly, the indigestion, diarrhea and acid reflux that can occur post-op leads some patients to avoid eating altogether just because eating becomes an unpleasant experience. These patients will become malnourished and resemble anorexics, but the psychological aspect of the disorder is not there.
It is important to distinguish between these medical reasons for anorexic/bulimic behavior and true, psychological cases of eating disorders, says Seppinni, who has traveled the country interviewing people about their experience with obesity, weight loss and bariatric surgery. In true cases of eating disorders, it's about the addiction to overeating getting transmuted into another addiction. For some, they become compulsive exercisers, for others, alcoholics, for still others, anorexics. "You take away the coping strategy they've been using all their lives, and the addiction has to go somewhere else," she says.
The "loss" of binging as a coping strategy was palpable for Turner following her surgery. "I lay in bed and cried for a week because I couldn't eat. Eating was the way I soothed myself my whole life. As soon as I could binge again, even though it was extremely painful, I did," she says.