Longitude follow-up of post-operational psychic structure of patients with bariatric surgery

This study was carried out with the aim of examining the longitudinal follow-up of post-operative psychic structures of patients who had undergone bariatric surgery with psychometric measurement tests and in-depth understanding of the results obtained through projective methods with psychoanalytic concepts. For this purpose, Demographic Information Form, Rorschach, TAT, Hospital Anxiety and Depression Scale (HAD-S), Social Appearance Anxiety Scale(SAAS), Body Perception Scale (BPS), Night Eating Questionnaire (NEQ), Dutch Eating Behavior Questionnaire (DEBQ), Psychological Resilience Scale (PDS), Eating Disorder Examination Questionnaire (EDE-Q), Childhood Trauma Scale, Short Form-36 Health Questionnaire (SF-36), Toronto Alexithymia Scale (TAS-20) were applied to ten participants before the surgery and after in the 1st and 2nd year of bariatric surgery to examine the post-surgical psychological structures of these patients by longitudinal follow-up. In addition, SCID-5/CV was used in the before the surgery and in te 6th month, 1st year and 2nd year evaluations after bariatric surgery. Along with these, semi-structured psychoanalytic interviews were conducted. It was determined that the total scores of the participants' childhood traumas scale were moderate and the night eating questionnaire scores were minimally lower after surgery than before, but did not make a statistical difference. It was observed that the presence of depression/anxiety and quality of life levels, body image scores, total and sub-dimension scores of psychological resilience did not differ before and after surgery. It was also shown that the emotional eating scores of the participants were lower after the surgery than before the surgery as it is smiliar in the SCID-5/CV findings, it was observed that the preoperative binge eating disorder symptoms of six participants were absent in the postoperative follow-up interviews. In addition to these, social appearance anxiety scores decreased 1 year after surgery compared to pre-surgery, but started to increase again 2 years after surgery. In Eating disorder assessment questionnaire, body shape concerns and weight concerns sub-dimension scores were found to be lower after surgery than before surgery. The presence of alexithymia decreased 1 year after the operation, but increased compared to the pre-surgery evaluation after 2 years. Also, in this study, the findings obtained from projective tests and semi-structured interviews in the longitudinal follow-up of the psychic structures of patients who underwent bariatric surgery were examined with psychoanalytic concepts under the headings of structure of ego and defense mechanisms, libidinal functioning and dynamics of conflict. Test protocols were evaluated using the content analysis method specific to the French School. Significant deteriorations in body image of the patients after bariatric surgery were observerd along with the impossibility of being alone, and difficulties in processing the depresive position. Findings showing the inability of the patients to work with separation, loss and grief are presented. It was also observed that skin-ego responses appeared in the protocols after bariatric surgery, which supports and enriched previous studies which mentions the concept "nebula". However, in a large number of patients in the Rorschach Test, reatively rich libidinal content answers in drive functioning seen before bariatric surgery did not appear in post-bariatric protocols, also difficulties in representation shown with a duller content and sometimes with more raw responses were discovered in the follow-up tests. It has been observed aggression is not processed, and answers are given that convey sexual identification problems on the axis of narcissistic impulsivity rather than sexualized body representation. In the TAT test, on the other hand, it was concluded that the libidinal world was themed over loss, illness and death. It was observed that the dynamics of the conflict continued unchanged around the problem of separation and individuation, inability to differentiate before and after surgery. Depending on all these, as in the neurotic structures such as displacement, isolation, cancellation, dramatization defense mechanisms used in the protocols but in addition to the inadequacy of symbolization process in the patients it is seen that patients effort to hold on to external realities, negation and denial mechanism when they are affected by the material which contains especially loss, separation or intense impulsivity themes that remain unchanged in pre- and post-surgical responses. These findings have been tried to be understood within the scope of psychoanalytic theories, mainly from the center of the problem of non-differentiation in the dynamics of conflict and from the interview findings. All these findings are explained within the scope of Bion's function of converting beta elements to alpha elements and Andre Green's death drive, deobjectalization concepts. Keywords: Bariatric surgery, longitudinal follow-up, projective tests, obesity.