Failed Psych Eval

[Restoration 0]

Hi, this is my first time posting......I have been following many threads as I have been deciding whether to pursue the sleeve or not. I am currently 32 years old and 140 pounds overweight, bmi=44, and had been researching for a while and had decided to pursue the sleeve. Well, I did all of preliminaries and was cleared on all except for the psych evaluation.

They denied me for surgery because they said I have an unhealthy connection to food and have eating disorder thoughts....(binge eating). This is all new to me, and you know, I already knew that I had an unhealthy connection to food otherwise I would not be over 300 pounds! I don't believe that I have an eating disorder, but I do emotionally eat. I have been overweight my entire life and actually have had some success (abt. 35 lbs in the past year) with Weight Watchers and I learned a lot in that program about eating healthy, etc. I kinda feel like I am in the perfect place to get the sleeve and continue on this path of bettering myself, and now to be told that I have an eating disorder, huh?

Ok, so if I pay all this money for therapy and get all my food issues fixed, then would I still need the surgery? I expect to have to work with the surgery...so.....I don't know. So, they want me to go thru 3 months of therapy and then redo the eval. So, I'm wandering.......if its legit or if they are just trying to get more money....since they recommend that I see them once a week for 12 weeks. But, I also know that therapist are paid to see what you don't see, so maybe they're right......hmmmm....i just don't know. Kinda bummed...Any thoughts anyone?

[Telisaswan 1]

Do you have the option of going to another doctor and/or therapist to get another opinion? That sounds ridiculous... of course we have what they would likely refer to as an "eating disorder!" Just the fact that you can recognize that about yourself and can be honest about it doesn't mean you should be penalized! Good luck... hope it works out for you.

[Oregondaisy 2,021]

If you want the insurance to pay, it sounds like you're going to have to jump through their hoops. Unless you can go to another surgeon and start the process over and the insurance company will accept another therapists opinion, it sounds like you're stuck.

I would suppose the option of self pay is out of the question. Those of us who chose to go to Mexico didn't have to have psych evals.

[TijuanaPlication 87]

Yeah, I just had a 20 minute chat with the psych AFTER my surgery!! She was just making sure that I had realistic expectations of what the surgery could achieve. I just decided that my health was worth the financial investment so I went to Mexico self-pay.

[Tiffykins 673]

I tend to agree with the therapy option. You might be surprised at how helpful these sessions would be for you. If you've read the forums, you know a lot of people go through the "what the hell have I done to myself", major buyer's remorse because they can't use food as a crutch anymore, etc etc. So, it might serve you well to go through the therapy, learn some new coping mechanisms, and beat some of the food demons now instead of hoping the sleeve will fix everything. I would think that the sessions would give you an upper hand on being successful long term.

[M2G 1,836]

I tend to agree with the therapy option. You might be surprised at how helpful these sessions would be for you. If you've read the forums, you know a lot of people go through the "what the hell have I done to myself", major buyer's remorse because they can't use food as a crutch anymore, etc etc. So, it might serve you well to go through the therapy, learn some new coping mechanisms, and beat some of the food demons now instead of hoping the sleeve will fix everything. I would think that the sessions would give you an upper hand on being successful long term.

I agree.

Playing all the insurance games isn't fun, but it certainly is cheaper than self-pay. I had an insurance 6-month required weight monitoring and THANK GOD I did because during that time I learned about the sleeve and switched from the band to the sleeve! Phew!

[deletedsally 8]

Hi Restoration,

I am a Licensed Mental Health Counselor and I truly believe that therapy is a great way for some people get help with problems, heal from old wounds, find new opportunities for healthier relationships, and learn to lead more fullfilling, productive lives. I say that to let you know that I am definitely not anti-therapy. However, I am thoroughly disillusioned and annoyed with the attitude that most medical and mental health professionals have toward obesity. The fact that you are 140 pounds suggests to me that you are struggling with a complex set of genetic and metabolic issues. I obviously don't know enough about you to give an opinion about whether or not you have an eating disorder--but at this point, what you have described about yourself would not meet the criteria for any kind of diagnosis. You can look up the diagnostic criteria for eating disorders online and see if you meet the criteria. That's not to say that counseling wouldn't be a good experience, or improve the quality of your life--I just don't think it's going to help with maintaining a permanent weight loss.

I was at 283 when I had my surgery. Prior to my decision to have surgery, I had previously reached my pre-marriage weight of 140-150 four different times through strict dieting efforts (Weight Watchers, Diet Center, etc...). After gaining the weight back each time, I pathologized myself by going to Overeater's Anonymous (and drove 1 1/2 hours with two children to get there). I had sponsors. I went to meetings. I walked. I went to the gym. I wore a pedometer everywhere I went. I sat in smoke filled AA meetings with alcoholics when I couldn't find an OA meeting because I was desperate to keep the weight off and willing to go to any length to beat myself into making healthy choices with food. I went to a therapist and placed myself on a food addiction plan with no sugar, wheat, or flour (which I adhered to for years at a time.)

Is that how I would have treated myself if I had been a diabetic? Hardly. I would have gotten medical attention for a medical problem. I wish I had known about VSG years ago and been able to afford it. Any unhealthy relationship I had with food was only exacerbated by years of dieting and my self-imposed "treatments."

My questions to you would be this:

1) Who decided who would do your psych eval? Could you have chosen someone else? Can you request a second opinion?

2) Did the evaluation go directly to you, or did you already release it to someone else?

3) If you have a copy of it, is there a Diagnosis section that would list an Axis I diagnosis? If yes, type the name of the diagnosis into your computer search engine along with the keywords, "diagnositic criteria". You should find a site that would give you a specific set of criteria that have to be met before a diagnosis can me made.

4) Did you pay for the evaluation, or was it covered by your insurance? Most insurance companies require a mental health diagnosis on the claim form before they pay for mental health services. The unfortunate truth is that most mental health professionals will pick out some diagnosis (even if the client doesn't exactly qualify), because it's one of the hoops they have to jump through to get paid.

5) If you believe you have been improperly diagnosed, contact the professional who did the evaluation and request that they remove the diagnosis (which can permanently affect your medical history). If the professional refuses to comply, and you still believe you have been improperly diagnosed, you can tell them that you will file a complaint with the state licensure board for improper diagnosis and possible fraudulent insurance billing if the issue can't be resolved in a satisfactory manner.

If you decide to just accept the label that has been attached to you and pursue the 3 months counseling, I would definitely insist on seeing a different professional than the one that did your evaluation, because your ability to trust has already been compromised. Therapy will always be more helpful if you trust the person you are working with.

Take care and keep us posted!

[deletedsally 8]

Defining characteristics of Binge Eating Disorder:

Binge eating disorder is a relatively recently recognized disorder (it is sometimes referred to as compulsive overeating). Some researchers believe it is the most common of the eating disorders affecting millions of Americans. Similar to bulimia nervosa, those with binge eating disorder frequently consume large amounts of food while feeling a lack of control over their eating. However, this disorder is different from bulimia nervosa because people with binge eating disorder usually do not purge (i.e. vomiting, laxatives, excessive exercise, etc) their bodies of the excess food they consume during a binge episode.

Diagnostic Criteria: DSM-IV

A. Recurrent episodes of binge eating. An episode is characterized by:

1. Eating a larger amount of food than normal during a short period of time (within any two hour period)

2. Lack of control over eating during the binge episode (i.e. the feeling that one cannot stop eating).

B. Binge eating episodes are associated with three or more of the following:

1. Eating until feeling uncomfortably full

2. Eating large amounts of food when not physically hungry

3. Eating much more rapidly than normal

4. Eating alone because you are embarrassed by how much you're eating

5. Feeling disgusted, depressed, or guilty after overeating

C. Marked distress regarding binge eating is present

D. Binge eating occurs, on average, at least 2 days a week for six months

E. The binge eating is not associated with the regular use of inappropriate compensatory behavior (i.e. purging, excessive exercise, etc.) and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

*From the DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Washington D.C.: American Psychiatric Association, 1994.

[BlackBerryJuice 349]

Diagnostic Criteria: DSM-IV

1. Eating a larger amount of food than normal during a short period of time (within any two hour period)

B. Binge eating episodes are associated with three or more of the following:

1. Eating until feeling uncomfortably full

2. Eating large amounts of food when not physically hungry

3. Eating much more rapidly than normal

Exactly, like someone above said, according to these, almost any obese person has an eating disorder. And every North American between Thanksgiving and Christmas!

I actually had serious eating issues as a teen and onwards - bulimia with binging/throwing up as often as 4 times a day at its worst, and binge eating so much, I'd pack on a steady 10 lbs a month. In fact, I had put on 50 lbs in 6 months prior to my surgery, right after losing it over the course of a year! So I'm sure if I had disclosed all this during psych eval for insurance, I would've been labeled a basketcase and ineligible for surgery, as well. Mind you, I did have to fill out a lengthy health history the day before my surgery, and I was honest about my prior history with bulimia (I hadn't thrown up for almost a decade by then) and binges. My Dr. just asked how long since I had last made myself vomit and once I said it had been a decade, he said he wasn't worried about me.

I did get some therapy for my bulimia back in the days, but it was absolutely terrible and I don't credit any of my recovery to it, it was all my own initiative and my own hard work. Re: binge eating, I read many books about it, etc, and while the principle of treatment is great (#1 tenet is to never let yourself get hungry), when you are obese, it's awfully hard to follow it. I mean, how can you lose weight without ever getting hungry? It's impossible, your body's not stupid and the leptin and ghrelin are going to kick in and rise until you finally give in and overeat/binge. I shadowed an eating disorder psychiatrist back in 1st year medicine, and she saw some very obese people with major BED issues, as well. One woman had gained 100 lbs in a year! I asked her how she deals with very obese pts who obviously need to lose weight and she said she puts them on a 2500-calorie diet so they don't get hungry and encourages them to lose weight through exercise - the hunger from food restriction just triggers more binges. Well, good luck losing 100+ lbs via exercise only! It's an awful lot easier treating someone who's underweight, in my opinion, you can't just tell an obese person with an eating disorder that she should keep eating, because it's not healthy, either.

Anyway, the rambling tangent aside, I've experienced a binge drive TWICE since my Aug. 9th surgery and both times found it fairly easy to overcome. I've been seeing a good counselor since my surgery, but recently we've both discovered that we rarely talk about eating these days - I simply don't have these issues anymore. I do find myself eating mindlessly by the computer sometimes, but who doesn't - as long as I rein myself in and choose things like fruits or vegetables, I don't stress about it too much. It's truly amazing how much of this "binge eating disorder" I had must've been triggered by hunger and messed up gastric hormones. I really do think that this surgery has the potential to cure this illness, which makes me wonder if BED is truly a mental illness or if it's primarily based on physiology. I even saw an obesity specialist about a research proposal re: bariatric surgery and emotional eating/BED, but he said that while the topic is interesting to him, I'd have to do a master's to pull it off, and at this point, I'm not ready to make a commitment (maybe after I graduate medical school in 2 years). But I really do think that this surgery cures some people of their eating issues - obviously not all, as I've seen some people on this forum really struggle, to the point of making themselves vomit after surgery - but I do think that the psych evals they have now may be overly stringent. It's one of the reasons I wanted to do that research project - to see if the results would make it possible for more people to become eligible.

[chilo1 62]

All I can say is that as BBJ clearly said, most obese people have at some point of "our" lives some sort of eating disorder. Overeating, extreme dieting, binge eating, they are all types of eating disorders or "disored eating". I have had an eating disorder my whole life, my parents put me on a diet when I was 9 years old, so I have been on extreme diets and then binge eating for 30 years until 5 months ago, when I got sleeved. I am no longer on a diet, even though I'm a slow loser I'm fine with that, because I know too well the consequences of abstaining from certain desirable foods and the binging on them. My goal is to be able to enjoy food albeit in small quantities, and not starve myself anymore. After 30 years of dieting I can certainly say that diets don't work, and it is a scientific fact. I LOVE my sleeve!

[chilo1 62]

All I can say is that as BBJ clearly said, most obese people have at some point of "our" lives some sort of eating disorder. Overeating, extreme dieting, binge eating, they are all types of eating disorders or "disored eating". I have had an eating disorder my whole life, my parents put me on a diet when I was 9 years old, so I have been on extreme diets and then binge eating for 30 years until 5 months ago, when I got sleeved. I am no longer on a diet, even though I'm a slow loser I'm fine with that, because I know too well the consequences of abstaining from certain desirable foods and the binging on them. My goal is to be able to enjoy food albeit in small quantities, and not starve myself anymore. After 30 years of dieting I can certainly say that diets don't work, and it is a scientific fact. I LOVE my sleeve!

[ Trying to post a picture of what I ate for Christmas lunch(not sure if it will work), a bit of everything,(including a few glasses of sparkling rose) and that night I had the same again and a cupcake

 

[deletedsally 8]

Actually that is not accurate. It's a little confusing, but to meet the criteria for the diagnosis, you must meet ALL the criteria. (A through E) and if you notice, under section D, it clearly states that the binge eating episode (as characterized in section A) and associated with behaviors in section B, must have occured an average of 2 days a week for six months and be accompanied by marked distress (section C). This is very different than someone who pigs out around the holidays.

[chilo1 62]

Actually that is not accurate. It's a little confusing, but to meet the criteria for the diagnosis, you must meet ALL the criteria. (A through E) and if you notice, under section D, it clearly states that the binge eating episode (as characterized in section A) and associated with behaviors in section B, must have occured an average of 2 days a week for six months and be accompanied by marked distress (section C). This is very different than someone who pigs out around the holidays.

With due respect Katt, I'm not talking about people who pig out on holidays and therefore have an eating disorder. I am familiar with this criteria, but having done research and a Masters in Nutrition and Psychological Sciences you will find that in EDNOS, patients who don't meet all the criteria are still categorized as having an eating disorder. I am not saying that all fat people have an eating disorder, but in the same way they are a lot of "normal" weight people who have an eating disorder.

[deletedsally 8]

I agree that there may be persons who are diagnosed with an Eating Disorder not otherwise specified. However, the person asking the original question did not feel that she had an eating disorder, and questioned the judgment and ethics of the person who evaluated her. That is why I suggested that she could look at her own "diagnosis" and compare it to the criteria before deciding how to proceed.

My other comment was more directed toward the following comment which was made in another post: "Exactly, like someone above said, according to these, almost any obese person has an eating disorder. And every North American between Thanksgiving and Christmas".

I will repeat myself, that is not accurate.

[Restoration 0]

Ok, so here's an update with this whole thing ---- I decided to go and see another psychologist for another evaluation and my insurance company was fine with that, so I did, and they passed me! I now have my surgery date of January 31st. So, that's all done and I'm on my way.

Here's the thing, I also contacted a different psychologist who specializes in eating disorders and made an appointment. I appreciate all of your responses and all the information you guys supplied and it's interesting because I still don't believe I have a full out eating disorder, but I figured maybe I should do some counseling anyway as I am going into the surgery and maybe for a couple of months after the surgery, just to give myself the best chance to succeed with the sleeve.

I did notice a lot of people on the boards having difficulty adjusting to not being able to use food as a coping mechanism....and I'm a little scared about that...I mean, maybe I can learn some coping skills in therapy other than food and ......hmmmm.........I'm hoping for the best of both worlds....but THANK GOD my insurance company let me go for a second opinion.........I'm ready!