Shame as a predictor of psychological morbidity in patients after bariatric surgery

Abstract

Background: Bariatric surgery is increasingly indicated to achieve significant weight loss and help reduce physical and co-morbidities in those who are morbidly obese. However its psychological impact is less well explored. Shame and self-conscious emotions have been increasingly identified and targeted in those with other eating disorders, yet this construct has been little explored in those receiving bariatric surgery. The aim of this study was to examine reported shame and its relationship to psychological morbidity in post-bariatric surgery patients. Method: A cross-sectional, questionnaire survey was responded to by eighty volunteers, all at least one year post-bariatric surgery. Measures assessed internalized, externalized and body shame; anxiety and depression; self-esteem; quality of life; and body image disturbance. Findings: Internalized and externalized shame, psychological morbidity, low self-esteem, impaired quality of life, and body image disturbance were significantly higher in participants than published community norms. Body shame was significantly elevated with participants reporting ‘problematic’ levels of body image disturbance. Regression analyses indicated that shame (externalized, internalized and body) accounted for around half of the variance in scores for psychological morbidity, body image disturbance, self-esteem, and a third of the variance for quality of life. Strong relationships were found between the parameters, with internalized shame accounting for most variance in anxiety and depression. Discussion: Greater focus on shame in those who are morbidly obese, even after bariatric surgery appears warranted and interventions targeting shame may alleviate other psychological difficulties, such as low self-esteem, impaired quality of life, anxiety and depression and body image disturbance.