“Complex Trauma”: Reflections on the Effect of Early Childhood Abuse among a Small Adult Group of Bariatric Patients

Abstract

The experience of early traumatic exposure, obesity and finally the paradoxical forced behavioural intervention experienced by a small group of five different participants (three women and two men) who underwent bariatric surgery¹ to “cure” a chronic disease such as obesity, were explored and structured around the prominent themes identified by the researchers from the “voices” of the participants. The aim was to arrive at a final “voice” that would reflect collectively on their stories. The research question was based on the interrelationship between prolonged traumatic exposures, morbid obesity and whether bariatric surgery acts as a form of remedial intervention for this small group of participants suffering from morbid obesity. A qualitative research paradigm and social constructivist epistemology were supported by the exploratory case study design as a systematic way of collecting data, analysing information through a process of thematic content analysis and finally reporting the results. The delineation of the themes resulted in the following collective sub-themes: Obesity was the result of psychological defences against the impact of prolonged childhood trauma; the symptom constellation of Complex Trauma seems paramount among the participants of this study; and the remedial effect of bariatric surgery on these patients seems complementary to the relief of the impact of early childhood traumatisation. Incidental findings includes: amnesia regarding “good” periods during childhood; obesity creates an “invisible” perception by others of the obese person; to lose weight causes more back pain due to less bodily support by those who had suffered from back pains prior to surgery; while the occurrence of stomach pains after “stressful periods” could be viewed as an unexpected finding from this research group. The research question is based on the interrelationship between prolonged traumatic exposures, morbid obesity and whether the remedial forced behavioural intervention such as bariatric surgery acts as a form of remedial intervention for this small group of participants suffering from morbid obesity.

Keywords

Bariatric surgery Body Mass Index (BMI)Child abuse Complex Posttraumatic Stress disorder(CPTSD)Complex trauma Disorder of Extreme Stress not otherwise specified (DESNOS)Early childhood traumatic experiences Gastric bypass surgery Morbid obesity Social constructivism

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn, text rev.). Washington, DC.

Artz

Lesizwe

(2005). Ethics Relating to Social Science Research with Victims of Violence and Other Vulnerable Groups [Brochure], Hatfield, South Africa:.

Berkowitz

C. D.

(1998). Medical consequences of child sexual abuse. Child Abuse and Neglect, 22, 541–550.

Briere

(2004). Psychological assessment of adult posttraumatic states: Phenomenology, diagnosis, and measurement (2nd edn). Washington DC, USA: American Psychological Association.

Creswell

J. W.

(1998). Qualitative inquiry and Research Design: Choosing among five traditions. London: Sage.

Draijer

Langeland

(1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric patients. American Journal of Psychiatry, 156, 379–385.

Felitti

V. J.

(2002). The relation between adverse childhood experiences and adult health: Turning gold into lead. Permanente Journal, 6, 44–47.

Felitti

V. J.

Anda

R. F.

Nordernberg

(1998). Relationship of childhood abuse to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14, 245–258.

Ford

(1999). Disorders of Extreme Stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes. Journal of Consulting Clinical Psychology, 67, 3–12.

10.

Herman

J. L.

(1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377–391.

11.

Herman

J. L.

(1992b). Trauma and Recovery: From Domestic abuse to political terror. London: Pandora.

12.

Hoepfl

M. C.

(1997). Choosing qualitative research: A primer for Technology Education researchers. Journal of Technology Education, 9, 1–17.

13.

Jensen

J. L.

Rodgers

(2001). Cumulating the intellectual gold of case study research. Public Administration Review, 61, 236–246.

14.

Luxenberg

Spinazzola

Van der Kolk

B. A.

(2001). Complex Trauma and Disorder of Extreme Stress (DESNOS) Diagnosis, Part One: Assessment. Directions in Psychiatry, 21, 373–392.

15.

Moon

S. M.

Dillon

D. R.

Sprenkle

D. H.

(1991). On balance and synergy: Family therapy and qualitative research revisited. Journal of Marital and Family Therapy, 17, 187–192.

16.

Oria

H. E.

Moorehead

M. K.

(1998). Bariatric Analysis and Reporting Outcome System (BAROS). Obesity Surgery, 8, 487–499.

17.

Patton

M. Q.

(1990). Qualitative Evaluation and Research Methods (2nd edn). Newbury Park, CA: Sage.

18.

Pelcovitz

Van der Kolk

B. A.

Roth

Mandel

Kaplan

Resick

(1997). Development of a criteria set and a Structured Interview for Disorder of Extreme Stress (SIDES). Journal of Traumatic Stress, 10, 3–16.

19.

Powers

P. S.

(1992). Psychiatric issues in bariatric surgery. Obesity Surgery, 2, 315–325.

20.

Powers

P. S.

(1999). Eating pathology before and after bariatric surgery: A prospective study. International Journal of Eating Disorders, 25, 293–300.

21.

Puhl

Brownell

K. D.

(2001). Bias, Discrimination, and Obesity. Obesity Research, 9, 788–805.

22.

Sarwer

D. B.

Fabricatore

A. N.

Wadden

T. A.

(2006). The behavioral evaluation of bariatric surgery candidates. Obesity Management, 103–109.

23.

Schwartz

M. F.

Cohn

(1996). Sexual abuse and eating disorders. New York: Brunner/Mazel, Inc.

24.

Sogg

Mori

D. L.

(2004). The Boston Interview for Gastric Bypass: Determining the psychological suitability of surgical candidates. Obesity Surgery, 14, 370–380.

25.

Strauss

Corbin

(1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications, Inc.

26.

Van der Kolk

B. A.

(2001). The assessment and treatment of Complex PTSD. In Yehuda

(Ed.), Traumatic Stress. New York: American Psychiatric Press.

27.

Van der Kolk

B. A.

Pelcovitz

Roth

S. H.

Mandel

F. S.

McFarlane

Herman

J. L.

(1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation to trauma. American Journal of Psychiatry, 153, 83–93.

28.

Van der Kolk

B. A.

Van der Hart

Marmar

C. R.

(1996). Dissociation and information processing in posttraumatic stress disorder. In van der Kolk

B. A.

MacFarlane

Weisaeth

(Eds), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (pp. 303–327). New York: Guilford Press.

29.

Van Hout

G. C. M.

Van Oudheusden

Van Heck

G. L.

(2004). Psychological Profile of the Morbidly Obese. Obesity Surgery, 14, 579–588.

30.

World Health Organization. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 10, 157–163.