Lifetime Trauma, PTSD and Post-Traumatic Stress Spectrum in 92 candidates to bariatric surgery

Background: High rates of psychopathology and mental disorders have been reported both in obese subjects and in bariatric surgery candidates. Previous researches suggested a possible association between traumatic events or Post-Traumatic Stress Disorder (PTSD) and obesity, as well as Feeding and Eating Disorders (FEDs). Aim of this work is to investigate the impact of a wide range of lifetime traumatic events in a sample of obese subjects seeking bariatric surgery, to elaborate on the relationship between post-traumatic stress symptoms and eating behaviors and to investigate the possible overlap between FEDs, full and partial PTSD and severity of obesity. Material and method: 92 obese subjects (mean age 47.7 years; mean BMI 42.6 Kg / m2; 71.7% females) underwent psychiatric evaluation before bariatric surgery, at the Pisa University Hospital. They were assessed through clinical interview and self-report questionnaires investigating post-traumatic stress spectrum and eating disorder features: the Trauma and Loss Spectrum (TALS-SR) and the Eating Disorder Examination (EDE-Q). Prevalence of psychiatric disorders, according to the DSM-5 criteria, was investigated by means of structured clinical interview (SCID-5). Results: 44.6% of subjects had at least one lifetime psychiatric disorder (any mood disorders: 25.0%, any anxiety disorders: 23.9%, any FEDs: 15.3%, no PTSD cases). Symptomatic PTSD (according to TALS-SR) was found in 10.8% (all women, with no significant gender difference) and partial PTSD in 41.9% of the sample. Subjects reported high rates of loss events and maladaptive behaviors related to poor self-care or poor adherence to medical indications. Many post-traumatic stress symptoms (in particular, reactions to loss events and re-experiencing symptoms) positively correlated with altered eating behaviors (EDE-Q) and Weight Concern resulted significantly more severe in PTSD subjects with respect to subjects with no PTSD. There was a growing trend in the prevalence of FEDs from no PTSD (8.6%), up to partial (19.4%) and then to full (37.5%) PTSD subjects. Among severe obese (BMI> 40), this trend was even greater (1:2 subjects with PTSD showed FEDs) and subjects with FEDs reported higher post-traumatic stress spectrum symptoms. Conclusions: Globally, these evidences suggested a positive correlation between altered eating behaviors and post-traumatic stress spectrum symptoms in obese subjects candidate to bariatric surgery. Individuals with a high sensitivity to loss events may develop a post-traumatic stress symptomatology, including maladaptive eating behaviors, which can lead to obesity or full-blown FEDs, more likely in women and in subjects with PTSD