Obesity Surgery

, Volume 22, Issue 3, pp 389–397 | Cite as

Axis I Psychopathology in Bariatric Surgery Candidates with and without Binge Eating Disorder: Results of Structured Clinical Interviews

  • LaShanda R. Jones-Corneille
  • Thomas A. WaddenEmail author
  • David B. Sarwer
  • Lucy F. Faulconbridge
  • Anthony N. Fabricatore
  • Rebecca M. Stack
  • Faith A. Cottrell
  • Melissa E. Pulcini
  • Victoria L. Webb
  • Noel N. Williams
Clinical Research



Prior studies have reached contradictory conclusions concerning whether binge eating disorder (BED) is associated with greater psychopathology in extremely obese patients who seek bariatric surgery. This study used the Structured Clinical Interview for DSM-IV Diagnoses (SCID) to compare rates of axis I psychopathology in surgery candidates who were determined to have BED or to be currently free of eating disorders. The relationship of BED to other psychosocial functioning and weight loss goals also was examined.


One hundred ninety five bariatric surgery patients completed the Weight and Lifestyle Inventory and the Beck Depression Inventory-II (BDI-II) and were later administered the Eating Disorder Examination. Of these 195, 44 who were diagnosed with BED, and 61 who were currently free of eating pathology, completed a telephone-administered SCID.


Significantly more BED than non-BED participants had a current mood disorder (27.3% vs. 4.9%, p = 0.002) as well as a lifetime history of this condition (52.3% vs. 23.0%, p = 0.003). More BED than non-BED participants also had a current anxiety disorder (27.3% vs. 8.2%, p = 0.014) and lifetime anxiety disorder (36.4% vs. 16.4%, p = 0.019). BED also was associated with greater symptoms of depression, as measured by the BDI-II, as well as with lower self-esteem. BED and non-BED groups, however, did not differ in their desired weight loss goals following surgery.


The present findings indicate that the presence of BED, in patients who seek bariatric surgery, is associated with an increased prevalence of axis I psychopathology, beyond the already elevated rate observed with severe (i.e., class III) obesity.


Obesity Binge eating disorder Axis I disorders Psychopathology 



Dr. David Sarwer serves as a consultant for Allergan, Baronova, Enteromedics, and Ethicon Endo-Surgery. He also sits on the Board of Directors for the Surgical Review Corporation. Dr. Anthony Fabricatore serves as a consultant to Allergan. The other authors have no conflicts of interest to declare.


  1. 1.
    Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Mauri M, Rucci P, Calderone A, et al. Axis I and II disorders and quality of life in bariatric surgery candidates. J Clin Psychiatry. 2008;69:295–301.PubMedCrossRefGoogle Scholar
  3. 3.
    de Zwaan M, Mitchell JE, Howell LM, et al. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry. 2003;44:428–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Wadden TA, Sarwer DB, Fabricatore AN, et al. Psychosocial and behavioral status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am. 2007;9:451–69.CrossRefGoogle Scholar
  5. 5.
    Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639–48.PubMedCrossRefGoogle Scholar
  6. 6.
    Zimmerman M, Francione-Witt C, Chelminski I, et al. Presurgical psychiatric evaluations of candidates for bariatric surgery, part 1: reliability and reasons for and frequency of exclusion. J Clin Psychiatry. 2007;68:1557–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosenberger PH, Henderson KE, Grilo CM. Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: a cross-sectional study using structured interview-based diagnosis. J Clin Psychiatry. 2006;67:1080–5.PubMedCrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Association; 2000.Google Scholar
  9. 9.
    Allison KC, Wadden TA, Sarwer DB, et al. Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features. Obesity. 2006;14 Suppl 2:77S–82S.PubMedCrossRefGoogle Scholar
  10. 10.
    Javaras KN, Pope HG, Lalonde JK. Co-occurrence of binge eating disorder with psychiatric and medical disorders. J Clin Psychiatry. 2008;69:266–73.PubMedCrossRefGoogle Scholar
  11. 11.
    Grucza RA, Przybeck TR, Cloninger CR. Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry. 2007;48:124–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Yanovski SZ, Nelson JE, Dubbert BK, et al. Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry. 1993;150:1472–9.PubMedGoogle Scholar
  13. 13.
    Specker S, de Zwaan M, Raymond N, et al. Psychopathology in subgroups of obese women with and without binge eating disorder. Compr Psychiatry. 1994;35:185–90.PubMedCrossRefGoogle Scholar
  14. 14.
    Telch CF, Stice E. Psychiatric comorbidity in women with binge eating disorder: prevalence rates from a non-treatment-seeking sample. J Consult Clin Psychol. 1998;66:768–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Hsu LK, Mulliken B, McDonagh B, et al. Binge eating disorder in extreme obesity. Int J Obes Relat Metab Disord. 2002;26:1398–403.PubMedCrossRefGoogle Scholar
  16. 16.
    Riener R, Schindler K, Ludvik B. Psychosocial variables, eating behavior, depression, and binge eating in morbidly obese subjects. Eat Behav. 2006;7:309–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Sansone RA, Schumacher D, Wiederman MW, et al. The prevalence of binge eating disorder and borderline personality symptomatology among gastric surgery patients. Eat Behav. 2008;9:197–202.PubMedCrossRefGoogle Scholar
  18. 18.
    Saunders R. Binge eating in gastric bypass patients before surgery. Obes Surg. 1999;9:72–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Stout AL, Applegate KL, Friedman KE, et al. Psychological correlates of obese patients seeking surgical or residential behavioral weight loss treatment. Surg Obes Relat Dis. 2007;3:369–75.PubMedCrossRefGoogle Scholar
  20. 20.
    de Man Lapidoth J, Ghaderi A, Norring C. A comparison of eating disorders among patients receiving surgical vs non-surgical weight loss treatment. Obes Surg. 2008;18:715–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Spitzer RL, Devlin M, Walsh TB, et al. Binge eating disorder: a multisite field trial of the diagnostic criteria. Int J Eat Disord. 1992;11:191–203.CrossRefGoogle Scholar
  22. 22.
    Gladis MM, Wadden TA, Foster GD, et al. A comparison of two approaches to the assessment of binge eating in obesity. Int J Eat Disord. 1998;23:17–26.PubMedCrossRefGoogle Scholar
  23. 23.
    Beck AT, Steer RA, Brown GK. Beck depression inventory II (BDI-II) manual. San Antonio: Harcourt Brace; 1993.Google Scholar
  24. 24.
    Kendall PC, Hollon SD, Beck AT, et al. Issues and recommendations regarding use of the Beck Depression Inventory. Cogn Ther Res. 1987;11:288–99.Google Scholar
  25. 25.
    Fairburn CG, Cooper Z. The eating disorder examination. In: Fairburn CG, Wilson GT, editors. Binge eating: nature, assessment, and treatment. 12th ed. New York: Guilford; 1993. p. 317–60.Google Scholar
  26. 26.
    First MB, Spitzer RL, Gibbon M, et al. Structured clinical interview for DSM-IV axis I disorders (SCID). New York: Biometrics Research, New York State Psychiatric Institute; 1995.Google Scholar
  27. 27.
    Gustafson TB, Gibbons LM, Sarwer DB, et al. History of sexual abuse among bariatric surgery candidates. Surg Obes Relat Dis. 2006;2:369–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Grilo CM, Masheb RM. Correlates of body image dissatisfaction in treatment-seeking men and women with binge eating disorder. Int J Eat Disord. 2005;38:162–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Wadden TA, Womble LG, Sarwer DB, et al. Great expectations: “I’m losing 25% of my weight no matter what you say”. J Consult Clin Psychol. 2003;71:1084–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Wadden TA, Foster GD. Weight and lifestyle inventory. Obesity. 2006;14 Suppl 2:99S–118S.PubMedCrossRefGoogle Scholar
  31. 31.
    Cooper Z, Cooper P, Fairburn CG. The validity of the eating disorder examination and its subscales. Br J Psychiatry. 1989;154:807–12.PubMedCrossRefGoogle Scholar
  32. 32.
    American Psychiatric Association. DSM-5 proposed diagnostic criteria for binge eating disorder. Accessed 22 April 2010.
  33. 33.
    Wilson GT, Sysko R. Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: diagnostic considerations. Int J Eat Disord. 2009;42:603–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatr Res. 1993;27:247–52.PubMedCrossRefGoogle Scholar
  35. 35.
    Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother. 2010 Mar 21. Epub ahead of print.Google Scholar
  36. 36.
    Wadden TA, Butryn ML, Sarwer DB, et al. Comparison of psychosocial status in treatment-seeking women with class III vs. class I–II obesity. Obesity. 2006;14 Suppl 2:90S–8S.PubMedCrossRefGoogle Scholar
  37. 37.
    Crerand CE, Wadden TA, Sarwer DB, et al. A comparison of weight histories in women with class III versus class I–II obesity. Obesity. 2006;14 Suppl 2:63S–9S.PubMedCrossRefGoogle Scholar
  38. 38.
    SPSS Inc. SPSS for Windows, release 11.5. Chicago: SPSS Inc; 2002.Google Scholar
  39. 39.
    Onyike CU, Crum RM, Lee HB, et al. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158:1139–47.PubMedCrossRefGoogle Scholar
  40. 40.
    Alger-Mayer S, Rosati C, Polimeni JM, et al. Preoperative binge eating status and gastric bypass surgery: a long-term outcome study. Obes Surg. 2009;19:139–45.PubMedCrossRefGoogle Scholar
  41. 41.
    de Zwaan M, Hilbert A, Swan-Kremeier L. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2010;6:79–85.PubMedCrossRefGoogle Scholar
  42. 42.
    Fabricatore AN, Crerand CE, Wadden TA, et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16:567–73.PubMedCrossRefGoogle Scholar
  43. 43.
    Ashton K, Drerup M, Windover A, et al. Brief, four-session group CBT reduces binge eating behaviors among bariatric surgery candidates. Surg Obes Relat Dis. 2009;5:257–62.PubMedCrossRefGoogle Scholar
  44. 44.
    Stunkard AJ, Allison KC. Binge eating disorder: disorder or marker? Int J Eat Disord. 2003;34(Suppl):S107–16.PubMedCrossRefGoogle Scholar
  45. 45.
    Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17 Suppl 1:S1–S70.PubMedGoogle Scholar
  46. 46.
    Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Obesity. 2006;14 Suppl 2:53S–62S.PubMedCrossRefGoogle Scholar
  47. 47.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  48. 48.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  49. 49.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.PubMedGoogle Scholar
  50. 50.
    Fabricatore AN, Sarwer DB, Wadden TA, et al. Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery. Obes Surg. 2007;17:1213–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • LaShanda R. Jones-Corneille
    • 1
    • 2
  • Thomas A. Wadden
    • 1
    • 4
    Email author
  • David B. Sarwer
    • 1
    • 3
  • Lucy F. Faulconbridge
    • 1
  • Anthony N. Fabricatore
    • 1
  • Rebecca M. Stack
    • 1
  • Faith A. Cottrell
    • 1
  • Melissa E. Pulcini
    • 1
  • Victoria L. Webb
    • 1
  • Noel N. Williams
    • 3
  1. 1.Department of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of SurgeryUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.University of PennsylvaniaPhiladelphiaUSA

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