Body Mass Index and morbid obesity

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Pre-surgical and post-surgical interventions

Detailed descriptions of the various interventions prior to and post surgery is not the main focus of this study and will therefore be briefly discussed in the following section. Bariatric patients usually progress through three phases and interventions should be customised according to the individual’s needs (Mitchell, Swan-Kremeier, & Myers, 2007). The first phase is considered the period before the operation, the second phase is the period from the surgery up to six months post-operatively and the third intervention phase is 18 to 24 months post bariatric surgery.

Conclusive links between childhood maltreatment, Complex Trauma, obesity and bariatric surgery as a forced behavioural intervention

A comprehensive systematic literature search by Van Hout, Van Oudheusden, & Van Heck, (2004) indicated that morbidly obese patients, and specifically those seeking surgical treatment, are described as depressed, anxious, having poor impulse control, low self-esteem and impaired quality of life. The typical symptoms and behavioural aspects of obese patients, based on their research, indicate a similar constellation of some of the symptoms as described by Herman (1992a) as Complex PTSD and Luxenberg, Spinazzola & Van der Kolk (2001) as DESNOS, commonly found among patients who present with a complicated form of trauma (Complex Trauma).

Introduction to a qualitative research paradigm

Strauss & Corbins’ (1990, p.17) broad definition of qualitative research implies: “any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification”. Opposed to quantitative researchers who seek causal determination, prediction, and generalisation of findings, qualitative researchers seek illumination, understanding, and extrapolation to similar situations, therefore qualitative analysis results in a different type of knowledge than quantitative research. Qualitative methods can be used to understand any phenomena about which little is known in a much better way; these methods are also used to gain new perspectives about things which are known already; or to gain, in contrast to quantitative research, more in-depth information.

The development of a social contructionist theory

The term social constructivism was developed during the late 1960’s. The origin of social constructivism however dates back to the 1920’s and the Swiss linguist, Ferdinand De Saussure. He investigated the nature and characteristics of language and consequently the influence of language on our world of experience. De Saussure developed hypotheses which are based on die assumption that our experiences in the social world is dependent on the 83 language that we use to describe these experiences. He also made the assumption that our observations are not reflecting an external reality, but are only a representation of a reality which is created in language (O’ Leary, 2001).

The Self in context

The technology of the 20th and 21st centuries, amongst others telephones, cell phones, vehicles, radios, air transport, computers, the internet and faxes, were the methods by which distance and space can be bridged easier and where communication occurs with less effort and time. However, this contributes to the fact that the social and cultural world expands and becomes more complex on a daily basis. Television and radio expose us to other cultures that were previously relative inaccessible and unknown. Competitive perception makes us aware that the world exists from more than just our own restricted knowledge (Gemin, 1999). Part of this social experience is to create a living space between the traditional and revolutionary, in order to connect fixed beliefs with freedom of thoughts.

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Is everything necessarily acceptable?

One of the most common misconceptions regarding social constructionistic thinking and constructed social realism is that it creates a framework wherein everything is interpreted as acceptable. This interpretation ignores one of the core assumptions of social constructivism, namely that we are not living in isolation, but are part of the social-cultural environment with specific prescriptions regarding acceptable behaviour. Our shared language distinctions form an integral part of our social realities. The way in which an event is constructed in the social domain/society, becomes inseparably a part of the way in which we experience it. Joint and shared definitions in a society influence accordingly the way in which an event is interpreted. Behaviour requirements and restrictions are built into the society’s social reality (Efran, Lukens & Lukens, 1988).

CONTENTS :

  • CHAPTER I INTRODUCTION
    • General Introduction and orientation
    • Explaining the title
    • Descriptions of key concepts
    • Body Mass Index and morbid obesity
    • Bariatric surgery
    • Motivation for the study
    • Aim and rationale of the study
    • Relevance
    • The bariatric patient
    • The field of psychology
    • Research design
    • Focus of study
    • Epistemological framework
    • Ethical considerations
    • Emergent design
    • Format of the study
    • Abbreviations
    • Conclusion
  • CHAPTER 2 LITERATURE REVIEW
    • Underlying mechanisms (factors) promoting and ameliorating the development of obesity
    • Psychobiological influences and genetic risk factors
    • Environmental and developmental risk factors
    • Contextualising childhood maltreatment
    • Prevalence and impact of childhood maltreatment
    • Complex Trauma symptom constellation as a psychological representation of childhood maltreatment
    • Characteristics of Complex Trauma
    • Affect dysregulation
    • Disturbances in attention or consciousness
    • Disturbances in self-perception
    • Disturbances in relationships
    • Somatisation
    • Disturbances in meaning systems
    • Complex Trauma and differential diagnosis
    • Factors associated with childhood maltreatment and obesity
    • Obesity as an adaptive function to early exposure to trauma
    • Role of bariatric surgery as a remedial intervention
    • Psychiatric/Psychological issues in bariatric candidates/patients
    • Psychiatric co-morbidity
    • Eating-specific psychopathology
    • Psychosocial issues
    • Patients’ expectations and perceptions
    • Psychological assessment of bariatric candidates
  • CHAPTER 4 ANN’S “VOICE”
    • Biographical information
    • Nature of interaction
    • Emerging Themes
    • Life script: a family driven socialisation
    • An inescapable double bind by the caregiver/s
    • A Complex Trauma symptom constellation following childhood trauma
    • Psychological defence mechanisms: a coping strategy
    • Process of bariatric surgery: a positive and/or negative life stressor
    • Perceptions of bariatric surgery and psychological processes
    • Conclusion
  • CHAPTER 6 SUE’S « VOICE »
  • CHAPTER 7 JAMES’S « VOICE »
  • CHAPTER 8 MANNY’S « VOICE »
  • CHAPTER 9 RECONSTRUCTION OF BARIATRIC PATIENTS’ « VOICES”: A COMPARATIVE ANALYSIS ACCORDING TO THE LITERATURE

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THE IMPACT OF EARLY TRAUMATIC EXPERIENCES ON BARIATRIC PATIENTS: A QUALITATIVE EXPLORATION OF THEIR “VOICES”

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