Emotional Abuse 1

The Toll of Emotional Abuse & How it Impacts Your WLS Success

July 20, 2020

The effects of emotional abuse can affect your success after Bariatric or Weight Loss Surgery (WLS). In this article, we will discuss the definition of emotional abuse, the prevalence of emotional abuse, the association between Obesity and emotional abuse, the consequences of emotional abuse, how emotional abuse can affect your WLS success, and how to mitigate the effects of emotional abuse on your WLS outcome.

What is Emotional Abuse?

There are several types of abuse that one can experience. Emotional abuse is neither physical nor sexual abuse; it is emotional in nature. Emotional abuse can also be “fallout” from other forms of abuse like physical, verbal, or sexual abuse. Often, emotional abuse is highly associated with physical abuse (Gondolf, Heckert, & Kimmel, 2002).

Emotional abuse can be hard to define. It can be described as any ongoing, negative behavior that is used intentionally to control or hurt a person. This means that the abuser uses certain tactics to control and manipulate the victim. Some of these emotionally abusive tactics may include:

  • Controlling how the victim looks - Any attempt to change how the victim looks, what they wear, or how they want to look
  • Giving constant criticism - Providing unwanted or unneeded negative feedback that is intended to hurt or harm the victim
  • Shaming - Saying or acting in a manner that makes the victim feel ashamed
  • Blaming - Instead of being accountable for their own actions, abusers may blame their own actions on their victim’s behavior. They may blame the victim for things out of their control
  • Humiliation - Saying jokes or rude statements that make the victim feel humiliated
  • Being condescending - Any statements or nonverbal behavior that is intended to make the victim question their self-worth.
  • Using infidelity as manipulation - Blaming the victim for the abuser’s infidelity or threatening to be unfaithful to the victim
  • Damaging Property - Destroying personal property or throwing things
  • Name-calling - Calling the victim names that are intended to be hurtful
  • Withholding affection - Refusing to engage in affection as a “punishment” for the victim
  • Refusing to communicate - Refusing to engage in any verbal or nonverbal communication as a “punishment” for the victim
  • Threatening - Any verbal or nonverbal words or gestures used to convey a threat
  • Gaslighting - Manipulating the victim so they question their sanity or their memory of events that transpired
  • Isolating the victim - Making it difficult for the victim to have access to their social support system
  • Withholding - Withholding information, basic resources, or finances from the victim
  • Jealousy - Refusing to trust the victim or acting possessive over the victim
  • Constant monitoring - Demanding to know the victim’s location and what they are doing at any given moment

The Facts of Emotional Abuse

Emotional Abuse in the United States

In 2017, the prevalence of emotional abuse and neglect ranged from 21.0% to 66.0% in an analysis that researched other prevalence estimates of several studies (Kimber et al, 2017). According to Breiding (2014), 48.4% of women and 48.8% of men have experienced at least one psychologically aggressive behavior by an intimate partner.

Emotional Abuse and Obesity

There is increasing evidence that suggests a positive correlation between childhood trauma (including emotional abuse) and the development of obesity, and several studies have come to this conclusion (Danese & Tan, 2014). The experience of childhood maltreatment has been associated with a 1.4 to1.6-fold increase risk of having a BMI over 35 (Felitti et al., 1998).

According to Gunstad et al., (2006), emotional abuse predicted adult obesity even after controlling for other factors like age. Almost 70% of bariatric surgery candidates report a history of childhood maltreatment, including emotional abuse and neglect (Still et al., 2014).

The Consequences of Emotional Abuse

Emotional abuse can have both mental and physical consequences. If not treated, having a history of trauma (like emotional abuse) can increase the chances of developing a substance use disorder, risky sexual behavior, and delinquency (Stills et al., 2014). Another study found that emotional abuse is associated with mood and anxiety disorders (Wildes et al., 2008). According to the National Coalition Against Domestic Violence (NCADV), victims of emotional abuse often experience depression, Posttraumatic Stress Disorder, suicidal ideation, low self-esteem, and difficulty trusting others.

Another study found that 7 out of 10 women who experienced emotional abuse experienced symptoms of Depression and/or Posttraumatic Stress Disorder (Pico-Alfonso et al., 2006). Women who have experienced emotional abuse also tend to rate their health as “poor” (Coker et al, 2000).

How Emotional Abuse Can Impact Your WLS Success

Since emotional abuse can be associated with poorer mental health and physical health outcomes, it can sabotage your WLS success. For example, if an individual is very depressed, they may not have the motivation to follow through with their bariatric meal planning or exercise regimen. Additionally, having poorer physical health may affect your postoperative recovery.

Eating may have been a way for some individuals to cope with the effects of emotional abuse before surgery. When we eat, biochemical changes happen in our brain to provide us comfort. Additionally, certain foods are conditioned to remind us of positive experiences, meaning certain foods may be linked with positive emotions. Therefore, eating can be used as a form of “self-soothing” or a way to regulate or change emotional states.

Mitigating the Effects of Emotional Abuse to Increase WLS Success

Though the effects of emotional abuse can be both chronic and detrimental, there are many avenues one can explore to start the healing process and to ensure WLS success.

There are some things you should consider if you have experienced emotional abuse and would like to ensure your WLS is a success. If you feel your emotional abuse is impacting you negatively and this is sabotaging your WLS success, you should look into speaking to a mental health professional. There are many psychotherapies that have been scientifically proven to treat Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) resulting from emotional abuse. Some specialized treatments for trauma like emotional abuse may include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR). Treating trauma resulting from emotional abuse can be an important step to ensuring your WLS success.

Emotional abuse is difficult to define, and it can happen during childhood or in an intimate partnership. Unfortunately, because it is difficult to define, it is difficult to estimate just how prevalent it is. However, we can all agree that any person experiencing emotional abuse is one too many. Emotional abuse is not only associated with Obesity, but with a host of other physical and mental health issues. It is important to understand that emotional abuse can be the reason behind the difficulty one experiences with success after WLS, and it is important to know that there are ways to combat the detrimental effects of emotional abuse.

If you are or have been a victim of emotional abuse and need help, please contact The National Domestic Violence Hotline at 1-800-799-SAFE (7223) or visit Domestics Shelters.


References:

  1. American Professional Society on the Abuse of Children. (1995). Psychosocial evaluation of suspected psychological maltreatment in children and adolescents: Practice guidelines. The Society.
  2. Breiding, M. J., Chen, J., & Black, M. C. (2014). Intimate partner violence in the United States--2010.
  3. Coker, A., Smith, P., Bethea, L., King, M. & McKeown, R. (2000). Physical health consequences of physical and psychological intimate partner violence. Archives of Family Medicine, 9(5), 451-457.
  4. Danese, A., & Tan, M. (2014). Childhood maltreatment and obesity: systematic review and meta-analysis. Molecular psychiatry19(5), 544-554.
  5. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., & Spitz, A. M. Edwards, & Marks, JS (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventive Medicine14(4), 245-258.
  6. Gondolf, E. W., Heckert, D. A., & Kimmel, C. M. (2002). Nonphysical abuse among batterer program participants. Journal of Family Violence17(4), 293-314.
  7. Gunstad, J., Paul, R. H., Spitznagel, M. B., Cohen, R. A., Williams, L. M., Kohn, M., & Gordon, E. (2006). Exposure to early life trauma is associated with adult obesity. Psychiatry research142(1), 31-37.
  8. Kimber, M., McTavish, J. R., Couturier, J., Boven, A., Gill, S., Dimitropoulos, G., & MacMillan, H. L. (2017). Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review. BMC psychology5(1), 33.
  9. Pico-Alfonso, M. A., Garcia-Linares, M. I., Celda-Navarro, N., Blasco-Ros, C., Echeburúa, E., & Martinez, M. (2006). The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. Journal of women's health15(5), 599-611.
  10. Still, C., Sarwer, D. B., & Blankenship, J. (2014). The ASMBS Textbook of Bariatric Surgery. New York, NY: Springer Science+ Media.
  11. Wildes, J. E., Kalarchian, M. A., Marcus, M. D., Levine, M. D., & Courcoulas, A. P. (2008). Childhood maltreatment and psychiatric morbidity in bariatric surgery candidates. Obesity surgery18(3), 306-313.

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ABOUT THE AUTHOR

Dr. Joanna R. Benavidez is a licensed clinical psychologist. She has her Ph.D. in clinical psychology, and she is a certified clinical trauma professional (CCTP). Dr. Benavidez is a member of the American Psychological Association (APA). Dr. Benavidez is the owner of a private practice in San Diego that focuses on providing presurgical psychological evaluations & works with local hospitals to help individuals prepare for surgery.

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