Intuitive eating buffers the link between internalized weight stigma and body mass index in stressed adults.

Internalized weight stigma (IWS) is independently associated with less intuitive eating (i.e., eating based on endogenous hunger/satiety cues) and higher Body Mass Index (BMI), and intuitive eating training is commonly conceptualized as protective against the effects of IWS on poor behavioral health. The 3-way relationship between IWS, intuitive eating, and BMI has yet to be examined, and it is unclear whether the link between IWS and BMI is buffered by high intuitive eating. This secondary preliminary analysis examined baseline data of stressed adults with poor diet (N = 75, 70% female, 64.1% White, 42.7% with overweight/obesity) in a parent clinical trial that tested the effects of yoga on diet and stress. Validated self-report surveys of IWS and intuitive eating were analyzed with objectively-assessed BMI. Moderated regression analyses using the SPSS PROCESS macro tested whether intuitive eating moderated the IWS-BMI link. The analysis revealed IWS was positively associated with BMI except among people with high intuitive eating. Results extend observational findings linking intuitive eating to lower BMI, and offer preliminary support for the hypothesis that this link may hold even among those with greater IWS. It's possible that individuals with lower BMI and greater IWS may gravitate more towards intuitive eating than those with greater BMI, and/or intuitive eating may be an important target for ameliorating the adverse association of IWS with behavioral and physical health indicators linked to BMI. Continued work is warranted in larger, more generalizable samples using causal and prospective designs.

Exploring the Optimal Factor Structure of the Five Facet Mindfulness Questionnaire: Associations Between Mindfulness Facets and Dimensions of Psychopathology.

Recent studies of the Five Facet Mindfulness Questionnaire (FFMQ) and its condensed version (FFMQ-SF) fail to replicate the initially proposed five-factor structure in clinical samples. Failure to adequately understand the dimensionality of common mindfulness measures within clinical samples, therefore, represents an important gap in the current literature. The increasing popularity of mindfulness-based interventions warrants further investigation of differential associations between facets of mindfulness and different forms of psychopathology. We examined (a) the underlying structure of the FFMQ and FFMQ-SF, and (b) associations between FFMQ and FFMQ-SF facets and dimensions of psychopathology (i.e., internalizing and substance use disorders) in two large clinical samples (N = 2,779). Results from bass-ackwards analyses suggested similarly defensible five- and six-factor model solutions in terms of fit. The five-factor model was optimal when factoring in parsimony. Exploratory structural equation modeling revealed that all FFMQ facets with the exception of observe were negatively associated with the internalizing factor. Associations with substance use disorders were more complex. In both samples, five-factor FFMQ and FFMQ-SF models were determined to best represent these data. Whereas deficits in all FFMQ facets with the exception of observe correspond with lower internalizing psychopathology, a more nuanced association was observed with substance use disorders.

Judgment towards emotions as a mediator of the relationship between emotional eating and depression symptoms in bariatric surgery candidates.

PURPOSE: Emotional eating is common in bariatric surgery candidates, and often is associated with depression and poorer weight loss outcomes following surgery. However, less is known about other modifiable risk factors that may link depression and emotional eating. The aim of the current study was to examine facets of mindfulness as potential mediators of the relationship between emotional eating and depression severity in bariatric surgery candidates. METHODS: Bariatric surgery candidates (n = 743) were referred by their surgeons for a comprehensive psychiatric pre-surgical evaluation that included self-report questionnaires assessing depression severity, emotional overeating, and facets of mindfulness. Mediation effects were examined for each mindfulness facet based on prior research. RESULTS: Only the nonjudging mindfulness facet significantly mediated the relationship between emotional eating and depression, suggesting that greater emotional eating may be associated with greater depression severity through higher levels of judgement towards thoughts and emotions. A reverse mediation analysis showed that depression severity was not a significant mediator of the relationship between nonjudging and emotional eating. CONCLUSION: Fostering a nonjudgmental stance towards thoughts and feelings may be helpful in improving eating habits that would support greater post-surgical success. Other clinical and research implications are discussed. LEVEL OF EVIDENCE: Level V, descriptive study.

Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study.

BACKGROUND: Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. METHODS: Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). RESULTS: Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. CONCLUSIONS: Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.

Is the DSM-5 anxious distress specifier sufficient for measuring anxiety in depressed patients? Implications for measurement-based care.

BACKGROUND: We examined whether a self-report measure of the DSM-5 anxious distress specifier, the Clinically Useful Depression Outcome Scale Anxious Distress Specifier Subscale (CUDOS-A), was as valid as a broader measure of the severity of anxiety, the Clinically Useful Anxiety Outcome Scale (CUXOS), in patients with depression. METHODS: Two hundred ninety-four patients with major depressive disorder were administered a semi-structured interview. The patients completed self-report measures of depression, anxiety, and irritability. Sensitivity to change was examined in a subset of patients. RESULTS: Both the CUDOS-A and CUXOS were more highly correlated with measures of anxiety than with measures of the other symptom domains. Patients with anxiety disorders scored significantly higher on both measures than did patients with no current anxiety disorder. Both measures were equally correlated with measures of coping, general well-being, and functioning. A large effect size of treatment was found for both measures (CUDOS-A: d = 1.2; CUXOS: d = 1.3). CONCLUSIONS: Both the CUDOS-A and CUXOS were valid self-report measures of anxiety symptom severity in patients with depression. Because anxiety is common in patients with depression, the addition of a small number of items assessing the DSM-5 anxious distress criteria should be added to depression measures and used in measurement-based care efforts.

DSM-5 anxious distress specifier in patients with bipolar depression.

BACKGROUND: DSM-5 introduced the anxious distress specifier in recognition of the significance of anxiety in patients who are depressed. Studies have supported the validity of the specifier in patients with major depressive disorder (MDD). In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier in patients with bipolar depression. METHODS: Forty-nine patients with a principal diagnosis of bipolar depression and 369 with MDD were evaluated with semi-structured diagnostic interviews, including the DSM-5 Anxious Distress Specifier Interview (DADSI). The patients were rated on measures of depression, anxiety, and irritability, and completed self-report measures. RESULTS: The majority of patients with bipolar depression met the DSM-5 anxious distress specifier, no different than the frequency in patients with MDD. The DADSI was significantly correlated with other measures of anxiety, and more highly correlated with other measures of anxiety than with measures of depression and irritability. Patients with panic and generalized anxiety disorder scored higher on the DADSI than patients without an anxiety disorder. CONCLUSIONS: The results of our study indicate that anxious distress is common in patients with bipolar depression and support the validity of the DSM-5 anxious distress specifier.

Emotion regulation accounts for associations between mindfulness and depression across and within diagnostic categories.

BACKGROUND: Previous research shows that mindfulness and emotion regulation (ER) are highly related to each other. Preliminary evidence in small clinical populations show that ER may partially account for the relationship between mindfulness and depressive symptoms. The present study aimed to investigate which diagnostic categories were associated with depressive symptoms after controlling for ER in a heterogeneous sample of treatment-seeking patients. METHODS: A large sample of psychiatric outpatients (N = 911) completed the Structured Clinical Interview for DSM-IV (SCID), Five Facet Mindfulness Questionnaire (FFMQ), Difficulties in Emotion Regulation Scale (DERS), and Clinically Useful Depression Outcome Scale (CUDOS). Partial correlations were conducted to evaluate to what degree the relationship between depression scores and facets of mindfulness were accounted for by ER scores. RESULTS: When controlling for baseline mindfulness, the relationship between emotion dysregulation and depression symptoms remained significant for all data points; however, when controlling for baseline emotion dysregulation, the association between mindfulness and depression was not significant in the majority of cases. Nonjudging was most resistant to this result. CONCLUSIONS: Although mindfulness is negatively associated with depressive symptoms, this association may be better accounted for by emotion dysregulation.

Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?

OBJECTIVE: Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability). METHODS: Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI). RESULTS: Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant. DISCUSSION: After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.

Principal Diagnoses in Psychiatric Outpatients With Posttraumatic Stress Disorder: Implications for Screening Recommendations.

In this study, we examined the prevalence of posttraumatic stress disorder (PTSD) in 3800 psychiatric outpatients with different principal diagnoses. For all disorders identified as a principal diagnosis, we compared patients' odds ratios of PTSD to all other patients in the sample. Approximately one-sixth of the sample (n = 663, 17.4%) was diagnosed with PTSD, including 417 patients with current PTSD and 246 with PTSD in partial remission. Patients with principal bipolar disorder and major depressive disorder (MDD) demonstrated higher rates of PTSD compared with those without principal bipolar and MDD. For most psychiatric outpatients with PTSD, the principal diagnosis for which they seek treatment is not PTSD, but rather a mood disorder. This highlights the importance of screening for PTSD, particularly in patients with a principal diagnosis for which the prevalence of PTSD is relatively high, namely, MDD, bipolar disorder, panic disorder, and borderline personality disorder.

Have Treatment Studies of Depression Become Even Less Generalizable? Applying the Inclusion and Exclusion Criteria in Placebo-Controlled Antidepressant Efficacy Trials Published over 20 Years to a Clinical Sample.

BACKGROUND: Antidepressants are amongst the most frequently prescribed medications. More than a decade ago, our clinical research group applied a prototypic set of inclusion/exclusion criteria used in an antidepressant efficacy trial (AET) to patients presenting for treatment in our outpatient practice and found that most patients would not qualify for the trial. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we apply the psychiatric inclusion/exclusion criteria used in 158 placebo-controlled studies to a large sample of depressed patients who presented for outpatient treatment to determine the range and extent of the representativeness of samples treated in AETs and whether this has changed over time. METHOD: We applied the inclusion and exclusion criteria used in 158 AETs to 1,271 patients presenting to an outpatient practice who received a principal diagnosis of major depressive disorder. The patients underwent a thorough diagnostic evaluation. RESULTS: Across all 158 studies, the percentage of patients that would have been excluded ranged from 44.4 to 99.8% (mean = 86.1%). The percentage of patients that would have been excluded was significantly higher in the studies published in 2010 through 2014 compared to the studies published from 1995 to 2009 (91.4 vs. 83.8%, t(156) = 3.74, p < 0.001). CONCLUSIONS: Only a minority of depressed patients seen in clinical practice are likely to be eligible for most AETs. The generalizability of AETs has decreased over time. It is unclear how generalizable the results of AETs are to patients treated in real-world clinical practice.

Validity of the DSM-5 anxious distress specifier for major depressive disorder.

BACKGROUND: DSM-5 introduced the anxious distress specifier in recognition of the clinical significance of anxiety in depressed patients. Recent studies that supported the validity of the specifier did not use measures that were designed to assess the criteria of the specifier but instead approximated the DSM-5 criteria from scales that were part of an existing data base. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier diagnosed with a semistructured interview. METHODS: Two hundred sixty patients with a principal diagnosis of major depressive disorder were evaluated with semistructured diagnostic interviews. The patients were rated on clinician rating scales of depression, anxiety and irritability, and completed self-report measures. RESULTS: Approximately three-quarters of the depressed patients met the criteria for the anxious distress specifier. Patients with anxious distress had a higher frequency of anxiety disorders, particularly panic disorder and generalized anxiety disorder, as well as higher scores on measures of anxiety, depression, and anger. The patients meeting the anxious distress subtype reported higher rates of drug use disorders, poorer functioning during the week before the evaluation, and poorer coping ability compared to the patients who did not meet the anxious distress specifier. Moreover, anxious distress was associated with poorer functioning and coping after controlling for the presence of an anxiety disorder. CONCLUSIONS: The results of the present study indicate that anxious distress is common in depressed patients and support the validity of the DSM-5 anxious distress specifier.

Should childhood conduct disorder be necessary to diagnose antisocial personality disorder in adults?

BACKGROUND: Antisocial personality disorder (ASPD) is the only DSM personality disorder that requires a diagnosis of conduct disorder (CD) during childhood. Previous research comparing adults diagnosed with ASPD with adults who meet all ASPD criteria except for a history of CD (referred to in this study as adult antisocial syndrome [AAS]) have reported mixed results. This study sought to clarify the differences among adults with ASPD, adults with AAS, and a large psychiatric outpatient control group. METHODS: A series of semi-structured interviews were conducted with 2,691 psychiatric outpatients. We compared groups on demographic variables, psychiatric comorbidity, symptom presentation, parental history, and psychosocial morbidity. RESULTS: Significant differences were found among ASPD, AAS, and controls in regard to demographic variables, comorbidity, symptom presentation, and parental history. The ASPD and AAS groups were similarly impaired with respect to global functioning, occupational and social functioning, and suicidality. CONCLUSIONS: Findings suggest that by including a history of CD in ASPD criteria, our diagnostic system excludes an important group of later-onset patients who also require attention and resources. Implications, limitations, and future directions are discussed.

Differentiating borderline personality from bipolar disorder with the Mood Disorder Questionnaire (MDQ): A replication and extension of the International Mood Network (IMN) Nosology Project.

INTRODUCTION: Vöhringer et al. identified a triad of items on the Mood Disorder Questionnaire (MDQ) that best discriminated between borderline personality disorder (BPD) and bipolar disorder (BD) in a tertiary mood clinic setting [23]. The present study aimed to replicate and extend these findings by examining the performance of the triad across a range of cut-off scores and comparing the operating characteristics of the triad to the full MDQ. METHODS: Patients presenting for treatment were assessed with the Structured Clinical Interview for DSM-IV (SCID) and the BPD module of the Structured Interview for DSM-IV Personality (SIDP-IV). The present report is based on 476 depressed patients who had a principal diagnosis of major depressive disorder or BD and who completed the MDQ. RESULTS: Fifty-seven patients were diagnosed with BD and fifty-four patients were diagnosed with BPD. Both the triad and full MDQ significantly predicted BD diagnosis (p < .001), but the triad had optimal operating characteristics, particularly at a cut-off of two. CONCLUSION: Within a sample of depressed patients, the MDQ triad is a better screener for BD than the full MDQ, particularly if a positive triad screen is indicated by the presence of any two items. The triad is particularly good for differentiating between BD and BPD, whereas the full MDQ does a poorer job of differential diagnosis. Future studies should administer the triad as a stand-alone scale.

Depression and substance use disorders in the offspring of depressed parents as a function of the parent's borderline personality disorder symptomatology.

BACKGROUND: Parental major depressive disorder (MDD) and borderline personality disorder (BPD) are associated with increased risk of offspring psychopathology. It is unclear whether BPD in depressed parents infers greater risk than depression alone. We hypothesized that BPD features in depressed parents would be associated with higher morbid risk of offspring MDD and substance use disorders (SUDs). METHODS: Participants included 912 psychiatric outpatients with a principal diagnosis of MDD. Semi-structured interviews determined diagnoses of parents and their 2,011 reported offspring. We compared the offspring's morbid risk of MDD and SUDs based on whether their parents had BPD, ≥1 BPD criteria, and by each criterion. RESULTS: Offspring of parents with ≥1 BPD criteria had higher morbid risk of MDD and SUDs. Differences were insignificant when comparing by BPD diagnosis. Anger and impulsivity were associated with increased risk of MDD, and emptiness was associated with increased risk of SUDs. CONCLUSIONS: Results suggest that BPD features confer additional risk to offspring beyond that of parental depression alone. Parental anger and impulsivity may be particularly important in determining risk of MDD, and parental feelings of emptiness may be particularly important for risk of SUDs. Limitations, future directions, and treatment implications are discussed.

Understanding the severity of depression: Which symptoms of depression are the best indicators of depression severity?

BACKGROUND: In DSM-5, all symptoms of depression are considered equal representations of severity. In ICD-10, the type of symptom is considered in classifying severity. It is important to better understand if the defining symptoms of depression are differentially associated with overall severity so that severity categorization in diagnostic systems is most valid. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the association between the individual diagnostic criteria for major depressive disorder (MDD) and global ratings of depression severity. We thus examined whether there is support for the ICD-10 approach in which some symptoms are better indicators of severity than are other symptoms. METHODS: Patients were evaluated with a semi-structured interview and the presence of each symptom of MDD was recorded. Patients were also rated on the Clinical Global Index of severity (CGI-S). RESULTS: All 9 DSM-5 criteria were significantly correlated with the CGI with suicidality having the highest correlation. A regression analysis found that all 9 criteria were significant predictors of the CGI. At the symptom level, 15 of the 17 symptoms were significantly correlated with the CGI (all except increased appetite and increased weight). DISCUSSION: There were differences between the symptoms of depression in their association with severity with suicidal ideation, depressed mood, and anhedonia having the highest correlations with severity whereas some symptoms were not significantly associated with severity distinctions. Future descriptions of the severity of depression should not consider all criteria as equal representations of severity.

Clinically useful screen for borderline personality disorder in psychiatric out-patients.

A total of 3674 psychiatric out-patients were evaluated with a semi-structured diagnostic interview for DSM-IV borderline personality disorder (BPD). The affective instability criterion had a sensitivity of 92.8%, higher than the sensitivities of the other eight BPD criteria. The negative predictive value of the affective instability criterion was 99%. We recommend that clinicians screen for BPD in the same way that they screen for other psychiatric disorders: by enquiring about a single feature of the disorder (i.e. affective instability), the presence of which identifies most patients with the disorder and the absence of which rules out the disorder.

A clinically useful screen for attention-deficit/hyperactivity disorder in adult psychiatric outpatients.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a serious illness that is frequently underdiagnosed in adults. The goal of this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project was to determine if it was possible to identify 1 or 2 ADHD criteria that could serve as "gate" criteria to screen for the disorder. METHODS: Psychiatric outpatients (N = 1,134) were evaluated using a semi-structured diagnostic interview for DSM-IV criteria of ADHD. We computed the sensitivity, specificity, and positive and negative predictive values of each of the 18 ADHD criteria to identify 1 or 2 criteria that could be used to screen for the disorder. We conducted a validation and cross-validation analysis by splitting the sample in half. RESULTS: In both the validation and cross-validation samples, a 2-item screen of difficulty sustaining attention and fidgetiness had a sensitivity of >90%. The negative predictive value of the 2-item screen was >95%. CONCLUSIONS: Clinicians can screen for ADHD in adults by inquiring about 2 features of the disorder (ie, difficulty sustaining attention and fidgetiness), the presence of which captures most patients with the disorder and the absence of which rules out the disorder.

Principal diagnoses in psychiatric outpatients with borderline personality disorder: Implications for screening recommendations.

BACKGROUND: In the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how often borderline personality disorder (BPD) is the principal diagnosis in patients presenting for outpatient psychiatric treatment. To inform clinicians when it is most productive to screen for BPD, we examined the prevalence of BPD in psychiatric outpatients with different principal diagnoses. METHODS: In this study, 3,674 psychiatric outpatients were evaluated with a semi-structured diagnostic interview for DSM-IV BPD. RESULTS: Slightly ≥10% of the sample was diagnosed with BPD (n = 390, 10.6%). For 80 (20.5%) patients with BPD, the chief concern was related to a feature of BPD; therefore, BPD was designated as a comorbid diagnosis. The highest rate of BPD as a principal diagnosis was found among patients with bipolar disorder. The rate of BPD in patients with principal diagnoses of adjustment disorder, dysthymic disorder, and generalized anxiety disorder was significantly lower than in patients without these principal diagnoses. CONCLUSIONS: For the majority of psychiatric outpatients with BPD, the principal diagnosis for which they seek treatment is not BPD but, rather, a mood or anxiety disorder. This highlights the importance of screening for BPD.

Subjective anger and overt aggression in psychiatric outpatients.

BACKGROUND: The attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression. METHOD: 3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N=3800) and Axis II (N=2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression. RESULTS: Almost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders. CONCLUSIONS: Anger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.

The Importance of Assessing for Childhood Abuse and Lifetime PTSD in Bariatric Surgery Candidates.

For bariatric surgery candidates, history of child abuse and PTSD may be under-recognized or under-reported at pre-surgical evaluation. On a range of clinically relevant factors, we studied 3045 candidates for bariatric surgery: (1) those with a history of childhood abuse compared to those without such history; and (2) among candidates with a history of abuse, those with a lifetime diagnosis of PTSD compared to those without that diagnosis. We compared them on current and lifetime eating disorders, physical health problems, health behaviors, physical functioning, psychosocial functioning, psychiatric disorders, emotional wellness, body satisfaction, and self-esteem. We hypothesized that patients with a history of childhood abuse, and within that group, those with a lifetime PTSD diagnosis, would display greater overall impairment. Patients were interviewed with semi-structured interviews and completed self-report questionnaires. Results showed that (1) patients with a history of childhood abuse exhibited significantly greater impairment than those without abuse; and (2) among candidates with a history of abuse, those with a lifetime history of PTSD displayed significantly greater impairment than those without a PTSD diagnosis. The findings suggest that a history of both childhood abuse and lifetime PTSD should be thoroughly assessed for at pre-surgical evaluation, and that greater attention be paid to the experience of PTSD symptoms in abuse survivors presenting for bariatric surgery.