Psychogenic Stuttering Following a Gastric Bypass Operation: Case Report

We evaluated a 44-year-old female with bipolar affective disorder who presented with a 4-month history of severe stuttering and vague neurologic complaints. She had lost 200 pounds after gastric bypass surgery two years before. A childhood sexualabuse victim, she admits that she “hid” in her weight for most of her life. Neurological evaluation of this patient was negative, and speech-pathology evaluation revealed highly atypical stuttering. Gastric bypass patients with a history of psychiatric disorders and childhood sexual abuse may be particularly vulnerable to somatoform disorders. It has been widely reported that psychological complications are prevalent among the morbidly obese, although this point has been controversial (1). Glinski et al. elucidated that 70% of patients evaluated for gastric bypass surgery meet criteria for an Axis I disorder in the past or present and 36% for Axis II disorder (2). In his study, he found that the lifetime prevalence of depressive disorders alone in this population was 56%, compared with the known lifetime prevalence of depressive disorders of about 17% in the general population. Glinski noted that gastric bypass surgical candidates tend to use denial as a defense mechanism for avoiding negative emotions. In keeping with this, overeating may serve as distraction from negative emotion in these individuals. Somatization is another tendency in this particular population. Some improvement of psychosocial functioning after surgical treatment of obesity has been reported (3). Van Gemert et al. recently investigated the longterm effects of surgically induced weight loss on the psychological functioning of morbidly obese patients. They found that preoperative subjects had elevated values on negativism, somatization, and shyness scales on personality profiles; postoperatively, all these values normalized except somatization. Thus, postoperative patients still were concerned about their health and still were inclined to react to psychological stress with physical complaints.