Sabotage, feeding and collusion after bariatric surgery. And the winner is . . .? A psychodynamic and systemic perspective on sabotage and feeding after bariatric surgery by means of a case series analysis.

Abstract

In the context of bariatric surgery, negative social support has recently been conceptualized in terms of sabotage, feeding behaviour and collusion undermining a person's effort to lose or maintain weight. While sabotage and feeding behaviour are thought to be motivated consciously, collusion is understood as a bond, by which protagonists are tied together sharing an unresolved and unconscious psychological issue such as dependency, domination and submission, and so on. Drawing upon a systemic and psychodynamic understanding, we analysed interviews with patients (n = 10) who had undergone bariatric surgery and their partners (n = 10) focusing on support. We selected interviews (n = 4 + 4), illustrative of sabotage, feeding, collusion and co-evolution based on the comprehensiveness of information, their emblematic quality and suitability to delineate these phenomena. Our analysis confirms that negative social support can be considered as an attempt to reestablish a level of homeostasis within the couple. However, rather than being intentional, we consider that sabotage and feeding behaviour are better conceptualised as consequences of collusive relationships.