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Background: Bariatric surgery leads to a substantial weight loss (WL), however, a subset of patients undergoing surgery fails to achieve adequate WL. The reason for the individual variation in WL remains unexplained. Using an exploratory cross-disciplinary approach, we aimed to identify preoperative and early postoperative factors explaining the variation in WL after bariatric surgery. Methods: Sixty-one subjects were recruited. Eighteen subjects did not receive surgery and three subjects dropped out, leaving a total sample of 40 subjects. Physiological, social, and psychological data were collected before and 6 months after surgery. All variables were analyzed in combination using a least absolute shrinkage and selection operator (LASSO) regression to explain the variation in WL 18 months after Roux-en-Y gastric bypass (n= 30) and sleeve gastrectomy (n= 10). Results: Mean WL was 31% (range: 10–52%). The following preoperative factors predicted 59% of the variation in WL: type of surgery (14%), diabetes status (12%), economic resources (9%), sex (7%), binge eating disorder (7%), degree of depression (5%), household type (3%), and physical activity (1%). Including information on early responses after surgery increased the ability to predict WL to 78% and was explained by early WL (47%), changes in energy density of food consumed from a buffet meal (9%), changes in glicentin (5%), degree of depression (5%), sex (5%), type of surgery (2%), economic resources (2%), and changes in drive for thinness (1%). Conclusions: Using a cross-disciplinary approach, a substantial part of the individual variation in WL was explained by a combination of basic patient characteristics, psychological profile, and social conditions as well as physiological, psychological and behavioral responses to surgery. These results suggest that patient characteristics collected in a cross-disciplinary approach may help determine predictors for less successful WL after bariatric surgery. If verified in larger cohorts this may form the basis for individualized postoperative support to optimize WL outcome.

AbstractA review of the history of the University Clinic at the Department of Psychology, University of Copenhagen, Denmark, is presented. The history of the Clinic can be viewed as a case illustrating more general trends at university clinics in Western societies. The history is viewed in relation to key points in the development of psychological science in general, with a special focus on clinical psychology and the emergence of social needs for clinical psychological practice in the wake of World War II. The so-called “scientist–practitioner” model is introduced, and it is argued that the higher priority given to research today is double-edged, entailing on the one hand the possibility of contributing to the development of research-based clinical theories and practices on a high level and on the other hand the risks of undermining university clinics tradition for clinical psychological practice and education.

ABSTRACTThe word ‘hägring’ (in English. ‘mirage’) can be understood in different ways: as an unrealistic hope or wish that cannot be achieved (wishful thinking); as an image in a mirror of something that is not there, but in another place, and as a sign of something that has not yet become visible, for instance, the first rays of sunlight on the horizon before the sun has risen. These meanings represent different ways in which presence and absence interplay, and are all illustrated in Kjell Westö’s impressive novel from 2013 for which he received the Nordic Literature Prize in 2014.The action of the novel takes place during eight months in Helsinki from March to November 1938 and unravels how the past and present are woven together on a historical, societal and individual level. The present article will try to illustrate this.

An increase in self-harm emergencies after bariatric surgery have been documented, but understanding of the phenomenon is missing. The following case report describes a 26-year-old woman with obesity, who initiated self-harm behaviour after bariatric surgery. The patient reported that the self-harm was a substitute for binge eating, which was anatomically impeded after bariatric surgery. Pre-surgical psychosocial assessment revealed Anorexia Nervosa in youth, which had later migrated to Binge Eating Disorder. At the time of surgery, the patient was not fulfilling the diagnostic criteria for Binge Eating Disorder because of a low frequency of binges. The remaining binges occurred when experiencing negative affect. Previous eating disorder pathology is an important consideration in pre-surgical assessments. For patients with affect-driven pre-surgical Binge Eating Disorder, therapeutic intervention before and after bariatric surgery could be indicated in order to secure the development of adaptive coping strategies. Furthermore, body weight as the only outcome measure for the success of surgery seems insufficient.

Despite substantial research efforts, the mechanisms proposed to explain weight loss after gastric bypass (RYGB) and sleeve gastrectomy (SL) do not explain the large individual variation seen after these treatments. A complex set of factors are involved in the onset and development of obesity and these may also be relevant for the understanding of why success with treatments vary considerably between individuals. This calls for explanatory models that take into account not only biological determinants but also behavioral, affective and contextual factors. In this prospective study, we recruited 47 women and 8 men, aged 25–56 years old, with a BMI of 45.8 ± 7.1 kg/m2from the waiting list for RYGB and SL at Køge hospital, Denmark. Pre-surgery and 1.5, 6 and 18 months after surgery we assessed various endpoints spanning multiple domains. Endpoints were selected on basis of previous studies and include: physiological measures: anthropometrics, vital signs, biochemical measures and appetite hormones, genetics, gut microbiota, appetite sensation, food and taste preferences, neural sensitivity, sensory perception and movement behaviors; psychological measures: general psychiatric symptom-load, depression, eating disorders, ADHD, personality disorder, impulsivity, emotion regulation, attachment pattern, general self-efficacy, alexithymia, internalization of weight bias, addiction, quality of life and trauma; and sociological and anthropological measures: sociodemographic measures, eating behavior, weight control practices and psycho-social factors.

ABSTRACTEating disorders cover different clinical syndromes, all of which are characterized by an immense focus on food, body and weight, an endless attempt to combat the body and by a fluctuation between ‘too much and not enough’ on different levels (e.g., behaviourally, mentally, physically).The aim of this article is to contribute to the psychoanalytic understanding of eating disorders, to highlight the vital importance of the symptoms as a psychological survival strategy and to illustrate similarities between eating disordered patients as well as the very different pathways that can lead to an eating disorder. Two clinical cases are presented, one very shortly and one in more detail.

Gergely and colleagues' state that their “Social Biofeedback Theory of Parental Affect Mirroring” can be seen as a kind of operationalization of the classical psychoanalytic concepts of holding, containing and mirroring. This article examines to what extent the social biofeedback theory of parental affect mirroring may be understood as a specification of these concepts. It is argued that despite similarities at a descriptive level the concepts are embedded in theories with different ideas of subjectivity. Hence an understanding of the concept of affect regulation as a concretization and specification of the classical concepts dilutes the complexity of both the concept of affect regulation and of the classical concepts.

The article presents a qualitative exploration of psychoanalytic psychotherapy cases in a randomized controlled trial comparing psychoanalytic psychotherapy and cognitive behavior therapy for bulimia nervosa. The cases selected represent both clients with good symptomatic outcome as well as clients with no clinically significant change in core bulimic pathology. All clients have a preoccupied attachment pattern. The aim of the study is to obtain a more differentiated picture of what constitutes “good” and “poor” outcome and to learn about strengths and limitations of psychoanalytic psychotherapy for bulimic clients with a preoccupied attachment pattern. The cases illustrate the diversity of clients' experiences of psychotherapeutic process and the variety of outcomes with regard to bulimic pathology, attachment patterns, interpersonal problems, depression, and general symptomatic distress.

Background: Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. Methods: Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Functioning scale; RF). Self-objectification was measured with the Objectified Body Consciousness Scale (OBCS). Results: Results from a multiple regression analysis showed that Global MI scores were significantly associated with Coherence of mind as an indicator of attachment, RF and scores on the OBCS. Conclusions: The study suggests that affective experiences of embodiment in patients with AN are associated with negative attachment representations, mentalizing impairments and objectified body consciousness. Plain English Summary: Body image disturbance is a key diagnostic feature in anorexia nervosa but the underlying psychological processes are poorly understood. Recently, there has been a growing interest in how disturbances in the more psychological experience of the body (embodiment) in anorexia nervosa is related to both attachment, how individuals make sense of both themselves and others and the degree to which they tend to experience ourselves from the outside. In this pilot study, this was assessed with an innovative interview, the Mirror Interview, where the individual is asked a set of question while standing in front of a full length mirror. Results showed that difficulties in embodied experiences in patients with anorexia nervosa were related to more fundamental representations of self and self-objectification. This has potential implications for both the understanding and treatment of anorexia nervosa, as disturbances in body image may be seen as an underlying factor in the development of an eating disorder.

In this paper, psychoanalysis is viewed as a method in opposition to the reigning spirit of our age with its demands for fast and measurable results. The concept „the psychoanalytic room” is introduced in order to grasp the uniqueness of psychoanalysis and how it distinguishes itself from what is ordinarily held to be included under the category of work. The psychoanalytic room is explored in both a concrete and metaphoric sense and is discussed in relation to the concept of time, reality, Ogden's concept of the analytic third, and, inspired by Winnicott, children's play. The playroom of the child and its similarity with the analytic room is illustrated by the book „Benny's Bathtub” by the Danish author Flemming Kvist Møller.

• The neuropsychologic sequelae of acquired immunodeficiency syndrome and human immunodeficiency virus were studied by comparing the results of a neuropsychologic test battery administered to the following three groups of Danish homosexual men: 20 patients with acquired immunodeficiency syndrome, 20 asymptomatic subjects who tested positive for the human immunodeficiency virus, and a matched control group of 20 subjects who tested negative for the human immunodeficiency virus. The group with acquired immunodeficiency syndrome performed significantly worse than the control subjects on the tests measuring concentration, memory, and psychomotor speed. The group with human immunodeficiency virus performed significantly worse than the control subjects on the tests measuring verbal memory and psychomotor speed. On the other tests, their results varied. The study supports the hypothesis that not only patients with acquired immunodeficiency syndrome but also asymptomatic subjects with human immunodeficiency virus may be neuropsychologically impaired early in the course of the disease.

Lunn S. Forholdet mellem anorexia nervosa og bulimi.The relationship between anorexia nervosa (AN) and bulimia (B) is discussed from three points of view: A diagnostic, a test-psychological and an etiological. From the diagnostic point of view uncertainty reigns. Patients will get different diagnoses depending on the diagnostician. The question whether AN and B are conceived as two independent syndromes or as closely related disorders plays a decisive role. From the test-psychological point of view the relationship between the two disorders is conceived rather as a question of degree than as a matter of essentially different psychopathology. The prevailing concept of B-patients as more pathological than AN-patients is debated. From the etiological point of view the greatest importance is attached to the family and individual-psychological level. Research into similarities and differences in the quality of the interaction between child and parents in families with AN-patients and B-patients is required. It is concluded that an exact answer to the relationship between the two disorders cannot be given. The immediate task will be to make a precise definition of the two groups in order to make research data comparable along with more clinical and qualitative research in the psychodynamics and development of the disorders.