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Resume Introduction Il existe pour les patients atteints d‘anorexie mentale peu d’interventions de psychoeducation. L’objectif de cette etude est d’evaluer la faisabilite et l’acceptabilite d’un programme de psychoeducation. Les objectifs secondaires exploratoires concernent l’evaluation de l’efficacite du programme sur la symptomatologie. Methode Vingt-sept patientes reparties en trois groupes ont beneficie d’un groupe hebdomadaire de huit seances, en adjonction a leur prise en charge habituelle, dans une etude ouverte. Les patientes ont beneficie de trois evaluations de suivi, a la fois quantitatives et qualitatives. Resultats Soixante-dix-huit pour cent des patientes ont assiste a plus de 75 % des seances. Soixante-dix pour cent des patients ont trouve le groupe utile et 95 % declarent qu’il leur a permis d’ameliorer leurs connaissances sur la maladie et ses consequences. L’IMC moyen des participantes, les dimensions alimentaires et le fonctionnement ont significativement et positivement evolue, immediatement apres le groupe et a trois mois. Sur le plan qualitatif, les patientes sont majoritairement satisfaites du groupe et rapportent pour la plupart des changements dans leur quotidien : soit dans leur rapport aux soins et a la maladie, soit dans les relations avec leurs proches ou encore dans leur comportement alimentaire. Conclusion Les resultats a la fois qualitatifs et quantitatifs suggerent que ce programme de psychoeducation par groupe en adjonction a la prise en charge habituelle est faisable et bien accepte par les patientes. Les ameliorations cliniques constatees sont encourageantes quant a l’innocuite de ce type d’intervention et a leur eventuelle efficacite, et plaident pour une etude controlee.

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.

Purpose: Anorexia nervosa (AN) is a serious mental illness that is frequently accompanied with a history of childhood maltreatment (CM) which may constitute a specific ecophenotype of the eating disorder necessitating special assessment and management. Chronic stress inflicted by CM in patients with AN may manifest through increased low grade inflammation reflected by an increase in ratios from white blood cells count such as neutrophils to lymphocytes ratio (NLR) platelets to lymphocytes ratio (PLR) and monocytes to lymphocytes ratio (MLR). Methods: N=206 participants were evaluated in an eating disorders daycare unit in Montpellier, France between March 2013 and January 2020. CM was assessed using childhood trauma questionnaire (CTQ). AN clinical severity was assessed using eating disorder examination (EDE-Q). The MINI was used to assess other clinical characteristics. Results: NLR has been found to be higher in patients with AN and a history of CM (p=0.029) as well as in patients with AN and a history of emotional abuse (p=0.021) when compared to patients with AN and without a history of CM. In the multivariate analysis, emotional abuse (β=0.17; p=0.027) contributed significantly to NLR’s variability. Conclusion: NLR is a low grade inflammation marker that is influenced by multiple sociodemographic, clinical and biological factors in patients with AN. It is more directly affected by certain subtypes of CM, especially emotional abuse than by the presence or absence of a history of CM. Future studies may focus on mediators between CM and increased inflammation such as interoceptive awareness, emotional dysregulation, food addiction and stress-sensitization.Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies

International audience; This study investigated the potential role of quantitative ultrasound (QUS) to assess low bone mass in anorexia nervosa patients (AN). Bone parameters from QUS and DXA were positively correlated and significantly reduced in AN compared with controls, suggesting that QUS is a pertinent technique to assess low bone mass in these patients.Purpose: The aim of this study was to investigate the potential role of an alternative technique, quantitative ultrasound (QUS), to assess low bone mass in patients with anorexia nervosa (AN).Methods: Two hundred seven young women (134 patients with AN and 73 healthy controls) with ages ranging from 14.4 to 38.4 years participated in this observational cross-sectional study. Bone mass was concomitantly evaluated by DXA to determine areal bone mineral density (aBMD; g/cm2) at hip, lumbar spine, and radius and by QUS to determine broadband ultrasound attenuation (BUA; dB/MHz) at the heel.Results: BUA (66.5 ± 4.6 dB/MHz vs 61.0 ± 5.0 dB/MHz) and aBMD at the hip (0.916 ± 0.013 g/cm2 vs 0.806 ± 0.010 g/cm2), lumbar spine (0.966 ± 0.012 g/cm2 vs 0.886 ± 0.010 g/cm2), and radius (0.545 ± 0.005 g/cm2 vs 0.526 ± 0.04 g/cm2) were significantly decreased (p < 0.01) in patients with AN compared with controls. When patient and control data were pooled, BUA was significantly correlated with aBMD at the hip (r = 0.60, p < 0.001), lumbar spine (r = 0.48, p < 0.001), and radius (r = 0.40, p

Patients with Anorexia Nervosa (AN) present many nutritional deficiencies (macro- and often also micro-nutrients), possibly explained by their inadequate food intake. Previous studies reported that selenium (Se) deficiency is common in the general population. As Se can be easily added as a supplement, the goal of this study was to evaluate the clinical impact of Se deficiency in patients with AN.This cross-sectional study concerned 153 patients with AN (92.9% women) followed at the Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Patients underwent an extensive neuropsychological assessment, and completed validated questionnaires. Blood samples were collected for Se quantification. Results were compared with the t-test, Mann-Whitney U, and Chi square tests, and univariate linear and multivariate logistic regression models.Se plasma levels were below the cut-off of 80 µg/L in 53.6% (N = 82) of patients. AN onset was earlier in patients with Se deficiency, (p = .005), whereas disease duration was comparable between groups (p = .77). General eating disorder symptomatology in the past 28 days (Eating Disorder Examination Questionnaire) was more severe in patients with Se deficiency (p = .010). The suicide risk (MINI International Neuropsychiatric Evaluation) tended to be higher (p = .037), and suicide attempt history was more frequent (28.39% vs 9.85%, p = .004) in patients with low Se levels. Se plasma concentration was negatively correlated with the performance in the temporal delayed discounting task (p = .006).Our findings suggest that in patients with AN, Se plasma concentration might be implicated in disease severity and suicide risk. The finding that Se deficiency in patients with AN was associated only with reward-related processes, but not with other psychological functions suggests the selective involvement of dopamine-related pathways. Our results suggest that it might be useful to monitor the plasma micronutrient profile in patients with AN. Future studies should determine whether Se supplementation in AN might improve clinical outcomes.

Joint hypermobility is a common trait in the general population but also a hallmark of the hereditary disorders of connective tissue such as Ehlers-Danlos syndromes. These altered collagen conditions have been associated with multisystemic complications such as gastrointestinal problems, temporomandibular dysfunction, fragility of oral mucosa, and test and smell abnormalities among others that can potentially affect eating behaviors, weight, and nutrition. In this chapter, we exposed existing evidence about the connection between hypermobility-related disorders and eating and weight issues as well as some clues to explain such association that deserve more research and clinical attention.

International audience; Objective: It is not yet clear what role previous history of anorexia nervosa (AN) plays in the clinical course of bulimia nervosa (BN). We aimed to investigate, using a comprehensive assessment, involving clinical characteristics, daily functioning, cognitive functions, and nutritional and physical markers in BN patients with a history of AN, and compare them with BN patients without a history of AN.Methods: Eighty-five patients with a current episode of BN (35 with a lifetime history of AN) were analysed. Diagnoses were established according to the DSM-5 criteria. Patients completed neuropsychological tests and filled out validated psychiatric questionnaires. Sociodemographic data and nutritional and somatic illness markers were collected and investigated.Results: BN patients with a history of previous lifetime AN had worse decision-making ability, worse general and specific functioning, decreased bone density, more antecedent of lifetime suicide attempts, more dietary restraint, and more frequent use of laxatives. The multivariate model shows that the history of AN is closely associated with worse decision-making ability, worse general function, and higher likelihood of lifetime suicide attempts.Discussion: Prior history of AN is an important clinical question that should receive proper attention when treating BN patients, as this subgroup of patients may have specific care needs.

Childhood abuse is frequent among individuals with eating disorders and is associated with complex clinical presentations. However, to date, the differences in the presentations of eating disorders between these groups are poorly understood. The present study employed a Bayesian network approach to model the interactive network structure of eating disorder psychopathology, and to investigate the differences in symptom importance and network structure between individuals with eating disorders with and without an experience of childhood abuse in a sample 327 treatment-seeking individuals. Among individuals with a history of childhood abuse, a specific 4-symptom pathway emerged, leading from overvaluation of shape and weight and ending in overeating (overvaluation of weight and shape → loss of control → depressed mood → overeating). Loss of control eating and depressed mood emerged as the more important driving symptoms. In contrast, the eating disorder symptom network among the group with no abuse was organized around a heightened investment in weight and shape, and resulting efforts to control or alter weight and shape through dieting and exercise behaviors. The symptoms with the highest importance in this nonabuse group were overeating and overvaluation of weight and shape. These results support the existence of a distinct eating disorder symptom network characteristic of individuals with a history of childhood trauma, and add to the hypotheses of a maltreated eco-phenotype in eating disorders. They may be also inform treatment target in abused people with eating disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

International audience; Objective: Eating disorders (ED) are associated with an in increased risk of suicidal behaviours. Laxative abuse might alter the gut-brain axis signaling, that might be implicated in the pathophysiology of suicide. This study aims to determine the association between laxative misuse and suicide attempt (SA) and suicidal ideation (SI) in patients with ED.Methods: 277 patients with ED were recruited from an Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Sociodemographic and clinical data were collected. Chi-square and t test were used, with Bonferroni corrections where required. Multiple regression models assessed the relationships between laxative misuse, SA, and SI.Results: 62 (22.4%) patients reported lifetime laxative misuse. They were more likely to have a history of SA than non-misusers [43.83 vs 19.9%, p < 0.001, odds ratio (OR) 3.68]. In the multivariate model, adjusted for other confounders, lifetime laxative misuse remained associated with SA (adjusted OR 3.79, p = 0.041). In past 28 days, patients with SA history reported misusing laxatives for more days than patients without SA history (6 vs 1.5 days, p = 0.01, adjusted for vomiting and ED severity). Laxative use days during past 28 days was associated with current SI, adjusted for vomiting in the same period (p = 0.017).Conclusions: Current and lifetime laxative misuse were associated with SA history and current SI in patients with ED, at least in part independently of other suicide-related factors.

Background: The current study aimed to test whether food addiction (FA) might mediate the relationship between the presence of a history of childhood maltreatment and eating disorder (ED) symptom severity. Methods: Participants were 231 patients with ED presenting between May 2017 and January 2020 to a daycare treatment facility for assessment and management with mainly the Eating Disorder Inventory-2 (EDI-2), the Child Trauma Questionnaire (CTQ), and the Yale Food Addiction Scale (YFAS 2.0). Results: Participants had a median age of 24 (interquartile range (IQR) 20&ndash, 33) years and manifested anorexia nervosa (61.47%), bulimia nervosa (16.88%), binge-eating disorders (9.09%), and other types of ED (12.55%). They were grouped into those likely presenting FA (N = 154) and those without FA (N = 77). The group with FA reported higher scores on all five CTQ subscales, as well as the total score of the EDI-2 (p &lt, 0.001). Using mediation analysis, significant indirect pathways between all CTQ subscales and the EDI-2 total score emerged via FA, with the largest indirect effect emerging for physical neglect (standardized effect = 0.208, 95% confidence interval (CI) 0.127&ndash, 0.29) followed by emotional abuse (standardized effect = 0.183, 95% CI 0.109&ndash, 0.262). Conclusion: These results are compatible with a model in which certain types of childhood maltreatment, especially physical neglect, may induce, maintain, and/or exacerbate ED symptoms via FA which may guide future treatments.

International audience; The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).

This study investigated the potential role of quantitative ultrasound (QUS) to assess low bone mass in anorexia nervosa patients (AN). Bone parameters from QUS and DXA were positively correlated and significantly reduced in AN compared with controls, suggesting that QUS is a pertinent technique to assess low bone mass in these patients.The aim of this study was to investigate the potential role of an alternative technique, quantitative ultrasound (QUS), to assess low bone mass in patients with anorexia nervosa (AN).Two hundred seven young women (134 patients with AN and 73 healthy controls) with ages ranging from 14.4 to 38.4 years participated in this observational cross-sectional study. Bone mass was concomitantly evaluated by DXA to determine areal bone mineral density (aBMD; g/cmBUA (66.5 ± 4.6 dB/MHz vs 61.0 ± 5.0 dB/MHz) and aBMD at the hip (0.916 ± 0.013 g/cmBUA measurement at the heel by QUS appears to be a pertinent nonionizing technique to assess low bone mass in patients with AN.

Although the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) has been shown to be a reliable and valid tool for assessing appearance pressures and appearance ideal internalization among French college students, to date its psychometric properties among French clinical populations have not been examined. The aim of this study was to evaluate the factor structure, reliability, and validity of the SATAQ-4 among a French female clinical eating disorder sample, and to compare the mean SATAQ-4 scores from this clinical sample to previously published means observed among French female college women. The current sample included 192 French women consecutively recruited from an outpatient eating disorders unit in France. Participants completed the SATAQ-4, as well as validated measures of body image and eating pathology. Confirmatory factor analysis revealed that the original 22-item five-factor solution provided less than adequate fit to the data. In contrast, the reduced 20-item five-factor solution identified among French college students provided a good fit to the data. The SATAQ-4 subscales generally exhibited moderate positive associations with convergent measures of body image and eating disturbance, consistent with expectations. Differences in SATAQ-4 subscale means across diagnostic groups were observed. In addition, the clinical group reported higher scores on the Internalization: Thin/Low Body Fat and Internalization: Muscular/Athletic subscales compared to a non-clinical French sample. Findings support the SATAQ-4 as a valuable tool for assessing sociocultural influences on body image and eating concerns among French women with eating disorders.

International audience; It has been reported that decision making is impaired in suicide attempters. Decision making is a complex process and little is known about its different components. Yet, this information would help to understand the functioning of suicidal minds. In this study, the Prospect Valence-Learning (PVL) computational model was applied to the Iowa Gambling Task (IGT) to investigate and compare decision-making components in patients with affective disorder and with/without history of suicide attempts and in healthy controls. To this aim, 116 inpatients with current major depressive episode (among whom 62 suicide attempters) and 38 healthy controls were recruited. Decision-making performance was measured using the IGT. The Bayesian computational PVL model was applied to compare the feedback sensitivity, loss aversion, learning/memory, and choice consistency components of decision making in the different groups. Depressive symptomatology was assessed using the Beck Depression Inventory short form (BDI-SF). The total IGT net score and the loss aversion and learning/memory scores were lower in suicide attempters than in healthy controls. The choice consistency score was low in all patients (with/without suicide history) compared with healthy controls. Moreover, patients with high BDI score showed a positive relationship between the choice consistency score and suicide attempt. These findings suggest that decision-making impairment in depressed patients with and without suicidal history might be the result of underlying problems in feedback processing and task learning, which influence the building of long-term strategies. All these impairments should be targeted in therapeutic strategies for suicidal patients.

International audience; OBJECTIVE: Impaired decision-making and inhibitory control may be involved in the pathophysiology of psychiatric disorders like bulimia nervosa (BN). Their improvement after neuromodulation may underpin clinical improvement. We assessed the effects of rTMS on these cognitive functions in a sample of women with BN. METHODS: Thirty-nine participants (22 in a sham group and 17 in an rTMS group) were assessed before and after 10 high frequency rTMS sessions over the left dorsolateral prefrontal cortex (DLPFC). RESULTS: The between-group analyses revealed no differences in the final neuropsychological performances. The within-group analyses showed that inhibitory control improved in both the go/no-go task (p = .03) and the BIS cognitive impulsivity subscale (p = .01) in the rTMS group only. Switches toward good choices on the Iowa gambling task significantly improved in the rTMS group only (p = .002), and understanding of the task contingencies increased between the two assessments, also in the rTMS group only (p = .03). DISCUSSION: This preliminary evidence suggests that modulation of left DLPFC might improve two putative cognitive biomarkers of BN.

International audience; We report results from an open-label study of the safety and efficacy of transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) in patients suffering from Anorexia Nervosa (AN). AN is a severe psychiatric illness associated with a high mortality rate and a severely impaired quality of life. However, only a limited number of treatments are available, and specifically, no medication is approved for AN management [ 1 ]. Usually, psychotherapeutic interventions and the management of physical complications are recommended. Lately, rTMS has emerged as a safe and somewhat effective treatment option for the treatment of AN. However, results were not conclusive [ 2 , 3 ]. A recent development of tDCS seems to be promising in depression and schizophrenia [ 4 , 5 ] and deserves to be further investigated in AN.

Objective The threefold aim was to (1) compare areal bone mineral density (aBMD), bone turnover markers, and periostin levels in young women with either anorexia nervosa (AN) or obesity (OB) and controls (CON); (2) model the profiles according to age; and (3) determine the parameters associated with aBMD. Subjects and Methods One hundred and fifty-two young women with ages ranging from 16.0 to 27.0 years were subdivided into 3 groups (AN, OB, CON). The CON group was age-matched by ±6 months. aBMD, bone turnover markers, and periostin levels were evaluated. Results aBMD modeling showed that hip aBMD was higher in OB than in the other 2 groups from 19 years, and AN presented lower values than CON from 21 years. aBMD at the lumbar spine was higher in older OB and CON women, starting from 20 to 22 years, but in AN the difference with the other 2 groups increased with age. Periostin levels were lower in OB than in AN or CON, but no variation with age was observed. Compared with controls, OB and AN presented similarly lower markers of bone formation, although markers of bone resorption were lower in OB and higher in AN. A modeling approach showed that markers of bone formation and resorption were lower in older than in younger CON, whereas the values of these bone markers remained relatively constant in AN and OB. In all groups, lean body mass (LBM) was the parameter most positively correlated with aBMD. Conclusion This study demonstrated that weight extremes (AN or OB) influence aBMD, bone remodeling and periostin profiles. Moreover, factors related to aBMD were specific to each condition, but LBM was the parameter most consistently associated with aBMD.

International audience

Background Comorbidity of bipolar disorder (BD) and eating disorders (ED) is common and increases the course and severity of BD. However, the impact of comorbid BD on the clinical profile of ED patients remains unclear. Most studies have focused on patients primarily assessed for BD and data on patients with a primary diagnosis of ED are sparse. We investigated the association between a dual diagnosis and severity in terms of clinical, neuropsychological dimensions and daily functioning. Method Two hundred and sixty-one patients with ED were consecutively recruited. BD was screened with the MINI and further confirmed in the French expert centre network. The severity of ED symptoms was assessed with the EDE-Q and EDI-2, daily functioning with the FAST. The neurocognitive assessment targeted attention, set-shifting and decision-making. Results Forty-nine patients screened positive for BD, but diagnosis was confirmed in only thirty patients (11.5% of the cohort). After multiple adjustments, comorbidity was associated with greater severity on the total score and three subscales of the EDE-Q and on four of the ten dimensions of the EDI-2. Comorbid BD was associated with lower daily functioning but not with lower neuropsychological performance. Limitations Sample referred to specialist clinics not large enough to authorize an analysis by subtype and cross-sectional evaluation. Conclusion The association between ED and BD increases ED severity for most of these core features. It negatively impacts daily functioning. The results also highlight issues about the validity of screening tools to detect BD in patients with ED.

International audience; Objective: To evaluate the potentially protective effects of oral contraceptives (OC) on bone loss in a large population of young women with anorexia nervosa (AN).Design: Cross-sectional study.Setting: University hospital.Patient(s): Three hundred and five patients with AN (99 of them using OC) and 121 age-matched controls.Intervention(s): None.Main Outcome Measure(s): Areal bone mineral density (aBMD) evaluated by dual-energy X-ray absorptiometry and bone turnover markers, with leptin evaluated concomitantly.Result(s): Although the AN patients taking OC presented lower aBMD compared with the controls at all bone sites, the whole body excepted, their aBMD values were systematically higher than those of AN patients who were not taking OC for the whole body and the lumbar spine, femoral neck, hip, and radius. These differences persisted after multiple adjustments. Preservation of aBMD improved with longer durations of OC use and shorter delays between disease onset and the start of OC. Moreover, patients with the lowest body mass index showed the best bone tissue responses to OC. Bone formation markers were systematically lower in the two groups of patients with AN compared with the controls. The markers of bone resorption were normalized in AN patients using OC.Conclusion(s): Although OC use does not provide total protection of aBMD, our data suggest that OC might be prescribed for young women with AN to limit their bone loss.

Studies suggest that stimulation of the left dorsolateral prefrontal cortex (DLPFC) reduces food craving in bulimic patients, but evidence supporting repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool is lacking. We investigated the safety and therapeutic efficacy of an adjunct high-frequency rTMS programme targeting the left DLPFC. Forty-seven women with bulimia nervosa were randomised to a real or sham stimulation group. The real group underwent 10 rTMS sessions, each consisting of 20 trains of 5 seconds with 55-second intervals between trains, at a frequency of 10 Hz. The main outcome was the number of binge episodes in the 15 days following the end of stimulation. Overall, no significant improvement in bingeing and purging symptoms was noted after the programme. rTMS was well tolerated. This suggests that 10 sessions of high-frequency rTMS to the left DLPFC provide no greater benefit than placebo. Future studies should consider methodological issues as well as alternative targets. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

International audience; OBJECTIVES:Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis.METHODS:We conducted a review using Preferred Reporting Items for Systematic reviews and Meta-Analysis criteria, and combined ("Inflammation") AND ("Suicidal ideation" OR "Suicidal attempt" OR "suicide").RESULTS:Post mortem studies demonstrated associations between suicide and inflammatory cytokines in the orbitofrontal cortex, a brain region involved in suicidal vulnerability. Also, microgliosis and monocyte-macrophage system activation may be a useful marker of suicide neurobiology. Kynurenine may influence inflammatory processes, and related molecular pathways may be involved in SB pathophysiology. Few recent studies associated inflammatory markers with suicidal vulnerability: serotonin dysfunction, impulsivity and childhood trauma. Interestingly, the perception of threat that leads suicidal individuals to contemplate suicide may activate biological stress responses, including inflammatory responses.CONCLUSIONS:Translational projects would be crucial to identify a specific marker in SB disorders, to investigate its clinical correlations, and the interaction between inflammatory cytokines and monoamine systems in SB. These researches might lead to new biomarkers and novel directions for therapeutic strategies.

Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively.

ContexteL’épisode dépressif majeur (EDM) est hautement prévalent, et est associé à une augmentation de la morbidité, de la mortalité (incluant le suicide), et des coûts de santé publique. En 2030, la dépression devrait être la première cause d’invalidité dans les pays développés. Même si une amélioration est observée chez 60–70 % des individus traités par antidépresseurs, seulement 35 % atteindront la rémission. De plus, parmi les patients qui ont expérimenté un EDM, il est estimé que 85 % présenteront une rechute. Deux principaux facteurs sont associés à l’augmentation du risque de rechute : la faible observance médicamenteuse, et la faible confiance dans ses compétences à gérer un nouvel épisode. Ces deux facteurs sont justement les cibles prioritaires des programmes de psychoéducation . En outre, la psychoéducation est recommandée dans les guidelines , mais aucun programme n’était disponible en France.InnovationNous avons développé le premier programme français de psychoéducation dans la dépression unipolaire, appelé « ENVIE ». Cette intervention de groupe se compose de neuf séances hebdomadaires. Son objectif est d’enseigner aux patients les connaissances actuelles sur la dépression unipolaires et les traitements efficaces, grâce à des séances didactiques et interactives. Au cours des séances, les patients sont également encouragés à expérimenter des compétences psychologiques innovantes (issues de la thérapie ACT) pour faire face à la symptomatologie dépressive, et maintenir leur motivation dans l’activation comportementale au cours du temps [3,4]. L’objectif global est que les patients deviennent experts et acteurs de leur maladie.PerspectiveDans le cadre d’un PHRC national, 332 patients déprimés unipolaires non chroniques (< 2 ans), d’intensité modérée à sévère, sans éléments psychotiques, seront randomisés en 2 groupes : programme ENVIE en add-on (n = 166) ou liste d’attente (n = 166). Le critère de jugement principal sera le taux de rémission (MADRS ≤ 12 sur 8 semaines sans rechute) à 15 mois. Démontrer l’intérêt du programme ENVIE permettrait sa diffusion plus large comme traitement adjuvant de la dépression unipolaire.