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International audience; The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams’ and Scott’s Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

International audience; Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

International audience; This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter ‘at the crossroads between remission and relapse’; second, the way that ‘anorexia reveals itself’; and finally, the way the ‘ménage à trois’ works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners’ development of appropriate responses.

Resume Objectif Les troubles du comportement alimentaire (TCA) peuvent survenir au decours d’un etat de stress post-traumatique (ESPT). L’objectif de cette etude etait d’evaluer la frequence de cette co-occurrence et son impact clinique et pronostique sur le TCA. Methodes Des patients atteints de troubles du comportement alimentaire ont ete inclus dans cette etude, sur une periode de 6 mois en 2014. L’intensite des symptomes alimentaires etait evaluee a l’aide de l’Eating Disorder Inventory 2. Le diagnostic d’ESPT etait porte apres passation du Mini-International Neuropsychiatric Interview et sa severite mesuree a l’aide de l’Impact of Event Scale – Revised. Resultats Cent trente patients (57 cas d’anorexie mentale, 26 cas de boulimie nerveuse, 18 cas d’hyperphagie et 29 cas de troubles du comportement alimentaire non specifique) ont ete inclus. L’ESPT etait associe au TCA dans 33,9 % des cas. Aucune difference de prevalence entre les types de TCA n’etait retrouvee. L’intensite des symptomes alimentaires etait significativement plus elevee chez les patients ayant un ESPT comorbide. Des caracteristiques cliniques specifiques de cette association TCA-ESPT ont ete observees. Il s’agissait d’un niveau plus eleve d’insecurite, de mefiance interpersonnelle, d’impulsivite et d’un plus faible niveau de conscience interoceptive. Conclusion La frequence et l’influence pejorative de l’ESPT sur le pronostic du TCA renforcent la necessite d’une evaluation clinique systematique et d’une prise en charge specifique conjointe.

Nous avons mis au point une therapie psychosensorielle que nous avons appele Soins a mediation multi-sensorielle (SMMS). Dans les formes severes d’anorexie mentale dans lesquelles les sujets maltraitent gravement leur corps, nous avons eu l’idee de proposer un espace psychotherapique singulier, dans un environnement sensoriel agreable, autorisant le patient a se mettre dans une position regressive qui lui facilite l’acces a des souvenirs infantiles, mais aussi a des ressentis psycho-affectifs archaiques. Cet espace therapeutique utilise des stimulations olfactives par le biais d’odeurs choisies au cours d’un atelier d’olfactotherapie et les combine a un enveloppement corporel chaud, un environnement musical relaxant et a la penombre de la piece. L’objectif de ces soins est d’amener le sujet anorexique a revisiter des souvenirs infantiles tant agreables que traumatiques et de l’aider dans un cadre contenant a se construire une sec0urite psychocorporelle qui lui etait jusque-la defaillante.

L’anorexie mentale fascine car elle met en scène la mort de façon si ostentatoire qu’elle provoque un tourbillon d’une force prodigieuse qui désarçonne l’environnement familial, réveille les morts et menace le socle sur lequel la famille s’est construite. À travers le prisme de l’alimentation, ces jeunes filles nous interpellent sur des questions sociétales importantes : le poids de l’histoire familiale sur la construction de la famille d’aujourd’hui, les transmissions intergénérationnelles, l’évolution des fonctions parentales, notre rapport à la mort etc. Pour être efficace, le traitement de l’anorexie nécessite une prise en charge globale et multimodale où le corps maltraité, tout comme la psyché sont soignés dans leur entité psychocorporelle. Notre expérience clinique nous a permis de mieux comprendre les mécanismes intergénérationnels dans la transmission des souffrances familiales. Elle nous a aussi rappelé que le corps était une formidable mémoire individuelle, collective, transgénérationnelle et même phylogénétique. Dans cet article, nous exposons la synthèse de nos observations résultant du traitement multimodal que nous proposons à nos patientes anorexiques, au sein de notre clinique psychiatrique. Nous précisons l’articulation entre la thérapie familiale révélatrice de morts non enterrés (Abraham et Torok, 1978) [5] qui imprègnent le tissu relationnel au sein de ces bulles familiales, le travail corporel qui permet de re-contacter une mémoire corporelle attachée à ces morts non enterrés et la psychothérapie individuelle qui permet la mise en mot de cette mémoire mortuaire. Anorexia nervosa fascinates because it re-enacts death in such an ostentatious way that it causes a turbine of such strength that it destabilises the family environment, awakens the spectres and threatens the foundations on which the family is built. Through the prism of food, these young girls talk to us about questions of importance for society: the weight of the family history on the construction of the modern family, intergenerational transmission, the evolution of the parental role, our relationship with death, etc. In order to be effective, the treatment of anorexia requires a complete, multimode takeover, in which the maltreated body and mind are taken care of in their mental and physical entirety. Our clinical experience enables us to better comprehend the intergenerational mechanisms that characterise the transmission of family suffering. It also reminds us that the body has a formidable individual, collective, transgenerational and even phylogenetic memory. In this article, we present a summary of our observations of the results of the multimode treatment we offer our anorexic patients at our psychiatric clinic. We specify the articulation of the family therapy to reveal the spectres (Abraham and Torok, 1978) [5] that impregnate the relational fabric within these family bubbles, the bodily work which enables the re-establishment of contact with a physical memory attached to these spectres and the individual psychotherapy which enables the verbalisation of the spectral memory. 75;2

Des travaux récents ont porté sur les difficultés à initier et maintenir les patients dans des démarches structurées d’accompagnement de l’arrêt du tabac. Les préoccupations concernant la prise de poids au cours de cette démarche ont été particulièrement étudiées. L’arrêt est accompagné par une prise de poids et ces préoccupations sont plus fréquentes chez les femmes. Parmi ces patients, beaucoup ne sont pas prêts à faire des efforts pour cesser de fumer. Ils ont également tendance à abandonner les traitements en cours et ont moins de succès dans leur démarche. De nombreuses femmes semblent utiliser la consommation de tabac comme un comportement compensatoire, en plus de conduites alimentaires péjoratives et d’autres comportements compensatoires variés comme les régimes, les jeûnes, les vomissements et les exercices physiques. Afin de les accompagner dans les programmes d’arrêt, il est important d’aborder les difficultés liées à l’image du corps en lien avec l’estime de soi, les comportements alimentaires et la dépendance au tabac. Plusieurs domaines doivent être explorés : les caractéristiques anthropométriques, le niveau de dépendance, les comportements compensatoires, les préoccupations pondérales, le niveau de confiance dans sa capacité à contrôler son poids, les restrictions cognitives et les troubles alimentaires, le niveau de satisfaction vis-à-vis de l’image du corps, l’existence d’autres troubles psychiatriques et la motivation à l’arrêt. Différentes stratégies d’accompagnement sont intégrées à partir de programmes éprouvés dans l’obésité et les troubles alimentaires, et à partir des thérapies cognitives, de l’approche transthéorique et des entretiens motivationnels. Recent attention has been paid to the difficulty in recruiting and retaining patients in smoking cessation programs. Worry about cessation-related weight gain has received substantial attention. Smoking cessation is accompanied by weight gain, and weight gain worries are more frequent among women than men. Many of these patients are unlikely to try to quit smoking. They are also likely to drop out of treatment, less likely to quit successfully or abandon their quit attempts early. Many women seem to use smoking as a "compensatory behaviour". This concerns essentially women, who are engaged in a pattern of unhealthy nutritional practices and compensatory behaviours, including dieting, fasting, purging, and physical exercise. In order to help women in smoking cessation programs, we discuss the need to address body image disturbance itself, in association with self-esteem, eating patterns and smoking dependence. Several domains have to be measured and explored during functional analysis: anthropometrics data, level of dependence, "compensatory" behaviours, weight preoccupations, confidence in the capacity to control weight, cognitive restrictions and eating disorders, level of body-image satisfaction, psychiatric disorders, and motivation for quitting. Different strategies are incorporated from many disorder treatment programs, including the leading evidence-based for obesity and eating disorders, the cognitive therapy, the transtheoretical approach and the motivational interviewing. 19;2

International audience; This study aimed to explore changes in heart rate variability (HRV), a proxy for parasympathetic activity characterizing emotion regulation processes before, during and after negative emotional induction in patients suffering from restrictive type anorexia nervosa (AN-RT). We compared two methods of HRV analysis, the Fast Fourier Transform high frequency (FFT-HF) and a specific HRV high frequency analysis technique, namely, the wavelet transform HRV (WT-HRV). A sample of 16 inpatients with AN-RT was compared to 24 control participants. Heart rate (HR) was continuously recorded for 5 min before the beginning of the video until 5 min after the video. The participants answered questionnaires concerning their eating behaviors, mood disorders and difficulties in emotion regulation. During the entire procedure, the FFT-HF in patients was lower than that in controls. Using the WT-HRV, the patients did not differ from the controls at baseline, and only the controls showed a decrease during emotional induction. After the video, the WT-HRV in patients began to decrease during the first 2 min of emotional recovery although the WT-HRV in controls was already increased. These results highlighted the disturbances in the physiological dynamics of emotion regulation processes in patients with AN-RT.

Objective We used event-related potentials (ERPs) to test whether anorexic subjects have difficulties in filtering out irrelevant stimuli in controlled information processing tasks. Methods ERPs from 12 anorexic patients were recorded during recognition of simple and complex body images and simple and complex geometrical shapes. Results Anorexic subjects had larger P300 amplitudes for frequent stimuli during body images and simple geometrical shape recognition tasks. Longer P300 latencies were also found in simple geometrical shape recognition tasks, although task complexity had no effect on the P300 latency and amplitude. Discussion These results are explained in terms of nonspecific hyperarousal in mental anorexia and relative inability to filter out irrelevant stimuli leading to working memory saturation. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 299–307, 2003.

Eating disorders (ED) are associated with a higher prevalence of post-traumatic stress disorder (PTSD). However, the impact they may have on the clinical features and severity of the ED remains unknown. In this study, we assessed the prevalence and the impact of PTSD in a disordered eating population sample.We recruited patients with eating disorders during a period of 6 months, in 2014. The patients underwent a semistructured diagnostic interview by trained psychiatrists. The severity of eating behaviours and PTSD was assessed using the Eating Disorder Inventory 2 and the Impact of Event Scale - Revised.One hundred and thirty patients (57 patients with anorexia nervosa, 26 with bulimia nervosa, 18 with eating disorder not otherwise specified and 29 with binge eating disorder) were included. Our analyses revealed a PTSD rate of 33.9% in patients with ED. No difference was observed between the ED subtypes. Severity of ED was significantly higher among patients suffering from PTSD. Specific clinical characteristics of the ED-PTSD association have been found. Analyses revealed a significantly higher level of insecurity, interpersonal distrust, impulsivity and a decrease of interoceptive awareness.The frequency and negative impact of PTSD on ED reinforce the need for a systematic clinical evaluation and the implementation of specific care.

International audience; In anorexia nervosa (AN), body distortions have been associated with parietal cortex (PC) dysfunction. The PC is also the anatomical substrate of a supramodal reference framework involved in spatial orientation constancy. Given the impaired spatial orientation constancy found in hemineglect, we sought to determine whether similar disturbances could be observed in anorexic patients. We investigated the effect of passive lateral body inclination on the tactile subjective vertical (SV). Fifty participants (25 AN patients and 25 healthy controls) were asked to manually set a rod into the vertical position under three postural conditions. For tilted conditions, we observed a significant deviation of the tactile SV towards the body. This effect was abnormally accentuated in AN patients and might be caused by higher weighting with respect to the egocentric frame of reference. Our findings reinforce the role of the PC in AN and suggest that this dysfunction affects spatial orientation constancy as well as body boundaries.

BackgroundPatients with anorexia nervosa (AN) usually report feeling larger than they really are. This body overestimation appears to be related not only to the patient's body image but also to an abnormal representation of the body in action. In previous work on a body-scaled anticipation task, anorexic patients judged that they could not pass through a door-like aperture even when it was easily wide enough--suggesting the involvement of the body schema. In the present study, we sought to establish whether this erroneous judgment about action is specifically observed when it concerns one's own body or whether it is symptomatic of a general impairment in perceptual discrimination.MethodsTwenty-five anorexic participants and 25 control participants were presented with a door-like aperture. They had to judge whether or not the aperture was wide enough for them to pass through (i.e. first-person perspective, 1PP) and for another person present in the testing room to pass through (i.e. third-person perspective, 3PP).ResultsWe observed a higher passability ratio (i.e. the critical aperture size to shoulder width ratio) in AN patients for 1PP but not for 3PP. Moreover, the magnitude of the passability ratio was positively correlated not only with the extent of the patient's body and eating concerns but also with the body weight prior to disease onset. Our results suggest that body overestimation can affect judgments about the capacity for action but only when they concern the patient's own body. This could be related to impairments of the overall network involved in the emergence of the body schema and in one's own perspective judgments.ConclusionOverestimation of the body schema might occur because the central nervous system has not updated the new, emaciated body, with maintenance of an incorrect representation based on the patient's pre-AN body dimensions.

International audience; Patients with anorexia nervosa frequently believe they are larger than they really are. The precise nature of this bias is not known: is it a false belief related to the patient's aesthetic and emotional attitudes towards her body? Or could it also reflect abnormal processing of the representation of the body in action? We tested this latter hypothesis by using a body-scaled action-anticipation task in which 25 anorexics and 25 control participants had to judge whether or not an aperture was wide enough for them to pass through. The anticipation of body-scaled action was severely disturbed in anorexic patients; they judged that they could not pass through an aperture, even when it was wide enough (i.e. they behave as if their body was larger than in reality). The abnormally high "passability ratio" (the critical aperture size to shoulder width ratio) was also correlated with the duration of illness and the degree of body concern/dissatisfaction. Our results suggest that body size overestimation in anorexia nervosa is not solely due to psycho-affective factors but rather suggest impaired neural processing of body dimensions that might take its source in parietal networks.

International audience; Depressive states are classically associated to increased sensitivity to negative events. However this hypersensitivity may not be stable in time, being absent in remission periods or further reinforced with recurrent depressive episodes, or may concern positive stimuli instead, e.g. in young depressive patients. To study the evolution of the processing of emotional information in depression we recorded late components of evoked potentials in first-episode and recurrent depressed patients before and after recovery. We used a visual attentional paradigm manipulating the processing of emotional information. Subjects first counted words with positive valence, and then words with negative valence from lists of usual words. The results showed that recurrent patients had increased P300 amplitudes for negative words selection only in negative words counting situation, while first-episode patients had decreased P300 amplitudes for positive words selection. After clinical improvement, the negative biases in recurrent patients group disappeared but P300 amplitudes of first-episode patients remained significantly low for positive words. First-episode depressed patients show a selective impairment for positive stimuli, with decreased response to pleasant stimuli, while recurrent depressive subjects show signs of hyperesthesia for negative stimuli. These results suggest that responses to emotional stimuli in word processing are related to the duration of the mood disorders.

International audience; Recent studies suggest that patients with anorexia may express dissociated cognitive and physiological reactivities to emotional stimuli. The present research aimed to compare subjective and autonomic responses to pleasant, unpleasant and neutral scenes during a categorization task and an activation rating task in anorexic (AN), alexithymic (AL), depressed (DEP) and control participants (CONT). The participants first categorized pictures according to their emotional valence, followed by a rating of their activation level, concomitant with the recording of skin conductance responses (SCRs). Main findings showed that the AN patients presented major difficulty in categorizing pictures, particularly neutral ones. Contrary to the AL participants, this difficulty did not induce significant increases of SCR amplitude in the AN patients. In the second task, the AN patients rated the intensity of activation of unpleasant pictures higher than the AL participants and that of pleasant ones higher than the AL and CONT participants. In addition, no significant linear correlation was observed between the intensity of activation ratings and SCR amplitude in the AN, AL or DEP participants contrarily to what was observed for control participants. This lack of relation suggests a non-specific disconnection between physiological and cognitive self-reported responses to emotional stimuli. Our results highlight a specific form of emotional processing in the AN patients distinct from that observed in alexithymia or depression and characterized by a dissociation between cognitive and physiological responses. This kind of disconnection could be associated with emotional regulation processes and may benefit the AN patients by lowering the psychological stress response.