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Les troubles des conduites alimentaires (TCA) désignent un groupe de maladies graves au potentiel mortel qui se déclarent généralement pendant l'adolescence et peuvent être associés à de graves complications médicales et psychosociales. Ils peuvent avoir d'importantes répercussions sur les proches et les autres membres de la famille. Les professionnels de la santé jouent un rôle important pour les dépister et les prendre en charge chez les adolescents et les jeunes adultes. Le présent document de principes aide les professionnels de la santé en milieu communautaire à dépister, diagnostiquer et traiter les TCA dans la population pédiatrique. Les modalités de dépistage, les indications d'hospitalisation, les complications médicales et la surveillance des jeunes ayant un TCA sont résumées. Les données probantes à jour appuient le recours au traitement familial comme modalité thérapeutique psychologique de première ligne auprès des adolescents ayant un TCA restrictif. Les traitements familiaux dépassent peut-être la portée de pratique de certains médecins en milieu communautaire, mais le présent document de principes en examine les éléments fondamentaux. Au diagnostic d'un TCA, les professionnels de la santé qui mettent rapidement ces éléments à exécution en milieu communautaire peuvent ralentir l'évolution de la maladie et donner des conseils aux familles. [ABSTRACT FROM AUTHOR]

L’anorexie est une pathologie du vide de sens, qui presente une défaillance au niveau des processus de la pensée, avec des implications directes au niveau de la construction identitaire. Le Rorschach a été utilise comme instrument d’évaluation du fonctionnement mental et comme méthode d’analyse des transformations psychiques. Martha est une adolescente de dix-sept ans, avec deux hospitalisations, avec un diagnostic d’anorexie. L’analyse du Rorschach à mettre en évidence deux mouvements psychiques: la présence d’une forte tension pulsionnelle, mobilisée face à l’atteinte ressentie dans la relation Moi-Autre; la dévitalisation du Moi, par un fort mouvement d’annulation du Moi. La compréhension de ces mouvements a permis une intervention thérapeutique dans le but de restaurer son Être, de consolider son identité et de permettre un ensemble de transformations psychiques qui permettent la subjectivation et la croissance mentale.

In a constantly evolving digital age, concern for health has taken a new form, generating new psychopathologies, including “orthorexia” and “cyberchondria”. Orthorexia involves an obsession with healthy eating, leading to restrictive dieting and social isolation. In contrast, cyberchondria is characterized by the obsessive search for medical information online and by anxiety about one’s own health. Although not officially recognized as disorders in current psychiatric diagnostic guidelines, these phenomena attract the attention of researchers and mental health professionals. Orthorexia can coexist with eating disorders and may require integrated assessment and treatment. Excessive health concern and social pressure are risk factors. On the other hand, cyberchondria can be associated with severe anxiety, requiring assessment and tailored treatment. The evolution of these disorders can go from seemingly harmless preoccupations to obsessions that affect the everyday life. The treatment, customized for each patient, involves psychological therapy, nutritional counseling, and sometimes drug interventions for anxiety or co-occurring symptoms. Appropriate therapeutic approaches and the support of a multidisciplinary team can contribute to the recovery and long-term health of those affected by orthorexia and cyberchondria [ABSTRACT FROM AUTHOR]

Dans l'anorexie mentale, les préoccupations corporelles sont un enjeu clé de la pathologie, mais aussi de la thérapeutique. Il est, à ce jour, établi que la perception de soi serait modulable par des interventions centrées sur le toucher. Dans ce contexte et avec l'appui de recherches en psychiatrie et en psychologie, nous posons la question de la place de l'ostéopathie en tant qu'aide à la remédiation physico-psychique. Nous avons réalisé le suivi de 40 patientes souffrant de troubles du comportement alimentaire et réparties en quatre sous-groupes de dix sujets non randomisés durant dix semaines afin d'évaluer la valeur ajoutée de l'ostéopathie vis-à-vis de la psychomotricité sur les préoccupations corporelles. À l'issue de la prise en charge, nous observons une diminution des préoccupations corporelles pour les sujets du groupe psychomotricité (p < 0,05) et ceux du groupe de double suivi ostéopathie-psychomotricité (p < 0,05). Le groupe ostéopathie ne montre pas d'amélioration suffisante vis-à-vis du groupe témoin (p > 0,34). Les résultats et les limites de la présente étude sont discutés, ainsi que les recommandations pour des recherches ultérieures. Anorexia nervosa is a psychosomatic disorder that mainly concerns women where body image and corporal sensations are questioned. For these patients, their morphology is an obsessional issue and they tend to ignore sensorial perceptions such as hunger or pain. Treatment remains extremely complex, in spite of the vast expanse of relevant specialities, and a close coordination of soma and psyche mediations is required. In fact, it has been proven that for anorexics, there is a strong link between the image of their degraded body and sensorial disorders. These phenomena also concern the structures of the interceptive system. Therefore, the body's perceived shape is a key issue not only in the pathology but also in the therapeutic intervention. To date, it has been established that self-perception can be modulated by interventions focused on touch. In this context and with the support of research in child psychiatry and psychology, we raise the question of the place of osteopathy as an aid in physico-psychic remediation. Our goal is to develop a therapeutic mediation covering the somatic phenomena induced by the muscular frame so as to demonstrate a possible improvement in how anorexics perceive their own morphology. We included 40 patients suffering from eating disorders in our experiment forming a heterogeneous age-group and respecting the minimum threshold. During the ten weeks of the trial, the group was divided into 4 subgroups of 10 non-randomized participants each and based on voluntary participation with one subgroup of 10 patients as a control group, one subgroup of 10 patients treated exclusively using psychomotricity, a third subgroup of 10 patients evaluated exclusively using osteopathy, and a fourth subgroup of 10 patients using a mixed approach. We relied on the "Body Shape Questionnaire" (BSQ-34) to conduct our comparative measurements. It is a reference psychometric tool for measuring bodily concerns, and the French version has been validated and is commonly used. At the end of our ten-week treatment period, we observed positive results for psychomotricity (P < 0.05) and a double osteopathy-psychomotricity follow-up (P < 0.05), but osteopathy alone does not show sufficient improvement compared to the control group (P > 0.34). In view of the results obtained with our patients, the modulations of bodily concerns among those participants treated by touch appear to be effective in the intra-group, but our approach could require extended treatment for more than 10 weeks with regard to intergroup comparisons. Osteopathy must, like the other bodily mediations already involved in the follow-up of anorexia nervosa before it, establish the extent of its contribution to and value in this pathophysiology. [ABSTRACT FROM AUTHOR]

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Si l'amalgame anorexie masculine/psychose qui a longtemps prévalu dans la littérature psychiatrique classique doit donc être nettement relativisé, il n'en demeure pas moins que les relations entre anorexie masculine et psychose froide, psychose mono-symptomatique ou syndrome d'influence méritent d'être explorées pour les patients développant les symptomatologies les plus chronicisées. Des similitudes et des résonnances assez surprenantes seront établies à partir de l'analyse croisée des fantasmes d'un patient souffrant d'une anorexie mentale restrictive évoluant depuis l'âge de douze ans et des écrits autobiographiques ou littéraires de Franz Kafka témoignant de la présence d'un imaginaire singulier en lien avec des préoccupations alimentaires particulièrement envahissantes. Cette étude analytique comparative des fantasmes et des fantasmorphoses en jeu dans la problématique anorexique et dans l'univers kafkaïen met en exergue le rôle majeur de ce que Tausk a pu décrire sous les termes de « machines à influencer », celles-ci trouvant leur origine dans la projection du corps propre considéré dans son entier comme organe génital. Paradoxalement, ces machines à influencer, en agissant avant tout comme agent inhibiteur de la pulsion, contribueront surtout à affaiblir la virilité des sujets. Pour cerner les motifs d'un tel rejet du pubertaire et de la génitalité, il convient d'envisager un défaut de structuration du Surmoi, en lien avec un échec de la bisexualisation de ce même Surmoi. L'une des hypothèses cliniques développées est que cet échec ou cette dislocation de l'instance surmoïque s'avère responsable de l'advenue d'un idéal du Moi mégalomaniaque et asexué. Là où Kafka aura su puiser dans cet imaginaire des ressources créatives et sublimatoires, les modalités défensives sollicitées par les patients anorexiques développant les symptomatologies les plus inquiétantes ne suffiront généralement pas à masquer totalement l'impact déréalisant des fantasmorphoses ou les sentiments d'étrangeté induits par la présence sous-jacente de ces « appareils à influencer ». Although the amalgam of male anorexia and psychosis that has long dominated classical psychiatric literature needs to be put into perspective, the relations between male anorexia and "cold" psychosis, mono-symptomatic psychosis, or delusions of passivity nevertheless warrant further exploration in cases of patients who develop the most chronic symptoms. Rather surprising similarities and echoes will be shown through the cross-analysis of the fantasies of a patient suffering from restrictive mental anorexia since the age of twelve and the autobiographical and literary writings of Franz Kafka that attest to the presence of a unique imaginary world linked to particularly invasive preoccupations with food and eating. This comparative analytical study of fantasies and fantasmorphoses involved in the issues of anorexia and in Kafka's universe highlights the important role of what Tausk described as "influencing machines," which originate in the projection of one's own body considered in its entirety as a genital organ. Paradoxically, these influencing machines, by acting primarily as inhibitors of the drives, will mainly contribute to a weakening of the subjects' virility. To identify the reasons behind this rejection of the pubertary process and genitality, we must consider that there is a defect in the structuring of the Superego, associated with a failure of bisexualization in this same Superego. One of the clinical hypotheses offered is that this failure or dislocation of the agency of the Superego is responsible for the emergence of a megalomaniacal and asexual Ego ideal. Whereas Kafka was able to draw creative and sublimatory resources from this imaginary world, the defensive modes elicited by anorexic patients who develop the most troubling symptoms will generally not be enough to completely conceal the de-realizing impact of fantasmorphoses or the uncanny feelings caused by the underlying presence of such "influencing machines." [ABSTRACT FROM AUTHOR]

Les caractéristiques usuelles de l’anorexie mentale — inanition, amaigrissement, aménorrhée — justifient que celle-ci soit prise en compte, du point de vue psychopathologique, bien plus en tant que “clinique de l’objet” que comme “dysfonctionnement alimentaire” ou “trouble de la représentation corporelle”. En effet, est mis ainsi en lumière non seulement le fait que la nourriture y vient présentifier l’“objet du désir” sous la forme du “rien”, mais aussi le fait que si le corps du sujet anorectique se consume, c’est parce qu’il est le siège d’une jouissance spécifique de la position féminine, d’une “jouissance Autre”, qu’il contribue paradoxalement de la sorte à contenir et à pacifier.

The epidemiology of Eating Disorders (ED) suggests that the issues involved in these conditions are largely related to the broader issues of femininity and the formation of psychic and bodily gender identity during adolescence. In this article, we will specifically address the issues of affect regulation, insecure attachment, the role of emotional conflicts, parental psychopathology, and family dynamics in this population of patients. Our psychopathological perspective will also focus on the transgenerational aspects of identification with the imaginary quest for identity and bodily lineage, as well as the specific role of bodily experience in the construction of awareness of femininity and motherhood. We will conclude that this prison, in which the individual is both prisoner and co-jailer with their own body, is not merely a mental prison. [ABSTRACT FROM AUTHOR]

The number of minors who believe they are „the wrong gender“ and seek sex reassignment has increased exponentially in recent years. It is striking that over 80 percent of affected gender dysphoric adolescents who wish to undergo body modification procedures and legal measures are now girls. The draft of the so-called „Self-Determination Act“ (Self-ID) stipulates that minors who have reached the age of 14 should be able to submit a corresponding application to the relevant registry office without any preconditions. In view of this, it is all the more important to analyze the causes of the observed epidemiological shifts. Above all, it must be critically reflected whether transgender identification might also be a maladaptive solution strategy for quite a few adolescent girls to avoid the pressure from the significant developmental tasks and adjustment requirements of female puberty. In order to gain a deeper understanding of this point, it is helpful to look at the analogies between a newly occurring gender incongruence that first manifests itself in early or middle adolescence and anorexia nervosa, and to work out the underlying developmental psychological causes of female puberty and adolescence in particular. Based on this, and following a brief discussion of different approaches to the treatment of gender dysphoric children and adolescents, possibilities for medical prevention are presented. [ABSTRACT FROM AUTHOR]

Anorexie

L'anorexie mentale

Cette réflexion anthropologique s’appuie sur une recherche menée auprès de jeunes garçons, de 13 à 25 ans, cloîtrés dans leur chambre. Leur immobilité, que ne justifie aucun handicap physique ou psychique, interroge la place du corps au moment du passage à l’âge adulte. Ces jeunes expriment une absence d’appétit de l’autre qui va de pair avec l’abstinence sexuelle que leur retrait oblige. L’hypothèse émise est qu’ils vivent un rapport au corps, à leur identité sexuelle - et à leur sexualité- ainsi qu’à l’alimentation, comparable aux jeunes filles souffrant d’anorexie mentale mais de manière inversée. Ces conduites interrogent les rapports de genre et la distribution des rôles au sein de la famille. À partir d’entretiens et d’observations, à domicile et dans des structures de soin, cet article montre que ces corps adolescents invisibilisés par l’enfermement ou l’extrême maigreur sont paradoxalement une expression ostentatoire d’une dépossession de soi. Un appétit nouveau est possible lorsque le désir de différenciation émerge et permet de nouvelles rencontres.

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Les médecins généralistes sont les acteurs privilégiés du repérage des troubles des conduites alimentaires (TCA) qui touchent entre 0,6 et 4,5 % de la population au cours de sa vie. Alors qu'un dépistage précoce améliore le pronostic, moins de la moitié des patients concernés sont repérés en ambulatoire. Explorer les représentations des médecins généralistes au sujet des TCA et les obstacles ressentis à leur abord en pratique. Une étude qualitative a été réalisée par focus group afin de comprendre ce sous-dépistage. Les cinq focus group nécessaires à l'atteinte de la saturation des données ont été transcrits et le verbatim a été analysé par théorie ancrée après un double codage. L'anorexie mise au premier plan, un BED méconnu et l'idée erronée que l'obésité appartient aux TCA constituaient les représentations les plus présentes chez les MG interrogés. Ils considéraient les TCA comme relatifs à l'intime du patient au même titre que la sexualité, craignant d'être trop intrusifs en les abordant et de mettre à mal la relation patient-médecin. L'aspect chronophage de la consultation, la méconnaissance des outils, le sentiment de manquer de compétences en communication et en psychologie, d'être démuni et la carence de réseau d'aval psychiatrique faisaient obstacle à l'abord des TCA en consultation. Une formation brève à des techniques communicationnelles, l'organisation d'une consultation de dépistage dédiée, une filière de prise en charge formalisée ou le remboursement des psychothérapies seraient des pistes pour un meilleur repérage des TCA. Étudier les représentations de la psychiatrie serait un premier pas pour vaincre la défiance à son égard. General practitioners (GP) are the most suitable candidates to screen for eating disorders (ED), which affect 0.6 to 4.5% of the population over their lifetime. 13% of adolescents are concerned if we consider sub-syndromic form. The outcome of ED improves with early detection but 50% of patients are still not identified in primary care. To explore GP's representations of ED and the barriers they face while broaching the subject in practice and to understand this under-screening of ED. It was a qualitative study by focus groups. The five focus-group need for data saturation were transcribed and the verbatim was double coded and analyzed by the grounded theory. The focus on anorexia nervosa, a BED remaining unrecognized and the misidentification of obesity as an ED were the main representations of the asked GPs. They considered ED as being bound to the intimacy of patients, just as sexuality would be, they feared to be too intrusive while approaching them and to compromise the patient-doctor relationship. The time-consuming part of such consults, the unknown assessment tools, a perceived lack of communication and psychological skills, the feeling of helplessness and lack of a psychiatric support stood in the way of approaching ED in general practice. Training for time-saving communication techniques, organizing a dedicated screening consult, a well identified psychiatric network or free psychotherapy sessions are ways to improve screening of ED. To study how psychiatry can be more positively perceived would be a first step to overcome its induced mistrust. [ABSTRACT FROM AUTHOR]

Créée en 2010, la première équipe mobile pour les troubles des conduites alimentaires (EMTCA), rattachée au Centre Hospitalier Guillaume Régnier (EPSM) à Rennes est née de la volonté de travail sur des modalités de proximité, d'accès facilité aux soins, d'une idée de l'« aller vers » comme les autres équipes mobiles plus habituellement dédiées à la précarité, aux enfants et adolescents, et en général aux situations de crise. Cette équipe fonctionne avec réactivité, souplesse, et adaptabilité dans cette clinique particulière. Population Patients souffrant de toutes les formes de TCA mais en particulier d'anorexie restrictive, anorexie boulimie, et boulimie, âgés de plus de 16 ans, sans limite d'âge supérieure, sans limite d'IMC, venant spontanément ou adressés par des partenaires institutionnels (dans le champ social, scolaire, etc.), par la famille ou des proches inquiets. Missions Elles sont centrées sur le domaine des TCA avec notamment la coordination des soins somatiques et psychiques entre des partenaires parfois multiples et appartenant à des cultures et institutions variées (établissements publics ou privés, professionnels libéraux, enseignants, familles, etc.) dans un réseau local, régional et national. On peut citer les missions suivantes : travail de liaison hospitalière et de réseau avec les équipes sanitaires et sociales; consultation en différents lieux afin d'évaluer la situation, d'apprécier la reconnaissance et l'évolutivité des troubles, le parcours de soins et orienter; coordination de soins complexes; soutien de l'entourage (la place donnée à l'entourage est essentielle); formation et information des différents partenaires. Fonctionnement Une pluridisciplinarité de l'équipe est nécessaire : psychiatre, psychologue, infirmière, assistante sociale, diététicienne. L'urgence étant fréquente (somatique et/ou psychique), un temps de réactivité rapide est essentiel, ainsi que garantir une sécurité dans la prise en charge avec la présence d'un référent somatique indiqué par les patients (médecin traitant, et si nécessaire nutritionniste en lien avec l'équipe mobile). L'infirmière est la personne souvent en première ligne lors de la rencontre, mais les réunions hebdomadaires et temps d'échange avec l'équipe limitent le risque de se retrouver seuls dans une prise en charge complexe. De fait, la référence au psychologue et au médecin en garant médical des soins est une nécessité, ce d'autant lorsqu' il existe une particulière fragilité somatique et/ou psychique. Travail en réseau Le réseau spécialisé est très important dans ce domaine spécifique. Ainsi l'EMTCA peut faire le lien entre les interlocuteurs ressources pour différents soins spécialisés, qu'ils soient locaux, régionaux ou nationaux. Ce lien partenarial est multiple : liens avec les soins somatiques et psychiques, la médecine libérale et en général les soins libéraux dans plusieurs spécialités, l'Éducation nationale, etc. À noter, un travail conséquent est réalisé sur les âges de transition (changements d'interlocuteurs à 16 ans). Nombre, durée et lieux d'intervention Chaque cas est individualisé, sans limite de durée, ni d'âge. La mobilité de l'équipe permet de se déplacer à domicile mais aussi dans les différents lieux où travaillent les professionnels du réseau. Les principaux lieux de rencontre sont le domicile (sur prescription du médecin de l'équipe), les bureaux sur le pôle de rattachement de l'EMTCA, l'unité d'hospitalisation, enfin tout lieu où l'échange peut se faire de façon sereine pour la personne (cabinet du médecin généraliste, lycée, CDAS, etc.). Si un relais est passé à une autre équipe, nous gardons alors la possibilité d'être rappelés et d'intervenir à tout autre moment nécessaire. Conclusion Nous avons été longtemps la seule équipe mobile TCA en France, même si des équipes mobiles notamment en psychiatrie de l'enfant et de l'adolescent rencontraient des patients TCA. Aujourd'hui des projets d'EMTCA se développent adossés à une hospitalisation à temps complet ou en hôpital de jour spécialisé. Des perspectives de partage d'expérience sont particulièrement intéressantes, par rapport à la diversité des parcours et innovations, chaque contexte amenant une créativité différente même si des outils communs nous rassemblent. [ABSTRACT FROM AUTHOR]

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Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.

We report the case of a 30-year-old woman presenting with fatigue, loss of weight, nausea, emesis and hyponatremia. The evaluation proved Addison's disease due to an autoimmune polyendocrine syndrome type 2 with Hashimoto thyreoiditis. Under substitution with hydrocortisone and fludrocortisone all the symptoms subsided completely. [ABSTRACT FROM AUTHOR]

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This paper addresses some articulations between mental anorexia and the so-called “non-violent” suicides in two moments of Lacan’s teaching. Initially, it makes a delimitation of the “violent” and “nonviolent” to be able to tackle, in a second time, the elaboration of suicide linked to the latter. Later, it places anorexia in Lacan’s subsequent developments on the separation process. This will allow us to highlight the structural homology of these elaborations in different coordinates of Lacan’s teaching. Finally, it will extract some ethical consequences from what has been proposed for the direction of the treatment of this kind of subjective suffering. [ABSTRACT FROM AUTHOR]

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This article presents the example of a clinical case that we face more and more often in the clinic, namely the associated pathology between depressive disorder and anorexia nervosa. It is necessary to focus our attention on the importance of mental health and how it influences our personal, family and social life, to notify early when an illness occurs and to intervene early in therapy, until it is not too late. These two disorders may have its base on a multifactorial etiology (genetic, biological, socio-cultural, psychological, etc.), which can evolve into different mental disorders, but when we are dealing with patients with these 2 associated disorders, we ask the first question that arose as a drug therapy. and especially the psychotherapy we use to have the desired effect in the shortest possible time, to identify what is the cause and what is the effect. [ABSTRACT FROM AUTHOR]

This reflective paper seeks to think about and question anorexia and bipolarity, not as nosological categories, but concerning the affective economy of the subject based on the object relation. It is proposed to con sider anorexia in relation to the hyperabsence of the object: the subject eats nothing; while bipolarity as a circuit in which the subject moves from the hyper-presence to the hyper-absence Recibido: 20/05/2019 • Aprobado: 10/09/2019 of the object: the subject is trapped in the mania-melancholia circuit. [ABSTRACT FROM AUTHOR]

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This paper intends to elucidate anorexia in the hysterical structure, emphasizing on the particular relationship that the subject establishes with the Other and desire in the creation of that symptom. Anorexia is taken by the subject as a radical strategy of separation from the Other, a way of high costs for the subject, and it is worth mentioning that many times it is paid with their own life. Such posture of the anorexic points, in that way, towards the paradoxical radicality of their attachment to the Other's desire. [ABSTRACT FROM AUTHOR]

The interest for the concept of jouissance (enjoyment) stems from the difficulties encountered in the management of eating disorders. When looking at the active part of the symptom, that which gives an impression of dependence on the behavior, an attachment to the disease, we stumble upon its main root. The anorexic jouissance could reveal a heuristic concept to grasp the satisfaction that the subject gets from his symptom. Indeed, enjoyment is defined as something that escapes from the sexual conceptions, or even from the logic of pleasure. From Freudian artwork, this is what leads to an experimental zone, heterogeneous to language, determined by the search for excitement, transgression, violence, until the psychic disintegration, and that Jacques Lacan understands as a place for subversion of the law. By the way, Lacan defines the "female jouissance" as a mystical experience that is out of the genital organization. Basically, this opening on primary experiences, where eating symptoms reveal their intersubjective economy, related to the request for love. [ABSTRACT FROM AUTHOR]

Throughout her life, a woman's body will grow, get older, be modified, transform. Such periods of body transformation, as represented by puberty or pregnancy, can be times of major changes for women, both physically and psychologically. The question of close links between body and psyche becomes even more meaningful when studying the psychopathology of patients suffering from anorexia nervosa, and notably when they get pregnant and are about to bear a child. We propose in this article to describe the place of the body in anorexia nervosa, both in its concrete reality and depending on the representations it is subject to. We then choose to detail the motherhood experience of pregnant women suffering from anorexia nervosa with a prominent narcissistic investment. Finally, we consider the history, the feelings and the fantasies of these patients, next to the metamorphosis of the body caused by pregnancy. [ABSTRACT FROM AUTHOR]

Although eating disorders are a public health issue, treating anorexia nervosa from a demographic and socio-economic perspective remains a challenge. Data are scarce, patchy and often of questionable quality. Such a lack of data on a somatopsychic illness with serious repercussions is a real problem, since reliable, longitudinal and detailed information could provide additional answers in understanding the illness, both in terms of age, sex and gender structure, and in terms of family, social and environmental factors., (Copyright © 2023. Published by Elsevier Masson SAS.)

The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which together become almost pathognomonic: excessive restriction of energy intake combined with an irrational fear of weight and an altered body image. Even if weight is at the heart of the medical team's concerns, it is important to question the pathology in its history, in order to put it in to context, and sometimes to understand the para-logic and its function in the patient's life history. It is necessary to work on emotions and cognitions in addition to behaviour., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The article inquires into the places of hate and the superego in the corporal constitution of anorexic subjects, in whom it is possible to observe disturbances in the way they perceive their bodies, thus leading us to inquire into the narcissistic image. We also observed that hate, as a passion revealed through the superego, prevails in the shaping of the body of the anorexic subject. In developing our inquiry, we specify the influence of the Ideal of the ego and superego on the shaping of the image; we address the relation between the superego and hate, love, and ignorance; and we delve into the articulation between the body in anorexia and hate as an ideal. These reflections allow us to draw several conclusions. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Les approches cognitivistes de l'anorexie insistent sur l'image déformée du corps chez les patients. L'expérience corporelle est ainsi réduite à sa représentation mentale. Dans ce travail, nous proposons d'approcher l'anorexie selon une démarche phénoménologique. La phénoménologie, au contraire des approches cognitivistes, invite à considérer l'expérience corporelle à partir d'elle-même. Méthode En suspendant les abstractions explicatives (neurobiologiques, psychanalytiques, cognitivistes) et sur la base de deux cas cliniques, nous étudions la manière dont se réorganise le sens de l'expérience du sujet dans l'anorexie. L'analyse s'inspire des travaux phénoménologiques de Edmund Husserl et Jean-Paul Sartre, de la sociologie de Pierre Bourdieu et, plus indirectement, de la théorie de l' embodied cognition. Résultats L'analyse phénoménologique de l'expérience ordinaire permet de souligner la réduction, dans l'anorexie, du vécu corporel aux sensations et à la représentation mentale du corps. Les patientes souffrent moins d'une image biaisée du corps objectif que d' une perte de l'évidence corporelle , associée à un investissement massif de la représentation du corps. Par « évidence corporelle » est désigné le rôle du corps en tant que vecteur tacite de participation au cours du monde. Discussion Envisager l'anorexie comme perte de l'évidence corporelle conduit à interroger les conceptions cognitivistes qui négligent l'expérience corporelle au profit de sa représentation. La démarche cognitiviste redouble ainsi la stratégie anorexique, qui associe, à la perte de l'engagement charnel et sensuel dans le monde, un surinvestissement du corps représenté. Conclusion L'approche phénoménologique de l'expérience anorexique nous conduit à bien distinguer le corps souffrant et agissant de la notion d'« image mentale », que l'on substitue trop souvent à l'expérience vive du corps propre. D'une manière générale, elle invite ainsi à se tenir au plus près de la constitution de l'expérience subjective. Abstract Aims Cognitive approaches to anorexia are centered on the notion of a distorted body-image entertained by patients. The bodily experience is thereby reduced to a set of mental representations. In this article, we outline a phenomenological exploration of anorexia. In contrast to cognitivist approaches, phenomenology is an attempt to understand the bodily experience in its own terms. Method On the basis of two case studies, and setting aside abstract explanations (neurobiological, psychoanalytical, cognitivist), we study how the person's actual experience is meaningfully reorganized in anorexia. Our analysis draws on the phenomenology of Edmund Husserl and Jean-Paul Sartre, the social theory of Pierre Bourdieu and, more indirectly, the theory of embodied cognition. Results The phenomenological analysis of everyday experience underlines how, in anorexia, bodily experience is reduced to a set of sensations and mental representations of the body. Patients are less prone to a distorted image of the objective body than to a loss of bodily evidence , linked to an excessive focus on representation of the body. By "loss of bodily evidence", we mean the role of the body as the tacit vehicle through which the person takes part in the doings of the world. Discussion Understanding anorexia as a loss of bodily evidence entails a critique of cognitive theories that neglect the living bodily experience in favor of mental representations of the body. Cognitive theory thus replicates the anorectic process, a process in which the carnal and sensual implication in the world is lost, while the body-image is over-emphasized. Conclusion Our exploration of the anorectic experience leads us to clearly distinguish the suffering and acting body from the notion of the "mental image", too often substituted for the living bodily experience. Phenomenology is an invitation to remain close to the actual constitution of subjective experience. [ABSTRACT FROM AUTHOR]

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Copyright of Zeitschrift für Psychodrama und Soziometrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Usually patients with nasopharyngeal carcinoma have weight loss due to the tumor itself and to the radiochemotherapy. Weight loss increases the incidence of complications during the treatment, influences the performance status and the prognostic of the disease. The aim of this retrospective study is toinvestigate the influence of BMI, age, histological type of NPC and stage of disease on the prognostic of patients with nasopharyngeal carcinoma. Methods: We analyzed 27 patients with nasopharyngeal cancer, admitted in Medical Oncology Clinic of Elias University Emergency Hospital between2010-2015. All patients undergo radiotherapy with concurrent chemotherapy, adjuvant chemotherapy and gene targeted therapy. We calculated BMI before the beginning of the treatment. Results: We remarked that normal and overweight patients had the best results at 3 years after the treatment. 78% of patients with complete response post radio-chemotherapy had complete remission at 3 years after finishing treatment. Underweight patients had the worse results and poor prognostic due to higher rates of tumor remnants or local-regional recurrence Conclusions: Nutritional status has an important impact over the response rate and tolerance of the treatment, performance status and quality of life. Being associated with a poor prognostic, cachexia must be treated properly, in order to improve patient's physical and functional status, quality of life and overall survival. [ABSTRACT FROM AUTHOR]

We chose anorexia as a clinical field to elucidate what particularizes the contemporary neurotic way of relating to objects. Based on a theoretical-conceptual survey on anorexia in Freud and Lacan's psychoanalysis, we find that anorexia is mostly defined as an inscription in the literalness of the body, of the lack that makes desire move towards hysteria. That psychopathology of the oral drive circuit refers to a precarious defensive response to an Other who is fragile in his symbolic function that transmits castration. We revisit and discuss this interpretation in the light of the features of today's society, highlighting the incidence - in contemporary neuroses - of a phantasmatic position inclined toward the logic of the unsatisfied consumer and the banal denial of symbolic authority. [ABSTRACT FROM AUTHOR]

The paper from psychological praxis presents two case studies of clients who have sought professional help because of their problems with obsessive exercise having a negative impact on their personal and work life and affecting both their health and mental state. In today's society that puts great pressure on performance and physical appearance, the regular exercise as part of a healthy lifestyle is a desirable strategy for increasing strength and perseverance. It can therefore be easy to appreciate even the excessive exercise and to consider it a proof of physical and mental strength. In the following case studies, it is obvious that both women did not realize the real impact of their behavior until after several years of intense day-to-day workouts lasting from three to six hours a day, when they had to organize their personal and work life around exercise units instead of working out for health or joy. The first case study presents a problem of obsessive exercise as a compensatory mechanism in a client with a history of anorexia nervosa, currently suffering from binge-eating disorder. The second case study looks at obsessive exercise as a form of the addiction syndrome in a client with a family history of alcohol addiction and a personal history of features of alcohol addiction. Different causes and development led to different intervention procedures in both cases, which are described in the study. The main factors of an effective treatment were clients´ self-awareness of the need for help, strengthening the social support system, and intervention based on the real causes of obsessive exercise in terms of either addiction or compensation of binge eating. [ABSTRACT FROM AUTHOR]

Objective: This pilot study conducted an open trial of a manualized adaptation to Family-Based Treatment for Transition Age Youth (FBT-TAY) for Anorexia Nervosa (AN). The aims were: (1) determine the acceptability of FBT for TAY; and, (2) establish preliminary effect sizes for the impact of FBT-TAY on eating disorder behaviour and weight restoration. Method: Twenty-six participants across two paediatric and one adult hospital site were recruited to participate. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at the start of treatment, the end-of-treatment, and three-month follow-up. Results: FBT-TAY is an acceptable and feasible treatment to all study therapists as evidenced by their fidelity to the model. FBT-TAY is a feasible and acceptable intervention to transition age youth, given only 27.27% chose treatment as usual over FBT-TAY. Participants presented significant improvement at end-of-treatment and threemonths post-treatment (p < .001; ES = 0.34) from baseline on the EDE-Q Global Score. Participants also achieved and maintained weight restoration at the end-of-treatment and three-months post-treatment when compared to baseline (p < .0001, ES = 0.54). Conclusions: FBT-TAY, the first manualized AN treatment for TAY, demonstrated feasibility and acceptability with therapists and participants as well as improvement for participants in EDE-Q global score and weight. Given the current dearth of effective treatments for TAY with AN, FBT-TAY is a promising adaptation of FBT. A larger clinical trial with a 12-month follow-up is recommended. [ABSTRACT FROM AUTHOR]

The correlation between melancholic states and the psychopathology of eating disorders has been observed since the early days of psychoanalysis, and continues to be observed today. To update the research on the consequences of the melancholic position in the clinic of the anorexia, bulimia and obesity, we revisit the object relation metapsychology of these psychopathological states. We believe it can be of use to elucidating a possible phantasmal pattern in the symptomatic configurations of the different kinds of anorexia, bulimia and obesity. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude À partir de huit situations cliniques de troubles du comportement alimentaire en Chine, pays vivant de nombreuses mutations, nous interrogeons l’impact des changements sociétaux rapides sur ces troubles. Méthode et population Nous présentons toutes les patientes hospitalisées pour un trouble du comportement alimentaire lors du stage d’un médecin français au centre de santé mentale de Shanghai, de décembre 2015 à janvier 2016. Une analyse thématique qualitative a été réalisée et les résultats ont été interprétés avec la méthode complémentariste, c’est-à-dire en utilisant une lecture psychiatrique et anthropologique. Résultats Six thèmes et deux mécanismes principaux ont été identifiés et semblent en lien avec le développement des troubles du comportement alimentaire en Chine : l’impact des changements socioculturels et le conflit identitaire culturel. Discussion Les changements sociétaux rapides auraient pour conséquences une acculturation avec l’adoption de l’idéal de minceur occidental, un changement du rôle des femmes, une pression scolaire, des difficultés relationnelles, ce qui pourrait vulnérabiliser au développement des troubles du comportement alimentaire en Chine. Les différences intergénérationnelles entre les parents et les enfants en Chine ont pour conséquence un conflit identitaire culturel qui pourrait fragiliser la construction identitaire, induirait des difficultés d’autonomisation et des difficultés familiales qui sont des facteurs de risques de développer un trouble du comportement alimentaire. La thérapie familiale adaptée aux Chinois semble pertinente ainsi qu’un soutien à la parentalité. Conclusion La connaissance des troubles du comportement alimentaire dans divers contextes culturels et l’approche transculturelle permettent de mieux comprendre ces troubles, d’améliorer l’approche thérapeutique et l’alliance. Background Eating disorders were long considered as a culture-bound syndrome specific to western countries. However, studies reported results for anorexia in other cultural areas such as China, where its prevalence and incidence is rising. This suggests that anorexia is rather a culture-change syndrome arising during fast sociocultural changes. Adaptation to those changes may contribute to the increasing prevalence of eating disorders. Furthermore, transcultural psychiatrists consider that acculturation and culture clash (conflict between different cultural models) are risk factors for developing eating disorders; but they are less transcultural studies about bulimia. Clinical cases of eating disorders studied around the world showed a great variability in symptoms and psychopathology. Therefore, the role of cultural played and transcultural factors in the increase in eating disorders needs to be defined. Method and population Based on a qualitative study of eight clinical cases of eating disorders in China, a country and a society undergoing and experiencing a lot of fast sociocultural changes, our work aims to show the impact of cultural and transcultural factors on eating disorders, and takes into account the psychopathology and the symptomatology. Patients were hospitalized in Shanghai Mental Health Center and observed during the internship of a French resident in psychiatry. Results Cultural factors accounted for the symptomatology differences identified with the Western country eating disorders such as: the variability of fat phobia, weight concern, and the absence of denial of thinness. The one child policy bears responsibility for eating disorders in China by improving the academic stress, changing the socialization context, impacting the affiliation process and the family context. Acculturation to western values such as the adoption of an ideal of thinness, growing autonomy claims, and desire for success favors the development of eating disorders. A cultural clash emerges as a consequence of contradictory expectations, of Chinese women's moving roles and of intergenerational gaps between parents and children; all these factors contribute to weaken the identity building, inducing individuation difficulties and parenthood difficulties. Eating disorders in China are also a means to protest against the family. Therefore, family therapy adapted to the Chinese setting seems relevant, together with a specific support for parenthood. Conclusion Knowledge about eating disorders from around the world and the transcultural approach enable a better understanding of these disorders, an enrichment of the diagnostic and therapeutic approach for eating disorders and an improvement of the therapeutic alliance. [ABSTRACT FROM AUTHOR]

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COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.