Les troubles du comportement alimentaire (TCA) touchent une part importante de la population et constitue un réel problème de santé publique, il est indispensable d’approfondir nos connaissances sur la physiopathologie des TCA afin d’identifier des perspectives thérapeutiques. L’écriture d’une revue systématique a permis d’évaluer la prévalence des TCA selon le sexe, l’origine géographique ou l’âge de la population étudiée et confirme son augmentation au cours des 15 dernières années. L’analyse des données épidémiologiques des patients avec un TCA de la cohorte Eating Disorder and Longitudinal Survey (EDILS) a souligné le stress et le régime alimentaire comme facteurs de survenue et des similarités entre les comorbidités des 3 catégories larges de TCA (Restrictive, boulimique et compulsive). Ces comorbidités étaient fortement associées entre elles et, selon un cercle vicieux pourrait contribuer au maintien de la physiopathologie des TCA. La littérature suggère l’implication d’une dérégulation peptidergique de la prise alimentaire au cours des TCA qui pourrait inclure un mécanisme immunitaire. Les analyses des échantillons plasmatiques de la cohorte ont permis de mieux définir les profils biologiques de peptides et immunoglobulines associés aux 3 catégories larges de TCA et d’évaluer leur utilité pour le phénotypage des patients. La collecte de selles dans la cohorte offre également la possibilité de préciser les profils de microbiote au cours des différents types de TCA. Cette thèse a donc permis de mieux définir les caractéristiques cliniques des TCA et les perturbations de l’axe microbiote-intestin-cerveau associées, en particulier les dérèglements biologiques. / Eating disorders (ED) affect a large population and are a serious public health issue. It is thus essential to deepen our knowledge of ED pathophysiology in order to open new therapeutic perspectives. The prevalence of ED according to sex, geographical origin or age of the study population and its increase over the last 15 years has been highlighted in a systematic review. The analysis of patients with ED from the Eating Disorder and Longitudinal Survey (EDILS) cohort underlined stress and / or diet as triggering factors and noted similarities between the comorbidities of the 3 broad categories of ED (Restrictive, bulimic and compulsive). These comorbidities were strongly associated with each other, and contributed in a vicious circle to the perpetuation of ED. The literature suggests during ED a dysregulation of neuropeptide signaling of food intake that may include some immunological mechanisms. Analyzes of plasma samples from the EDILS cohort allowed a better definition of the peptides and immunoglobulins profiles associated with the 3 broad categories of ED and to evaluate their utility for phenotyping patients. The collection of feces in the cohort offers the possibility of refining the specificity of the microbiota according to different type of ED. This thesis allows to better define the clinical characteristics of 3 broad categories of ED and disturbances of the microbiota-intestine-brain axis, particularly the associated biological dysregulations of neuropeptide signaling.

The diploma thesis is focusing on the topic of eating disorders in young men. The literature review summarizes the current information concerning eating disorders in this population. Eating and feeding disorders included in DSM - 5 are described. The thesis also focuses on orthorexia nervosa and muscle dysmorphia. A separate chapter deals with body image in men and its connection to eating disorders. The final chapter of the literary review section is focused on the possibilities of diagnostics and therapy. The empirical part of the work consists of a quantitative research conducted on a sample of 164 men aged 18-30 years. A questionnaire survey was carried out. Using Spearman's correlation coefficient, a significant correlation was found between the symptomatology of eating disorders and muscle dysmorphia. There was also a significant correlation between Body Mass Index and the symptoms of eating disorders and also between BMI and muscular dysmorphia. Data analysis revealed a positive correlation between the higher symptomatology of eating disorders and dissatisfaction with the amout of body fat. No significant relationship was found between the symptomatology of eating disorders and dissatisfaction with muscle mass. There was a significant correlation between Body Mass Index and dissatisfaction...

Title: Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis Objective: Eating disorders, such as bulimia nervosa (BN) and anorexia nervosa (AN), are characterized by abnormal eating behavior. The main features of BN are binge-eating and inappropriate compensatory methods to prevent weight gain. The appetite-modulating peptide ghrelin is secreted by the stomach and shows a strong release of growth hormone (GH). A potential GH-ghrelin feedback loop between stomach and the pituitary has been recently reported. Acipimox (Aci), an analogue of nicotinic acid, inhibits lipolysis in adipose tissue (AT) and reduces plasma glycerol and free fatty acids (FFA) levels. Exercise and Aci are stimulators of GH secretion. We suppose that a negative feedback from increased GH levels during exercise may play a role in reducing plasma ghrelin levels. We surmised that altered baseline activity and exercise-induced activation of the sympathetic nervous system (SNS) results in excessive stimulation of lipolysis associated with negative energy balance and may lead to abnormal AT metabolism in patients with BN. Disruption of the gut-brain-AT axis might be involved in the pathogenesis of BN. The...

Title: Kinesiotherapy in the treatment of patients with eating disorders Summary: The aim of our experiment was evaluate the effect of kineziotherapy (psychomotor therapy) on body image in the treatemnet of the patiens with eating disorders in The Department of Psychiatry on General University Hospital in Prague. The study included 10 women divided into two groups according to the psychiatrist`s diagnosis of anorexia nervosa and bulimia nervosa. The effectiveness of kinesiotherapy was also evaluated about the type of treatment - inpatient of the department for eating disorders and outpatient of the day care institution for eating disorders. We used a validated questionnaire Body Attitude Test (BAT) which is used for negative evaluation of body size, lack of familiarity with one`s own body and general body dissatisfaction. Then we used Test of silhouette according to Stunkard and Test for the evaluation of sensory stimuli according to Petrie. Due to the small sample size, we supplemented the quantitative part with the qualitative interview with open questions. It allowed us to understand the interaction of individuals with their own body. Keywords: anorexia nervosa, bulimia nervosa, kinesiotherapy, psychomotor therapy, body image, Body Attitude Test, Petrie`s test, Stunkard`s test of silhouette, structured...

Despite well-established diagnostic measures and measures of specific dimensions of eating disorder symptomatology, little work has been done to develop a brief, comprehensive, and valid measure for assessing change in eating disorder symptoms. Further, empirically-supported change indices to assess treatment progression and outcome have not yet been developed. The Change in Eating Disorder Symptoms Scale (CHEDS) is a new comprehensive measure designed to assess progress and change during treatment in persons with diagnoses on the eating disorder spectrum. Previous studies have demonstrated the subscale structure, reliability, and validity of the CHEDS. This study determined clinically significant change criteria for the CHEDS to complement the studies that have supported the CHEDS as a reliable and valid measure of eating disorder symptomatology. The CHEDS was also compared to a life functioning scale, the Clinical Impairment Assessment. A reliable change index (RCI) was developed, which generated an inferential statistic that estimates the magnitude of change in a score necessary for a change score to be considered statistically reliable. A cutscore was also developed, which differentiates between functional and dysfunctional populations, between eating disordered clinical subjects and non-clinical subjects. Trajectories were identified using hierarchical linear modeling methods for use in conjunction with clinical significance criteria to aid in the tracking of symptoms during treatment, treatment decision-making, and tailoring treatment according to expected and observed progress. The clinical significance change criteria were then applied to the clinical sample to determine change patterns descriptive of recovered, reliable improvement, deterioration, and no change. Finally, a scoring program with clinical significance change criteria and trajectory analyses for total and subscale scores was developed.

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Il s'agit d'une hypothèse largement répandue que l’égo-dystonie et l’égo-syntonie caractérisent les obsessions dans les troubles des conduites alimentaires (TCA) et que ces facteurs sont cliniquement pertinents pour la conceptualisation et le traitement des TCA. Cependant, les résultats empiriques sur ce sujet sont rares. Compte tenu du chevauchement reconnu entre les TCA, notamment l'anorexie et la boulimie (BN), et le trouble obsessionnel-compulsif (TOC) dans la phénoménologie et les caractéristiques psychologiques, un programme de thérapie cognitive basée sur les inférences (TBI) de 24 semaines, démontré efficace dans le traitement des TOC, a été adapté pour traiter les TCA. La recherche sur le TOC suggère que la transformation des pensées intrusives en obsessions est liée à la mesure dans laquelle les pensées intrusives menacent des perceptions fondamentales du soi et de l’identité. Cette thèse a pour objectif d'examiner le lien entre l’égo-dystonie et les TCA. Pour se faire, nous avons exploré le lien entre la nature égo-dystone des obsessions chez les patients souffrant d'un TCA et la peur de l'image de soi. Nous avons également étudié la relation entre la sévérité des symptômes TCA et l’égo-dystonie dans les obsessions. En outre, nous avons investigué les différences dans la présence de pensées égo-dystones et de peur face à son identité entre des sujets non-cliniques et des personnes atteintes d’un TCA. Enfin, nous avons comparé le degré d’égo-dystonie dans les pensées de personnes atteintes d’un TCA à celui dans les pensées d’individus souffrant d’un TOC. L’égo-dystonie dans les pensées a été mesurée par l'Ego Dystonicity Questionnaire (EDQ) et le degré de peur face à l’identité a été mesuré par le Fear of Self Questionnaire (FSQ) d’une part dans un échantillon de femmes souffrant d’un TCA (n = 57) et d’autre part dans un échantillon de participantes non-cliniques (n = 45). Les résultats révèlent que l’égo-dystonie et la peur face à l’identité étaient fortement corrélées à la fois dans l’échantillon clinique et non-clinique. Les scores de l’EDQ n’étaient pas significativement corrélés à la sévérité des symptômes TCA à l'exception de la sous-échelle d’irrationalité de l’EDQ qui était fortement associée à la sévérité des comportements compulsifs compensatoires. Les participantes souffrant d'un TCA avaient des scores significativement plus élevés à l’EDQ et au FSQ que les sujets non-cliniques. Ensuite, une étude de cas décrit l’application du programme de thérapie cognitive TBI pour une femme de 35 ans avec un diagnostic de BN. La pathologie TCA s’est significativement améliorée au cours de la TBI et six mois suivant la thérapie. Cette étude de cas met en évidence l'importance de cibler les idées surévaluées, les doutes et le raisonnement face au soi et à l’identité dans le traitement psychologique pour les TCA. Enfin, l’objectif final de cette thèse était d’examiner les changements au niveau (1) des symptômes TCA, (2) du degré d’égo-syntonie dans les obsessions, et (3) des mesures de peur face à l’identité, de motivation, d’humeur et d’anxiété au cours de la TBI et au suivi post six mois. L’égo-dystonie, la peur face à l’identité, les symptômes TCA et le stade motivationnel ont été mesurés chez 15 femmes souffrant de BN au cours du traitement et six mois après la TBI. Quatre vingt pourcent de l’échantillon, soit 12 des 15 participantes, ont démontré une diminution cliniquement significative des symptômes TCA et 53% ont cessé leurs comportements compensatoires au suivi post six mois. Les retombées cliniques relatives au traitement des TCA sont discutées. / There is a widely held assumption that both ego-dystonicity and ego-syntonicity characterize obsessions in eating disorders (EDs), and these factors are clinically relevant to the conceptualization and treatment of EDs; however, empirical findings on this subject are scarce. Given the recognized overlap between EDs, particularly anorexia and bulimia nervosa (BN), and obsessive-compulsive disorder (OCD) in phenomenology and psychological characteristics, a 24-week cognitive inference-based therapy (IBT) program shown to be effective in treating OCD was adapted to treat EDs. OCD research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. The present thesis aims to examine the relationship between ego-dystonicity and EDs. To do so, we explored the link between the ego-dystonic nature of obsessions in patients suffering from an ED and fear of self concept. We also investigated the relationship between ED symptom severity and ego-dystonicity in obsessions. Moreover, we studied differences between non-clinical and eating-disordered individuals in the presence of ego-dystonic thoughts and extent of fear of self. Finally, we compared the degree of ego-dystonicity in individuals with EDs’ thoughts to those suffering from OCD. Ego-dystonicity in thoughts was measured by the Ego Dystonicity Questionnaire (EDQ) and degree of feared self was measured by the Fear of Self Questionnaire (FSQ) in both a clinical sample (n = 57 women with EDs) and a non-clinical female sample (n = 45). Ego-dystonicity and fear of self were highly correlated in both clinical and non-clinical samples. EDQ scores were not significantly correlated to overall ED symptom severity with the exception of the EDQ Irrationality subscale, which was related strongly to ED compulsion (ritual) severity. Participants suffering from an ED had significantly higher EDQ scores and FSQ scores compared to controls. Next, a case study describes the application of IBT treatment for a 35-year-old woman diagnosed with BN. ED pathology significantly decreased from pre-IBT to six-month follow-up. This case study highlights the importance of addressing overvalued ideas, fear of self and self-doubt in psychological treatment for EDs via a focus on self-cognitions and reasoning about self. Furthermore, the final objective of this thesis was to examine the change in (1) ED symptom severity, (2) the degree of ego-dystonicity in obsessions, and (3) fear of self, motivational, mood and anxiety measures from pre-IBT to six-month follow-up. Ego-dystonicity, fear of self, ED symptoms and motivational stage were assessed in 15 women with BN over the course of IBT and at follow-up. Eighty percent of the sample demonstrated a clinically significant reduction in ED symptoms and 53% ceased their compensatory behaviors at six-month follow-up. Clinical implications relevant to the treatment of EDs are discussed.

Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to have the strongest impact on psychosocial functioning. A quantitative design was used for this investigation, using measurement scales that have been shown to be valid and reliable in measuring the constructs of trauma and psychosocial functioning among individuals with an eating disorder. Participants completed a single survey of the combined measurement scales. A non-random purposive sample was collected from online social media cites Tumblr, Facebook, eating disorder message boards, and an outpatient eating disorder treatment center. Using a study sample of N= 2,319 descriptive and inferential statistics were conducted using SPSS. Based on the results of correlation and multiple regression analyses, a statistically significant relationship was found between traumatic life events and psychosocial impairment among those with eating disorders. The findings of this study have the potential to impact the way social work policies address the relationship between trauma and eating disorders, and influence the way social work clinicians implement strategies to treat both trauma and eating psychopathology.

Els trastorns de la conducta alimentària (TCA) tenen una etiologia complexa en la que hi intervenen factors de predisposició socioculturals, ambientals i genètics. S'ha aprofundit en les bases moleculars dels TCA mitjançant estudis en pacients i en models murins. S'ha descrit una alteració en la concentració de BDNF en plasma de pacients, una correlació d'aquests nivells amb trets psicopatològics, i una associació de determinats polimorfismes a bulímia nerviosa i als nivells de BDNF en plasma. Un estudi d'associació en vàries poblacions ha demostrat una forta associació de variants del gen NTRK3, amb epistasi amb NGF, a TCA. Un model de sobreexpressió de BDNF confirma el seu paper en la regulació del pes corporal i estableix un possible vincle entre BDNF i la fisiopatologia de les tremolors. La caracterització del ratolí anx/anx suggereix que pot ser un model de la síndrome caquètica que acompanya malalties com el càncer, la SIDA o les malalties autoimmunitàries. / Eating disorders (ED) are complex disorders were environmental, sociocultural and genetic factors are involved. We have improved the knowledge of the genetic basis of ED through studies involving ED patients and murine models. Altered BDNF blood levels have been linked to ED and its related psychopathological traits. In addition several polymorphisms in the BDNF gene have been associated to bulimia nervosa and BDNF plasma levels. A family based association study has shown a strong association of NTRK3 variants to ED which show epistasis with NGF. The generation of an overexpression mouse model for BDNF confirms its role in body weight regulation and establishes a possible link between BDNF and the pathophysiology of tremors. The characterization of the anx/anx mouse model suggests that it may be a good model for the cachexia syndrome that accompanies certain chronic or inflammatory diseases such as cancer, AIDS or autoimmune diseases.

To gain a better understanding of those struggling with severe eating disorders (anorexia nervosa and bulimia nervosa), the inner life-world and subjective experiences of therapy clients were explored within the South African context. This was an empirical qualitative study. Specifically, the study’s focus was on the psychological construct of perfectionism as experienced during the respondents’ treatment resistant eating disorders. The two objectives of the research were to describe and explain perfectionism, which served to increase an overall improved understanding of perfectionism. The study’s methodology encompassed a combination of phenomenological- and grounded theory methodology, exploring the narratives of six female candidates that were undergoing individual therapy for their eating disorders. These candidates were considered to have a treatment resistant eating disorder, because they had been struggling with this diagnosis for longer than a decade, and/or had previously received multiple treatment interventions without recovering. The therapy sessions were recorded via digital audio recordings, and used in the data analysis process. The discourses pertaining to the study’s focus were transcribed and analysed using phenomenological- and grounded theory methods. The phenomenological analysis produced individual descriptions of the participants’ experiences of their perfectionism, as well as a general description for perfectionism. The grounded theory analysis produced an emerging theory in the form of a cognitive schema. This schema was named The Perfectionistic Eating Disorder Self-schema (PEDSS), and explains the inner psychological process of perfectionism within a treatment resistant eating disorder client. The results of this study, in particular the PEDSS, has implications for those trying to understand, assist, and treat those who suffer from treatment resistant eating disorders, as well as helping those who struggle with perfectionism to understand their own problem more. / Psychology / D. Phil. (Psychology)