Introduction: The thesis deals with the relationship between substance use and eating disorder. In particular, it focuses on the phenomenon of self-medication substance abuse among women who have experienced an eating disorders. The theoretical part provides a comprehensive picture of the studied issue, supported by Czech and international research in the area. The empirical part is based on qualitative data collection and consists of a combination of short case studies and thematic analysis. Objectives: The main aim of the thesis is to map out and find out whether women who suffer from eating disorders use addictive substances, including alcohol, for the purpose of self-medication. The thesis also aims to find out whether there is a difference between the different forms of eating disorders and the pattern of substance use. Sample: The research sample consisted of 10 women aged 19 - 38 years who have had experiences with eating disorders. Methods: The method of semi-structured interview was chosen for the purpose of the research. The data obtained were presented using short case reports. The case studies were supplemented by a timeline and a test battery, which consisted of AUDIT, DAST and FTND questionnaires for better orientation of the researcher. The data were subsequently analyzed through...

Ce travail doctoral propose d’étudier les troubles de l’image du corps et les troubles psychologiques associés, chez des patientes anorexiques, comparées à des femmes sans trouble du comportement alimentaire (TCA), et d’examiner l’impact des facteurs socioculturels sur l’émergence de ces troubles, ainsi que l’influence d’un programme d’activés physiques adaptées (APA) sur leur régulation. L’étude 1 indique que l’insatisfaction corporelle des femmes sans TCA augmente significativement en fonction de l’âge et de la corpulence, démontrant de l’importance de l’image du corps sur la santé mentale des femmes dans nos sociétés occidentales. L’étude 2 montre que les patientes anorexiques ont une insatisfaction corporelle significativement plus importante, des scores d’anxiété physique sociale et de dépression significativement plus élevés, ainsi que des scores d’estime de soi globale et de soi physique globale significativement plus faibles que les femmes sans TCA, traduisant la coexistence de troubles psychologiques chez les patientes anorexiques. L’étude 3 révèle que les mécanismes de comparaison sociale et d’internalisation des messages sociaux sont significativement plus activés chez les anorexiques comparées aux femmes sans TCA. Toutefois, il apparaît qu’une amorce « idéal de minceur » n’a aucun effet significatif sur l’insatisfaction corporelle et la silhouette idéale, chez les deux groupes. Enfin, l’étude 4 montre que, même si le programme d’APA ne permet pas de réguler les troubles de l’image du corps et les troubles psychologiques, il n’interfère pas négativement dans le traitement thérapeutique de l’anorexie mentale. Ces différents résultats sont ensuite discutés, et des perspectives de recherche sont proposées. / The present doctoral research aims to investigate body image disturbances and associated psychological troubles, in patients with anorexia nervosa as compared to healthy controls, and to examine the impact of sociocultural factors on the emergence of the aforementioned troubles, as the effects of an adapted physical activity program (APA) on their regulation. Study 1 indicates that body dissatisfaction of women without eating disorders (ED) increases significantly according to age and shape, enlightening the role of body image in women’s health in Western societies. Study 2 shows that anorexics present significantly more body dissatisfaction and significantly higher scores of social physical anxiety and depression, but also a global self-esteem and a global physical self significantly lower, as compared to women without ED. Study 3 reveals that social comparison and social messages internalization are more relevant in anorexics than in women without ED. However, we observed no significant effect of thin ideal priming on body dissatisfaction and ideal body size in both groups. Finally, Study 4 shows that, even if APA program reveals no significant effect on body image disturbances and associated psychological troubles, it does not interfere negatively with the therapeutic treatment for anorexia nervosa. These results are then discussed and perspectives of research are presented.

Dans cette thèse nous nous sommes intéressés aux relations entre ghreline (GHR) d'une part et sécrétion d'hormone de croissance (GH) et prise alimentaire (PA) d'autre part. Nous avons montré : a) que la sécrétion de GHR est rythmique ; b) que les pics de GHR, peu corrélés avec ceux de GH, sont en relation étroite avec les épisodes de PA. Néanmoins, un antagoniste du récepteur GHSR1a montre que la GHR endogène modulerait l'amplitude du pic de GH et que ses effets sur la PA mettraient en jeu soit le GHSR1a dans des états d'activation différente soit des récepteurs différents ; c) que les taux de GHR dépendent plus de l'état nutritionnel que de la masse grasse et seraient régulés par des facteurs présents dans l'intestin. Une dérégulation de ces derniers pourrait participer au développement de l'obésité ; d) que chez l'anorexique (AN) le polymorphisme Leu72Met présente un déséquilibre de transmission qui est plus marqué chez l'AN boulimique que chez l'AN restrictive.

L'anorexie mentale est une pathologie affectant à la fois la santé mentale et la santé physique. Les formes les plus sévères alors qu'elles nécessitent des soins hospitaliers longs, ont un taux d'échappement aux soins très élevé (20% des adolescents et 60% des adultes) et sont celles présentant le plus mauvais pronostic. Or cet échappement aux soins (ou sortie prématurée) génère à la fois des rechutes et une chronicisation. Si le devenir à long terme de ces patients est documenté, les études centrées sur les formes les plus sévères sont peu nombreuses, et parmi elles, celles prenant en compte simultanément les aspects somatiques et psychiques de leur évolution sont quasi inexistantes. C'est pourquoi, après une mise au point sur les données épidémiologiques, concernant l'anorexie mentale, nous avons choisi de centrer notre travail de thèse sur d'une part la recherche de facteurs expliquant l'échappement aux soins, et pouvant devenir des cibles thérapeutiques, et d'autre part le devenir physique et psychique de ces sujets dix ans après une hospitalisation.La première étude portant sur 180 patients issus de dix centres français prenant en charge des patients anorexiques sévères, s'est appuyé sur une étude d'épidémiologie clinique prospective multicentrique appelée EVALHOSPITAM. Notre objectif était d'identifier des facteurs prédictifs de l'échappement prématuré aux soins lors d'une hospitalisation pour anorexie mentale. En effet, la prise en compte de tels facteurs dès l'admission permettrait peut-être de diminuer l'échappement prématuré aux soins en cours d'hospitalisation, et par là contribuerait à améliorer le pronostic de ces sujets. La seconde étude expose les résultats d'une étude de devenir de ces patients hospitalisés à l'adolescence neuf années en moyenne après une hospitalisation. Notre travail se centre sur le devenir somatique à long terme de patients ayant souffert d'anorexie mentale, son lien avec le devenir psychique et une comparaison avec un échantillon issu de la population générale de même âge et de même sexe.

Le schéma corporel est une représentation interne et dynamique du corps, de la morphologie, et des positions relatives des segments corporels. Celui-ci serait le support à partir duquel une motricité adaptée va pouvoir se mettre en place. L’objectif principal de ce travail doctoral était d’évaluer plus précisément cette intrication entre schéma corporel et comportements moteurs. Nous avons ainsi évalué à la fois l'effet de différentes distorsions du schéma corporel sur le comportement moteur, et inversement l'effet des comportements moteurs sur la modulation éventuelle du schéma corporel.Tout d’abord, nous avons testé si la distorsion morphologique du schéma corporel rapportée récemment dans l’anorexie mentale avait un retentissement sur la locomotion des patientes, dans une tâche de passabilité d’ouvertures (Etude 1). Les patientes ont effectivement tourné leurs épaules pour des largeurs d’ouvertures qui, compte tenu de leur nouvelle morphologie, ne nécessitaient pas une telle contorsion. Des comportements moteurs identiques ont été observés chez une patiente ayant perdu massivement et rapidement du poids, mais sans souffrir d’anorexie mentale (Etude 2). Ces résultats dans leur ensemble soulignent la rigidité du schéma corporel face à des changements corporels majeurs, ainsi que son incidence forte sur le comportement moteur dans l’anorexie mentale.Dans un deuxième temps, nous avons induit chez le sujet sain, grâce au paradigme miroir, souvent utilisé en réadaptation motrice, une distorsion entre schéma corporel et segments corporels, afin d’en évaluer les conséquences sur le comportement moteur volontaire (coordination bimanuelle, Etude 3) et involontaire (post-effet moteur, Etude 4). Les résultats de nos études font apparaître que la modulation des comportements moteurs dans le paradigme miroir serait plus liée aux afférences proprioceptives du bras face au miroir ou encore à une meilleure répartition des processus attentionnels, plutôt qu’à la distorsion du schéma corporel via le miroir.Enfin, nous avons testé si les comportements moteurs, ou tout du moins l’intention motrice à l’origine, pouvaient en retour moduler le schéma corporel et le sens du mouvement (Etude 5). Les illusions de mouvement induites dans le paradigme miroir ont bien été modulées selon que l’intention motrice du bras soumis à l’illusion soit congruente ou non avec le sens du mouvement illusoire généré.Compte tenu de l’implication de l’intention motrice dans la mise à jour du schéma corporel, nous suggérons que la prise en charge des troubles du schéma corporel (e.g. dans l’anorexie mentale), souvent basée sur une réadaptation visuelle de la représentation du corps, devrait être complétée par une remédiation sensori-motrice.Mots clefs : schéma corporel, comportement moteur, anorexie mentale, paradigme miroir, kinesthésie / The body schema is an internal and dynamic representation of the body, of the relative positions of body parts, but also of their metrics. It is supposed to be the support for motor behavior to develop appropriately. The main purpose of this doctoral work was to better assess this entanglement between body schema and motor behaviors. Specifically, we sought to evaluate how different motor behaviors are affected by distortions of the body schema, and conversely how the body schema could be modulated by motor behaviors.First, we tested whether the distortion between body schema and body morphology, recently reported in the anorexia nervosa patients, had an impact on their motor behaviors during a locomotion task of door crossing (Study 1). Results show that these patients are actually turning their shoulders for door widths which, given their body morphology, do not require such a contortion. Similar motor behaviors were observed on a patient who lost weight massively and quickly, without suffering from anorexia nervosa (Study 2). Altogether these results confirm the rigidity of body schema towards major body changes, as well as its significant impact on motor behavior in anorexia nervosa.In the second part of this work, we sought to experimentally induce a visual distortion between body schema and segmental positions in healthy subjects, with a mirror paradigm, usually used as therapeutic tool, and to assess the implications for a voluntary motor behavior (bimanual coordination task - Study 3) and an involuntary one (post-contraction response- Study 4). These results show that modulation on motor behaviors is more related to proprioceptive inputs from one arm facing the mirror or better allocation of attention, rather than distortions of the body schema and mirror itself.Finally, our last aim was to test whether the motor behavior, or at least the original motor intention, could in turn modulate the body schema (Study 5). Our results revealed that illusions of movement induced in the mirror paradigm were regulated by whether the participant conducted a motor intention, with the arm subject to the illusion, that was congruent or not with the induced illusory motion.Given the involvement of motor intention in updating the body schema, we suggest that the treatment of body schema disorders (e.g. anorexia nervosa), often based on a visual rehabilitation of the body representation, should be supplemented by a sensorimotor remediation.Keywords: body schema, motor behavior, anorexia nervosa, mirror paradigm, kinesthesia

The thesis focuses on knowledge of eating disorders by students of University of South Bohemia. The theoretical part defines particular types of eating disorders and the causes related with this problems. There are possible treatment methods for eating disorders mentioned at the end of this part. The practical part deals with students? awareness of eating disorders. It focuses on students? knowledge of eating disorders and orthorexia nerovosa. The research is based on questionnaire construction. The students of selected faculties of University of South Bohemia were the respondents. The results of the research were statistically processed.

This diploma thesis describes eating habits of pupils at elementary school. It mainly focuses on results of bad eating habits. The first chapter describes eating habits of pupils. The second chapter characterizes the age group 13 to 16 years. The following chapters are focused on eating disorders (in general and also specifically on anorexia nervosa and bulimia nervosa), individual and social factors influencing the disorder and disease prevention. The practical part informs about the results of the research focused on pupils of the eighth and ninth grade at two elementary schools in Třebíč region. The aim of the research was to find out whether pupils are satisfied with their figures and what the main source of information about eating disorders is for them.

ABSTRACT Eating disorders (mental anorexia and bulimia) and obesity entail grave health, social and economic problems, and lead to detrimental health consequences, often irreversible consequences. Currently the disorders affect about 6% of population, with young girls particularly vulnerable and 16% of women obese. As the relevant surveys reveal, these figures are constantly on the rise. Apart from producing somatic symptoms, both the disorders, anorexia and bulimia, have been observed to bring about typical negative emotions and maladaptive cognition, first and foremost a distorted (negative) self-image focused on inappropriate perception of own body also known as the body image. The paper aims to find out and mutually compare features characteristic of the body image issues as they relate to the eating disorders and obesity / excessive weight. The paper is based on a survey combining qualitative and quantitative research strategies. To collect data, both strategies employed the technique of inquiry - the qualitative part relied on the theory of semi-structured interviews while the quantitative part used a questionnaire. The data thus acquired were processed by quantitative and qualitative procedures. Building on the previous Bachelor paper intended to map the issues of body image in persons with eating disorders, this paper expands the previous survey set of women suffering the condition and adds a new set of obese females. Results of the qualitative part of the survey brought about hypotheses on how the mentioned disorders affected the body image. The quantitative part of the survey revealed similar characteristics in the perceived body image in both the sets, but disclosed also some differences. Significant differences were found when the body image of the diseased persons was compared with that encountered in healthy population. This paper can boost the awareness of this subject in lay public but also in professional community, primarily where psychotherapy and prevention are regarded.

The presented thesis deals with problems of eating disorders (hereinafter abbreviated to EDs). The theoretical framework is the Social Construction of Reality; a concept saying that the individual perceives reality - as a phenomenon formed and determined socially - in the way it is presented by the "power structures" of the society. The thesis pays special attention to the aetiology of these disorders, laying emphasis on family factors. The aim of the thesis refers to one of the topics resulting from my Bachelor thesis, when it appeared worthwhile to work up in detail the problem of subjectively seen factors substantial for onset of EDs. Thus the aim of the thesis was to map which factors the persons suffering from EDs as well as members of their families consider to be significant for onset of the disease - either their own or their daughter´s /sister´s on one hand and EDs generally on the other hand - and what led them to take their stand, in so doing two ranges of time were mapped. The set of persons under review was represented by the same respondents as in case of research for the Bachelor thesis. In order to ensure mapping of the above-mentioned problem in the most possible complex way, a qualitative research strategy was chosen. The necessary data was obtained by employing the technique of deep semi-structured interviews, then the data was processed using qualitative analysis of the respondents´ statements. Part of the research work was also confrontation of the collected and processed data with specialised resources. On the basis of the results of our research it is evident that the factor causing onset and development of the respondents´ or their daughter´s/sister´s EDs mentioned most often is family background. Unlike the Bachelor thesis, this factor was rather mentioned as one of many; it is not so dominant any longer. This may be explained by the fact that the patients spoke about their situations under the influence of other factors that experts had been emphasising. As for EDs generally, then the respondents mostly mentioned desire to be slim, which, however, has now substantially fallen into the shade. This may be explained by the respondents´ experience with EDs. It may be said that in taking their standpoints, family members were much more influenced by information from specialised resources than the persons suffering from EDs themselves, who mostly took their stand on the basis of their own conviction. Our research shows that for persons suffering from EDs, family background was not a source of information on the problem of these disorders. The research pointed out the importance of engaging the family in solving the problem of EDs as well as the necessity of individual approach to each case of this disease. The presented thesis may be a helpful source of information not only for people interested in the problem of EDs; it may also serve as materials for instruction in the medical social field, and last but not least it can be used to bring more information to the general public.

La crise de boulimie est vécue comme une perte de contrôle par les patientes atteint de boulimie (BN), d’anorexie avec crise de boulimie (ANB) et d’hyperphagie boulimique. Si ces patientes présentent effectivement des performances dégradées aux tâches neuropsychologiques évaluant les mécanismes du contrôle cognitif modulant la tendance à s’engager dans des actions sans prendre en compte leurs conséquences, la méthodologie employée ne permet pas de séparer les mécanismes propres à la crise de boulimie de ceux plus généraux du trouble. La comparaison des performances à une batterie de tâches évaluant les différents mécanismes du contrôle cognitif, de patientes BN, ANB, anorexiques restrictives avec des sujets sains en conditions alimentaire et neutre révèle que les crises de boulimie seraient liées à un contrôle cognitif perturbé par un surplus attentionnel vers les stimuli alimentaires lors de la réalisation de tâches intuitives, déséquilibrant la modulation de ce contrôle sur la tendance générale à choisir des options risquées ou immédiates explicites. En modifiant la séquence d’ingestion des aliments au cours de la crise de boulimie pour augmenter leurs compétences de contrôle faisant défaut en situation alimentaire, des patientes répondant faiblement à la thérapie comportementale et cognitive ont diminué spontanément de 44% les quantités ingérées et la moitié d’entre elles a guéri. Si ces résultats nécessitent confirmation par une étude en imagerie fonctionnelle, ils montrent l’utilité de modéliser finement les mécanismes de traitement automatique de l’information pour améliorer les thérapies actuelles / Binge eating episodes are experienced by bulimic (BN), anorexic binging subtype (ANB) and binge eating disorder (BED) patients as periods of loss of control. This feeling is corroborated by the impaired behavioral performances to neuropsychological tasks assessing cognitive control but these results do not allow separating the mechanisms that are specific to the binge from those related to the whole psychopathology of the disorder. The goal of this thesis is to identify these mechanisms, to build a model explaining the occurrence of binges and to design and test a new behavioral intervention to treat directly binges. BN, ANB and anorexic restrictive subtype patients as well as matched controls underwent a battery of neuropsychological tasks performed in food and neutral conditions. Comparison of performances between the two conditions exhibited an impairment in food condition of intuitive mechanisms of cognitive control due to a higher attention paid to food stimuli. This results in an unbalanced modulation of the general trend to choose risky or immediate options when explicitly mentioned. Another group of ANB, BN and BED patients modified the sequence of ingestion of foods during the binge in order to train themselves to recruit the impaired mechanisms of cognitive control identified at the previous step. They experienced a spontaneous reduction of 44% of food intake during binges and half of them recovered from binges. While these results need to be confirmed by a functional neuroimaging study, they stress the importance of modeling precisely the instantaneous automated mechanisms that mediate behavior in order to improve current therapies