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

La conduite alimentaire n'obéit pas nécessairement au besoin physiologique de consommer des aliments (la faim) ou à la satiété suggérant qu'un système nerveux volontaire de la restriction (anorexie) et de la consommation excessive d'aliments (boulimie, « binge-type eating ») inhibe le système nerveux autonome. Ces deux anomalies affectent plus fréquemment, et souvent à la fois, la femme que l'homme. Si l'utilisation de modèles animaux permet l'étude d'une part des bases neuronales en cause, ceux possiblement responsables de l'alternance « anorexie / boulimie » restent encore à identifier. Dans ce contexte, nous avons ainsi centré nos analyses sur l'étude de l'implication de récepteurs cérébraux couplés aux protéines G ; les récepteurs 4 de la sérotonine (R5-HT4) car leur stimulation dans le noyau accumbens (NAc), une structure du système de la récompense, inhibe la faim y compris après la mise à jeun de souris, par l'action AMPc/PKA dépendante d'un peptide de l'addiction ; « cocaine- and amphetamine-regulated transcript » (CART). Nous montrons que le maintien d'une plus forte expression (ectopique ou physiologique) des R5-HT4 dans le NAc a réduit plus durablement la faim que sa seule stimulation et augmente l'activité locomotrice. En incluant dans notre raisonnement l'activité constitutive des R5-HT4 (e.g. accumulation de la forme active R*), nous montrons que l'injection d'un agoniste inverse (inhibition de l'activité constitutive : accumulation de la forme inactive, R) spécifique des R5-HT4 dans le NAc entraîne une baisse du taux d'AMPc et de CART tout en augmentant celui des ARNm codant le NPY d'autant plus que l'hyperphagie est élevée. Les effets induits par l'injection de l'agoniste inverse ne sont pas observés lorsqu'il est adjoint à un antagoniste des R5-HT4. Ces résultats suggèrent une implication physiologique de l'activité constitutive des R5-HT4 dans la régulation de la conduite alimentaire; son inhibition (agoniste inverse) dans le NAc augmente la prise et reprise alimentaire après un jeûne. L'ensemble de ces résultats rend probable que la plus forte activité des R5-HT4, à la base d'une association « anorexie /hyperactivité locomotrice », souvent décrite comme paradoxale au plan énergétique dans le syndrome de l'anorexie mentale, représente plutôt un mécanisme de compensation globale d'une valeur énergétique à perdre en conséquence d'une trop forte consommation d'aliments. Puisque la densité des R5-HT4 peut varier selon un taux variable de 5-HT après stress, lequel aggrave les anomalies alimentaires, nous avons étudié plus avant l'implication des R5-HT4 dans l'effet anorexigène du stress (immobilisation forcée) chez des souris femelles privées de leur gène : l'hypophagie induite par le stress n'a pas été observée chez les souris privées des R5-HT4 qui présentent une possible hyperactivité de l'axe hypothalamo-hypophysaire corticosurrénalien vraisemblablement compensée par un plus fort rétrocontrôle négatif. Il est donc probable que les R5-HT4 contribuent à réduire les conséquences du stress et que la modification de l'équilibre de leur activité contribue à une part de la symptomatologie de patients atteints d'anorexie / boulimie. / Feeding behavior does not necessarily obey to the physiological need to eat (hunger) or to satiety, suggesting that voluntary nervous system of the restriction (anorexia) and overeating (bulimia, binge-type eating) inhibits the autonomic nervous system. These two anomalies affecting more frequently, and often both, the woman than man. If animal models are used to study a part of neural bases involved, those possibly responsible for the oscillation of"anorexia / bulimia" remain to be identified. In this context, we thus focused our analysis on the study of the involvement of brain receptors coupled to G proteins ; serotonin 4 receptors (5-HTR4) because their stimulation in the nucleus accumbens (NAc), a brain reward area, inhibits hunger even after a food deprivation, by the action ofcAMP / PKA, dependent of an addiction peptide, "cocaine-and amphetamine-regulated transcript" (CART). Weshow that maintaining a higher expression (ectopic or physiological) of 5-HTR4 in the NAc, reduced hunger more longer than the acute stimulation and increased locomotor activity. Including in our reasoning the constitutive activity of 5-HTR4 (e.i. accumulation of the active form R*), we show that injecting a specific inverse agonist of the5-HTR4 (inhibition of constitutive activity: accumulation of inactive form, R ) in the NAc induced a decrease incAMP and CART levels, while increasing NPY mRNA level, especially when binge is high. The effects induced by the injection of the inverse agonist are not observed when a 5-HTR4 antagonist was coadministrated. These results suggest a physiological involvement of the constitutive activity of 5-HTR4 in the regulation of feeding behavior ; its inhibition (inverse agonist) in the NAc increases the food intake in fed or food-deprived mice. All of these results makes it likely that the highest activity of 5-HTR4, at the base of the association "anorexia /locomotor hyperactivity", often described as paradoxical in terms of energy, in the syndrome of anorexia nervosa,represent rather a global compensation mechanism of energy to be lost as a result of an excessive consumption of food. Since the density of the 5-HTR4 may vary depending on a variable rate of 5-HT following stress, which aggravates the feeding disorders, we further investigated the involvement of 5-HTR4 in the appetite-suppressant effect of stress (forced immobilization) in female mice deprived of their gene: stress-induced hypophagia was not observed in mice deprived of 5-HTR4 who present a possible hyperactivity of the hypothalamic-pituitary adrenocortical axis likely offset by a stronger negative feedback. It is therefore likely that the 5-HTR4 contribute to reduce the effects of stress and that the modification of the balance of their activities contribute to a part of the symptoms of patients with anorexia / bulimia.

L’anorexie mentale (AN), un trouble du comportement alimentaire multifactoriel, se traduit par une perte de poids. La sévère dénutrition retrouvée dans l’AN est associée à des altérations métaboliques induisant une dérégulation de l’axe intestin cerveau. Les mécanismes physiopathologiques sont encore mal connus. Le travail de cette thèse était de mieux appréhender les dysfonctions de l’axe intestin cerveau en évaluant le métabolisme protéique de divers tissus (hypothalamus, côlon et estomac) dans un modèle murin d’anorexie par une approche protéomique. Le premier travail a permis de mieux caractériser le modèle d’anorexie nommé activity-based anorexia (ABA) en fonction du sexe. Puis les différentes analyses protéomiques ont permis de constater une adaptation tissu dépendant des mécanismes régulant l’équilibre énergétique, avec une activité cérébrale potentiellement augmentée au détriment des fonctions digestives. Chez les souris femelles ABA, il a été constaté une augmentation d’expression de protéines mitochondriales au niveau de l’hypothalamus et à l’inverse, une diminution du métabolisme protéino-énergétique au niveau colique avec un rôle de la voie de signalisation mTOR. L’autophagie était augmentée dans ces deux tissus. Ensuite, nous avons démontré un ralentissement de la vidange gastrique secondaire à la dénutrition, et l’analyse protéomique a permis de constater une augmentation du stress oxydant au niveau de l’antre des souris ABA femelles. Ces altérations peuvent contribuer aux troubles fonctionnels gastro intestinaux. En conclusion, nos études soulignent des mécanismes d’adaptation tissu dépendants dans l’anorexie, qui devront être ultérieurement approfondis. / Anorexia nervosa, a multifactorial eating disorder, is a major public health problem and results in a severe body weight loss. The severe malnutrition observed in anorectic patients is associated with metabolic alterations inducing disturbance of the gut-brain axis. However, involved mechanisms remained poorly understood. The aim of the present thesis was to better understand the alterations of the gut-brain axis in the activity-based anorexia (ABA) model by evaluating the protein metabolism of various tissues (hypothalamus, colon and stomach) by proteomic approach. Firstly, we have better characterized the response to ABA model according to sex. Then, different proteomic analyses were performed using female C57BL/6 mice. Our results revealed a tissue-dependent adaptation of protein and energy metabolism with an increased hypothalamic activity and a decrease in the gastrointestinal tract. Indeed, ABA mice exhibited an increased expression of proteins involved in mitochondrial metabolism at the level of the hypothalamus, and conversely a decrease of proteins involved in protein and energy metabolism in colonic mucosa with a key role of the mTOR signaling pathway. Both in hypothalamus and colon, autophagy was increased. We were also able to show that gastric emptying was delayed in ABA mice that is mainly due to malnutrition. In addition, proteomic analysis revealed an increase in gastric oxidative stress in female ABA mice. These alterations may contribute to the gastrointestinal functional disorders frequently described in anorexia nervosa. In conclusions, our study underlined tissue-dependent adaptive metabolic process during anorexia that should be further explored.

Die vorliegende Arbeit entwickelt einen Vorschlag für einen neuen, kompakteren Fragebogen mit dem Akronym „BaFEK-45“ zur Diagnostik von Essstörungen, der auf einer statistischen Analyse von Daten aus fünf bereits etablierten Fragebogen (ANIS, EAT – 26, FBeK, EDI – 2, EDES) mit einer Gesamtzahl von 231 Items basiert. Dabei wurden die Antworten von Patientinnen aus den 1990er- und 2000er-Jahren der Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters der Universität Leipzig ausgewertet. Auf Grundlage zweier „Signalfragen“ zu Ess-Anfällen wurden die Fragebogen-Serien in drei Gruppen (anorektisch, bulimisch und grenzwertig) eingeteilt, daraufhin konnte eine Analyse zu den Unterschieden im Antwortverhalten zwischen eben diesen Gruppe vorgenommen werden. Nach einem auf dieser Analyse basierenden Auswahlverfahren wurden die verbliebenen Items einer mehrstufigen Faktorenanalyse und kritischen inhaltlichen Differenzierung unterzogen. An deren Ende steht der o.g. Vorschlag eines neuen Diagnostikinstruments, das sich aus 45 Fragen in fünf Skalen zusammensetzt.

The main aim of this diploma thesis is to analyze the problem of anorexia from Foucault's perspective. The first hypothesis is that this 'pathology' is rather a social construction which has its origins in social norms and standards that operate in the society to make firm distinction between the normal and the pathological, the ideal and the unacceptable. In this study we will use Foucault's theory of power and discipline, the concept of biopower and also his critics of psychiatry. At the same time, we will complete our survey with the concept of construction and deconstruction of Jacques Derrida and with the social identity theory of Judith Butler.