Objective: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

Objectives: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. Methods: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. Results: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. Conclusions: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

Background. Previous studies have highlighted the role of the brain reward and cognitive control systems in the etiology of anorexia nervosa (AN). In an attempt to disentangle the relative contribution of these systems to the disorder, we used functional magnetic resonance imaging (fMRI) to investigate hemodynamic responses to reward-related stimuli presented both subliminally and supraliminally in acutely underweight AN patients and age-matched healthy controls (HC). Methods. fMRI data were collected from a total of 35 AN patients and 35 HC, while they passively viewed subliminally and supraliminally presented streams of food, positive social, and neutral stimuli. Activation patterns of the group × stimulation condition × stimulus type interaction were interrogated to investigate potential group differences in processing different stimulus types under the two stimulation conditions. Moreover, changes in functional connectivity were investigated using generalized psychophysiological interaction analysis. Results. AN patients showed a generally increased response to supraliminally presented stimuli in the inferior frontal junction (IFJ), but no alterations within the reward system. Increased activation during supraliminal stimulation with food stimuli was observed in the AN group in visual regions including superior occipital gyrus and the fusiform gyrus/parahippocampal gyrus. No group difference was found with respect to the subliminal stimulation condition and functional connectivity. Conclusion. Increased IFJ activation in AN during supraliminal stimulation may indicate hyperactive cognitive control, which resonates with clinical presentation of excessive self-control in AN patients. Increased activation to food stimuli in visual regions may be interpreted in light of an attentional food bias in AN.

La forte prévalence des conduites alimentaires à risque (CAAR), par exemple la restriction alimentaire, les vomissements auto-induits ainsi que les crises d’hyperphagie boulimique de sévérité non diagnostique, et les conséquences importantes qu’elles peuvent entraîner ont amené les chercheurs à vouloir mieux comprendre les facteurs impliqués dans leur développement. Cette thèse s’intéresse à un phénomène à la base d’un nombre grandissant de théories sur les CAAR : la régulation émotionnelle. Le premier article se concentre sur le concept d’alexithymie, un trait de personnalité jouant un rôle clé dans la régulation émotionnelle ainsi que le développement, le maintien et la rechute des CAAR. Bien que l’association entre l’alexithymie et les CAAR soit bien établie, les études n’offrent pas d’explication quant aux facteurs qui contribuent à l’apparition de traits de personnalité alexithymiques qui, à leur tour, placent l’individu à risque de développer des CAAR. En explorant la documentation scientifique disponible, il est possible de constater que plusieurs psychanalystes ont autrefois proposé des concepts pour expliquer le développement de l’alexithymie (p. ex. refoulement primaire, expérience non formulée, déni), mais ces théories ont rarement fait l’objet d’études empiriques. L’objectif du premier article est donc de tester ces modèles en utilisant deux stratégies de régulation émotionnelle provenant du modèle de James J. Gross, soit la suppression expressive et la réévaluation cognitive. Un échantillon de 292 femmes provenant majoritairement d’une population non clinique universitaire a complété le Toronto Alexithymia Scale-20 items, le Emotion Regulation Questionnaire et le Eating Disorder Inventory-2. Les résultats des médiations proposent que la suppression expressive prédit positivement les traits de personnalité alexithymiques, ce qui prédit positivement les CAAR. Inversement, la réévaluation cognitive prédit négativement les traits de personnalité alexithymiques, ce qui prédit ensuite négativement les CAAR. Ces résultats suggèrent qu’il pourrait être pertinent d’intervenir sur certains mécanismes potentiellement précurseurs de l’alexithymie afin de favoriser la diminution d’agirs comportementaux comme les CAAR. Les résultats de cette première étude ouvrent la réflexion sur des pistes d’intervention concrètes pouvant être mises en application auprès des personnes souffrant de CAAR. En effet, les résultats de cette thèse suggèrent qu’il pourrait être important d’aider l’individu à diminuer l’évitement/la suppression de ses émotions pour plutôt encourager leur exploration. Il est possible d’émettre l’hypothèse que ce type d’intervention permettrait, avec le temps, la diminution des traits alexithymiques, ceci en favorisant la formation de représentations mentales des émotions. Conséquemment, la diminution de décharges somatiques comme les CAAR pourrait s’en suivre. L’implication des résultats pour les thérapies de différentes approches (p.ex. psychodynamique, cognitivo-comportementale et basée sur la mentalisation) est ensuite discutée. Afin de préciser l’étude de la régulation émotionnelle dans les CAAR, le second article a pour but d’identifier les émotions jouant un rôle particulier au sein de ces comportements. Pour ce faire, cet article, qui comprend deux études, s’intéresse aux liens entre les catégories émotionnelles distinctes du modèle des émotions différentielles d’Izard (p. ex. tristesse, joie) et les CAAR. La première étude a pour objectif d’explorer l’association entre les émotions-traits et les conduites alimentaires de recherche de minceur et boulimiques. Un total de 244 femmes provenant en majorité d’une population non clinique universitaire a complété le Eating Disorder Inventory-2 et le Differential Emotion Scale-trait version. Les analyses de régression démontrent que le modèle d’Izard prédit significativement les conduites de recherche de minceur et boulimiques. La contribution unique de chaque émotion-trait est ensuite étudiée. Les résultats indiquent que la honte est la seule émotion qui reste un prédicteur significatif des conduites de recherche de minceur et que seuls la culpabilité, le mépris et l’hostilité dirigée contre soi demeurent des prédicteurs significatifs des comportements boulimiques. Pour sa part, la seconde étude a pour but d’explorer l’association entre les émotions-états et les CAAR. Un total de 155 participantes provenant de l’échantillon de la première étude a complété un questionnaire leur demandant de rapporter par écrit un comportement de restriction ou de boulimie ayant eu lieu dans le passé. Elles ont ensuite complété le Differential Emotion Scale-state version. Les analyses descriptives démontrent que nonobstant la nature du comportement, la tristesse est l’émotion vécue la plus intensément par les participantes avant l’épisode rapporté. De plus, une comparaison de groupes a révélé que les personnes ayant décrit un épisode de boulimie ressentent significativement moins de joie et d’intérêt avant l’épisode que celles ayant rapporté un comportement restrictif. En résumé, les résultats suggèrent tout d’abord que les émotions négatives semblent jouer un rôle important au sein des CAAR. En ce sens, cet article appuie les recommandations de certains chercheurs à l’effet que l’intervention auprès des personnes ayant des CAAR nécessite d’inclure des volets dédiés à la régulation des émotions. Toutefois, ces études vont encore plus loin en proposant qu’il pourrait être pertinent de développer des interventions ciblées et concrètes permettant la gestion d’émotions ou de patrons d’émotions qui jouent un rôle prédominant auprès des différents CAAR. / The high prevalence of disordered eating (DE), for example food restriction, selfinduced vomiting or binge eating that are not of diagnostic severity, and the important consequences that they can entail have led researchers to further investigate the premorbid factors involved in them. The present thesis is interested in a phenomenon that is the basis of a growing body of theories on DE: emotion regulation. The first paper focuses on the concept of alexithymia, a personality trait that plays a key role in emotion regulation as well as in the development, maintenance, and relapse of DE symptoms. Although the association between alexithymia and DE is well established, current studies offer no explanation as to what factors contribute to the development of alexithymic personality traits, which in turn puts the individual at risk for DE. Several psychoanalysts have offered theoretical concepts to explain the development of alexithymia (e.g. primary repression, unformulated experience, denial), but these have not been submitted to empirical studies. The aim of the first study is to test these theories using two empirically established emotion regulation strategies taken from James J. Gross's model, namely expressive suppression and cognitive reappraisal. A sample of 292 women, the majority being undergraduated students, completed the Toronto Alexithymia Scale-20 items, the Emotion Regulation Questionnaire, and the Eating Disorder Inventory-2. The results of the mediation analyzes suggest that expressive suppression significantly and positively predicts alexithymic personality traits, which positively predicts DE. Inversely, cognitive reappraisal negatively predicts alexithymic personality traits, which then negatively predicts DE. These results suggest that it could be important to intervene on certain mechanisms that are potential precursors of alexithymia in order to promote the reduction of DE. More specifically, the results of this first study open up reflection on concrete lines of intervention that could be applied to vii people suffering from DE. Indeed, the results propose that it could be beneficial to encourage these individuals to explore their emotions rather then to avoid / suppress them. It can be hypothesised that these types of intervention will allow, over time, the reduction of alexithymic traits by promoting the formation of mental representations of emotions. Consequently, it is possible that the decrease in somatic discharges such as DE will follow. The implication of the results for different therapeutic approaches (psychodynamic, cognitive behavioral and mentalization-based) is then discussed. In order to further clarify the role of emotional regulation in DE, the second paper aims to identify emotions that play a key role in the disorder. This article, divided into two studies, focuses on the association between distinct emotional categories from Izard's differential emotions theory (e.g. sadness, joy) and pathological eating. The first study explores the relationship between trait-emotions and DE. A total of 244 women, the greater part being undergraduated students, completed the Eating Disorder Inventory-2 and the Differential Emotion Scale-trait version. Regression analyzes show that Izard's model significantly predicts both drive for thinness and bulimic behaviors. The unique contribution of each trait-emotion is then explored. The results indicate that shame is the only emotion that remains a significant predictor of drive for thinness and that only guilt, contempt and self-directed hostility remain significant predictors of bulimic behavior. As for the second study, a total of 155 participants coming from the first study sample completed a questionnaire asking them to report in writing an episode of restriction or bulimia that occurred in the recent past. They then completed the Differential Emotion Scale-state version. Descriptive analyzes reveal that regardless of the kind of DE, sadness is the emotion experienced most intensely by the participants before the reported episode. Furthermore, group comparisons indicate that people who report a bulimic episode felt viii significantly less joy and interest before the event than those who recalled a restrictive behavior. In summary, the results first suggest that people with DE experience more negative emotions on a daily basis. Thereby, this article supports the recommendations of certain researchers suggesting that interventions with people exhibiting DE should include components dedicated to the regulation of emotions. Moreover, these studies go even further by suggesting that it could be relevant to develop targets and concrete interventions allowing the regulation of specific emotions or patterns of emotions, which could play a predominant role with the various DE.

Esta investigación busca determinar la asociación entre el riesgo de trastornos de la conducta alimentaria (TCA) y el comportamiento alimentario en estudiantes de nutrición y dietética de una universidad privada de Lima. A 264 estudiantes se les aplicó una encuesta sobre sus datos personales y los cuestionarios EAT-26 y TFEQ-r21. Se utilizaron la prueba de Chi cuadrado para para analizar la asociación entre las variables categóricas y la prueba de t de student para variables numéricas. Del total de estudiantes incluidos en el estudio, el 18,2% presentó riesgo de padecer TCA. El mayor riesgo fue encontrado en estudiantes de segundo año de la carrera y el menor riesgo en los de último año (p=0,048). De las 3 subescalas del cuestionario TFEQ-r21, “restricción cognitiva” fue la subescala con las puntuaciones más altas, indicando alto riesgo a tener comportamiento alimentario inadecuado en estudiantes de ambos sexos con un promedio de 2,93(DE:0,45; p<0,001). Se encontraron asociaciones positivas entre el riesgo de padecer TCA con el peso corporal (p=0,027), el autorreporte de residencia en mujeres (no vivir con familia) (p=0,013) y con la no omisión de comidas en hombres (p=0,010). En conclusión, se encontró alta prevalencia de riesgo de padecer TCA, sobretodo en los estudiantes de segundo año académico y de sexo femenino en la carrera de nutrición y dietética. Además, se encontró una alta tendencia a la restricción cognitiva en los estudiantes de la carrera. Debe haber mayor conciencia y preocupación por prevenir, detectar y abordar los TCA en los estudiantes de nutrición, puesto que los TCA no sólo pueden afectar su salud física y mental, sino también su criterio profesional a futuro. / The aim of this research is to determine the association between eating disorder risk and disordered eating behaviour in students of the career of nutrition and dietetics of a private university in Lima. A survey of personal information and two questionnaires: EAT-26 and TFEQ-r21 were applied to 264 students. The Chi-square test was used to analyze the association between categorical variables and the Student’s t-test for numerical variables. Of the total of students included in the study, 18,2% presented a risk of suffering from eating disorders; the highest risk was found in second-year students of the degree and the lowest risk in seniors (p=0,048). Of the 3 subscales of the TFEQ-r21 questionnaire, “cognitive restriction” was the subscale with the highest score in students of both sexes with a mean of 2,93 and a SD of 0,45 (p<0,001) indicating a high risk of disordered eating behaviours. Positive associations were found between risk of eating disorders and body weight (p=0,027), self-report of residence (p=0,013) in women (living without family) and with the non-omission of meals in men (p=0,010). In conclusion, high tendency to cognitive restriction and high prevalence of risk of suffering from eating disorders was found in nutrition students, especially those in the second year of studies and in women. Greater awareness and concern to prevent, detect and address eating disorders in nutrition students is needed, since eating disorders can not only affect physical and mental health, but also professional judgment of the students in the future. / Tesis

Mémoire en recherche-création / la liste de mes jointures récupère certaines paroles reçues, bruits parasitaires qui restent comme les acouphènes. Ils se déclenchent parfois à la suite d’un stress : les sifflements de la narratrice empirent au secondaire. Le trouble alimentaire aussi. Poésie du déséquilibre, la liste de mes jointures recense les chutes, les absences, les jugements, la jumelle qui nous échappe. Chaque section du recueil relie une partie du corps à une pièce de la maison. Et la peur de mourir à celle de vivre. Le regard des autres et de soi-même sont des miroirs impossibles à décrocher. L’alliance entre le corps et la maison se rencontre aussi dans Lecture en vélocipède d’Huguette Gaulin. Difficile à cerner, le quotidien apparaît aussi fragmenté que le sujet poétique : la maison est le lieu où tous deux se reconstruisent. Avec Habiter le corps : mise en scène du quotidien dans Lecture en vélocipède d’Huguette Gaulin, on a accès au dialogue entre l’intérieur et l’extérieur, au dédoublement du manque et à une maternité sans fin. / the list of my knuckles retrieves some words heard, paratic noises who stay like tinnitus. These are often triggered by anxiety : the narrator’s ringing gets worse in high school. The eating disorder too. Poetry of imbalance, the list of my knuckles inventories falls, absences, judgments, the twin sister who gets away from us. Each section of the book connects a part of the body to a room in the house. And a fear of dying to a fear of living. The gaze of others and of oneself are mirrors impossible to take down. Lecture en vélocipède of Huguette Gaulin also joins the body to the house. Everyday life is hard to define and appears as divided as the poetic subject : they both rebuild themselves in the house. Habiter le corps : mise en scène du quotidien dans Lecture en vélocipède d’Huguette Gaulin gives us access to the dialogue between the inside and the outside, the duplication of a lack and to an endless motherhood.

The purpose of the study has been to, through a qualitative interview create an understanding of abused women and their experience of psychological violence, how it has affected their emotional experiences and mental health and how relationships with people outside the relationship have been affected. Four female participants were interviewed where they shared their experiences and opinions of living with psychological violence in a close relationship based on the following questions: How do women feel that their emotions and health are affected by being exposed to psychological violence? How have abused women's relationships with people outside the relationship been affected? The study is based on previous research that deals with abused women's emotions, mental health, and social relationships as well as sociological theories. The theories used are Thomas Scheff's social bond and shame theory, Susan Scott's theory of role-playing and guilt, Erving Goffman's theory of prominence and facade, and Catherine Haslam, Alexander Haslam and Jolanda Jetten's theory of social ties and mental illness. The results show that the informants experienced strong feelings of guilt and shame, as their everyday lives were marked by violations, guilt, and manipulation. Women's social relationships with those around them were affected due to controlling behaviors or feelings of shame. All informants became ill in mental illness, where eating disorders were most common. / Syftet med studien har varit att genom en kvalitativ intervjuundersökning skapa förståelse hur våldsutsatta kvinnor upplever att psykiskt våld i en parrelation påverkat deras emotionella upplevelser och psykiska hälsa samt hur relationer till personer utanför parrelationen påverkas. Fyra kvinnliga deltagare har intervjuats där dem delat med sig av sina upplevelser och erfarenheter av att leva med psykiskt våld i nära relation utifrån följande frågeställningar: Hur upplever kvinnor att deras emotioner och hälsa påverkats av att utsättas för psykiskt våld? Hur har våldsutsatta kvinnors relationer till personer utanför parrelationen påverkats? Studien baseras på tidigare forskning som behandlar våldsutsatta kvinnors emotioner, psykiska hälsa och sociala relationer samt sociologiska teorier. Teorierna som används är Thomas Scheff sociala band och skam teori, Susan Shotts teori om rolltagande och skuld, Erving Goffmans teori om framträdande och fasad, samt Catherine Haslam, Alexander Haslam och Jolanda Jettens teori om sociala band och psykisk ohälsa. Resultatet visar att informanterna upplevde starka känslor av skuld och skam, då deras vardag präglades av kränkningar, skuldbeläggning och manipulation. Kvinnornas sociala relationer till sin omgivning påverkades på grund av kontrollerande beteenden eller känslor av skam. Samtliga informanter blev sjuka i psykisk ohälsa, där ätstörning var mest förekommande.

Den här studien undersöker hur kvinnor upplever och tolkar hur kvinnokroppens representation i sociala medier påverkar deras självkänsla och psykiska hälsa. Genom en översikt av tidigare forskning, intervjuer med sex kvinnor i åldern 20-30 år samt tillämpning av social inlärningsteori och receptionsforskning, syftar vi till att ge en nyanserad insikt i detta viktiga samhällsproblem och ge läsarna en stark teoretisk grund för att förstå problemet. Kombinationen av social inlärningsteori och receptionsforskning ger oss möjlighet att få en nyanserad förståelse för hur publiken tolkar och interagerar medieinnehållet, detta genom att använda oss av begrepp som bland annat aktiv publik, mediebruk, inlärning och modellering. Resultaten av studien visar att sociala medier kan ha en negativ påverkan på hälsa och självkänsla på grund av den utbredda förekomsten av orealistiska skönhetsnormer och den konstanta jämförelsen med andra. Detta kan vara skadligt och i en del fall leda till ätstörningar. Vårt resultat visar också på att det finns positiva aspekter av sociala medier som kan främja en hälsosam självbild, såsom möjligheten att få tillgång till kropps-positivistiskt innehåll. / This study examines how women perceive and interpret the representation of the female body on social media and its impact on their self-esteem and mental health. Through a review of previous research, interviews with six women aged 20-30 years, and the application of social learning theory and reception studies, our aim is to provide nuanced insight into this important societal issue and give readers a strong theoretical foundation for understanding the problem. The combination of social learning theory and reception studies allows us to gain a nuanced understanding of how the audience interprets and interacts with media content, using concepts such as active audience, media use, learning, and modeling. The results of the study show that social media can have a negative impact on health and self-esteem due to the widespread prevalence of unrealistic beauty standards and constant comparison with others. This can be harmful and, in some cases, lead to eating disorders. Our findings also highlight that there are positive aspects of social media that can promote a healthy self-image, such as access to body-positive content.

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