[Evaluation of the effectiveness of a cognitive remediation program in anorexia nervosa using new neuropsychological tools: A case study]. / Évaluer un programme de remédiation cognitive dans l'anorexie : nouveaux outils.

The management of anorexia nervosa (AN) remains complex with insufficient success rates. Based on clinical and empirical observations implicating neuropsychological difficulties in AN, cognitive remediation (CR) therapy appears to show positive effects. Nevertheless, these results remain subject to debate as some studies do not show this improvement, or in the case of positive improvements, a smaller effect size on cognitive performance. A possible explanation could lie in the cognitive tests used to assess CR. The aim of this study is to propose a new protocol for the evaluation of cognitive remediation for patients suffering from ED through the presentation of a case study.

Is addictive-like eating an overlooked stroke risk factor? A study case.

PURPOSE: While stroke is already considered a nutrition-related disease, the prevalence of the broad array of disordered eating behaviors is under-reported in this disease. We describe the case of a stroke in a young woman following a recent food addiction to fatty-sweet food. METHODS: She was diagnosed with a Night-Eating-Syndrome, with a loss-of-control exclusively towards sugary carbohydrates used to manage her insomnia and distress, and her consummatory behaviors were investigated. RESULTS: This case report illustrates a self-medication of a significant psychological distress by shifting from a healthy diet to an overconsumption of hyper-palatable foods, triggering an addiction disorder. The related hypertriglyceridemia, on top of chronic smoking, contributed to the development of an atherosclerotic plaque and thrombus formation. CONCLUSION: Food addiction might be considered as an emerging stroke risk factor. We suggest it fosters the need to take into consideration addictive-like eating behaviors and associated mental disorders in the primary and secondary prevention of stroke. This may be particularly relevant for the prevention of stroke in women as they are more prone to comfort their emotions with food. LEVEL OF EVIDENCE: V, descriptive study.

Examination of emotion-induced changes in eating: A latent profile analysis of the Emotional Appetite Questionnaire.

It is now recognized that emotions can influence food intake. While some people report eating less when distressed, others report either no change of eating or eating more in the same condition. The question whether this interindividual variability also occurs in response to positive emotions has been overlooked in most studies on Emotional Eating (EE). Using the Emotional Appetite Questionnaire (EMAQ) and Latent Profile Analysis, this study aimed to examine the existence of latent emotion-induced changes in eating profiles, and explore how these profiles differ by testing their relations with 1) age and sex, 2) BMI and risk for eating disorders (ED) and 3) factors that are known to be associated with EE such as perceived positive/negative feelings, depression, anxiety, stress symptoms and impulsivity. Among 401 university students (245 females) who completed the EMAQ, 3 profiles emerged (P1:11.2%, P2:60.1%, P3:28.7%), with distinct patterns of eating behaviors in response to negative emotions and situations but few differences regarding positive ones. Negative emotional overeaters (P1) and negative emotional undereaters (P3) reported similar levels of emotional distress and positive feelings, and were at greater risk for ED. However, the people in the former profile i) reported decreasing their food intake in a positive context, ii) were in majority females, iii) had higher BMI and iv) were more prone to report acting rashly when experiencing negative emotions. Our findings suggest that a person-centred analysis of the EMAQ scores offers a promising way to capture the inter-individual variability of emotionally-driven eating behaviors. These observations also add to the growing literature underscoring the importance of further investigating the role of different facets of impulsivity in triggering overeating and to develop more targeted interventions of EE.

Are emotionally driven and addictive-like eating behaviors the missing links between psychological distress and greater body weight?

There is now a large body of evidence suggesting a significant association between emotional discomfort management, disordered eating behaviors and weight status. In the field of overweight and obesity, emotionally driven eating habits that resemble addictive behaviors are considered as a risk factor. This study aimed to investigate in a large sample of French university students 1) the associations between self-reported levels of psychological distress (PD), emotional eating (EE), food addiction (FA) and Body Mass Index (BMI); and 2) the potential mediation effect of eating behaviors (EE and FA) between PD and BMI. The responses of 1051 students (76.3% females) to self-reports assessing PD (Perceived Stress Scale, Hospital Anxiety and Depression Scale), EE (Intuitive Eating Scale-2) and FA (modified Yale Food Addiction Scale) were analysed. Associations between variables (Spearman correlation) and group comparisons by sex and BMI categories (Student's t tests/ANOVA) were tested, followed by Structural Equation Modeling (SEM) by sex. Among females and males, EE and FA scores were positively inter-related and correlated with PD scores and BMI. Moreover, among females and males, SEM showed that both EE and FA acts as mediators between PD and BMI. Hence, among educated young adults, using food consumption for down-regulating negative mood places the individual at risk for overweight and obesity. This study further emphasizes the necessity to take into account emotionally driven and addictive-like eating behaviors in interventions for promoting healthy eating and weight management.

[Which psychiatric comorbidities in cannabis dependence during adolescence? Comparison of outpatients and controls]. / Quelles comorbidités psychiatriques dans la dépendance au cannabis à l'adolescence ? Comparaison de patients consultants et de témoins.

BACKGROUND: The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence. OBJECTIVES: We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities. METHODS: In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use. RESULTS: Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ2=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38-16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ2=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41-46.87]), life-time panic attack disorder (χ2=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ2=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ2=7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ2=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19-25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14-18years old; n=65) (70.8 % versus 94.3 %; χ2=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ2=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ2=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators. CONCLUSION: This study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.

Predictive factors of dropout from inpatient treatment for anorexia nervosa.

BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS: We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION: To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.

[Self-esteem, coping, perceived social support and substance use in young adults with a cannabis dependence disorder]. / Estime de soi, coping, soutien social perçu et dépendance au cannabis chez l'adolescent et le jeune adulte.

INTRODUCTION: Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients' substance use pattern. METHOD: Data from 43 young patients (36 males; mean age=19.6±3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age=19.7±3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use. RESULTS: Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P=0.002) and social (P=0.035) self-esteem, task-oriented coping (P<0.001) and both availability and satisfaction regarding perceived social support (respectively P=0.029 and P<0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P=0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively ß=1.16, P=0.043 and ß=1.06, P=0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P=0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P=0.028), and frequency of cannabis use and global self-esteem scores (P=0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables. CONCLUSION: These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.

Nutritional status and anxious and depressive symptoms in anorexia nervosa: a prospective study.

The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive-compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.

[The Dependent Personality Questionnaire (DPQ): French translation and validation study in a population of 138 hospitalized psychiatric patients]. / Le questionnaire de personnalité dépendante (QPD) : traduction française et étude de validation dans une population de 138 patients psychiatriques hospitalisés.

INTRODUCTION: Dependent personality disorder is a new diagnosis introduced in the third version of the DSM (DSM-III). Contrary to other disorders of personality, as the borderline or the schizotypal personalities, there are no specific interviews or questionnaires focusing on dependent personality. Thus the study of dependent personality disorder requires the use of global interviews or questionnaire as the SCID -II or SIDP-IV. Recently, Tyrer and colleagues (2004) have proposed an 8-item questionnaire, the DPQ (Dependent Personality Questionnaire). Each item of the DPQ is rated from 0 to 3 with a total score ranging from 0 to 24. Using a sample of 30 psychiatric patients presenting various diagnoses and a dependent personality disorder for the half of the sample, the authors have determined the cutoff score allowing the diagnosis of DSM-IV Dependent Personality Disorder. A cutoff of 10 was associated with the best sensitivity (87.5%), specificity (87.5%) and positive predictive value (87.5%). Moreover, the value of the Youden coefficient (Sensitivity+Specificity - 100) was 75. OBJECTIVE: The aim of the study was to present the French version of the DPQ and to determine its psychometric properties as well as the cutoff score. METHODS: One hundred and thirty-eight psychiatric inpatients (97 females, 41 males) with a mean age of 42.26 years were included in the study. The patients were hospitalized in an inpatients unit receiving mood disorders, neurotic disorders or suicide attempters. The subjects filled out the French versions of the DPQ and the Personality Disorders Questionnaire of Hyler, PDQ-4+. Using the PDQ-4+ two groups were built: 25 subjects filled out the diagnoses of dependent personality disorder and 20 subjects did not meet any criteria of dependent personality disorder. Then, for different values of the DPQ, sensitivity, specificity and positive predictive value and Youden indicia (Sensitivity+Specificity - 100) were calculated. RESULTS: The best values of Youden indicia (74) were obtained for the cutoff of 13 on the DPQ. The corresponding sensitivity, specificity and positive predictive value were respectively 84, 90 and 91.3%. CONCLUSION: The French version of the DPQ is now available and permits detection of dependent personality in French populations. LIMITATIONS: Our results must be replicated using structured interviews of personality disorder instead of questionnaires (PDQ-4+) and other samples with different prevalence of dependent personality disorders must be used to test the potential cutoff scores of the DPQ.

[The Alexithymia Questionnaire for Children (AQC): French translation and validation study in a convenience sample of 80 children]. / Le questionnaire d'alexithymie pour enfants (QAE): traduction française et étude de validation dans une population de 80 enfants « tout venant ¼.

INTRODUCTION: Alexithymia refers to a specific disturbance in psychic functioning characterized by a limited ability to identify and communicate one's feelings. Development of specific rating scales and notably the well-validated 20-item Toronto alexithymia Scale (TAS-20) have allowed the study of alexithymia in numerous samples of clinical or non-clinical subjects. Recently, Rieffe et al. [Pers and Individ Differ 40 (2006) 123-133] have developed an alexithymia questionnaire for children (AQC) basing on the TAS-20. The AQC comprised 20 items divided into three subscales: difficulty-identifying feelings (DIF), difficulty describing feelings (DDF) and externally-oriented thinking (EOT). Using a sample of 740 children and the Dutch version of the AQC the three-factor structure of alexithymia was found, using confirmatory factorial analysis, but the EOT factor showed low factor loadings and reliability. OBJECTIVE: The aim of the study was to present the French version of the AQC and to assess the psychometric properties of this version. METHODS: Eighty children recruited from a convenience sample were included in the study. There were 43 boys and 37 girls with a mean age of 11.81 (SD = 1.99, range: 9-16). The validity and the reliability of the AQC were studied using a confirmatory factorial analysis (CFA), the determination of the Cronbach alpha coefficient, and the calculation of the correlations between each item and the total score. RESULTS: Adequation parameters of the CFA showed that the 3-factor solution of the AQC was adequate (χ 2/df = 1.27, RMSEA = .039) although the EOT factor had low factor loadings. The Cronbach alpha coefficient was 0.64 and 15 items had significant correlations with the total score. CONCLUSION: The three-factor model of the AQC was reported for the French version of scale but the EOT factor had low validity. This result confirms the recent study using the Dutch version of the AQC. Moreover, several studies using foreign versions of the TAS-20 reported low reliability of the EOT factor. Thus, other studies are necessary to explore the reliability of the EOT factor of the French version of the AQC, and it's recommended to use only the total score of the AQC instead of the sub-scores.

The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects.

BACKGROUND: The evaluation of alexithymic deficits has become increasingly desirable in health and psychopathology research. The purpose of this study was to calculate alexithymia cutoff scores for a recently developed self-report alexithymia questionnaire: the Bermond-Vorst Alexithymia Questionnaire Form B (BVAQ-B). SAMPLING: Three hundred subjects (47 eating-disordered patients and 253 healthy individuals) completed the BVAQ-B and the 20-item Toronto Alexithymia Scale (TAS-20). METHODS: The TAS-20 was used as a gold standard for this research, with its previously established cutoff scores serving as diagnostic criteria for determining the presence or absence of alexithymia. The BVAQ-B cutoff score selection was based on the examination of psychometric data (i.e., the sensitivity and specificity of the BVAQ-B scores and receiver operating characteristic curve analyses) and of clinical data (i.e., BVAQ-B mean score of the control subjects, who were mostly nonalexithymic, and BVAQ-B mean score of a group of patients with eating disorders, the majority of whom were alexithymic). RESULTS: This research found that the most appropriate BVAQ-B cutoff scores for determining the absence and presence of alexithymia were 43 and 53, respectively. CONCLUSION: In light of these findings, we believe that the BVAQ-B may also lend itself to a categorical evaluation of alexithymia, with these cutoff scores determining its absence or presence.

Comorbidity studies of eating disorders and mood disorders. Critical review of the literature.

OBJECTIVE: We conducted a critical literature review of studies assessing the prevalence of mood disorders (MD) in subjects with eating disorders (ED; anorexia nervosa and bulimia nervosa). In the first part of this article, we discuss methodological issues relevant to comorbidity studies between ED and MD. In the second part, we summarize the findings of these studies in light of the methodological considerations raised. METHOD: A manual computerised search (Medline) was performed for all published studies on comorbidity between ED and MD. In order to have sufficiently homogeneous diagnostic criteria for both categories of disorders, this search was limited to articles published between 1985 and 2006. RESULTS: Too few studies include control groups, few studies compared diagnostic subgroups of ED subjects, and results are scarce or conflicting. DISCUSSION: The results are discussed in the light of the methodological problems observed. The implications when reviewing the results of published studies and planning future research are set out.

[Relations between alexithymia and anhedonia: a study in eating disordered and control subjects]. / Etude des relations entre alexithymie et anhédonie chez des femmes présentant des troubles du comportement alimentaire et chez des témoins.

INTRODUCTION: Alexithymia and anhedonia both refer to a deficit in emotion regulation. Although these 2 concepts have been conceptualized to be closely linked, very few studies aimed at examining carefully their interrelations. OBJECTIVES: Therefore, the purpose of the present study was to investigate the relationships between scores on alexithymia and anhedonia self-reports, and to assess whether the results were influenced by the presence of an emotional disorder. LITERATURE FINDINGS: The 20-item Toronto Alexithymia Scale is the self-report most frequently used to assess alexithymia. Nevertheless, the results of recent studies comparing the psychometric properties of the TAS-20 and another alexithymia self-report - the Bermond-Vorst Alexithymia Questionnaire (BVAQ) - have recommended the BVAQ over the TAS-20. DESIGN: Thus, both questionnaires were included in the present study. In addition, since depression and anxiety may influence the correlations between alexithymia and anhedonia scores, we also measured depression and anxiety and these scores were used to control for their potential confounding effect in the analyses. Two groups of participants were included in this study: 46 eating disordered female patients (ED) and 198 female control subjects. All the participants filled up the Bermond-Vorst Alexithymia Questionnaire-form B (BVAQ-B), the 20-item Toronto Alexithymia Scale (TAS-20), the Chapman and Chapman Social Anhedonia Scale (SAS) and Physical Anhedonia Scale (PAS), the 13-item Beck Depression Inventory (BDI) and the Spielberger State and Trait Anxiety Inventory (STAI-Y). The analyses consisted, first, in establishing the matrix of correlations between these self-reports total scores, using Pearson's coefficients of correlation. Then, TAS-20, BVAQ-B, SAS and PAS scores were correlated, adjusting for BDI and STAI scores, using partial correlation analyses. Mean scores comparisons according to the group of participants, and to the presence/absence of alexithymia, as well as to the presence/absence of anhedonia were performed using ANCOVAs or Mann-Whitney tests. RESULTS: As predicted, BDI and STAI scores were found significantly and positively correlated with alexithymia and anhedonia scores in both participant groups. After controlling for depression and anxiety scores, TAS-20 and PAS scores remained significantly correlated, but not TAS-20 and SAS scores. BVAQ-B scores remained significantly correlated with PAS and SAS scores in the control group, but only with the PAS scores in the ED group. ED patients had higher alexithymia and anhedonia scores than the controls. In total, among the alexithymic individuals, 8.9% were social anhedonics, and 31.1% had a physical anhedonia. Conversely, among the participants with a physical anhedonia, two third were alexithymics. The same proportion of participants with a social anhedonia was alexithymic (66.7%). CONCLUSION: The results of the present study are informed about the relationships between alexithymia and anhedonia. They also stress the need to rely on several alexithymia measurements, and they further demonstrate the necessity to compare the associations between different affect regulation dimensions in normal and psychopathological disorders.

Risk factors for substances use and misuse among young people in France: What can we learn from the Substance Use Risk Profile Scale?

BACKGROUND: The prevention of addictions in young people is a challenge for Mental and Public Health policies, and requires specific risk-screening tools. Specific personality traits, as assessed using the Substance Use Risk Profile Scale (SURPS), could play a key role in the onset and escalation of substance use. This study aimed to examine (1) measurement invariance across age and gender (2) the effects of age and gender on associations between SURPS scores and the most frequently-consumed substances. METHODS: Analyses were based on the responses from 5069 participants (aged 14-20 years) from the 2011 ESPAD-France dataset. Substance-use outcomes were experimentation and current frequency of alcohol, tobacco and cannabis use, and drunkenness. RESULTS: Our approach, consisting in analysing measurement and structural invariance and interaction terms, established the stability of (i) SURPS profiles, and (ii) relationships between these scores and substance experimentation and use over a developmental period ranging from mid-adolescence to early adulthood. Measurement invariance across genders was also confirmed despite the absence of scalar invariance for 2 items. Significant interactions between gender and SURPS factors were established, highlighting differential vulnerability, especially concerning Hopelessness and experimentation of alcohol and drunkenness, or Impulsivity and tobacco experimentation. Finally, Anxiety Sensitivity could be protective against substance use, especially for cannabis in girls. CONCLUSIONS: Our results suggest the relevance of the SURPS to assess vulnerability towards drug use, and underline the need to consider gender differences in addiction risks.

Alexithymia and anxiety: compounded relationships? A psychometric study.

This study is a careful examination of the relationships between different components of the alexithymia construct and state versus trait anxiety. In order to study the relations between anxiety and alexithymia in a subclinical population, we administered to 125 female college students a test battery including measures of alexithymia (TAS26), state and trait anxiety (STAI) and depression (QD2A). Results indicated positive correlations between depression, anxiety (state and trait) and alexithymia scores. Partial correlations revealed a tight link between trait anxiety and alexithymia. Furthermore, in agreement with the view that alexithymia is a multidimensional construct, the various alexithymia dimensions were found to be diversely correlated with anxiety. On the basis of partial correlation analyses, a descriptive model of the relationships between depression, state anxiety, trait anxiety and alexithymia was postulated. This model was confirmed by pathways analyses.

[Validity of the BVAQ: a study in eating disorder patients and controls]. / Validité du questionnaire d'alexithymie de Bermond et Vorst: étude chez des sujets présentant des troubles du comportement alimentaire et chez des témoins.

UNLABELLED: Alexithymia core features are the difficulties in identifying and describing feelings; the difficulties in distinguishing feelings from the bodily sensations of emotional arousal; an impaired symbolization, as evidenced by a paucity of fantasies and other imaginative activity; and a tendency to focus on external events rather than inner experience. Several measures of alexithymia have been developed, including interviewer-rated questionnaires and self-report questionnaires. Among the self-report questionnaires, the 20-item Toronto Alexithymia scale (TAS-20) is the most commonly used, but it fails to measure all the core features of alexithymia. A recently developed instrument, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), allows the measurement of the alexithymia core features, as well as an additional one. It appeared to present good psychometric properties, notably the abbreviated BVAQ-form B. The results of recent studies comparing the psychometric properties of the TAS-20 and the BVAQ have recommended the BVAQ over the TAS-20. However, this questionnaire needed further validation. OBJECTIVES: Thus, the aim of the present study was to determine the convergent, discriminant and concurrent validity of the Bermond-Vorst Alexithymia Questionnaire -- form B (BVAQ-B) in a clinical sample of 59 eating disorder patients, as well as in 191 controls. The TAS-20 constituted the gold standard for the assessment of the BVAQ-B' convergent validity. To compare the concurrent validity of the BVAQ-B and the TAS-20, participants also completed several self-reports investigating different dimensions of emotion regulation capacities: the 13-item Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI-form Y), as well as the Chapman and Chapman Physical and Social Anhedonia Scales (PAS and SAS). One way analyses of variance were used for mean scores comparisons. Convergent validity was determined using Pearson coefficients of correlation. RESULTS: Results of the analyses suggested the BVAQ-B has a satisfying convergent and discriminant validity. This was observed in both the clinical and control samples. Moreover, the comparison of the convergent validity of the BVAQ-B and the TAS-20 revealed several differences between these two alexithymia self-report questionnaires. The BVAQ-B appeared less sensitive to the subjective emotional state of the participants than the TAS-20. Whereas it was argued the TAS-20 overlaps with other emotional state scores, the BVAQ-B would allow to measure alexithymia more specifically. In addition, the present results allowed to further determine the relations between alexithymia and other dimensions of emotion regulation capacities. The analyses confirmed that alexithymia is linked to other emotion regulation dimensions such as depression and anxiety. Moreover, alexithymia was associated with physical and social anhedonia, two dimensions that received less interest in the alexithymia literature to date. This study also showed that control and clinical sample have different emotion regulation capacities. Eating disorder patients were not only more alexithymic and more depressed, but also more anxious and more anhedonic than the controls. Finally, this study revealed that alexithymia differs whether the alexithymic individuals are patients or controls. Healthy alexithymic individuals (ie, individuals categorized as alexithymic in the control group) seemed characterised by a selective deficit of emotional cognition, with sparing of emotional experience (Bermond's type II alexithymia). Alexithymics individuals of the eating -disorder group seemed particularly unabled to experience affect. This pattern could correspond to Bermond's type I alexithymia, which is characterised by the absence of emotional experience and, consequently, by the absence of the cognition accompanying the emotion. In summary, results of the present study add to the literature debating on whether alexithymia is similar in different types of population.

A failure to grasp the affective meaning of actions in autism spectrum disorder subjects.

The ability to grasp emotional messages in everyday gestures and respond to them is at the core of successful social communication. The hypothesis that abnormalities in socio-emotional behavior in people with autism are linked to a failure to grasp emotional significance conveyed by gestures was explored. We measured brain activity using fMRI during perception of fearful or neutral actions and showed that whereas similar activation of brain regions known to play a role in action perception was revealed in both autistics and controls, autistics failed to activate amygdala, inferior frontal gyrus and premotor cortex when viewing gestures expressing fear. Our results support the notion that dysfunctions in this network may contribute significantly to the characteristic communicative impairments documented in autism.

Amygdala activation when one is the target of deceit: did he lie to you or to someone else?

The ability to figure out whether a person is being honest or deceitful is an important part of social competence. Reactions to deceit may however differ depending on whether one is being deceived oneself or observes a deceitful exchange between others. In the present study, we investigated whether personal involvement influenced the neural responses associated with the detection of deceit. Subjects watched videos of actors lifting a box and judged whether the actors had been misled about the real weight of the box. Personal involvement was manipulated by having the participants themselves among the actors. The critical finding was that there was activity in amygdala and fusiform gyrus only for the condition in which participants observed themselves being deceived. In contrast, the superior temporal sulcus and anterior cingulate cortex were activated irrespective of whether the participants detected that the experimenter had deceived themselves or another. These four brain areas are all interconnected and are part of the discrete neural system subserving social cognition. Our results provide direct evidence, using judgments of deceit in a social context, that the crucial factor for amygdala activation is the involvement of the subjects because they are the target of the deceit. We interpret the activation of the amygdala in this situation as reflecting the greater affective reaction when one is deceived oneself. Our results suggest that when one is personally involved, deceit is taken as a potential threat.

Affective response to one's own moral violations.

Morality depends on a set of cultural rules that regulate interpersonal behaviour and provide a basis for social cohesion. The interpretation of moral transgressions and their affective consequences depends on whether the action is intentional or accidental, and whether one is the agent of or witness to the action. We used event-related functional magnetic resonance imaging (fMRI) to investigate whether the amygdala is involved in judging one's own moral violation of social norms. In this study, participants (n = 12) were asked to make evaluations regarding the degree of inappropriateness of social behaviours described in stories in which they themselves, or someone else, transgressed social norms either intentionally or accidentally. Consistent with our hypothesis, the amygdala was activated when participants considered stories narrating their own intentional transgression of social norms. This result suggests the amygdala is important for affective responsiveness to moral transgressions.

An fMRI study of intentional and unintentional (embarrassing) violations of social norms.

The aim of this investigation was to identify neural systems supporting the processing of intentional and unintentional transgressions of social norms. Using event-related fMRI, we addressed this question by comparing neural responses to stories describing normal behaviour, embarrassing situations or violations of social norms. Processing transgressions of social norms involved systems previously reported to play a role in representing the mental states of others, namely medial prefrontal and temporal regions. In addition, the processing of transgressions of social norms involved systems previously found to respond to aversive emotional expressions (in particular angry expressions); namely lateral orbitofrontal cortex (Brodmann area 47) and medial prefrontal cortex. The observed responses were similar for both intentional and unintentional social norm violations, albeit more pronounced for the intentional norm violations. These data suggest that social behavioural problems in patients with frontal lobe lesions or fronto-temporal dementia may be a consequence of dysfunction within the systems identified in light of their possible role in processing whether particular social behaviours are, or are not, appropriate.