[Anorexia nervosa: An addiction? Application of the addiction model to eating disorders. A narrative commented review]. / L'anorexie mentale : une addiction ? Application du modèle addictologique aux troubles du comportement alimentaire. Une revue narrative commentée.

OBJECTIVES: Addiction offers a framework for the understanding of eating disorders, particularly those characterized by hyperphagia, with growing interest in food addiction. However, the application of the addiction model to anorexia nervosa remains more controversial. In this commented narrative review, we examine and discuss the addictive features of anorexia nervosa. METHODS: Commented narrative review of the literature. RESULTS: Anorexia nervosa could be the consequence of the loss of control of several objects of positive reinforcement: food restriction, physical hyperactivity, and food itself. Craving has been little studied in the field of eating disorders. When investigated, studies mainly focus on food cravings and tend to highlight food cravings that are inversely correlated with the restrictive nature of the disorder. This would thus be less found in anorexia nervosa, in which it is nevertheless reported. The existence of a pre-existing food craving, or its appearance secondary to food restriction, is currently under discussion. In the meantime, the question of a craving for food restriction, underpinned by the gratifying effect of fasting, is raised. CONCLUSIONS: The management of eating disorders has its place within the addiction care sectors. An integrative approach should be favored, for anorexia nervosa, combining, on the one hand, classic nutritional care, and, on the other hand, care within the framework of addiction treatment. Finally, in people with an eating disorder, the search for an addiction to food, food restriction and physical activity, including a systematic assessment of craving, should be systematized.

[Food addictions]. / Les addictions alimentaires.

Addictions are invading our daily lives. Eating and body image have become major preoccupations. Anorexia nervosa and bulimia nervosa are eating disorders with a high risk of chronicity and death. Curing them and preventing their recurrence requires a solid therapeutic alliance that aims to work around individual symptoms. The low self-esteem associated with these disorders may contribute to their maintenance, despite their negative impact on quality of life. One of the challenges of treating these disorders is to help patients find the motivation to seek treatment.

Anorexia nervosa: Enhancing motivation to change with self-determination theory.

Motivational deficits (little or no motivation to change) are often reported in patients with eating disorders, particularly anorexia nervosa. The motivational approaches frequently used by French clinicians rely solely on a dichotomous view of motivation (intrinsic vs. extrinsic). In self-determination theory, certain forms of extrinsic motivation can strengthen an individual's commitment to an activity, providing they are self-determined. This theory therefore extends and enriches the dual motivational approach by highlighting potentially useful forms of extrinsic motivation and by emphasizing the importance of behavioral regulation. Empirical work is now needed to assess how clinicians can use self-determination theory to enhance motivation to change among patients with anorexia nervosa and encourage their adherence to care management plans.

[Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different?] / Kasuistik einer früh im Lebensverlauf an Morbus Addison erkrankten 14 Jahre alten Patientin bei Verdachtsdiagnose einer Anorexia nervosa.

Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.

Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis.

Previous systematic reviews have reported on the relationship between eating disorders (EDs) and birth outcomes, but there are no existing meta-analyses on this topic. This systematic review and meta-analysis examines the association between lifetime maternal EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) with low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), and miscarriage. Four databases were systematically searched for quantitative literature on maternal EDs that preceded birth outcomes. Eighteen studies met the inclusion criteria and were included in the review. The meta-analyses included 6 studies on miscarriage, 11 on PTB, 4 on LBW, 9 on SGA, and 4 on LGA. The Mantel-Haenszel random effects model was used to test the associations between EDs and birth outcomes. The results showed significant positive associations between AN and LBW (OR 1.74, 95% confidence interval (CI) 1.49, 2.03), AN and SGA (OR 1.39, 95% CI 1.17, 1.65), BN and PTB (OR 1.19, 95% CI 1.04, 1.36), and BED and LGA (OR 1.43 95% CI 1.18, 1.72). EDs were not significantly correlated with miscarriage. These findings reveal the importance of screening for and treating EDs in pregnant women.

La restauration de l'être: par le Rorschach d'une adolescente anorexique / A restauração do ser: através do Rorschach de uma adolescente anoréxica / The restoration of being: Through the Rorschach test of an anorexic adolescent / La restauración del ser: a través del Rorschach de una adolescente anoréxica

L'anorexie est une pathologie du vide de sens, qui presente une défaillance au niveau des processus de la pensée, avec des implications directes au niveau de la construction identitaire. Le Rorschach a été utilise comme instrument d'évaluation du fonctionnement mental et comme méthode d'analyse des transformations psychiques. Martha est une adolescente de dix-sept ans, avec deux hospitalisations, avec un diagnostic d'anorexie. L'analyse du Rorschach à mettre en évidence deux mouvements psychiques: la présence d'une forte tension pulsionnelle, mobilisée face à l'atteinte ressentie dans la relation Moi-Autre; la dévitalisation du Moi, par un fort mouvement d'annulation du Moi. La compréhension de ces mouvements a permis une intervention thérapeutique dans le but de restaurer son Être, de consolider son identité et de permettre un ensemble de transformations psychiques qui permettent la subjectivation et la croissance mentale.

Resumos A anorexia é uma patologia do vazio do sentido, que apresenta uma falha ao nível dos processos do pensamento, com implicações diretas ao nível da construção da identidade. O Rorschach foi usado como um instrumento para aceder ao funcionamento mental e como um método de análise das transformações psíquicas. Martha é uma adolescente de dezessete anos, com duas internações, com um diagnóstico de anorexia. A análise de Rorschach permitiu destacar dois movimentos psíquicos: a presença de uma forte tensão pulsional, mobilizada perante o ataque sentido na relação Eu-Outro; a desvitalização do Eu, através de um movimento de uma forte anulação do próprio eu. A compreensão desses movimentos permitiu uma intervenção terapêutica com o objetivo de restaurar o seu Ser, consolidar sua identidade e permitir um conjunto de transformações psíquicas que possibilitam a subjetivação e o crescimento mental.

Anorexia is a pathology of the emptiness of meaning, which presents a failure at the level of thought processes, with direct implications in self-identity. Rorschach test was used as an instrument to assess mental functioning and as a method to analyze the psychic transformations. Martha is a 17-year-old adolescent, with two previous hospitalizations, diagnosed with anorexia. Through Rorschach test, it was possible to highlight two movements: the presence of a strong instinctual drive, mobilized in the face of the perceived attack in the Self-Other relationship; the devitalization of the Self, through a strong annulment of the self. The understanding of such movements enabled a therapeutic intervention aimed at restoring her Being, consolidating her identity and enabling a set of psychic transformations that allow for subjectivation and mental growth.

La anorexia es una patología del vacío de sentido, que presenta una falla al nivel de los procesos del pensamiento, con implicaciones directas en la construcción de la identidad. El Rorschach se utilizó como instrumento para evaluar el funcionamiento mental y como método de análisis de las transformaciones psíquicas. Martha es una adolescente de 17 anos, con dos hospitalizaciones y diagnóstico de anorexia. El análisis del Rorschach reveló dos movimientos psíquicos: la presencia de una fuerte tensión instintiva, movilizada frente al ataque sentido en la relación Yo-Otro; la desvitalización del Yo, mediante un fuerte movimiento de anulación del Yo. La comprensión de estos movimientos permitió aplicar una intervención terapéutica con el objetivo de restaurar el Ser de la paciente, consolidar su identidad y permitir un conjunto de transformaciones psíquicas que permitan la subjetivación y el crecimiento psíquico.

[Effects of non-invasive neuromodulation on the cognitive profile of people with anorexia nervosa: A scoping review]. / Effets de la neuromodulation cérébrale non invasive sur le profil cognitif des personnes atteintes d'anorexie mentale : étude de la portée.

BACKGROUND: The use of non-invasive neuromodulation is emerging in the treatment of anorexia nervosa. Despite promising results, further research is needed to improve our understanding of these techniques and to adapt interventions to this population. As anorexia nervosa is associated with several cognitive difficulties and cerebral anomalies, the aim of the present study was to summarize the available data on the effects of non-invasive neuromodulation on the neuropsychological profile of people with anorexia nervosa. METHOD: A scoping review was conducted by searching in PsycINFO, PubMed and CINAHL databases to systematically identify relevant studies published between 1994 and 2023 on the treatment of anorexia nervosa with repetitive transcranial magnetic stimulation, transcranial direct current stimulation or neurofeedback electroencephalogram. RESULTS: Seventeen articles were included, including 12 on repetitive transcranial magnetic stimulation, four on transcranial direct current stimulation and one on neurofeedback electroencephalogram. Of these, only three studies included a neuropsychological measure to assess the impact of neuromodulation on participants' cognitive functions. CONCLUSIONS: Including detailed neuropsychological measures in clinical trials of non-invasive neuromodulation is highly recommended and appears essential to improve our understanding of these techniques and optimize their efficacy in the treatment of anorexia nervosa.

[Anorexia nervosa, a familiar and complex pathology]. / L'anorexie mentale, une pathologie familière et complexe.

Anorexia nervosa affects people of all ages, and has the highest mortality rate of all psychiatric disorders, following medical complications inherent in the disease or suicide. Early and appropriate treatment is crucial to prevent the risk of chronic disease, which may affect one in two anorexics. Severe undernutrition linked to a complex psychopathology calls for the necessary theoretical and clinical knowledge on the part of the caregiver, applied to the dynamics of care, ideally conceived in a transdisciplinary way and involving nursing teams.

[Anorexia nervosa: demographic, socio-economic and cultural data still too limited]. / Anorexie mentale, des données démographiques, socio-économiques et culturelles encore trop limitées.

Although eating disorders are a public health issue, treating anorexia nervosa from a demographic and socio-economic perspective remains a challenge. Data are scarce, patchy and often of questionable quality. Such a lack of data on a somatopsychic illness with serious repercussions is a real problem, since reliable, longitudinal and detailed information could provide additional answers in understanding the illness, both in terms of age, sex and gender structure, and in terms of family, social and environmental factors.

[Clinical management of anorexia nervosa in a hospital ward]. / Clinique et prise en charge de l'anorexie mentale dans un service hospitalier.

The Lou-Andréas-Salomé unit, which specializes in behavioral addictions, is part of the addictology department of the Nantes university hospital center, and offers inpatient care for people suffering from eating disorders. It manages, prevents or limits the consequences of this addictive pathology, based on the work carried out by a multi-professional team focusing on different areas: somatic, psychological, cognitive, social and family.

[From diagnosis to symptoms]. / De la nécessité de passer du diagnostic au symptôme.

The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which together become almost pathognomonic: excessive restriction of energy intake combined with an irrational fear of weight and an altered body image. Even if weight is at the heart of the medical team's concerns, it is important to question the pathology in its history, in order to put it in to context, and sometimes to understand the para-logic and its function in the patient's life history. It is necessary to work on emotions and cognitions in addition to behaviour.

[Anorexia nervosa and the perinatal period]. / Anorexie mentale et période périnatale.

As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.

[Unconditional self-acceptance and self-compassion: another clinic for anorexia nervosa?] / L'acceptation inconditionnelle de soi et l'autocompassion : une autre clinique de l'anorexie mentale ?

People suffering from anorexia have a particular emotional and cognitive profile (altered body and self-perception, emotional dysregulation, perfectionism, obsessive traits), which the disorder can compensate for through emotional distancing strategies. Self-compassion and unconditional self-acceptance have been shown to have therapeutic effects on the barriers to recovery associated with this profile.

[High-level sports and anorexia nervosa]. / Pratiques sportives de haut niveau et anorexie mentale.

Due to intensive physical training, and the pressure exerted by coaches, parents and the athlete him/herself during pre-competitive and competitive periods, a large number of high-level sporting activities can trigger or participate in anorexia nervosa. That said, some of these activities are more likely than others to promote this eating disorder. It is worth highlighting the sports most at risk for the onset or development of anorexia nervosa, and then addressing the means of prevention and regulation adapted to these circumstances.

[Anorexia nervosa and music therapy]. / Anorexie mentale et musicothérapie.

Supporting people suffering from anorexia nervosa remains a challenge. While traditional treatment focuses more on speech and its emergence for the patient and family, non-medicinal and non-verbal therapies are used more systematically, sometimes as a last resort. Yet, as a non-verbal mediated therapy, music therapy can find a legitimate place and complement all the psychiatric, psychotherapeutic, somatic, dietetic and nursing areas where speech already circulates.

[Healing the mind by healing the body in anorexia nervosa]. / Soigner le mental en soignant le corps dans l'anorexie mentale.

In anorexia nervosa, physical and psychological vulnerability confines the sufferer to the confines of his or her pathology. The physical body is the first victim of undernutrition, but also the first resource for restoring the psychic and emotional body. Reduced food intake has repercussions on cognition and affect, all of which affect relational capacities. Accompanying, understanding and caring for people means reaching out to them and their bodies, to re-establish the link between what has been broken, and to establish a relationship of trust with them.

[COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics]. / COVID-19 und psychische Störungen bei Minderjährigen: Veränderungen der Behandlungen nach der Krankenhausstatistik.

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

Day hospital program for anorexia nervosa in children and adolescents: Assessment, management and specific focus on early onset anorexia nervosa.

INTRODUCTION: The French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP. METHODS: Ninety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13). RESULTS: Patients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups. CONCLUSION: These preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents.

[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.