Mood disorders in eating disorder patients: Prevalence and chronology of ONSET.

Objectives: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender.

Method: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version.

Results: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group.

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.

[Are anxiety or depressive disorders more frequent among one of the anorexia or bulimia nervosa subtype?].

Unlabelled: Our objective was to answer the following question: are there differences between diagnostic groups of eating disorders (ED) for the prevalence of depressive and anxiety disorders, when clinical differences between the groups are taken into account (ie age of subjects, ED duration, inpatient or outpatient status, and Body Mass Index)?

Method: We evaluated the frequency of anxiety disorders and depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview (MINI), DSM IV version. We compared the prevalences between sub-groups of anorexics (AN-R and AN-BN), between sub-groups of bulimics (BN-P and BN-NP) and between anorexics and bulimics while adjusting for the variables defined below.

Results: Current or lifetime comorbidity of anxiety and depressive disorders did not differ between AN-Rs and AN-BNs, nor between BN-Ps and BN-NPs.

[Comorbidity between eating disorders and anxiety disorders. First part: methodological review].

Unlabelled: The objective of our work is to conduct a critical literature review on studies assessing the prevalence of anxiety disorders (AD) in subjects with eating disorders (ED) (anorexia nervosa and bulimia nervosa). In the first part (this paper), we will discuss methodological issues relevant to comorbidity studies between ED and AD.

Method: We performed a manual and computerised search (Medline) for all published studies on comorbidity between ED and AD, limiting our search to the 1985-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders (most often RDC, DSM III, DSM Ill-R, or DSM IV criteria).

[Comorbidity between eating disorders and anxiety disorders: results].

Taking into account the methodological problems underlined in the first part of this paper, the current review aims to answer three questions: 1) Is there convincing evidence that anxiety disorders (AD) are more frequent among women with eating disorders (ED) than among women from the community? 2) Is there convincing evidence that prevalence of AD differs across diagnostic types or subtypes of ED? 3) What is the chronology of appearance of the two disorders? We performed a manual and computerized search (Medline) for all published studies on comorbidity between ED and AD (1985-2002 period), and selected the most relevant studies. An increased risk for AD in subjects with ED has been shown in several community studies, but studies conducted in referred subjects have led to inconstant findings. The answer to the questions remains uncertain, because too few studies included control groups and few studies have compared diagnostic subgroups of ED subjects, with scarce or conflicting results.

Predictive factors of social disability in anorexic and bulimic patients.

Objectives: The purpose of this study was to determine whether subjects suffering from anorexia nervosa (AN) or bulimia nervosa (BN) would demonstrate more severe social disability than a control group; and whether social disability could be best explained as a function of the eating disorder itself or as a function of comorbid anxiety or depressive disorders.

Method: Subjects were 166 AN subjects, 105 BN subjects and 271 control subjects matched for age, sex and socio-economic status. Prevalence of anxiety or depressive disorders was assessed (through the Mini International Neuropsychiatric Interview), and social functioning was measured (through the Groningen scale).

Treatment of adolescent patients with eating disorders: description of a psychodynamic approach in clinical practice.

Anorexia nervosa (AN) is now usually considered to be a multifactorial disorder, and there is a consensus among clinicians that its treatment should be aimed at restoring weight, altering anorexic attitudes, treating any medical complications, supporting and treating the family, enhancing autonomy, facilitating identity formation, and increasing self-esteem by means of psychotherapy. The practical aspects of such treatments not only vary from country to country, but sometimes also from one treatment team to another. International meetings dedicate considerable discussion to the subject but, as it seems to be relatively ignored in the published literature, we here describe the main elements of our own method.

[Alexithymia, depression and drug addiction].

Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject.

[Validation study of the Depressive Experience Questionnaire].

Sidney Blatt, considering as being insufficient the categorical-symptomatic approach of depression, has worked out a theory of depression and psychopathology that integrates the contributions of psychoanalysis as well as cognitive and developmental psychology. Within a broad psychoanalytic framework, Blatt's formulation focus on the quality of interpersonal relationship, the nature of object representation and early life experiences. Personality development is viewed as the consequence of the interaction of 2 basic developmental tasks: the establishment of the capacity to form stable, enduring, mutually satisfying interpersonal relationships and the achievement of a differentiated, realistic, essentially positive identity.

Cytokines and depression: an analogic approach.

A growing body of evidence suggests that major depressive disorders may be accompanied by immune dysfunction and more particularly by an enhanced production of pro-inflammatory cytokines. The possible involvement of cytokines in depressive illness are based upon an analogic model. Pro-inflammatory cytokines are known to induce behavioral effects, and neuro-endocrine and immune activation similar to those observed in depression; these can be alleviated by antidepressant treatment.

Therapeutical management of depression during adolescence.

Our model of reference remains essentially the psychoanalytic theory of psychic functioning which has permitted us to have a general outlook on the individual: taking into account the genetic and biological aspects of mental functioning, cognitive capacities, requirements concerning learning, as well as the role of affectivity such as is organized through interactions with the environment throughout the patient's life. We suggest that the therapeutical management of depression in adolescence is related to the psychopathology of the patient, especially when there are narcissistic dimensions.