Fabienne Perdereau

Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study

Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.

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 were166 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). Results: The majority of AN and BN subjects demonstrated social disability in the “social role” (leisure time, time spent with friends) and the “occupational role” (work or educational activities). A regression analysis was employed to uncover predictive factors of social disability. Eating disorders (AN and BN), anxiety disorders and depression accounted for a large portion of social disability. Discussion: Anxiety and depressive disorders appear to play an important role in the type of social disability demonstrated in eating disorder patients. Therapeutic implications are discussed.

Comorbidity of Dependent Personality Disorder and Separation Anxiety Disorder in Addictive Disorders and in Healthy Subjects

The aim of the study was to determine the comorbidity of dependent personality disorder (DPD) and separation anxiety disorder (SAD) in large nonclinical and clinical samples. Using a cross-sectional method, the relationship between these disorders was studied in 784 healthy subjects and in 708 subjects presenting with various addictive behaviors. DPD was significantly associated with SAD in healthy subjects, alcoholics, drug abusers and anorectic and bulimic patients. The comorbidities of SAD and DPD suggest that specific therapeutic strategies could be discussed. Moreover, longitudinal studies are required to determine if SAD constitutes a risk factor for DPD.

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. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

Family history of anxiety and mood disorders in anorexia nervosa: Review of the literature

OBJECTIVE: To provide a critical review of the research on mood and anxiety disorders in relatives of individuals with anorexia nervosa (AN). In the first section, we explore methodological issues with these studies. In the second section, we present results. METHOD: A Medline search identified studies published on family history of mood and anxiety disorders in AN, and was complemented by a manual search. Only studies from 1980 to 2006 using strict diagnostic criteria for the disorders were included [Feighner and Halmi criteria for AN, Reasearch Diagnostic Criteria (RDC), Diagnostic and Statistical Manual of Mental Disorders — Third Edition — Revised (DSM-III-R) or DSM — Fourth Edition (DSM-IV) for anorexia and other disorders]. RESULTS: A review of the research methods used in the studies revealed a number of methodological problems. Therefore, we provide only a description of the prevalence of mood and anxiety disorders in relatives of individuals with AN. CONCLUSIONS: In the light of the methodological issues uncovered, the value of the results of these studies and their implications for further study are considered.

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.

Expressed emotion measure adaptation into a foreign language

Expressed emotion (EE) measures have been created in English; adaptation into a foreign language is difficult. The aim of this study was to adapt the five minutes speech sample (FMSS), with a designed procedure ensuring optimum quality of the adaptation, and thus better trans-cultural validity. A strategy for improving inter-rater agreement comprised three phases: (1) phase of initial ratings (70 French samples), (2) experimental phase in two steps: ratings of 40 other samples in French, followed by analysis of differences between the French-language ratings and English-language ratings and (3) final rating phase of the initial 70 samples. For each phase, the κ coefficients measuring inter-rater agreement were calculated and compared using a bootstrap procedure. The improvements between these scorings were significant at p < 0.05 (phase 2 initial versus phase 2 final and phases 1 versus 3). The French inter-rater agreement significantly improved after this procedure.

Antécédents familiaux de troubles anxieux et de troubles de l'humeur dans l'anorexie mentale

Resume Objectif Nous avons souhaite realiser une revue critique de la litterature des etudes evaluant la prevalence des troubles de l’humeur et des troubles anxieux chez les apparentes de sujets souffrant d’anorexie mentale (AN). Dans une premiere partie, nous avons discute les problemes methodologiques poses par ces etudes, dans une seconde partie nous avons expose les resultats. Methode Nous avons effectue une recherche informatique (sur Medline) afin de retrouver les etudes publiees sur les antecedents familiaux des troubles de l’humeur et des troubles anxieux dans l’anorexie mentale, et l’avons completee par une recherche manuelle. Nous avons limite notre travail a la periode 1980-2002, afin de ne retenir que les etudes ayant utilise des criteres diagnostiques stricts pour les troubles etudies (criteres de Feighner ou de Halmi pour l’anorexie mentale, RDC, DSM III, DSM III-R ou DSM IV pour l’anorexie ou les autres troubles). Resultats Dans une premiere partie, nous avons etudie la methodologie de ces etudes en prenant en compte principalement la composition des echantillons, les criteres et les instruments diagnostiques utilises, les methodes permettant l’etablissement d’un diagnostic psychiatrique chez les apparentes, les apparentes evalues, le nombre et le type de troubles recherches. Dans une seconde partie, compte tenu des disparites methodologiques, nous avons resume les donnees chiffrees de prevalence des troubles de l’humeur et de troubles anxieux chez les apparentes de sujets anorexiques. Discussion A la lumiere des variations dans la methodologie de ces etudes, nous discutons la valeur des resultats concernant les antecedents familiaux de troubles de l’humeur et de troubles anxieux dans l’anorexie mentale ainsi que les implications pour des etudes ulterieures.UNLABELLED In the literature, no review concerning the family comorbidity of mood and anxiety disorders of anorexic subjects exists. However, this data can be important for the comprehension of this disorder and for the assumption of responsibility. OBJECTIVE We conducted a critical literature review on studies assessing the prevalence of anxiety disorders (AD) and mood disorders in relatives of anorexia nervosa (AN) subjects. In the first part, we discuss methodological issues relevant to these comorbidity studies. In the second part, taking into account the methodological considerations raised, we summarise the findings of these studies. METHOD We performed a manual and computerised search (Medline) for all published studies on the frequency of MD and AD in AN relatives and MD or AD, limiting our search to the 1980-2002 period, in order to get sufficiently homogeneous diagnostic criteria for both categories of disorders (most often RDC, DSM III, DSM III-R, or DSM IV criteria). RESULTS We review methodological issues regarding population sources, general methodological procedures, diagnostic criteria for AN, MD and AD, diagnostic instruments, age of subjects and course of the eating disorder. DISCUSSION We discuss the results taking into account the methodological problems observed. We give implications for reviewing the results of published studies and planning future research.

Antécédents psychiatriques familiaux dans l’anorexie mentale

Resume Lors d’une etude systematique de 58 patientes hospitalisees consecutivement pour anorexie mentale a l’Institut Mutualiste Montsouris, la comorbidite individuelle et les antecedents familiaux ont ete recherches lors d’un entretien clinique. Conformement aux donnees de la litterature, les troubles des conduites alimentaires ainsi que les troubles depressifs sont frequemment retrouves chez les apparentes de ces patientes. Cette comorbidite familiale est discutee a la lumiere des connaissances actuelles sur l’origine du trouble alimentaire associe ou non a des troubles de l’humeur. Enfin, les antecedents familiaux sont etudies comme des elements importants de la prise en charge d’adolescentes anorexiques.

L’existence d’un épisode dépressif majeur est-elle liée à la présence de troubles anxieux chez les anorexiques et les boulimiques ?

Resume L’objectif principal est de determiner si la presence de certains troubles anxieux est liee a la comorbidite depressive chez les sujets souffrant de TCA, en tenant compte des variables qui peuvent, elles-memes, etre liees a la depression (âge des sujets, duree d’evolution du TCA, antecedents d’anorexie mentale chez les BN, statut hospitalier ou ambulatoire, etat nutritionnel). Nous avons evalue la frequence des troubles anxieux et depressifs dans un echantillon de 271 sujets presentant un diagnostic actuel d’AN ou de BN, et 271 sujets temoins, en utilisant le Mini International Neuropsychiatric Interview (MINI), version DSM IV. Les anorexiques ont 4,7 fois plus de risque de developper un EDM en cas de comorbidite avec un trouble anxieux, et les boulimiques environ 3 fois plus. L’anxiete generalisee est le trouble anxieux le plus frequent chez les AN et les BN de notre etude, il apparait aussi comme l’un des principaux facteurs predictifs de l’EDM (AN 2.4 et BN 4.2). Le diagnostic de TOC chez les AN augmente par 3,5 le risque de depression independamment de l’anxiete generalisee. La depression chez les sujets atteints de TCA est plus frequente en cas de comorbidite avec le TOC, l’anxiete generalisee et le trouble panique.