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Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual.A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available.At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040).Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

Multifamily therapy (MFT) for adolescent eating disorders (ED) is anchored in systemic theory and family therapy, but two conceptual and practical paths have emerged from this common framework. The first one, called ED-focused MFT, is centered on behavioral change and weight gain in the early stages of treatment, while the second, known as relationship-focused MFT, is less directly focused on symptom improvement and more on family changes. Compared to ED-focused MFT, validation of more relationship-focused MFT models has been lagging behind although they are frequently implemented and practiced in Europe. The purpose of this article is to give more visibility to existing relationship-focused MFT models by presenting an integrative, yet predominantly family-oriented MFT program developed for adolescent anorexia nervosa (AN) (12 to 18 years) on the ED unit of a large pediatric hospital in France. After presenting the history and development of this relationship-focused MFT program, including the challenges it encountered and its evaluation, we describe its rationale and objectives, then outline its course and content, giving illustrations of techniques and activities for each of the five phases of the program. Finally, we review the current status of this model, its advantages and limitations, and provide a critical appraisal of existing evidence and recommended future research directions.青少年饮食障碍(ED)的多家庭治疗(MFT)植根于系统理论和家庭治疗，但在这一共同框架下出现了两种概念和实践路径。第一种是关注早期发展的MFT，主要关注治疗早期阶段的行为改变和体重增加，而第二种是关注关系的MFT，不太直接关注症状改善，更多关注家庭变化。与以早期发展为中心的MFT相比，更注重关系的MFT模型的验证一直滞后，尽管它们频繁地在欧洲被实施和实践。本文的目的是通过介绍在法国一家大型儿科医院的急诊科为青少年神经性厌食症(an)(12至18岁)开发的一个综合的、但主要以家庭为导向的MFT项目，使现有的以关系为中心的MFT模型更加引人关注。在介绍了这个以关系为中心的MFT项目的历史和发展，包括它遇到的挑战和它的评估之后，我们描述了它的原理和目标，然后概述了它的过程和内容，为项目的五个阶段中的每个阶段提供了技术和活动的说明。最后，我们回顾了该模型的现状、优点和局限性，并对现有证据进行了批判性评价，并对未来的研究方向提出了建议。.

En quoi l’intimite peut-elle participer a la construction du self du sujet ? Sur la base d’un cas clinique d’une adolescente souffrant d’addictions, les auteurs montrent comment l’effraction de l’intimite dans l’enfance peut entraver le processus de subjectivation. Ils s’interessent a la facon dont le travail therapeutique au sein d’une institution peut apporter une reponse adaptee a l’absence de delimitations du moi et de legitimation du self chez un fonctionnement limite. Trois axes de travail sont ici proposes : la dynamique des symptomes, la fonction du corps et enfin la place du tiers comme garant du desir et temoin d’une intimite retrouvee.

Purpose. Anorexia Nervosa (AN) is a severe chronic disorder and parents’ experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to examine parents’ and adolescents’ characteristics that underlie parental burden and grief in AN, and the link between these two dimensions. Methods. Eighty mothers, 55 fathers and their adolescents (N=84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent’s illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief.Results. Main findings indicated that burden was higher in parents of adolescents with a more severe AN; fathers’ burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents’ clinical state was more severe. Paternal grief was related to higher anxiety and depression, while in mothers, grief was correlated to higher alexithymia and depression. Paternal burden was explained by father’s anxiety and grief, and maternal burden by mother’s grief and her child’s clinical state.Conclusion. Parents of adolescents suffering from AN experienced high levels of burden, emotional distress and grief. These perceptions (that are also inter-related) should be specific targets for intervention aimed at supporting parents. Our results sustained the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child.ClinicalTrials.gov Identifier: NCT00910169grief; burden; caregiving; parents; anorexia nervosa; gender roleLevel of evidence III

Background: Awareness of one’s own states is a particularly important part of cognition and emotion regulation. Difficulties in this domain is seen as the roots of several types of disorders. Impairments in perceiving emotional states has been widely documented, leading to show alexithymia - the difficulty in identifying, conceiving and communicating one's states - as a central mechanism of somatic and mental disorders. Recently, the concept of alexisomia has been used to refer to lack of awareness and expression of somatic sensations. Developing self-reported questionnaires to evaluate alexisomia represents a challenge for clinical psychology and medicine. In this context, we suggested to adapt the Body Awareness Questionnaire (BAQ, Shields et al., 1989) in France to assess alexisomia in relation to alexithymia. Methods: For this study, 610 participants completed questionnaires measuring alexithymia and alexisomia. Results: Confirmatory factor analyses showed that the BAQ can be envisaged through 4 factors as well as a unidimensional model to refer to alexisomia. We also found that body awareness was negatively related to scores of alexithymia. Conclusion: Results are discussed in light of the construct of alexisomia and its clinical implications in somatic as well as mental disorders. We suggest that alexisomia is a key concept, in the same way as alexithymia, to design treatment and prevention programs.

Resume Contexte L’anorexie mentale (AM) presente frequemment des comorbidites avec les troubles de l’humeur, en particulier, la depression, par contre les antecedents individuels et/ou familiaux de troubles bipolaires (BP) a, quant a lui, ete peu etudie. Objectifs Cette etude a pour objectifs : (1) d’evaluer, d’une part, la frequence des troubles bipolaires aupres de patients souffrant d’anorexie mentale hospitalises a l’adolescence et leurs parents ; (2) et d’autre part, de rechercher si les patientes aux antecedents personnels et/ou familiaux de trouble bipolaire presentent des caracteristiques particulieres quant a l’expression clinique de leur anorexie mentale, leurs antecedents, les diagnostics secondaires poses, les traitements prescrits. Methode Au total, 97 patientes, âgees entre 13 et 20 ans, hospitalisees pour anorexie mentale ont ete evaluees. Les diagnostics anorexie mentale et trouble bipolaire ont ete poses selon les criteres du DSM IV-TR. Resultats Une frequence elevee de troubles bipolaires de type II et de type V a ete observee. Les patientes souffrant d’anorexie mentale et presentant des antecedents personnels ou familiaux de trouble bipolaire ont un debut plus precoce de l’anorexie mentale, un nombre d’hospitalisations plus important, un delai plus long entre le debut de l’anorexie mentale et l’hospitalisation un nombre plus eleve de tentatives de suicide et presentent davantage de comorbidites psychiatriques. Conclusion La presence d’une comorbidite anorexie mentale–trouble bipolaire semble importante et liee a la severite de l’anorexie mentale.

International audience; Abnormally high levels of physical activity have been documented throughout the literature in patients with eating disorders (ED), especially those diagnosed with anorexia nervosa (AN). Yet no clear definition, conceptualization, or treatment of the problematic use of physical activity (PPA) in ED patients exists. The aim of this review is to propose a new classification of PPA, report the prevalence, triggers, predictors, maintainers and other related factors of PPA in ED patients, in addition to proposing a comprehensive model of the development of PPA in AN. A total of 47 articles, retrieved from Medline and Web of Science, met the inclusion criteria and were included in the analysis. As a result, the new approach of PPA was divided into two groups (group 1 and group 2) according to the dimension (quantitative vs qualitative approach) of physical activity that was evaluated. The prevalence of PPA in ED was reported in 20 out of 47 studies, the comparison of PPA between ED versus controls in 21 articles, and the links between PPA and psychological factors in ED in 26 articles, including depression (16/26), anxiety (13/26), obsessive-compulsiveness (9/26), self-esteem (4/26), addictiveness (1/26), regulation and verbal expression of emotions (1/26) and anhedonia (1/26). The links between PPA and ED symptomatology, PPA and weight, body mass index (BMI) and body composition in ED, PPA and age, onset, illness duration and lifetime activity status in ED, PPA and ED treatment outcome were reported in 18, 15, 7, 5 articles, respectively. All of the factors have been systematically clustered into group 1 and group 2. Results focused more on AN rather than BN due to the limited studies on the latter. Additionally, a model for the development of PPA in AN patients was proposed, encompassing five periods evolving into three clinical stages. Thus, two very opposite components of PPA in AN were suggested: voluntarily PPA increased in AN was viewed as a conscious strategy to maximize weight loss, while involuntarily PPA increased proportionally with weight-loss, indicating that exercise might be under the control of a subconscious biological drive and involuntary cognition.

International audience; PurposeAccording to the Cognitive-Interpersonal Maintenance Model of anorexia nervosa, social factors are involved in the maintenance and development of this disorder. Therefore, this study aimed to test whether patients with restrictive-type anorexia nervosa (AN-R) experience malicious envy (negative emotions associated with the wish that others lack their superior quality), benign envy (negative emotions associated with the desire to reach and obtain the others’ superior quality) and Schadenfreude (pleasure at the misfortunes of others) with a higher intensity than healthy controls (HC).Methods26 AN-R patients and 32 HC completed scenarios that aimed to induce envy and Schadenfreude and completed questionnaires measuring envy, self-esteem and social comparison.ResultsAN-R patients reported more benign envy than HC. Interestingly, higher body mass index (BMI) was associated with less Schadenfreude, malicious and benign envy in AN-R only.ConclusionsThis study shows that AN-R patients present higher motivation to evolve when facing others’ superior quality (i.e., benign envy). It also underlines the importance of considering social factors in the maintenance of AN-R and the role of BMI when examining emotions related to others’ fortune.Level of evidenceLevel III, case-control analytic study.

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.

International audience; Experimentation among adolescents with illicit substances, particularly cannabis, is increasing. The impact of these consumptions has a major impact on their life's course and the family climate in which they evolve. One way to assess its dynamics is to consider the family relationships using the concept of “Expressed emotion” which is a measure of the family environment, a concept born 50 years ago based on the observations of schizophrenic patients and their families. Indeed, for several decades, studies have shown the influence of “Expressed emotion” and its predictive value for relapse in many severe psychiatric disorders. In the field of addiction, the question of the EE has been less discussed. The mechanisms and the development of “Expressed emotion” reasons are still unclear. In the literature, there is indeed a lot of research dealing with psychiatric disease association and addiction but not on the effect of EE on substance use issues with or without comorbidity. Thus, the objective of this article, after recalling briefly the concept of “Expressed emotion”, is to review the studies on this topic in the field of addiction and discuss factors behind “Expressed emotion” to consider tracks resulting in terms of research and treatment.; L’expérimentation de la consommation de substances illicites chez les adolescents et jeunes adultes est en augmentation. Les répercussions de ces consommations se font sur leurs parcours et le système familial dans lequel ils évoluent. Une manière d’évaluer la dynamique de ce système est de considérer le climat familial via le concept d’« Émotion exprimée » largement utilisé dans de nombreuses pathologies psychiatriques. L’objectif de cet article est, après avoir brièvement défini le concept d’« Émotion exprimée », de résumer les résultats des études sur ce sujet dans le champ des addictions, puis de discuter les résultats afin d’envisager les pistes qui en résultent en termes de recherche et de thérapeutique. Les recherches se référant à l’« Émotion exprimée » sont peu nombreuses dans le domaine des addictions en comparaison d’autres champs psychiatriques. Néanmoins ces études montrent que le niveau d’« Émotion exprimée » est fréquemment élevé dans les familles comptant en leur sein un patient souffrant de dépendance à des produits psychoactifs. Cette « Émotion exprimée » familiale haute, et plus particulièrement une dimension critique, a un impact négatif sur le parcours des patients consommateurs de substances, avec ou sans comorbidité. Il serait donc pertinent de mieux faire connaître ce concept, marqueur de la dynamique familiale, notamment auprès des thérapeutes ayant en charge des adolescents consommateurs et leurs familles. L’enjeu est de promouvoir la recherche dans ce domaine, de développer et d’intégrer des techniques psychothérapeutiques à l’appui de meilleures connaissances des facteurs contributifs de l’« Émotion exprimée ».

Resume Objectifs Explorer les styles d’attachement d’adolescentes souffrant d’anorexie mentale en comparaison avec un groupe controle sain a l’aide d’un nouvel autoquestionnaire mesurant plusieurs dimensions de ce concept. Patients et methodes Cette etude pilote a ete menee aupres de six patientes souffrant d’anorexie mentale hospitalisees ou suivies en ambulatoire et de six jeunes filles issues de la population generale. Resultats La prevalence d’un attachement securise aux deux figures parentales est observee pour les adolescentes des deux groupes, meme si une plus grande proportion d’attachement insecure-evitant envers la figure paternelle est a noter pour les adolescentes du groupe clinique en comparaison de celles du groupe controle. Conclusion Nos resultats, en contradiction avec la litterature existante, peuvent s’expliquer par l’âge de notre echantillon et les differentes modalites therapeutiques dont beneficiaient les patientes. Ces elements ont pu contribuer a reorganiser, voire restaurer la qualite de l’attachement, et orientent la reflexion vers une conceptualisation plus developpementale du role de l’attachement dans l’anorexie mentale.

Resume But de l’etude Evaluer le devenir global (somatique, psychique et social) de sujets ayant souffert d’une anorexie mentale severe a l’adolescence et ayant ete hospitalises, de ce fait, dans un service specialise 6 a 12 ans auparavant. Patients et methodes Les 180 jeunes femmes hospitalisees entre 1996 et 2002 ont ete contactees. Leur devenir a ete evalue a partir d’auto-questionnaires et d’entretiens standardises. Le statut vital a ete etudie grâce aux donnees de l’INSEE. Leur etat de sante a ete compare a un echantillon de temoins apparie sur l’âge. Resultats Six a 12 ans apres la sortie d’hospitalisation, environ la moitie des sujets ont pu etre evalues. A l’admission et a la sortie d’hospitalisation, les sujets retrouves ne differaient pas des autres. Parmi les sujets retrouves, 85 % des sujets ne souffraient plus d’anorexie mentale. Leur devenir global etait bon ou intermediaire dans 62,9 % des cas selon le score de Morgan et Russell et 85,3 % avaient un indice de masse corporelle superieur au seuil diagnostique d’anorexie mentale (17,5). Cependant ce devenir etait entache par une mortalite non negligeable puisque 6 fois superieure a celle observee en population generale du meme âge. Conclusion L’anorexie mentale necessitant une hospitalisation a l’adolescence est une pathologie ayant une morbi-mortalite considerable.

Objective Expressed Emotion has been called a “black box”, since little is known about contributing factors. The aim of this study was to examine which parental and which patient/illness-related characteristics contribute to maternal and paternal Expressed Emotion levels. Method Sixty adolescent girls with Anorexia Nervosa (AN) and their parents completed instruments that evaluate characteristics of the adolescent's illness and patient/parental psychological characteristics (depression; anxiety; obsession–compulsion; social anxiety and alexithymia). The following illness-related characteristics were recorded: age at AN onset, duration of illness, AN subtype (restrictive AN-R vs. purging type AN-B), current Body Mass Index (BMI) (in kg/m2), minimum lifetime BMI and number of previous hospitalizations, the Global Outcome Assessment Scale total score. Levels of Expressed Emotion were assessed for the two parents using the Five-Minute Speech Sample. Results Less than 30% of the parents in our sample expressed high levels of Critical EE and Emotional Over-Involvement. Our main findings indicate that maternal Criticism (Critical EE levels, Critical Comments, Dissatisfaction) and the sub-dimensions of maternal Emotional Over-Involvement (EOI EE) (Statement of loving Attitudes and Excessive Details about the past) were related both to the severity of the daughters' clinical state and to maternal psychological functioning. Only paternal levels of anxiety explained paternal Dissatisfaction, EOI EE and Statement of loving Attitudes. Discussion Parental psychological functioning and the severity of the daughters' clinical state have an impact on the family relationships. These elements should be targeted by individual treatment for parents where necessary, and by psycho-educational sessions about Anorexia Nervosa for parents generally.

Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22 years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12 years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

International audience; Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidences from physiology, genetics, epigenetics, and brain imaging which allow to consider AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelino-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors—the “pondero-nutritional-feeding basements”- are also discussed.

Objective: To review studies assessing Expressed Emotion among parents/relatives of patients with Anorexia Nervosa and Bulimia Nervosa. Method: A systematic computerized search was performed in Medline complemented by a manual search of the literature for all studies published between 1981 and 2011. A total of 27 papers in English were reviewed for their methods, instruments used and results. Results: Comparisons were not easy due to methodological disparities in assessments. Levels of Expressed Emotion depend concurrently on parental characteristics (parent assessed, social status and psychological distress), patient characteristics (age, social adjustment) and Eating Disorders characteristics (type of Eating Disorders, duration and severity of illness and previous treatment). Expressed Emotion has a predictive value for patient outcome and for compliance with/ and implication in treatment. Levels of Expressed Emotions vary with the parent assessed. The crosscultural aspects of Expressed Emotion in Eating Disorders are not widely documented. Discussion: Both positive and negative aspects of Expressed Emotion are important therapeutic targets and further research on this topic is needed.

Background Depression, anxiety and obsessive–compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). Clinical consensus admits that depressive symptoms and anxiety are the sequelae of malnutrition in AN. This review presents a critical assessment of the literature that looked into the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment. Methods We performed a systematic search of literature in Medline and PsychInfo for all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords “Anorexia Nervosa”, “depression”, “anxiety”, “obsessive-compulsive disorder” and “malnutrition”. Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept. This search was complemented by a manual search. We also checked the reference lists of the articles we found. Results Seven papers were analyzed and critically reviewed for their methods and results. Results are contradictory and inconsistent at all levels of assessment. Conclusions Evidence based data is very rare. From the 7 reviewed studies, none of them draw the same conclusion. This is mainly due to the large differences in the samples' populations and the studies' protocols. Future studies are needed to focus on the relationship between depression/anxiety symptoms and malnutrition. A more critical nutritional assessment should be undertaken with multiple psychological assessment scales.

Background: Bonding and expressed emotion (EE) are two concepts modeling family relationships. Two studies, with contradictory results, have explored whether these concepts and their corresponding instruments [the Parental Bonding Instrument (PBI) and the Camberwell Family Interview] do indeed measure the same aspects of family relationships. Our first objective was to compare the adolescents' perceptions of family relationships using the PBI, and the parental viewpoint using the Five-Minute Speech Sample (FMSS-EE). Secondly, we compared the PBI scores and EE levels of the parents. Sampling and Methods: Sixty adolescent girls with anorexia nervosa completed the PBI. The FMSS and a modified version of the PBI were administered to parents separately. Results: No significant link was identified between adolescent PBI scores and parental EE levels. However, a link between maternal ‘modified' PBI scores and maternal EE was observed: when mothers registered a high Final EE, they were more likely to deny their daughter's psychological autonomy compared to mothers with lower EE. Conclusions: Our empirical results do not support the hypothesis of an overlap between the two concepts. Indeed bonding and EE measure the same object, i.e. the quality of family relationships, but time scales differ and so do the perspectives (patient vs. parental viewpoint).

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

Objective Individual Cognitive Remediation Therapy (CRT) for AN has been found to improve patients’ neuropsychological functioning and short term outcome. No French speaking country has tested its effectiveness. Moreover, the question whether it is similarly efficient for both restrictive and binge-purging AN remains unanswered. We thus designed a randomized clinical trial on the effectiveness of individual CRT in AN adolescents or young adults. Method 120 female AN [16-35 years old] (60 AN-R; 60 AN-BP) from three specialized care units (P.Brousse, IMM, Cochin- MDA). Patients of each AN type are randomly allocated to one of the two treatment arms: CRT or Sham Therapy (ST). The Sham therapy (ST) has been designed to match the CRT format: an individual manualised therapist-led 10-sessions long program (2 sessions/week). ST sessions have been designed so as to avoid set-shifting and central coherence training and rather tap 3 domains: soft physical activity, emotional expression and recognition and interpersonal functioning. Primary outcomes are neurocognitive improvement at the end of therapy (TMT, WSCT performances) and better clinical status (GOAS) at the end of therapy and at follow-up (6 months, 1 year). Secondary outcomes are changes in BMI, central coherence, selfreported eating disorders symptoms and cognitive flexibility, and motivation to change. Results Inclusions started in September 2012. Preliminary findings (at least 15 participants in each arm are expected by then) on short term CRT effectiveness will be presented.

BackgroundVery few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety.Methods155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels.ResultsNo correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = -0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216).ConclusionThe present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.