Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy.

OBJECTIVES: Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. DESIGN: Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. SETTING: Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). RESULTS: Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). CONCLUSION: This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

The Challenges of Potential Destructiveness in Designing a Therapeutic Framework for Adolescents with Anorexia Nervosa.

The authors begin by presenting the epistemological foundations that enabled them to design a therapeutic mediation framework aimed at enhancing the treatment of hospitalized anorexic patients. This unique framework utilizes bodily exploration through sound and music vibration. The authors were inspired by a method of dynamic structuring of the body image through clay modeling, created by Gisela Pankow, and by the bodily aspects of the subject's relationship with the object in transitional phenomena and in playing, as elaborated by Donald W. Winnicott. A detailed account of a clinical experience with a young female patient highlights the way in which the framework helped reveal destructive fantasies linked to scenes of psychic conflict.1.