Pattern of encounters to emergency departments for suicidal attempts in France: Identification of high-risk days, months and holiday periods.

INTRODUCTION: Seasonal change in patterns of suicidal attempts is not well known in France and may differ from other western countries. We aimed to determine the peak times (days, months and holiday periods) of suicidal attempts in France. METHODS: We carried out a multicentre retrospective epidemiological study, using data from the Organization for Coordinated Monitoring of Emergencies (OSCOUR®) network. We aggregated daily data from January 1, 2010, to December 31, 2019. Variations in suicidal attempts on specific days were investigated by comparing their frequencies (ad hoc Z-scores). RESULTS: 114,805,488 ED encounters were recorded including 233,242 ED encounters regarding suicidal attempts. Men accounted for 45.7%. A significantly higher frequency of ED encounters for suicidal acts were found on Sundays in the months of May-June for both sexes and on New Year's Day for all genders and age groups. An increased risk was also noted on July 14th (National Day) and June 22nd (Summer Solstice). A protective effect was noted on the day after Valentine's Day, on Christmas Day and Christmas time (in particular December 24 and 26). CONCLUSION: Sundays, June, New Year's Day were at increased risk of suicidal attempts in France requiring a strengthening of prevention.

Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients.

The reduced specificity of positive and negative autobiographical memories observed in anorexic (AN) patients may reflect a global disturbance in their emotional information processing. However, their emotional difficulties may differ according to the subtype of AN, implying possible differences in the manifestation of autobiographical memory impairments. The aims of the study were (1) to confirm the autobiographical memory deficits in AN patients in terms of specificity and wealth of memories, and (2) to compare autobiographical deficits according to the AN subtype: restrictive type (AR) or binge/purging type (AB). Ninety-five non-clinical (NC) individuals and 95 AN patients including 69 AR and 22 AB patients were administered the Williams' and Scott's Autobiographical Memory Test. The results confirmed a lack of specificity regardless of emotional valence in the overall AN patient group without any distinction of subtype, which was linked to the number of hospitalizations. When the AN subtype was considered, AR patients demonstrated reduced specificity for negative memories only, suggesting differences in emotional functioning or in the mechanisms underlying reduced specificity between AR and AB patients. Furthermore, the overall AN group demonstrated lower variability and complexity in their memory content than the NC group. However, this difference in the complexity of recalled memories was only found in response to negative cues. When AN subtypes were considered, AR patients showed fewer complex memories than NC individuals. Beyond a reduced specificity, AN patients also depict a poverty in the range of event recall and a difficulty in developing narrative content. The clinical implications of such autobiographical memory deficits need to be further investigated.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia.

OBJECTIVE: Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN. METHOD: Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety). RESULT: Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients. CONCLUSIONS: Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews.

Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

Living as a couple with anorexia nervosa: A dyadic interpretative phenomenological analysis.

This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter 'at the crossroads between remission and relapse'; second, the way that 'anorexia reveals itself'; and finally, the way the 'ménage à trois' works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners' development of appropriate responses.

[Prevalence and impact of post-traumatic stress disorder in a disordered eating population sample]. / Prévalence et impact de l'état de stress post-traumatique chez les patients atteints de troubles du comportement alimentaire.

OBJECTIVE: Eating disorders (ED) are associated with a higher prevalence of post-traumatic stress disorder (PTSD). However, the impact they may have on the clinical features and severity of the ED remains unknown. In this study, we assessed the prevalence and the impact of PTSD in a disordered eating population sample. METHODS: We recruited patients with eating disorders during a period of 6 months, in 2014. The patients underwent a semistructured diagnostic interview by trained psychiatrists. The severity of eating behaviours and PTSD was assessed using the Eating Disorder Inventory 2 and the Impact of Event Scale - Revised. RESULTS: One hundred and thirty patients (57 patients with anorexia nervosa, 26 with bulimia nervosa, 18 with eating disorder not otherwise specified and 29 with binge eating disorder) were included. Our analyses revealed a PTSD rate of 33.9% in patients with ED. No difference was observed between the ED subtypes. Severity of ED was significantly higher among patients suffering from PTSD. Specific clinical characteristics of the ED-PTSD association have been found. Analyses revealed a significantly higher level of insecurity, interpersonal distrust, impulsivity and a decrease of interoceptive awareness. DISCUSSION: The frequency and negative impact of PTSD on ED reinforce the need for a systematic clinical evaluation and the implementation of specific care.

Maintenance of parasympathetic inhibition following emotional induction in patients with restrictive type anorexia nervosa.

This study aimed to explore changes in heart rate variability (HRV), a proxy for parasympathetic activity characterizing emotion regulation processes before, during and after negative emotional induction in patients suffering from restrictive type anorexia nervosa (AN-RT). We compared two methods of HRV analysis, the Fast Fourier Transform high frequency (FFT-HF) and a specific HRV high frequency analysis technique, namely, the wavelet transform HRV (WT-HRV). A sample of 16 inpatients with AN-RT was compared to 24 control participants. Heart rate (HR) was continuously recorded for 5 min before the beginning of the video until 5 min after the video. The participants answered questionnaires concerning their eating behaviors, mood disorders and difficulties in emotion regulation. During the entire procedure, the FFT-HF in patients was lower than that in controls. Using the WT-HRV, the patients did not differ from the controls at baseline, and only the controls showed a decrease during emotional induction. After the video, the WT-HRV in patients began to decrease during the first 2 min of emotional recovery although the WT-HRV in controls was already increased. These results highlighted the disturbances in the physiological dynamics of emotion regulation processes in patients with AN-RT.

Emotional differentiation and parental bonding in inpatients suffering from eating disorders.

OBJECTIVES: This study aimed (1) to determine whether inpatients with eating disorders (EDs) have difficulty differentiating their emotions and being aware of the emotions of others; (2) to investigate the link between actual skills in emotional awareness and the sense of self-efficacy concerning these skills; and (3) to assess the impact of the quality of parental bonding on patients' levels of emotional awareness. METHODS: A sample of 44 inpatients with EDs, including a subgroup of 25 patients with restricting type anorexia nervosa (AR) and a subgroup of 19 patients with purging symptoms (PUR), were compared with 37 controls. All participants completed measures on emotional awareness (using the Level of Emotional Awareness Scale [LEAS]), alexithymia (using the Toronto Alexithymia Scale-20 [TAS-20]), and parental bonding (using the Parental Bonding Inventory). RESULTS: Inpatients with EDs reported difficulties in identifying and describing their feelings when using the self-report questionnaire (TAS-20). However, using a performance-based instrument (LEAS), inpatients with ED exhibited no deficits in differentiating their emotional states, although AR patients experienced difficulties when differentiating the emotional states of others. Moreover, there was no significant association between the TAS-20 and the LEAS scores, suggesting that the two measurements provide insight into different aspects of emotional processing. Regression analyses showed that maternal care had a positive influence on emotional awareness in the AR subgroup, whereas maternal overprotection had a negative influence on emotional awareness in PUR subgroup. CONCLUSIONS: Inpatients with EDs do not present with deficits in personal emotional awareness despite their self-perception. AR patients showed deficits in the emotional awareness of others. In patients with EDs, perceived maternal bonding influenced the development of emotional awareness, and this influence was dependent on the type of ED. Psychotherapies that focus on maternal bonding and emotional communication within the family unit may enhance emotional awareness in patients with anorexia or subclinical eating pathologies as an alternative.

Imagining one's own and someone else's body actions: dissociation in anorexia nervosa.

BACKGROUND: Patients with anorexia nervosa (AN) usually report feeling larger than they really are. This body overestimation appears to be related not only to the patient's body image but also to an abnormal representation of the body in action. In previous work on a body-scaled anticipation task, anorexic patients judged that they could not pass through a door-like aperture even when it was easily wide enough--suggesting the involvement of the body schema. In the present study, we sought to establish whether this erroneous judgment about action is specifically observed when it concerns one's own body or whether it is symptomatic of a general impairment in perceptual discrimination. METHODS: Twenty-five anorexic participants and 25 control participants were presented with a door-like aperture. They had to judge whether or not the aperture was wide enough for them to pass through (i.e. first-person perspective, 1PP) and for another person present in the testing room to pass through (i.e. third-person perspective, 3PP). RESULTS: We observed a higher passability ratio (i.e. the critical aperture size to shoulder width ratio) in AN patients for 1PP but not for 3PP. Moreover, the magnitude of the passability ratio was positively correlated not only with the extent of the patient's body and eating concerns but also with the body weight prior to disease onset. Our results suggest that body overestimation can affect judgments about the capacity for action but only when they concern the patient's own body. This could be related to impairments of the overall network involved in the emergence of the body schema and in one's own perspective judgments. CONCLUSION: Overestimation of the body schema might occur because the central nervous system has not updated the new, emaciated body, with maintenance of an incorrect representation based on the patient's pre-AN body dimensions.

Spatial orientation constancy is impaired in anorexia nervosa.

In anorexia nervosa (AN), body distortions have been associated with parietal cortex (PC) dysfunction. The PC is also the anatomical substrate of a supramodal reference framework involved in spatial orientation constancy. Given the impaired spatial orientation constancy found in hemineglect, we sought to determine whether similar disturbances could be observed in anorexic patients. We investigated the effect of passive lateral body inclination on the tactile subjective vertical (SV). Fifty participants (25 AN patients and 25 healthy controls) were asked to manually set a rod into the vertical position under three postural conditions. For tilted conditions, we observed a significant deviation of the tactile SV towards the body. This effect was abnormally accentuated in AN patients and might be caused by higher weighting with respect to the egocentric frame of reference. Our findings reinforce the role of the PC in AN and suggest that this dysfunction affects spatial orientation constancy as well as body boundaries.

Cognitive and physiological dissociations in response to emotional pictures in patients with anorexia.

Recent studies suggest that patients with anorexia may express dissociated cognitive and physiological reactivities to emotional stimuli. The present research aimed to compare subjective and autonomic responses to pleasant, unpleasant and neutral scenes during a categorization task and an activation rating task in anorexic (AN), alexithymic (AL), depressed (DEP) and control participants (CONT). The participants first categorized pictures according to their emotional valence, followed by a rating of their activation level, concomitant with the recording of skin conductance responses (SCRs). Main findings showed that the AN patients presented major difficulty in categorizing pictures, particularly neutral ones. Contrary to the AL participants, this difficulty did not induce significant increases of SCR amplitude in the AN patients. In the second task, the AN patients rated the intensity of activation of unpleasant pictures higher than the AL participants and that of pleasant ones higher than the AL and CONT participants. In addition, no significant linear correlation was observed between the intensity of activation ratings and SCR amplitude in the AN, AL or DEP participants contrarily to what was observed for control participants. This lack of relation suggests a non-specific disconnection between physiological and cognitive self-reported responses to emotional stimuli. Our results highlight a specific form of emotional processing in the AN patients distinct from that observed in alexithymia or depression and characterized by a dissociation between cognitive and physiological responses. This kind of disconnection could be associated with emotional regulation processes and may benefit the AN patients by lowering the psychological stress response.

Anticipation of body-scaled action is modified in anorexia nervosa.

Patients with anorexia nervosa frequently believe they are larger than they really are. The precise nature of this bias is not known: is it a false belief related to the patient's aesthetic and emotional attitudes towards her body? Or could it also reflect abnormal processing of the representation of the body in action? We tested this latter hypothesis by using a body-scaled action-anticipation task in which 25 anorexics and 25 control participants had to judge whether or not an aperture was wide enough for them to pass through. The anticipation of body-scaled action was severely disturbed in anorexic patients; they judged that they could not pass through an aperture, even when it was wide enough (i.e. they behave as if their body was larger than in reality). The abnormally high "passability ratio" (the critical aperture size to shoulder width ratio) was also correlated with the duration of illness and the degree of body concern/dissatisfaction. Our results suggest that body size overestimation in anorexia nervosa is not solely due to psycho-affective factors but rather suggest impaired neural processing of body dimensions that might take its source in parietal networks.

Emotional information processing in first and recurrent major depressive episodes.

Depressive states are classically associated to increased sensitivity to negative events. However this hypersensitivity may not be stable in time, being absent in remission periods or further reinforced with recurrent depressive episodes, or may concern positive stimuli instead, e.g. in young depressive patients. To study the evolution of the processing of emotional information in depression we recorded late components of evoked potentials in first-episode and recurrent depressed patients before and after recovery. We used a visual attentional paradigm manipulating the processing of emotional information. Subjects first counted words with positive valence, and then words with negative valence from lists of usual words. The results showed that recurrent patients had increased P300 amplitudes for negative words selection only in negative words counting situation, while first-episode patients had decreased P300 amplitudes for positive words selection. After clinical improvement, the negative biases in recurrent patients group disappeared but P300 amplitudes of first-episode patients remained significantly low for positive words. First-episode depressed patients show a selective impairment for positive stimuli, with decreased response to pleasant stimuli, while recurrent depressive subjects show signs of hyperesthesia for negative stimuli. These results suggest that responses to emotional stimuli in word processing are related to the duration of the mood disorders.

Cognitive processing of anorexic patients in recognition tasks: an event-related potentials study.

OBJECTIVE: We used event-related potentials (ERPs) to test whether anorexic subjects have difficulties in filtering out irrelevant stimuli in controlled information processing tasks. METHODS: ERPs from 12 anorexic patients were recorded during recognition of simple and complex body images and simple and complex geometrical shapes. RESULTS: Anorexic subjects had larger P300 amplitudes for frequent stimuli during body images and simple geometrical shape recognition tasks. Longer P300 latencies were also found in simple geometrical shape recognition tasks, although task complexity had no effect on the P300 latency and amplitude. DISCUSSION: These results are explained in terms of nonspecific hyperarousal in mental anorexia and relative inability to filter out irrelevant stimuli leading to working memory saturation.