How French subjects describe well-being from food and eating habits? Development, item reduction and scoring definition of the Well-Being related to Food Questionnaire (Well-BFQ©).

Providing well-being and maintaining good health are main objectives subjects seek from diet. This manuscript describes the development and preliminary validation of an instrument assessing well-being associated with food and eating habits in a general healthy population. Qualitative data from 12 groups of discussion (102 subjects) conducted with healthy subjects were used to develop the core of the Well-being related to Food Questionnaire (Well-BFQ). Twelve other groups of discussion with subjects with joint (n = 34), digestive (n = 32) or repetitive infection complaints (n = 30) were performed to develop items specific to these complaints. Five main themes emerged from the discussions and formed the modular backbone of the questionnaire: "Grocery shopping", "Cooking", "Dining places", "Commensality", "Eating and drinking". Each module has a common structure: items about subject's food behavior and items about immediate and short-term benefits. An additional theme - "Eating habits and health" - assesses subjects' beliefs about expected benefits of food and eating habits on health, disease prevention and protection, and quality of ageing. A preliminary validation was conducted with 444 subjects with balanced diet; non-balanced diet; and standard diet. The structure of the questionnaire was further determined using principal component analyses exploratory factor analyses, with confirmation of the sub-sections food behaviors, immediate benefits (pleasure, security, relaxation), direct short-term benefits (digestion and satiety, energy and psychology), and deferred long-term benefits (eating habits and health). Thirty-three subscales and 14 single items were further defined. Confirmatory analyses confirmed the structure, with overall moderate to excellent convergent and divergent validity and internal consistency reliability. The Well-BFQ is a unique, modular tool that comprehensively assesses the full picture of well-being related to food and eating habits in the general population.

[Relapse in schizophrenia: an exploratory study of the joint conceptions of patients, parents and caregivers]. / Regards croisés sur les signes précoces de rechute des sujets schizophrènes.

INTRODUCTION: The question of the course of schizophrenia relapses, is of considerable interest in different clinical and social areas such as prognosis, quality of life, therapeutic relationship, psychoeducation, rehabilitation and so on. The more the schizophrenic relapses, the higher the level of handicap. Although there is a widespread agreement that it is essential to detect early signs of relapses in order to prevent them, there still remain theoretical and methodological difficulties in identifying these signs because they are personal, heterogeneous and not always specific to psychosis. That is why the notion of "relapse signature" seems relevant by taking into account differentiated and personal assessment of early signs of relapse. This implies the consideration of the different visions of relapse given by patients, parents and caregivers. OBJECTIVE: We propose a qualitative study of the joint appraisal of patients, patients' parents and medical staff. The aim of this study is to regroup the expertises in order to further our understanding of the early signs of relapse. We assume that patients and parents are able to describe signs that are not considered as pathological symptoms, but refer to a personal manner of initiating the relapse process. This should then help in designing early intervention and provide reinforced therapeutic alliance and more positive responses to psychoeducation programs. METHOD: We have interviewed 30 subjects divided in three groups: 10 schizophrenic patients, 10 caregivers (including physicians, psychologists and nurses) and 10 parents of schizophrenics. The patients met the following criteria: patients with a diagnosis of schizophrenia (DSM IV criteria), under neuroleptic treatment, and stabilized. The mean duration of illness was 15 years. The patients as well as caregivers were recruited in two external hospital structures. All the subjects gave their written consent for this study and its methods. We did not recruit parents who were not living with their schizophrenic child or who did not see or have frequent contact with him or her for this study. We conducted a semistructured interview and analysed the transcripts of the narratives provided by our three groups on the definition of relapse and early signs of relapse. Recorded interviews were processed using the Alceste Method, a computer program of textual analysis that identifies the word patterns most frequently used by the subjects. Alceste creates classes of words using a hierarchical descending classification. The description of each class is presented in the form of a word list (with the value of the word's Chi(2) association in this class). We assessed the awareness of problems using the 8-Q. RESULTS: The three groups described relapses as a distressed, even traumatic experience. This experience is shared by the patients' siblings who sometimes mention violent situations and difficulties at home. The analysis showed that each group uses a compartmentalized universe of speech. This raises the question of the communication and the sharing of information between the different groups. Parents who didn't live the relapse of their children and the caregivers gave prepsychotic or psychotic symptoms of relapse. Conversely, parents who had lived relapse(s) of their children gave nonspecific and very personalized signs of relapse (e.g., "When she relapses, our daughter eats much more cheese than usually"). The patients with a low level of awareness of his/her problem were able to describe early signs of relapse. They described mood and sleep disturbances. This is an unexpected result and calls for a debate on the need or not to have good insight in order to follow a psychoeducation program. CONCLUSION: This study insists on the complementarity of different conceptions of all persons involved in schizophrenic relapse in order to identify as accurately as possible the "relapse signature" of patients. According to us, and in order to promote suitable subjective data to increase insight, compliance and therapeutic alliance, psychoeducation programs should rely on these personal criteria rather than propose systematic programs. Then the relapse signature could be the first step to the appropriation of the course of illness and control of psychotic symptoms by schizophrenic patients.

Comparative study of body image among dancers and anorexic girls.

In order to examine the nature of body image distortions, we studied their perceptual and idealised components using a video distortion technique to create photographs of dancers, anorexics and controls that made their bodies look larger. Each subject was then asked to adjust the photograph until it reflected her estimated and desired body size. The results show that: 1) all three groups perceived themselves to be heavier than they actually are, but the dancers had a more realistic perception of their body weight; 2) the dancers would have liked to be thinner, whereas the controls and anorexics were satisfied with their body weight; 3) the scores of the anorexic subjects were characterised by a lack of correlation between their perceptual and idealised distortions, whereas those of the dancers--and even more so those of the controls--were characterised by consistency between the two types of distortion.

[Study of the categorization process among patients with eating disorders: a new cognitive approach to psychopathology]. / Etude du processus de catégorisation chez des patientes aux troubles des conduites alimentaires: une nouvelle approche cognitive de la psychopathologie.

Anorexic and bulimic patients have a highly distorted relationship with food and eating, even though they tend to be knowledgeable about diet and nutrition. The progress of this disease, as well as its complications and associated difficulties, are increasingly understood, while the etiopathogeny of eating disorders remains obscure. The approach that we are proposing involves the study of one of the most fundamental cognitive functions of human reasoning--the cognitive process of categorization. The purpose of this study is to understand the procedures used by these patients to construct representations of food. Categorization, one of the basic features of human cognition, allows individuals to organize their subjective experience of the surrounding environment by structuring its contents. This ability to group different objects into the same category based on their common characteristics is important for explaining the major cognitive activities of planning, memorization, communication and perception. Indeed, our categories reflect our conceptions of the world. They depend on our experiences and representations, as well as the expertise acquired in a specific field. The differences that appear in the categories created by subjects when they are asked to classify objects reveal the properties that are most salient to them and, as a result, the interests, values and ideas associated with these properties. There are three types of properties: perceptive properties, which describe the object's shape, color, odor and texture; structural properties, which relate to the object's components; and functional properties, which specify the way in which the object is used and provide an answer to the question, "What is it used for?". Subjects attribute these functional properties by means of knowledge or inference according to their representation of the object's role; such properties are especially likely to emerge during top-down (theory-driven) processing. The type of processing used (bottom-up or top-down) is dependent on a certain number of factors. We hypothesize, within the context of food product categorization, that patients suffering from eating disorders largely resort to processing based on acquired information or beliefs about the objects, i.e. top-down processing. We present two studies: a naturalistic and exploratory pilot study whose goal is to identify whether the various categorization processes used by eating disorder patients differ from those employed by subjects not suffering from an eating disorder. A second study aims to identify the different categorization procedures. During the first experiment, 68 women (17 control subjects, 17 anorexics, 17 anorexic bulimics and 17 bulimics) aged 18-39 (average age: 26.6) verbalize all representations that come to mind during a limited time period as the name of a food item is read. Eighty-nine food items are presented in alphabetical order. The list is read out loud and all comments are recorded. The data is processed in three ways : an analysis based on the positive or negative valence of each representation, an analysis based on each categories of food and an analysis of representations based on themes expressed. The three analyses (valence, categories of food and theme assigned to the representations) show differences between the representations of the four experimental groups. In fact, the anorexics and anorexic bulimics mainly express strongly negative representations about food, whereas bulimics and control produce representations whose positive and negative valences balances. These negative cognitions concern mainly meat for the control subjects and cakes for the subjects reached of TCA. Concerning theme assigned to the representations, the control subjects produce mainly cognitions relating to the hedonism, the flavor of food and their purpose on health. The anorexics and anorexics-bulimics evoke mainly the fat and sugar content of the foods. The bulimics evoke mainly cognitions relating to the effect on health and the intestinal transit time of food. These results lead one to believe that it is not the bulimic binging and purging of these patients, but rather their restrictive behavior that is the determining factor in the differences in food representations observed between the two experimental groups. During the second experiment, 60 women (15 controls, 15 anorexics, 15 anorexic bulimics and 15 bulimics) aged 18-32 (average age: 25.6) classified 27 food names according to their similarities and differences, and then explained the reasons for their categorizations. The data were analyzed in terms of similarity/difference, and the verbalizations were analyzed by content. The results indicate that 10 of the 27 foods were categorized differently by the controls and the subjects with eating disorders. Subjects classified the following foods: camembert cheese, cold cuts, cheese spread, fruit in syrup, whole milk, mayonnaise, bread, fresh fish, potatoes and plain yogurt. Bulimics and controls use similar classifications for food names, while anorexics and atypical bulimics classify foods in a similar way. Examining the categorization criteria used during verbalizations allows us to better understand these differences. The control group's major criterion seems to be the succession of dishes. These subjects group into separate categories entry foods (beef, eggs, fish, etc.), vegetables, cheese or dairy foods, and finally desserts. Additional foods, like bread and mayonnaise, belong to the same category. Other categories are nutritional criteria (for example, dairy products contain calcium) and biological criteria (for example, bananas and apples are fruits). These categorization criteria include structural properties (which describe what the object is made of) and functional, "academic" properties, those which describe how foods are used, "as in cookbooks or diet books." On the other hand, the categorization criteria expressed by anorexic patients are very different from those used by control subjects: foods that are hard to eliminate, rich, high-fat and therefore indigestible are considered to be similar. Some examples are cold cuts, potatoes, mayonnaise and prepared desserts. A second categorization criterion involves the concept of natural foods : certain foods "are unhealthy because they're processed, so they're bad for you"--one such example is cheese spread. A third criterion concerns the notion of familiar foods: poultry and eggs, for example, are "familiar to us." We are clearly seeing here the importance of functional properties in the categorization of food names: certain foods are indigestible, hard to eliminate, cause heartburn or reflux, are not natural, and thus are avoided. The categorization criteria mentioned by bulimic patients also clearly take into account the functional properties of foods. The criteria are of the following type: "it's filling, it relieves a bulimic attack, it helps prevent heartburn and constipation, etc." It appears that bulimics' categorization criteria are solely associated with these foods' imagined or real effect on the body. The categorization criteria used by anorexic bulimics seem to be especially associated with weight gain or the consumption of such foods during bulimia attacks because "they make you feel full." On the other hand, light foods, which patients allow themselves to eat, are placed in the same category. This study, which seeks to understand the cognitive functioning of eating disorder patients with anorexia and bulimia, has brought new elements to light. All patients exhibit food categorization processes that differ greatly from those displayed by control subjects. Patients also attribute greater significance to the functional properties of foods as compared to controls, who give priority to structural properties. Anorexic and bulimic patients base their food categorizations on the consequences of ingestion, in terms of health, digestion and weight gain. Their processing of food stimuli is therefore radically different and gives a dominating place to top-down processes. Additional studies should supplement these findings in order to gain a better understanding of patients' disturbed processing of information.

[Cognitions in eating disorders and their assessment]. / Les cognitions et leur évaluation dans les troubles des conduites alimentaires.

UNLABELLED: Cognitions are of crucial importance in the -aetiology and the maintenance of eating disorders. Dysfunctional cognitions in eating disorders are related to body image, self-esteem and feeding. The aim of this paper is to review the actual knowledge in this area. First, we will display -cognitive models in eating disorders. Cognitive factors in -eating disorders are logical errors, cognitive slippage and conceptual complexity. Eating disorder patients seem to have a deficient cognitive development. Some cognitive models stipulate that eating disorder patients may develop organised cognitive structures schemas concerning the issues of weight and its implications for the self. These schemas can account for the persistence and for the understanding the "choice of the eating disorder symptomatology. Cognitive pheno-mena of interest are self-schema, weight-related schema and weight-related self-schema. The maintenance model of ano-rexia nervosa argued that, initially there is an extreme need to control eating which is supported by low self-esteem. The maintenance of the disorder is reinforced by three mechanisms: dietary restriction enhances the sense of being in control; aspects of starvation encourage further dietary restriction; concerns about shape and weight encourage restriction. The development and maintenance of bulimic symptomatology are explained by placing a high value on attaining an idealised weight and body shape accompanied by inaccurate beliefs. The cognitive model of specific family of origin experiences puts forward the development of -maladaptative expectancies for eating and thinness. Second, we discuss distortions in information processing. a) In feeding laboratories, bulimics show a wide range of caloric intake and a disruption of circadian feeding patterns. In overeating bulimics, large meals occurred mainly during afternoon and evening with high fat and carbohydrate intake, but the majority of meals were of normal size and frequency. Responsivity to food cues indicates that bulimics were more responsive to sight, smell and taste of their favourite binge food, and a greater responsivity was associated with increasing -cue salience. Eating disorder patients appear to have internalised a mediated social rule concerning "good food" and make drastic selections thus removing the possibility of choice of foodstuffs. b) Experimental processes: temporal factors in the processing of threat seem to be of importance in patients with high levels of eating psychopathology. There is no evidence for preattentive processing biases among anorectics. Changes in information processing speed after treatment were not linked to treatment condition or treatment response. c) Judgement and emotions: in eating disorder patients, distortions of depressogenic nature are found that influence the cognitive style; thoughts about eating, weight and shape are characterised by negative affective tone; negative emotions could account for bulimic behaviour; anxiety and distress are correlated to thought control strategies. Information treating seems to be impaired in a non-homogeneous way. d) Cognitive schemas are seriously maladaptive and not well investigated. In eating disorder patients, core beliefs are absolute, unconditional and dichotomous cognitions about oneself and the world. There are only few studies in this field moreover showing controversial results. Core beliefs can explain links between personality disorders and eating psychopathology. Pathological core beliefs have to be taken in to account because they influence the outcome and the efficacy of cognitive behavioural therapy. Third, the last part of this paper summarises actually available rating scales eva-luating distorted cognitions in eating disorders. There are different methods for evaluation: specific and non-specific self-report questionnaires, thought-sampling procedures, -methods derived from cognitive psychology. The Mizes Anorectic Cognition questionnaire (MAC) is a well-known self-rating scale with good psychometric properties. The revised form of the MAC appears to be an improvement in the area of internal consistency, sensitivity, and reliability. It is obvious that there is no particular rating scale referring to specific cognitions on food. IN CONCLUSION: the main result of this literature review reflects that the cognitive treatment in eating disorders is altered in a specific way on an emotional basis and on self-representation.