Abstract
Eating disorders (ED) are common mental illnesses that have a significant impact regarding morbidity and mortality. Psychological trauma (PT) and one of its earliest forms, childhood maltreatment (CM), are factors frequently associated with more severe and more difficult to treat forms of ED. We hypothesize that the presence of a PT in general and a CM in particular predetermines a “maltreated ecophenotype” characterized by a specific form of ED that needs to be specially considered in assessment and management. In a first part of this thesis, an evaluation of the data of subjects included in two cohorts of 600 participants was carried out. In this context, food addiction has been demonstrated to be a mediator between the severity of CM and the clinical severity of ED with a particular interest to physical neglect in this mediation effect. We have also demonstrated that, in subjects with anorexia nervosa (AN), the variability of the neutrophils to lymphocytes ratio, as a marker of low-grade inflammation, is associated with the presence of an emotional abuse during childhood or adolescence. From a weight variability perspective, we have demonstrated that the severity of CM, most importantly sexual abuse, was significantly correlated with weight suppression at lowest weight (WS-LW) in subjects with AN and bulimia nervosa. Similarly, WS-LW, which would be otherwise a marker of a more severe ED, was a mediator between the severity of CM and the clinical severity of ED. Finally, we have demonstrated that subjects with AN and a history of sexual abuse had a more disturbed perception of their central coherence, implying the presence of a tendency to pay more attention to details as an information processing style. In a second part, an ongoing comparative study between subjects with and without PT (the ATAC study) will be described. During this study, both groups of patients with AN are compared with respect to their executive functions and then exposed to a psychological stress test in order to assess their heart rate variability as well as their tryptophan metabolism and neurokinins’ level before and after the exposure. In conclusion, we recommend that the presence of a PT should be on the one hand systematically screened in current clinical practice and on the other hand should be at the origin of a subcategory of ED that facilitates the classification of patients in a group that probably implies a more clinically severe and difficult to treat disorder.