Troubles du comportement alimentaire chez l'adulte

Adults' disorders of the feeding behaviour encompass anorexia, bulimia nervosa, and various atypical forms of nutritional disorders. Following a clinical review of anorexia and bulimia, the authors describe the so-called binge eating disorder in which the nutritional behaviour is assessed by the number of days of overfeeding rather than by the number of crises per week, over a period lasting 6 months at least. This disorder is 2- to 3-fold more frequent than bulimia nervosa. The night eating syndrome often induces obesity. Potomania, merycism, and pica are also described. Establishing the prognosis is always difficult. Published studies show important variations. Therapeutic follow-up studies show frequent relapses during the first year following a hospitalization. Poor prognosis corresponds to a long pre-treatment duration of the disorder and to a persistent anorexic behaviour. Epidemiologic data confirm the seriousness of such disorders, with a significant mortality rate associated to prolonged disease. The authors analyze the aetiopathogenesis of these disorders and their relationships with other psychiatric affections (depressive disorders, anxiety, personality disorders); addictions; biological perturbations; genetic factors; and the social and educational context. The cognitive-behavioural model and the psychodynamic theories are presented. The authors recommend approaching the ambivalence inherent in nutritional disorders by a series of specific interviews and a special attention to the singularity of each case and to the risk of negative reinforcement related to the measures of strict isolation. The family should be integrated in the therapeutic program. Resuscitation measures must be adapted. Precise and relevant criteria for hospitalization are presented, a definition of the therapeutic goals is recommended, together with the establishment of a care contract, and dietary and behavioural measures aimed at modifying both the relationships of the patient with feeding and weight gain. Group therapies are emphasized.