Study of the Difference Between Anorexia Nervosa With a History of Psychological Trauma and Classical Anorexia Nervosa on the Neurocognitive and Neurophysiological Factors

Study Overview
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Brief Summary
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Recent studies suggest that patients with an history of trauma may represent a specific subtype of anorexia nervosa (AM) underlined by specific neurobiological and psychopathological mechanisms. Thus, AM-T subjects would manifest cognitive (specific difficulties in executive functions), emotional (emotional disruption, impulsivity, etc.) and neurobiological (secretion of kynurenine and neurokinins in the face of stress) caracteristics different from those of AM subjects.

Detailed Description
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We will recruit a total of 100 patients with a diagnosis of anorexia nervosa in the university hospital of Montpellier : 50 patients with an history of psychological trauma and 50 patients without any history of psychological trauma Participation consists of a half-day visit. Patients will perform clinical and neuropsychological assessments and an exposition test. During this test, participants will be exposed, for 7 minutes, to neutral, positive or negative emotional photos. Heart rate variability will be determined through a Biopac MP160 before, during and after this event. Saliva samples to measure kynurenin, tryptophan, substance P and neurokinin-1 will be collected before and directly after the test.

Official Title
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Study of the Difference Between Anorexia Nervosa With a History (s) of Psychological Trauma (AM-T) and Classical Anorexia Nervosa (AM-C) on the Neurocognitive and Neurophysiological Factors

Conditions
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Anorexia Nervosa

Intervention / Treatment
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* Behavioral: Exposition Test


Participation Criteria
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Eligibility Criteria
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Inclusion criteria common to the 2 groups AM-T and AM-C : Women Patient Present a diagnosis of anorexia nervosa according to the DSM-5 criteria Between 18 and 65 years old Present a BMI> 14 Do not present a sight problem or be corrected appropriately by wearing glasses or contact lenses. Be affiliated to a social security scheme, or beneficiary of such a scheme Be able to understand the nature, purpose and methodology of the study Inclusion criteria specific to patients in the AM-T group: - To have answered at least one of the grayed out items of the LEC-5, that is to say to have answered it happened to me to at least one of the items 1 to 13 or to item 16 and / or having answered I witnessed it to at least one of items 14 and 15. Inclusion criteria specific to patients in the AM-C group: - Not having answered it happened to me or I witnessed it to one of the items of LEC-5 Exclusion Criteria: Present a severe unstable mental pathology in the opinion of the investigator Present active suicidal ideation Have consumed psychoactive substances in the last 24 hours before the assessment Present a severe major depressive episode incompatible with the assessment, in the opinion of the investigator. Present in the opinion of the investigator an unstable somatic state (eg severe metabolic disorder making it impossible or likely to impair the reliability of neuropsychological and cardiac evaluations). Take a drug treatment acting on the cardiovascular system Refusal of the patient Be protected by law (tutorship or curatorship). To be deprived of liberty by administrative decision.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Anorexic women<br>Anorexic women with or without history of psychological trauma will perform study procedure : sociodemographic and clinical assessments, measurement of cardiac variability and salivary cortisol changes, before, during and after the exposition test. | Behavioral: Exposition Test<br>* During this test (7 minutes) participants will be exposed to photos evoking positive or negative emotions (anger, disgust, sadness and fear) interspersed with emotionally neutral photos. The test sequence is composed of 3 blocks as follows: 12 photos evoking positive emotions (2 min) Pause of 30 seconds (white screen) 12 photos presenting a neutral emotional valence (2 min) Pause of 30 seconds (white screen) 12 photos evoking negative emotions (2min) In each block, photos will be selected and presented to the participant in a randomized and sequential manner. In total, 30 photos will be presented in 7 minutes to each participant (10 seconds per photo). The participant must be at rest in front of the computer screen during these 7 minutes with optimal visibility. The photos will be presented sequentially using software (E-Prime or Visual Basic 6.0). During this exposure test, a heart rate recording will be made using a BIOPAC MP160 recording system.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in high frequency heart variability (HF-HRV) across the exposition test (before, during and after) | We aim to investigate if AM-T patients present changes in HF-HRV across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in low frequency heart variability (LF-HRV) across the exposition test (before, during and after) | We aim to investigate if AM-T patients present changes in LF-HRV across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Changes in very low frequency heart variability (VLF-HRV) across the exposition test (before, during and after) | We aim to investigate if AM-T patients present changes in VLF-HRV across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Changes in the highest peak of the high frequency (HFhz) across the exposition test (before, during and after) | We aim to investigate if AM-T patients present changes in HFhz across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Changes in the interval between R peaks (R-R across the exposition test (before, during and after) | We aim to investigate if AM-T patients present R-R changes across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Changes in the R-R interval standard difference (STD-RR) across the exposition test (before, during and after) | We aim to investigate if AM-T patients present STD-RR changes across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Changes in the root mean successive squared differences of the R-R interval (RMSSD). across the exposition test (before, during and after) | We aim to investigate if AM-T patients present RMSSD changes across exposition test compared to AM-C patients, measured by Biopac MP160 | inclusion visit | 
| Score to the Difficulties in Emotion Regulation Scale | We aim to assess the link between emotional regulation and psychological trauma in AN. DERS is a self-assessment scale measuring emotion dysregulation. The original DERS includes 36 items scored 1-5 where 1 is almost never, 2 is sometimes, 3 is about half the time, 4 is most of the time, and 5 is almost always. Of the 36 items, 11 are reverse scored. The DERS-36 yields a total score as well as six subscales where higher scores indicate more difficulties. | inclusion visit | 
| Score to the Beck depression inventory II | We aim to assess the link between eating symptomatology and psychological trauma in AN. The BDI-II is a self-administered questionnaire assessing the severity of depressive symptoms in 21 items. Each item is rated on a 4-points Likert scale ranging from 0 to 3. The total score varies between 0 and 63. higher scores mean more depressive symptoms | inclusion visit | 
| Score to the Eating Disorder Questionnaire | We aim to assess the link betxeen eating symptomatology and psychological trauma in AN. self-administered questionnaire assessing the intensity of eating symptoms over the past 28 days. A total score as well as 4 sub-scores (restriction, diet, weight, shape) varying from 0 to 6 are obtained.Higher scores mean higher eating concerns | inclusion visit | 
| Score to the Eating Disorder Inventory | We aim to assess the link between eating symptomatology and psychological trauma in AN. The EDI-2 is a 91-item self-report questionnaire assessing cognitive, emotional, and behavioral symptoms of eating disorders. It rates from 0 to 273. Higher scores means severe symptoms | inclusion visit | 
| Score to the Childhood trauma questionnaire |  | inclusion visit | 
| Score to the PTSD Checklist for DSM-5 |  | inclusion visit | 
| Score to the Wisconson Card Sorting Test | We aim to assess the link between mental flexibility, working memory, inhibition and psychological trauma in AN | inclusion visit | 
| Score to the Stroop Test | We aim to assess the link between mental flexibility, working memory, inhibition and psychological trauma in AN | inclusion visit | 
| Score to the Delay Discounting Test | We aim to assess the link between decision making and psychological trauma in AN | inclusion visit | 
| Score to the Trail Making Test | We aim to assess the link between mental flexibility, visio-spatial attention, processing speed and psychological trauma in AN | inclusion visit | 
| Changes in salivary tryptophan | study changes in salivary tryptophan before and after exposition test | inclusion visit | 
| Changes in salivary kynurenine | study changes in salivary kynurenine before and after exposition test | inclusion visit | 
| Changes in salivary P substance | study changes in salivary P substance before and after exposition test | inclusion visit | 
| Changes in salivary neurokinin-1 | study changes in salivary neurokinin-1before and after exposition test | inclusion visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anorexia nervosa, Psychological Trauma, Heart Rate Variability, Kynurenine, Substance P