Troubles du comportement alimentaire et symptomatologie dépressive : étude épidémiologique chez les jeunes hommes

Abstract

Le but de cette étude était d’évaluer la fréquence des troubles du comportement alimentaire (TCA) cliniques (anorexie mentale, boulimie et troubles non spécifiés) et subcliniques et des comportements compensatoires (vomissements, régimes stricts, jeûne) dans un échantillon de jeunes hommes français, et enfin d’examiner l’association à une symptomatologie dépressive. Un échantillon de 458 jeunes adultes a complété le Questionnaire for Eating Disorders Diagnoses (Q-EDD) pour évaluer les TCA ainsi que la Center for Epidemiologic Studies-Depression Scale (CES-D) afin d’évaluer les symptômes dépressifs. Toutes catégories confondues, les TCA étaient présents chez 17% des participants, dont 12% de troubles subcliniques. Une majorité des participants a rapporté vouloir prendre du poids et les comportements compensatoires les plus fréquents étaient l’exercice physique excessif (35 %) et le jeûne (11 %). Avec le seuil de 22 à la CES-D, 18 % de la population avait une symptomatologie dépressive modérée à sévère, dont 5 % présentait également un TCA. Une analyse de variance a montré que les participants ayant un TCA clinique et subclinique avaient obtenu des scores de dépression significativement supérieurs à ceux des participants sans trouble. Cette étude suggère l’importance d’évaluer les troubles subcliniques lors d’études sur les TCA en population masculine.

Objective.—The objective of the study was to evaluate the incidence of eating disorders, including not otherwise specified eating disorders (EDNOS) and subthreshold disorders, inap- propriate compensatory behaviors (such as self-induced vomiting, strict dieting, fasting) along with depressive symptoms among young French adult males. Method.—The sample was composed of 458young men in age ranging from 18 to 30years (mean age=21.9±2.4). The average body mass index was 22.8±3. Participants completed two questionnaires: the Questionnaire for Eating Disorders Diagnoses (Q-EDD) assessing full- criteria eating disorder symptoms based on DSM-IV criteria (i.e. clinical eating disorders) and subthreshold disorders, and the Center for Epidemiological Studies-Depression scale (CES-D) assessing depressive symptoms. Results.—Out of the 458surveyed respondents, eating disorders were reported by approxi- mately 17% of the overall sample, with 1.5% meeting diagnostic criteria for serious clinical disorders, 3% meeting diagnostic criteria for EDNOS and 12% meeting diagnostic criteria for subthreshold disorders. Exercise bulimia represented 1% of the overall sample and binge-eating disorder 2%. The most frequent subthreshold disorder was subthreshold nonbinging bulimia (7%). Participants with eating disorders were equally divided between those desiring weight gain, those desiring weight loss and those wanting to keep their current weight. Participants without eating disorders were more likely to want to gain weight compared to participants with eating disorders (45.5% versus 30% respectively; P < 0.05). After controlling for body mass index, 30% of participants tended to perceive themselves as thinner than they actually were and 6% tended to perceive themselves as fatter. Regarding normal-weight participants, 28% perceived themselves as thinner and 8% as fatter than in reality. Overeating episodes were reported by 19% of participants. Binge-eating episodes (recurrent or not) were reported by 8% of young men, including 32% of participants with eating disorders and 3% of participants without eating disorder. Six percent reported repeated binging (at least twice a week for at least once a month). Inappropriate compensatory behaviors were mostly used by participants with eating disorders, except for excessive exercise (34% versus 35% for participants without eating disor- ders). The most typical compensatory behavior was fasting (11%). According to the cut-off score of 22, 18% of young men had a moderate to severe depressive symptomatology, including 5% of participants who also reported an eating disorder (i.e. 30participants). A one-way ANOVA was conducted to examine differences in depressive symptoms as a function of eating disor- der groups, namely the clinical eating disorders sample (n=22), the subthreshold disorders sample (n=54) and the asymptomatic sample (participants without eating disorder; n=382). Results were statistically significant, (F(2,455)=7.27, P<0.001) and post-hoc tests (Scheffé tests) were used to examine the group differences. The mean CES-D scores for the clinical eating disorders sample (19.45 ± 8.2; P < 0.05) and the subthreshold disorders sample (18.15 ± 10.9; P < 0.05) were significantly higher than for the asymptomatic sample (14.19 ± 8.9). There was no significant difference between the two eating disorder groups (P > 0.05). Discussion. — The results demonstrate that a significant proportion of men with eating disorders manifest comorbid depressive symptomatology. These results suggest that EDNOS and subthre- shold disorders should be taken into consideration, as they represent 15% of the total sample. Participants reported high rate of excessive exercise and fasting, which could reflect the impor- tance of muscle tone or strategies to increase muscle mass. Further research is necessary in order to better understand male eating behaviors and disorders.