Depuis les années 1980, les dysfonctionnements cognitifs des patients présentant des troubles des conduites alimentaires ont été identifiés à la fois comme des facteurs prédisposant aux troubles et comme des facteurs de maintien des comportements restrictifs ou boulimiques. Dans les années 1990, différents travaux expérimentaux ont confirmé cette observation clinique et ont pu démontrer que le fonctionnement cognitif des sujets ayant des troubles des conduites alimentaires différait de celui de sujets témoins sains. De plus, certaines études ont montré également que les cognitions dysfonctionnelles du patient anorexique portent essentiellement sur les aliments. Cependant aucun outil utilisable en pratique clinique ne permet de repérer ces dysfonctionnements cognitifs. L'objet de cette étude est la construction d'un outil d'évaluation des cognitions des patients ayant un trouble des conduites alimentaires. Un premier recueil de données de cognitions alimentaires a permis de construire un autoquestionnaire incluant des cognitions de sujets anorexiques, boulimiques, anorexiques avec boulimie et de sujets témoins, tous les sujets étant de sexe féminin. L'autoquestionnaire intitulé « Questionnaire des cognitions alimentaires » a ensuite été proposé à une autre population de 131 patientes et de 86 sujets témoins de sexe féminin. L'analyse statistique des données recueillies a permis d'identifier 6 critères susceptibles de discriminer spécifiquement les sujets pathologiques des sujets sans trouble des conduites alimentaires. Les items significatifs portent tous simultanément sur l'absorption de certaines qualités ou quantités d'aliments et sa répercussion sur le corps ou la forme du corps ; ces résultats paraissent congruents aux descriptions cliniques.

Many authors evoke the role of cognition in the persistence of symptoms or in relapse. In pathology the cognitions produced by the patients are called dysfunctional or erroneous. The content of the cognitions are words or images issued from the treatment of information. In emotional disorders, the structure of thoughts named dysfunctional « schemata » involves a biased treatment of information and leads to erroneous cognitions. Several studies have attempted to elicit the most specific cognitions of different diseases. In this field, Hollon and Kendall found 36 cognitions specific to depression gathered in the automatic thoughts questionnaire (ATQ). In the same spirit, Beck et al. gathered 14 cognitions of anxiety and 12 depressed cognitions in the cognition check list (CCL). In the etiology and maintenance of eating disorders the cognitions take a large place. Around 1980 cognitive dysfunctioning was described and concerned food, interpersonal relationship and body shape. A few years later, some experimental studies explored these processes. The Stroop test, a categorization task, showed specific cognitive impairment in with patients eating disorders versus normal control subjects. It was then established that cognitive errors were based on food cognitions in restrictive patients, whereas they were based on body shape cognitions in bulimic patients. In several famous papers, Garner described typical cognitions of eating disorder patients and distinguished food-cognitions, eating-cognitions using case reports. As far as we know there is no clinical tool concerning such cognitions in France. That is the main motivation of the authors.

The aim of this paper was to determine the characteristic cognitions of anorexic, anorexic-bulimic and bulimic patients and to compare them with those of normal control subjects. The goal of the study was to create a foodcognition questionnaire.

In the first step, food cognitions were collected among female eating disorder patients and normal female control subjects during systematic investigation. Ninety-two women were assessed and provided more than 3 000 foodcognitions. Two independent psychologists identified the most frequent cognition per group and thus retained 115 food items. These items were randomly assigned. This provided the questionnaire. To illustrate the latter, here are the first five items : 1) Apricots are good for the health because they are rich in vitamins. 2) Pears are big fruit, difficult to digest. 3) Canned fruit is soaked with sugar. 4) Banana is a fruit which makes one put on weight. 5) White coloured food give the impression that it is not alive... The list of possible answers was : never, rarely, sometimes, often enough, often, always.

In the second step, the food cognition questionnaire was proposed to 217 women including 131 eating disorder patients (53 anorexic, 50 anorexic bulimic, 28 bulimic) and 86 normal control subjects. The values of body mass index and the eating attitude test differed when we compared the two groups, and the mean age was close to 26 years in both groups.

The statistic analysis highlighted six discriminative variables : two clinical criteria (weight and height) and four food-items given below : Q24 : When I see food being fried, I feel the grease all over my body. Q76 : When I start a cookie packet, I eat it up. Q102 : When I feel anxious, I crave for food to fill my body. Q106 : Eating pastry gives me heart-burn and makes me belch. The statistical model allowed us to differentiate eating disorder patients from normal control subjects. The content of the four food items is in agreement with experimental and clinical data. All these items included some aspects of the quality or quantity of food and also the negative consequences of food consumption on the body.

To conclude, the model can help clinicians identify the patients and then initiate treatment. We also insist on the fact that this study is new and empirical, and should be extended by determining some food items for example, which would clarify the difference of behaviour between anorexics and bulimics.