Peu de recherches ont été consacrées aux facteurs inducteurs de crises de boulimie et de compulsions alimentaires.

Nous avons exploré ceci chez 186 malades : 65 anorexiques-boulimies (AMB), 62 boulimiques (B) et 59 compulsives (C) : âge moyen : 27,5+9,1ans ; nombre de crises : 15+9/semaine, durée des crises : 1h 36min (+ 38min/jour). Le questionnaire « Start » a été validé par une démarche en 4 étapes, pour évaluer sa pertinence et sa reproductibilité.

Concernant le moment, c’était le soir en rentrant (67 % des malades), à l’heure du goûter (55 %), le soir après le dîner (42 %) et la nuit (22 %) qui étaient les plus forts déclencheurs. Concernant le lieu, c’était l’arrivée au domicile (96 %). Pour beaucoup de malades, la pensée de crise était inhibée par le fait d’être chez les parents (62 à 89 %), au travail (96 %) ou dans la rue (97 %). La sensation de faim était un fort inducteur chez 42 % des C et seulement 24 % des B et AMB (p=0,04). Les aliments gros inducteurs de crises étaient les aliments caloriques (77 %) et jugés appétissants (60 %). L’odeur, la vue et surtout la mise en bouche des aliments des crises induisaient plus la crise que celles des autres aliments : olfaction (19 % versus 10 %), vision (52 % versus 25 %) et surtout mise en bouche (71 % versus 26 % ; p<0,02 pour tous, dans les 3 groupes). La fatigue (37 %), l’excitation (38 %), le stress (65 %), l’angoisse (74 %) ou la pression exercée par autrui (55 %) étaient de forts déclencheurs. La tristesse (61 %), le sentiment d’incapacité (73 %), la dépression (71 %) et les flashs du passé aussi (flashs : 44 % des AMB et C et 23 % des B, p<0,05). Mais la crise était vécue comme apaisante chez 43 % des C, vs 20 % des B et AMB (p<0,05).

Cette étude montre l’importance des facteurs métaboliques et sensoriels, à côté des classiques facteurs émotionnels.

There are few published studies on the triggers of binge eating in anorexia nervosa of binge/purging subtype (BPAN), bulimia nervosa (BN) and binge eating disorder (BED).

We validated in 29 patients (10 BPAN, 10 BN and 9 BED) the perspicuity, the clarity and the intra- (doubles) and inter- (test-retest) reproducibility of a 24-item Start questionnaire on the triggers of binge eating. Then the Start questionnaire was administered to 176 patients (65 BPAN, 62 BN and 59 BED patients) being 27.5+9.1 yr old, having 15+9 binge eating (BE) episodes/week, with a mean binge duration of 1 hr 36min (+ 38min)/day.

BE episodes occurred mainly during the second part of the day: afternoon after work (67% of the patients), “tea” time (55%), evening after dinner (42%) and at night (22%). The principal place for BE episodes was at home (96%). The BED patients avoided binges at the parents’ home (89%) more often than the BPAN (62%, P<0.02). The binges occurred mainly in the living room (44%), in the kitchen (43%), and less in the bedroom (31%). Hunger pangs seemed to be a trigger of binges in 31% of the patients, and a stronger trigger in BED (42%) than in the BPAN and BN patients (24%; P=0.04). Binge eating episodes could occur despite a high satiety level (just after lunch or dinner) in 29% of the BN and in 16% of the BED patients (P<0.02). Concerning food, the major triggers were high energy-density food (77%) and comfort food (60%), such as chocolate, cakes, bread and pasta. The food consumed for binge episodes (in-binge food) was more often a strong trigger than the other food (not used for binges): olfaction (19% versus 10%), sight (52% versus 25%) and placing in the mouth (71% versus 26%; P<0.02 for all, in the 3 groups). Being tired could be a strong trigger in 37% of the patients, but “being aroused” in the other 38 % of the patients. Stressful events (65%), anxiety (74%), “being under pressure” or irritated (51% and 55%) were of course major triggers in a majority of the patients, as well as sadness (61%), feeling of powerlessness (62%), inefficiency (73%) and depressive state (71%). Flashback from traumatism (sexual trauma in 17% of the patients) was a strong trigger of binges more often in BPAN and BED (44%) than in BN (23%; P<0.05). The binge eating was painful (and “not at all a pleasure”) in 69% of the patients, but could also be a relaxing behavior in 31% of the patients, more often in the BED (43%) than in the BPAN patients (20%; P<0.05). The binge eating behavior was quoted as obsessive in 63% of BPAN, 92% of BN and only 34% of BED patients (P<0.001). The patients said that they were unable to avoid the binge (76% of the patients), more often in BPAN and BN than in BED patients (P<0.01). As a whole, 62% of BPAN, 89% of BN and only 4 % of BED patients (P<0.05) were unable to avoid purging (vomiting). In 12% of the cases, there was a pleasure felt when binging. For the other patients, shame, filth and incapacity were the feelings related to binges in 58% of the BPAN, 45% of BN and 43% of BED patients (P<0.04). The global score of addiction (zero=not addicted, 10=very addicted) was 8.56+1.2 in BPAN, 8.42+1.5 in BN and 6.74+1.1 in BED patients (NS between BPAN and BN; P<0.01 between BPAN and BN on the one hand and BED on the other).

The present study has demonstrated the usefulness of the Start questionnaire. It also evidences the key role of intrinsic factors, both metabolic and emotional, as strong triggers for binge eating episodes in BPAN, BN and BED. It has also demonstrated the role of environmental determinants.