Place de la nourriture dans les relations familiales d'adolescents présentant une anorexie mentale : étude qualitative par la photographie

Abstract

L’objectif de cette étude était d’explorer la place de la nourriture dans les relations familiales auprès d’adolescents présentant une anorexie mentale. Onze entretiens ont été menés avec des adolescentes anorexiques âgées de 13 à 18 ans et leurs parents. Nous avons choisi une méthodologie qualitative utilisant un outil original : la photo-elicitation. Le matériel verbal a été analysé à l’aide de l’Interpretative Phenomenological Analysis (IPA). Les résultats ont été organisés selon deux axes : le premier explore la place de la nourriture dans la dynamique parents-enfants (le contrôle relationnel, la ressemblance et la différence ainsi que la fonction parentale), le second explore la dynamique groupale et familiale (la cohésion, le conflit écran et le fonctionnement familial). Notre étude a permis de montrer la pertinence de la photo-elicitation et son apport dans la recherche en psychiatrie de l’adolescent. Sur le plan thérapeutique, elle confirme la nécessité de l’abord familial dans le soin et ouvre sur l’intérêt de la prise en charge individuelle des adolescents anorexiques notamment dans la construction de leur self.

The Role of Food in the Family Relationships of Adolescents With Anorexia Nervosa and Bulimia in Northeastern Brazil: A Qualitative Study Using Photo Elicitation

“…The lack of family identity through food brought experiences of sadness, mainly for parents and grandmothers, and anger for adolescent girls in the act of eating together. It contrasted with previous studies indicating that there was conflict avoidance in families with a member presenting anorexia nervosa (11,29,30,55). Both adolescent girls and their parents recognize their conflicts, but it seemed they did not know how to manage them.…”

“…Adolescent girls with bulimia had a strong emotional reactivity during family mealtimes and regarding questions not only focused on food, but they had more difficulties in expressing their emotions toward food and their families during the interviews. The emotional reactivity in anorexia did not appear in the other study with French teens using the same methods, in which all attempts at opposition focused on the issue of food (30). It also differs from studies showing an inhibited expression of negative emotions in anorexia (57,58).…”

“…In addition, in this research, it was more evident that the interviewed families did not avoid conflict in their relationships in either group. Specifically, in the anorexia group, the main difference observed was that, in the study with French teens (30), seating at family mealtimes was fixed and changing it strongly discouraged. This was not observed in either of our study's groups.…”

“…This research included a convenience sample of eight girls aged 12-18 years with anorexia nervosa or bulimia nervosa. We interviewed these adolescents, their parents (N = 12), and, unlike in our previous work (27)(28)(29)(30), their grandmothers (N = 05) and one sister. This decision was based on specific aspects of Brazilian culture: the closeness of extended and nuclear families, linked by concepts of loyalty and responsibilities (38).…”

“…This issue was the starting point of a research project conducted by our team: to study the interrelations between eating disorders and family relationships in adolescence in different cultural contexts. Several studies have been carried out in normal and pathological contexts both in France and Brazil (27)(28)(29)(30)(31), using photo elicitation, a visual narrative method which consists of using one or several photographs taken by the subject as the basis of the interview (32).…”