Les stratégies d'attachement, leur transmission et le fonctionnement familial d'adolescentes anorexiques mentales
- 作者：S. Delannes ; C. Doyen ; S. Cook-Darzens and M.-C. Mouren
- 关键词：Adolescence ; Anorexia Nervosa ; Attachment ; Ca-Mir Questionnaire
- 刊名：Annales medico-psychologiques
- 出版年：2006
- 期刊代码：78_00034487
- 类别：psy
- 出版时间：September 2006
- 卷：164
- 期：7
- 页码：565-572
- 文件大小：284 K
摘要
Bowlby's attachment theory emphasizes the importance of early child-environment interactions in order to develop “internal working models”, secure or insecure, which will influence future relationships with caregivers, peers and other members of the environment. Many factors are involved in the development of eating disorders, and for some authors anorexia nervosa may also be considered as a form of psychological regulation. It is surmised that this type of regulation facilitates coping with occurrences of separation during the “separation-individuation” stage of the adolescent period in a specific group of adolescents who are vulnerable to separation or transition events. During puberty, it has been observed that this vulnerable group displays a specific pattern of attachment or modification of prior internal models of attachment. Following Mary Ainsworth's paradigm, many studies have therefore suggested that subjects with eating disorders show “insecure” attachment, and more precisely “avoidant” attachment in anorexia nervosa. Recent studies on family functioning in anorexia nervosa have also suggested specific types of family interactions, enmeshed and rigid, and some authors such as Stevenson-Hinde hypothesized a link between family functioning and attachment strategies. We decided to study a population of young anorexic girls in terms of their quality of attachment and family interactions, and hypothesized that attachment types in subjects with anorexia nervosa would be associated with maternal type of attachment and specific family functioning. This paper describes a study conducted on a cohort of 29 subjects from the Outpatient Eating Disorder Unit of Robert Debré Hospital in Paris. Ten female adolescents with a mean age of 14 years and a DSM-IV diagnosis of restrictive anorexia nervosa, their ten mothers and nine fathers agreed to participate in the study. The main objective was to examine links between attachment strategies in outpatients with anorexia nervosa, their mode of transmission and family functioning. Two self-questionnaires were administered: Ca-mir and FACES III. Results suggested that patients and families perceived themselves as having secure attachment and that attachment transmission stemmed from the paternal rather than the maternal side. Our results do not confirm those from previous studies on attachment and anorexia nervosa. Young anorectic patients from our cohort perceived themselves as secure whereas in the literature attachment is described as insecure. Several reasons may explain this result. Our cohort of patients had a mean age of 14 years; previous studies were performed on older adolescents or young adults and it is possible that attachment strategies change over time, especially during adolescence when the subject is faced with the separation-individuation stage. At the beginning of puberty, young subjects may display a secure attachment which may be modified towards the end of puberty. Bowlby has suggested that attachment may be sensitive to psychotherapy; our subjects were involved in outpatient treatment or family therapy that may also have influenced their attachment strategies. Mothers from our group described insecure attachment but surprisingly it is the fathers' attachment type which is supposed to be transmitted to daughters. Perhaps these insecure women have chosen specific companions to protect themselves and their children? In opposition to Stevenson-Hinde's hypothesis, we did not find a correlation between attachment strategies and family functioning. Nevertheless, our results have to be interpreted with caution because of methodological biases. Our cohort is small, we have no control group and the “gold instrument” for evaluating attachment is the Adult Attachment Interview that is not validated as a French instrument. In conclusion, results from this study do not confirm the existence of relationships between insecure attachment and anorexia nervosa, or attachment type and family functioning, in young subjects. Future controlled studies are needed in order to explore attachment and psychopathology in children and adolescents, links between attachment, family functioning and internal temperamental dimensions.