Grande précarité, psycho-traumatisme, souffrance narcissique : résultats d’une recherche-action à méthodologie quantitative et qualitative intégrée

RésuméDans le cadre d’un projet de recherche multi-annuel portant sur les relations entre les événements biographiques traumatogènes, vécus depuis l’enfance, et le fonctionnement structurel de la personnalité à l’âge adulte, les résultats d’une étude transversale, réalisée auprès d’une population de personnes en grande précarité (n = 105), seront discutés. L’étude est basée sur une méthodologie quantitative et qualitative intégrée, combinant l’entretien biographique semi-structuré, le questionnaire autorapporté HADS et le test semi-projectif de Rotter (Sentences Completion Test). La discussion porte sur la pertinence de nos résultats expérimentaux dans le contexte de la littérature actuelle portant sur le psycho-traumatisme et la grande précarité, en tenant compte de quelques propositions récentes d’élargissement du cadre conceptuel.

In the context of a multi-annual research project, aiming at exploring the relations between traumatic biographic events since childhood and the structural functioning of personality at adult age, the results of a cross-sectional study with people living in great precariousness (n = 105) are discussed.Context of the studyThis research project was implemented according to a sequential design: An exploratory study with n = 206 people suffering from exclusion and marginalization was based on the exploration of the links between a semi-structured biographical interview and the assessment of current personality functioning with psychometric and projective tests. A theoretical modelization was constructed with the help of multidimensional statistical procedures. In a second stage, this modelization was tested by means of a confirmatory study with a new sample of n = 195 people. The third stage of the research project was focused on the assessment of arts psychotherapeutic interventions with people of the two samples suffering from severe posttraumatic symptoms (not developed in this article).Clinical and theoretical backgroundThe clinical and theoretical background of the project was, on the one side, the traumatogenic hypothesis of borderline functioning, on the other side, the current discussion on broadening the definitions of posttraumatic states and adjustment disorders. According to the criteria of DSM-IV and ICD-10, the posttraumatic syndromes we encounter in our research population comprehend the Posttraumatic Stress Disorder (PTSD) and the Adjustment Disorder (AD) with Anxiety and/or Depression. More recently identified syndromes, relevant for clinical reality, could be the Complex Posttraumatic Stress Disorder (CPSD) with dissociation and the Posttraumatic Embitterment Disorder (PED). This article is focused on the exploration of the above mentioned research questions in the subgroup of people living in great precariousness. Our data are drawn from the confirmatory stage of the study. The research population was encountered in shelters for homeless people.State-of-the-artsThe international research literature tends to demonstrate, by means of retrospective studies, the great amount of disastrous events in the biography of homeless people (breaks of human bonds, attachment problems, multiple interruptions of life course, violence, negligence, humiliations, etc). On the other side, the situation of exclusion and marginalization itself acts as a permanent psychic stressor. Recent research objectives are focused on the neuro-psychological effects of long-term homelessness, as well as on the interaction between personality traits and the exterior stressors, leading to the distinction between protective and harmful personality traits.MethodsThe cross-sectional study with n = 105 people living in great precariousness adopted an integrated qualitative and quantitative research methodology, combining a semi-structured biographical interview, the auto-reported questionnaire HADS and the semi-projective Sentences Completion Test by Rotter. The data of the Rotter Test are analyzed with the help of original rating scales allowing to move from qualitative analysis to quantification and the application of appropriate non parametric statistical procedures.Research resultsIn our sample, the prevalence of traumatic biographic events since childhood is much higher than in the general population. It is also higher than in the other subgroups participating to the same research project (refugees and asylum seekers, drug addicted prisoners). The data of the Rotter test make also appear the prevalence of borderline functioning, defined according to structural psychopathology and operationalized by the scores on the dimensions of archaic aggressiveness, anaclitical objectal relationship and pathological narcissism in the Rotter test. The dissociative tendencies of participants are explored by means of the Rotter test and the HADS. According to the rating scales for the Rotter test, the comparison beween the answers in the first person and the answers in the third person revealed many discrepancies between the conscious and unconscious expression of needs and emotions, pointing towards defense mechanisms of splitting, scotomization and rationalization. The investigation of the pathology of the Ego Ideal (in the sense of hypertrophy or underdevelopment) also highlights the opposition between the conscious and unconscious representation of oneself. In the HADS, the types defined by a discrepancy between anxiety and depression occur with a frequency superior to the theoretical expectancies, according to the results of the Configural Frequency Analysis. These results of the confirmatory study concord with the data of the exploratory stage and confirm the theoretical modelization.Discussion and conclusionThe discussion is focused on the pertinence of the results of this study in the context of the current literature related to psycho-trauma and great precariousness, taking into account some recent proposals of conceptual enlargement (CPSD and PED).