Capacités d’adaptation et fonctionnement défensif dans les troubles du comportement alimentaire. Étude structurale comparée basée sur le codage optimal

RésuméObjectifSur la base des théories classiques et récentes portant sur le stress et le coping, nous réfléchissons sur l’interaction entre les stratégies d’ajustement dysfonctionnelles, influencées par les mécanismes de défense, et le déclenchement, voire le maintien des troubles du comportement alimentaire (TCA).Patients et méthodeNous proposons une étude comparative entre patients souffrant d’anorexie mentale, respectivement de boulimie nerveuse (n total = 41) et un groupe contrôle d’étudiantes ne présentant pas de TCA, réalisée à l’aide du SVF 120 (Stressverarbeitungsfragebogen, Questionnaire d’ajustement au stress) et du MDBF (Multidimensionales Befindlichkeitsfragebogen, Questionnaire d’état psychologique multidimensionnel).RésultatsLa comparaison des moyennes est basée sur des Anovas univariés. Les stratégies d’ajustement associées préférentiellement à l’anorexie, respectivement à la boulimie nerveuse, sont étudiées à travers la régression logistique. L’étude structurale comparée est basée sur l’analyse non linéaire en composantes principales (PRINCALS), réalisée séparément pour chaque sous-groupe.ConclusionsL’analyse des résultats montre que l’affirmation selon laquelle les personnes souffrant de TCA utiliseraient surtout des stratégies de coping centrées sur les émotions est trop catégorique. Les données de l’étude plaident plutôt en faveur d’une approche dimensionnelle de la psychopathologie. L’interaction entre l’évolution des stratégies d’ajustement et le maintien, respectivement l’abandon des conduites pathologiques, devrait être étudiée à travers une étude longitudinale accompagnant la psychothérapie.

ObjectivesConsidering classic and current theories relevant to stress and coping, we reflect on the interaction between dysfunctional coping strategies influenced by defensive functioning and the launching, respectively maintaining of eating disorders (ED). Our objectives are to verify: (a) if the coping strategies of patients with anorexia and bulimia nervosa are different from those of young women without a current eating disorder, (b) what are the latent dimensions underlying the privileged way of coping associated with both anorexia nervosa and bulimia nervosa. The latent dimensions can create meaning in a disparate distribution of variables and objects by analyzing their configuration in a two or three dimensional space.Patients and methodsWe present a comparative study between patients suffering from anorexia or bulimia nervosa (Total n = 41) and a control group of female students non affected by eating disorders. The mean age was 19.95 years (SD = 3.73) in women diagnosed with anorexia nervosa, 19.81 years (SD = 2.33) in women diagnosed with bulimia nervosa and 20.88 (SD 1.40) in women without a current eating disorder. The study is based on the SVF 120 (Stressverarbeitungsfragebogen, Stress Coping Questionnaire, by Janke, Erdmann and Kallus, 1997) and the MDBF (Multidimensionales Befindlichkeitsfragebogen, Multidimensional State Questionnaire, by Steyer et al., in 1997).ResultsThe means of the three subgroups are compared with the help of Univariate Anovas, preferential coping strategies associated to anorexia and bulimia nervosa are studied through Logistic Regressions, whereas the comparative structural exploration is based on the Non Linear Principal Components Analysis (PRINCALS). We observe that our two clinical subgroups (patients with anorexia and patients with bulimia) do not try to cope with stress by implementing active strategies (problem-oriented coping strategies), that is to say, seeking a solution or planning stages of the solution. Instead, they tend to get overwhelmed by the unpleasant situation. Coping strategies based on satisfaction seeking (β = 0.87) and positive reframing (β = −0.33) make a significant contribution to prevalent coping strategies in women with anorexia nervosa, whereas change into triviality (β = 0.87), isolation (β = 0.50), use of psychotropic medications (β = 0.43), denial of responsibility (β = −0.33) as well as diversion (β = −0.46) are predictors of coping manners in women with bulimia nervosa. Whereas the general features of latent dimensions were similar in all three groups, these dimensions were nuanced differently according to the psychopathological profile. One dimension was focused on an active handling of the situation as opposed to passivity, another was focused on restoring narcissism as opposed to a sense of humiliation and self-degradation and a third one was focused on the reinterpretation of reality (cognitive restructuring) as opposed to other types of strategies. This interpretation of the meaning of the latent dimensions seems plausible at the light of recent theories of eating disorders, as well as at the light of the current state-of-the-art.ConclusionsOur multidimensional comparative study allowed us to identify some specific profiles, concerning the use of coping strategies, while also showing some similarities between clinical subgroups and control group. The analysis of the results shows that the general assumption saying that patients suffering from eating disorders use above all emotion-oriented coping strategies is too categorical. The data of the study point rather to a dimensional approach of psychopathology. The interaction between the fact of changing coping strategies and maintaining, respectively abandoning pathological conducts should be studied through a prospective longitudinal study accompanying psychotherapeutic interventions.