Existe-t-il une typologie familiale dans les pathologies addictives ? Revue critique de la littérature sur les familles d’adolescents présentant des troubles alimentaires ou des conduites de dépendance aux substances

RésuméParmi les facteurs favorisant les conduites addictives, certaines caractéristiques du fonctionnement familial sont souvent évoquées dans les troubles alimentaires et dans les dépendances aux substances psychoactives ou à l’alcool. La mise à l’épreuve des observations des processus familiaux par des recherches empiriques intégrant différents niveaux épistémologiques et méthodologiques a conduit à des résultats contradictoires concernant les différentes formes de fonctionnements familiaux associés à ces pathologies addictives. Cet article propose une revue critique de la littérature dans le cadre des conceptions systémiques concernant les dérèglements familiaux impliqués dans l’apparition des troubles alimentaires et des dépendances aux substances ou à l’alcool chez les adolescents. Il s’agira également de discuter la similarité des caractéristiques familiales entre ces pathologies addictives et l’hypothèse d’une typologie familiale propre aux conduites addictives.

Among factors favoring the addictive behaviors, some specific family processes are often identified in eating disorders and dependences with psychoactive substances. Different models of systemic orientation described the familial disturbances involved in the addictive pathologies emphasizing either the emotional interaction and the processes of differentiation family, either the structure and the level of family cohesion. This article proposes a critical review of the systemic literature on the familial disturbances involved in the families of adolescents with eating disorders or with a substance-dependence. The systemic models (Bowen, Minuchin) are reference values in the understanding of family processes and therapy with families. The observations of these family processes have been confronted to empirical researches integrating different epistemological levels and different methods. The empirical results are heterogenous concerning the different forms of family functioning associated with these addictive pathologies. The empirical studies support the hypothesis of a family dysfunctioning in the different addictive behaviors and demonstrate the relationship between the severity of familial disorders and the severity of the addictive disorders. However, the family configuration described by the typological models is rarely found complete or with a similar intensity between the families. The studies support the hypothesis of an emotional distance in the family interactions and a lack of parental care which could correspond to factors of chronicity or vulnerability. Comparing the family characteristics of these two types of addictive behaviors, the literature supports the existence of (1) some specific family characteristics according to the type of addictive behavior (in particular the conflict avoidance which appears specifically in anorexic families) (2) some similar family patterns of interactions between the members of addictive families in particular the representation of a low family cohesion, an intergenerational enmeschment and a high level of control. These family patterns suggest rather to a dimensional approach of the family characterized by different protective or risk factors. We suggest that these family patterns could constitute, according to their importance (intensity and frequence), a family risk factor of development or aggravation of the addictive behaviors.