Anorexie masculine en Chine : psychopathologie, facteurs culturels et transculturels

Abstract

AimAnorexia nervosa was long considered as a culture-bound syndrome of Western countries. However, studies have found anorexics in other cultures, for instance in China. The prevalence and incidence of anorexia in China seem lower than in the West, but on the increase, which suggests an influence of cultural factors. Anorexia could thus be a culture-change syndrome arising during fast sociocultural changes on individual scale, on the occasion of a migration, or on societal scale. Transcultural psychiatrists consider that acculturation and culture clash (conflict between different cultural models) are risk factors for developing eating disorders. Further to this, knowledge of male anorexia nervosa is limited, and there are few studies on this pathology in a transcultural setting. MethodFrom a clinical illustration of male anorexia in China, our purpose is to show the impact of cultural and transcultural factors on the emergence, the psychopathology, the symptomatology and the care of male anorexia in a society experiencing rapid change. ResultsZang presented atypical symptoms: absence of denial of weight-loss, transitory fat phobia, and atypical food restrictions. He also presented symptoms that are found in descriptions of cases in Western countries, such as perfectionism, obsessional disorders and autonomy difficulties. The development of Zang's anorexia seemed linked to a culture clash and an acculturation process. DiscussionThe absence of any denial of weight-loss by Zang and his transitory fat phobia could be explained by the traditional non-valuation of thinness in China. Abdominal pains could be an accepted idiom for distress in China for patients suffering from anorexia nervosa and might reflect social disharmony. With Zang, the culture clash shows itself in his desire on one hand to decide for himself on his own future and on the other hand his filial duty. Acculturation could explain the development of pathological eating behaviours via a valuation of dieting attitudes and the adoption of an ideal of thinness. Concerning the therapeutic approach, family therapy adapted to the Chinese setting seemed appropriate for this patient, mainly to redefine his own way of being a good son. ConclusionThis clinical case questions the use of Western diagnostic criteria, the meaning of symptoms, and the relevant therapeutic approaches for patients suffering from anorexia outside Western countries. The transcultural approach enables a reconceptualization and an enrichment of the diagnostic and therapeutic approach to male anorexia.