Anorexie mentale chez une fille de migrants chinois : apports de la psychiatrie transculturelle

Abstract

BackgroundAnorexia nervosa has for a long time been considered to be an occidental culture bound syndrome, but it also exists in other cultural areas such as China. It has been diagnosed at migrant females of Asian origins as well. It should rather be considered as a syndrome linked with rapid social changes or appearing during migration. We question the way cultural factors and transcultural factors, culture clash or acculturation are entangled in this pathology. MethodWe analyzed the clinical situation of an anorexic teenager, Laure, the daughter of Chinese immigrants in France, with the qualitative method of thematic analysis and with the tools provided by a transcultural clinic: a psychiatric and anthropological reading. ResultsFour themes were identified that seemed linked to Laure's anorexia development: acculturation, culture clash, identity construction, and family difficulties. This clinical situation is quite unique because of its history, her strong resistance to being cared for, and also because transcultural and cultural factors are entangled. DiscussionLaure's acculturation could be responsible for two atypical symptoms of anorexia nervosa, as compared with those occurring among Chinese anorexic girls: fat phobia and denial about thinness. Laure's difficulties encountered with her first name, the fact that she refused to learn the Chinese language and her atypical food restriction on Chinese food show intense internal conflicts. Laure meets difficulties with her self-esteem and identity construction which could be linked to the vulnerability induced by migration and also by the effects of racism from which she suffered. The construction of the parents-child relationship and in-between siblings could be more complex in a migration context because of cultural and family breaks it leads to. For instance, migration could result in different acculturation features inside the family or in a culture clash. Consequently, it could be suggested in such a clinical case to provide specific care: transcultural care associated with other forms of care such as individual and familial care. ConclusionTranscultural factors, acculturation and cultural identity conflicts could weaken identity construction and family ties and therefore be risk factors for developing anorexia nervosa among migrants’ children. Transcultural approach is then essential for a better understanding of these disorders, for improving therapeutic alliance, for a better care and for aiding with cultural mixing.