Aspects culturels et transculturels des troubles du comportement alimentaire chez des adolescentes et jeunes adultes chinoises

Abstract

BackgroundEating disorders were long considered as a culture-bound syndrome specific to western countries. However, studies reported results for anorexia in other cultural areas such as China, where its prevalence and incidence is rising. This suggests that anorexia is rather a culture-change syndrome arising during fast sociocultural changes. Adaptation to those changes may contribute to the increasing prevalence of eating disorders. Furthermore, transcultural psychiatrists consider that acculturation and culture clash (conflict between different cultural models) are risk factors for developing eating disorders; but they are less transcultural studies about bulimia. Clinical cases of eating disorders studied around the world showed a great variability in symptoms and psychopathology. Therefore, the role of cultural played and transcultural factors in the increase in eating disorders needs to be defined. Method and populationBased on a qualitative study of eight clinical cases of eating disorders in China, a country and a society undergoing and experiencing a lot of fast sociocultural changes, our work aims to show the impact of cultural and transcultural factors on eating disorders, and takes into account the psychopathology and the symptomatology. Patients were hospitalized in Shanghai Mental Health Center and observed during the internship of a French resident in psychiatry. ResultsCultural factors accounted for the symptomatology differences identified with the Western country eating disorders such as: the variability of fat phobia, weight concern, and the absence of denial of thinness. The one child policy bears responsibility for eating disorders in China by improving the academic stress, changing the socialization context, impacting the affiliation process and the family context. Acculturation to western values such as the adoption of an ideal of thinness, growing autonomy claims, and desire for success favors the development of eating disorders. A cultural clash emerges as a consequence of contradictory expectations, of Chinese women's moving roles and of intergenerational gaps between parents and children; all these factors contribute to weaken the identity building, inducing individuation difficulties and parenthood difficulties. Eating disorders in China are also a means to protest against the family. Therefore, family therapy adapted to the Chinese setting seems relevant, together with a specific support for parenthood. ConclusionKnowledge about eating disorders from around the world and the transcultural approach enable a better understanding of these disorders, an enrichment of the diagnostic and therapeutic approach for eating disorders and an improvement of the therapeutic alliance.