CO-72 – Efficacité du traitement par GH dans l'anorexie mentale de l'enfant

Abstract

Explorer les stratégies de coping des jeunes frères et sœurs confrontés à l’anorexie mentale prépubère.Huit frères et sœurs (six à quatorze ans) de patientes suivies pour anorexie mentale ont pris part à des entretiens semi-directifs analysés par théorisation ancrée.L’analyse a fait émerger 22 stratégies de coping centrées sur les émotions, sur le problème ou sur la recherche de soutien. Ces résultats montrent aussi l’importance du cercle extrafamilial et l’intérêt de la participation de la fratrie à la prise en charge thérapeutique.Ces fratries ont besoin d’être soutenues, guidées et informées sur l’anorexie mentale : c’est à cette condition qu’elles peuvent adopter les stratégies adaptatives les plus adéquates, lesquelles préviennent l’apparition de troubles psychiques et préservent également leur relation fraternelle et leurs relations familiales.Siblings faced with anorexia nervosa in a sister have rarely been studied. Most existing studies do not deal with siblings’ experiences of anorexia per se but rather use siblings as a control group in an attempt to understand the patient's illness. Furthermore, the few studies which focus on sibling experiences involve adolescents or adults whose anorexic sister is herself an adolescent or an adult. The present study examined the experience of young siblings of prepubertal children with anorexia nervosa. Given the lack of knowledge on this topic, an exploratory approach based on a qualitative methodology was selected, with the following research question as a starting point: “How do young siblings cope with anorexia nervosa in their prepubertal sister and with her hospitalisation?”The authors individually interviewed eight siblings aged six to fourteen years whose anorexic sisters were currently or recently hospitalised on the Eating Disorders Unit of Robert-Debré Hospital in Paris (France). The semi-directive interviews were recorded, transcribed verbatim and analysed with Atlas.ti software according to the qualitative methodology of grounded theory.The results shed light on the variety of coping strategies used by these young siblings to deal with the daily repercussions of their sister's anorexia and to manage the stress it generates. Through grounded theory analysis, twenty-two coping strategies emerged. These were of three different types: Problem-centered strategies, emotion-centered strategies and social support seeking strategies. Results also highlighted the importance of the extrafamilial environment for these children: Siblings showing the best coping strategies relied significantly on school, sports or friendships to keep their life as normal as possible. In comparison with previous studies, siblings from this study seemed less depressed, less isolated and better informed. The authors believe this may be due to the support that is available to them at Robert-Debré hospital. Indeed, they are encouraged to attend regular family therapy sessions, as well as a multifamily group twice a year. Within this therapeutic framework, they have the opportunity to obtain information and guidance on their sister's illness, to describe their experiences and to learn various coping strategies from their fellow siblings.Siblings must be informed about anorexia nervosa in order to understand what their sister is going through and the reasons why the illness has a significant impact on family routine, especially by reducing parental availability. Our results showed that siblings benefit from psychoeducational support. This involves providing parents with information on siblings’ specific needs and thus, indirectly, greater awareness by health professionals, who must determine ahead of time the role they want to give to siblings in their therapeutic interventions. By helping siblings rely on adequate coping strategies, such provision of support also contributes more broadly to the prevention of mental illness, as well as the maintenance of adequate sibling and family relationships.