Comparaison des exp�riences dissociatives � l'adolescence entre un groupe de coll�giens et un groupe clinique

Abstract

Les auteurs s'interrogent sur d'éventuelles différences pouvant exister entre une population adolescente de collégiens et une population clinique en ce qui concerne les expériences dissociatives. L'étude permettra également d'interroger la structure théorique des composants de la DES afin de comprendre les différences relevées entre les deux groupes. L'étude utilise la version française de la Dissociative Experiences Scale (DES) pour cette comparaison. Les résultats obtenus seront référés à la structure des composants théoriques de l'outil, laquelle présente trois types d'expériences dissociatives, l' absorption dans l'imaginaire, l'amnésie dissociative et la dépersonnalisation-déréalisation . Les résultats sont paradoxaux : bien que la fidélité (consistance interne) soit bonne pour les deux groupes, les résultats à l'échelle sont globalement plus élevés dans la population des collégiens, en particulier sur le facteur absorption dans l'imaginaire . Une interprétation est proposée en regard des processus psychodynamiques de l'adolescence, en rapport avec l'incapacité de l'adolescent souffrant à pratiquer l'introspection, et à répondre finement à ce type de questionnaire. Est également évoqué le fait qu'un adolescent en bonne santé psychique développe de façon plus soutenue un monde interne imaginaire et a tendance à s'y laisser absorber de façon fréquente, surtout dans la population féminine (il existe une différence liée au sexe). Dissociation involves alterations in consciousness, memory and identity, as well as disruptions in the perception of time and the environment. They contain an inability to remember aspects of one’s life, the experience of feeling oneself in an unfamiliar situation, feelings of unreality, feeling absorbed or completely lost in an activity, and feeling of being detached or disconnected from oneself. These experiences are conceptualized as existing on a continuum ranging from non-clinical conditions to pathological dissociation. Dissociatives experiences are relatively common in the general population, occur equally often in American male and female subjects, and tend to be reported less frequently with age. Data of these experiences are unknown in French adolescent subjects. In 1994, the DSM-IV deleted the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They included now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). The purpose of this study will compare the frequency of dissociative disorders between a sample of normal adolescent population and a clinical sample of adolescents. Further, results will be compared to the theoric structure of DES’s components to understand differences of dissociative experiences between the two populations. Clinical sample ( N = 55) is made up of French adolescents aged 12–17 (mean age = 14.6; 36.4% is female population). Subjects were streaming from several pedopsychiatric unities. Normal sample ( N = 96) is made up French adolescents aged 13–17 (mean age = 15.1; 51% is female population). Subjects were streaming from a secondary school. The screening tool, which was used is the dissociative experiences scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. The mean score obtained is 26.15% for secondary school pupils sample and 19.24% for clinical sample. Comparison of the theoric three-factor solution (imaginative absorption, depersonalization-derealization, and dissociative amnesia) gives the following datas: mean score for each factor is, respectively: imaginative absorption = 32.72% for secondary school pupils group, 19.46% for clinical group; dissociative amnesia = 23.97% for secondary school pupils group, 18.31% for clinical group; depersonalization-derealization = 20.45% for secondary school pupils group, 19.65% for clinical group. DES reliability was studied through computation of Cronbach’s coefficient (0.84 for secondary school pupils and 0.92 for clinical sample). Results are paradoxical: reliability is good for the two samples and results are highest for non-clinical population, particularly for imaginative absorption component. An interpretation of this phenomena is, from the point of view of psychopathology and psychodynamics processes at adolescence, that the adolescent who is afflicted and feels psychic pain, is in difficulty to be in a good introspective capacity and to answer thinly to this sort of scale. Suffering adolescents tend to reduce score at DES, facing their own anxiety to be mad or abnormal. The authors mention so that an adolescent in a psychic good health is more able to develop an internal psychic world and can be involved to frequent moments of imaginative absorption, especially for female population (results show a significative difference).