Quand le féminin est mis à mal … À propos d’une prise de poids significative chez des jeunes femmes en post-annonce diagnostique d’une agénésie utéro-vaginale

Abstract

ObjectivesBased on data from a vast medical-psychopathological research study proposed to girls suffering from utero-vaginal agenesis — Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) —, the value and the function of a frequently occurring (10%) bulimic disorder (with weight gain) at the announcement of the diagnosis are analyzed from a psychodynamic perspective. The psychic implications of the diagnosis and its consequences in terms of the modalities of the sessions with these adolescents, alongside genital sexuality, are underlined. The analysis of two cases studies, put into perspective, allows us to refine our understanding of the meaning of this food-related symptom. Therefore, this could both constitute a defensive modality signaling the impasses of the process of construction of the feminine as it could be a lever of psychic transformation of the traumatic repercussions of this process. MethodsForty young MRKH women aged 19 to 34 (with an average age of 25 ½) are met. The research is offered to them from two to 17 years after their diagnostic announcement; clinical reflection consists of a retrospective analysis of their adolescent traumatic experience. The patients’ stories are collected using a clinical research non-directive interview. Two projective methods — Rorschach and Thematic Apperception Test (TAT) — are also proposed to better understand the modalities of their psychic functioning at the time of the clinical encounters. Interview data are subjected to a thematic clinical analysis. The protocols of the Rorschach and of the TAT are analyzed according to the method of interpretation of the French School, which refers to the psychoanalytic theory of psychic functioning. The material, resulting from sessions with two patients diagnosed with MRKH at the age of 17 and having gained 10kg in the aftermath of this announcement, is compared in a thorough way. ResultsThe contrasts — in terms of problematics and of levels of elaboration — between the interview and the projective protocols are striking for each patient. With the analysis of the interview, the bulimic symptom of the first patient occurs in a psychic context where feminine interiority seems unrepresentable. On the contrary, projective protocols reveal access to conflicting and symbolic feminine work. In the same way, the second patient's discourse about her symptom is at first sight much more elaborate than that of the first patient; she establishes a subjective link between the renunciation of maternity inherent in the announcement of MRKH and the compensatory dimension provided by weight gain. However, the discrepancy with the projective tests is surprising in this second patient. Indeed, her productions reflect fragilities in her identity and an insufficient symbolization of the sexual that testify to the defensive value of the excessive symbolization of her speech, evident in the interview. DiscussionThese contrasts lead us to consider binge-eating as an attempt to treat an already conflicting female sexuality, even in deadlock, before the discovery of MRKH. Its traumatic accents are updated and potentiated with the diagnostic announcement. The different levels of identified problems can coexist in a same woman, whether it is a feminine that has neither been constructed nor integrated; an impossible investment of the internal body; or a counter-investment of an impossible maternity. In this context, the etiopathogeny of weight gain subsequent to the announcement of the diagnosis is unique for each young woman, but always in connection with an affected or wounded feminine and/or maternal. ConclusionIn conclusion, if the weight gain following the diagnosis reflects a hindrance or even an impasse (possibly punctual) of the psychic treatment of its effects, this medical announcement in adolescence can constitute, afterwards, a new chance for these girls, with a potentially mutative value.