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Putois O, Riegert M, Bahi N, Pires J, De Luca M. Joint family consultations for psychiatric inpatients with severe eating disorders transitioning to adulthood: psychoanalytic design of a therapeutic setting. Front Psychiatry 2023; 14:1270499. [PMID: 37876621 PMCID: PMC10590888 DOI: 10.3389/fpsyt.2023.1270499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
While family work is acknowledged as relevant in the care of eating disorders (EDs), not much literature has explored it in the period of transition from adolescence to young adulthood (16-18 to 30 y.o.). Yet this period is of significant importance in the prognosis and evolution of EDs; but its particular stakes require specific therapeutic settings-especially for inpatient EDs. In this paper, we start from the paradoxical observation that some families refuse this type of work in its usual form, with a family-dedicated therapist, and require to only exchange with the psychiatrist in charge of the treatment plan. We use a psychosomatic-informed psychoanalytic approach to shed light on this refusal as a latent denial of the contribution of family dynamics to the current symptom, and an unconscious tendency to stick to a dependency-laden family scheme. We then explain the conception of a specifically dedicated therapeutic setting, designed to address this specific type of resistance, offered to families as a therapeutic compromise designed to give them a specific position in the care of their child. In our joint therapeutic consultations, family dynamics are addressed on the basis of exchanges regarding treatment and in particular feeding. While such exchanges start from medical considerations, the therapeutic couple (psychiatrist-psychologist) uses them to address the parent and patient expectations underlying the symptom. We propose to call this act "inscription"; it enables a separation from the underlying dependency-oriented family scheme, while stressing the importance to care for associated parental anxieties.
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Affiliation(s)
- Olivier Putois
- SuLiSoM UR 3071, Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- Service de Psychiatrie, Santé Mentale et Addictologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut d’Immunologie et d’Hématologie, Institut Thématique Interdisciplinaire TRANSPLANTEX NG, Université de Strasbourg, Strasbourg, France
- Institut Contemporain de l’Enfance, Paris, France
| | - Myriam Riegert
- Service de Psychiatrie, Santé Mentale et Addictologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nadine Bahi
- SuLiSoM UR 3071, Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- PSInstitut, Strasbourg, France
| | - Joël Pires
- SuLiSoM UR 3071, Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- PCPP UR 4056, Institut de Psychologie, Université de Paris, Paris, France
| | - Manuella De Luca
- PCPP UR 4056, Institut de Psychologie, Université de Paris, Paris, France
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De Luca M, Gargiulo M. Dispositifs cliniques thérapeutiques et de recherche. L'Évolution Psychiatrique 2023. [DOI: 10.1016/j.evopsy.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Guyomard P, De Luca M, Lepoutre T. Faut-il enseigner la psychanalyse à l’Université ? Entretien avec Patrick Guyomard par Manuella de Luca et Thomas Lepoutre. L'Évolution Psychiatrique 2020. [DOI: 10.1016/j.evopsy.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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De Luca M. Hikikomori: Cultural idiom or present-day expression of the distress engendered by the transition from adolescence to adulthood. L'Évolution Psychiatrique 2017. [DOI: 10.1016/j.evopsy.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Luca M. Les scarifications comme après-coup du féminin. Les vicissitudes d’un masochisme bien mal tempéré. L'Évolution Psychiatrique 2011. [DOI: 10.1016/j.evopsy.2010.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Luca M. Psychothérapies des psychoses : entre histoire et évaluation. L'Évolution Psychiatrique 2009. [DOI: 10.1016/j.evopsy.2009.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alberici A, Bonato C, Borroni B, Cotelli M, Mattioli F, Binetti G, Gennarelli M, Luca MD, Simonati A, Perani D, Rossini P, Padovani A. Dementia, delusions and seizures: storage disease or genetic AD? Eur J Neurol 2007; 14:1057-9. [PMID: 17718701 DOI: 10.1111/j.1468-1331.2007.01664.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a case of a young patient suffering from a rapidly progressive cognitive decline, associated with delusions, myoclonus and seizures and with no family history for dementia. Clinical features, along with skin biopsy findings were overlapping storage disease; the genetic analysis, however, demonstrated a de novo presenilin 1 mutation. The present report suggests the usefulness of genetic determinations in early-onset cases of dementia, even without an autosomal dominant trait of inheritance; for these cases and their relatives an extensive genetic counselling should be recommended.
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Affiliation(s)
- A Alberici
- Alzheimer Unit, IRCCS-S. Giovanni di Dio-FBF, Brescia, Italy.
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