A Study of the Behavioural and Affective Profile of Inpatient Adolescent Girls Presenting a Restrictive Anorexia Nervosa

Les troubles du comportement alimentaires (TCA) sont reconnus comme le troisième problème de santé chronique le plus fréquent chez les adolescents (Herpertz-Dahlmann, 2015; Rosen, 2003). L’évolution du trouble peut être assez variable d’un individu à l’autre, mais le pronostic semble meilleur lorsqu’il apparait à l’adolescence (Steinhausen, 2002; 2009). L’étude des difficultés propres aux adolescentes présentant un TCA semble être une avenue intéressante pour approfondir nos connaissances concernant leur fonctionnement psychologique. La présente étude poursuit trois objectifs. Elle vise à : (1) Décrire le profil des difficultés comportementales et affectives d’un groupe d’adolescentes hospitalisées pour une anorexie mentale de type restrictive (ANR); (2) Examiner la relation entre les problèmes comportementaux et affectifs à l’étude et l’intensité du trouble alimentaire; (3) Explorer le lien entre les difficultés mesurées et l’évolution pondérale pendant l’hospitalisation. Le groupe à l’étude est composé de 52 adolescentes hospitalisées pour une ANR. Les difficultés comportementales et affectives ont été évaluées à l’aide du Youth Self Report, et l’intensité du trouble alimentaire a été appréciée à l’aide du Eating Disorder Risk Composite (EDRC). Un ratio entre l’Indice de Masse Corporelle (IMC) à l’admission et l’IMC à la fin de l’hospitalisation a été utilisé pour évaluer l’évolution pondérale des participantes. Les résultats de l’étude montrent que le profil moyen de l’échantillon est majoritairement intériorisé, avec des difficultés qui diffèrent des normes au niveau des problèmes retirés/déprimés et anxieux/déprimés. Trois profils de difficultés spécifiques sont observés dans l’échantillon soit: (1) normatif, (2) difficultés intériorisées, (3) problèmes intériorisés et extériorisés. Des corrélations positives significatives sont observées entre l’intensité du trouble mesurée par l’EDRC et les problèmes répertoriés. Une corrélation négative modérée est observée entre le gain de poids et l’intensité des difficultés extériorisées. Il semble donc y avoir un lien entre rapporter davantage de difficultés extériorisées et une plus faible prise de poids lors de l’hospitalisation pour cette population. La prépondérance de difficultés intériorisées trouvées dans cette étude (particulièrement au niveau des problèmes liés à l’anxiété et la dépression) semble cohérente avec la littérature portant sur les principales comorbidités de ce trouble. Cette description permet également de constater une hétérogénéité dans les profils de fonctionnement trouvés pour cet échantillon par ailleurs assez homogène, mettant ainsi l’emphase sur l’importance d’une évaluation globale des jeunes hospitalisées pour une ANR et un traitement individualisé aux problématiques rapportées par chacune. En second lieu, la présence d’une relation positive entre l’intensité des difficultés comportementales et affectives intériorisées et externalisées et l’intensité du trouble alimentaire démontre que plus les symptômes associés à l’ANR sont importants, plus le fonctionnement global de l’adolescente sera affecté. Finalement, il est possible de se demander si certains types de traitement pourraient être plus bénéfiques à certains types de patients concernant le gain pondéral pendant l’hospitalisation. Eating Disorders (ED) are recognized as the third most common chronic illness among adolescents (Herpertz-Dahlmann, 2015; Rosen, 2003). Evolution of ED is known to be heterogenous in between patients, but prognosis seems more favourable when the disorder appears at adolescence (Steinhausen, 2002; 2009). The study of individual difficulties seems like an interesting avenue to refine our understanding of the psychological functioning of those suffering from ED. This study aimed to: (1) Describe the behavioural and affective profile of inpatient adolescent girls with a restricting type of Anorexia Nervosa (ANR) ; (2) Investigate the presence of a relationship between the behavioural and affective difficulties measured and the intensity of the disorder; (3) Examine the presence of a relationship between the individual problems and weight gain during inpatient treatment. The sample consisted of 52 inpatient adolescent girls presenting an ANR. The Youth Self Report assessed the behavioural and affective difficulties, while the Eating Disorder Risk Composite was used as the indicator of the intensity of the disorder. A ratio between Body Mass Index (BMI) at admission and at the end of hospitalization was calculated to measure weight gain during treatment. The sample was characterized by an average internalized profile of individual difficulties that reached the clinical threshold. Three different profiles of problems were found within the sample: (1) normative, (2) pure internalizing, (3) mixed (with difficulties that differed from norms on both the internalizing and externalizing clusters). Strong positive correlations were found between individual characteristics and intensity of the disorder, whereas a moderate and negative association was found between weight gain and the externalizing features measured. The internalized profile of difficulties found for the sample (particularly elevated for anxious and depressed problems) seems consistent with previous studies on comorbidities for adolescent ED. This description provides information on the heterogeneity of this specific population, which is otherwise quite similar, hence giving strength to the idea of a global assessment of the functioning of the adolescent at admission and an individualized form of treatment that takes into consideration the specific difficulties reported by the patient. Significant correlations were found between results on the YSR and on the EDRC which proposes that the more important the symptoms of the ANR are, the more affected the functioning of the adolescent will be for the emotional and behavioural problems measured. Finally, results show that girls presenting higher levels of externalized difficulties were those who gained less weight during treatment, which seems to demonstrate that certain treatment strategies could benefit more certain types of patients.

Keyphrases: adolescence, Youth Self Report, Problèmes comportementaux et affectifs, IMC, anorexie restrictive, adolescence, Youth Self Report, Restrictive anorexia, Emotional and behavioural problems, BMI