Les parents d'adolescents hospitalisés pour anorexie mentale : expérience d'aidant et émotion exprimée

Anorexia nervosa is an illness with severe physiological and psychological consequences (Meczekalski, Podfigurna-Stopa, & Katulski, 2013). Family members’ involvement is highly recommended by the latest treatment guidelines for people suffering from anorexia nervosa (National Institute for Health and Care Excellence, 2017). During the last decade, clinicians and researchers have taken interest in the way relatives experience their caregiving role. The first article of this thesis presents a critical review of qualitative and quantitative studies on the relatives’ caregiving experience of people suffering from an eating disorder. The reaction of close others to anorexia nervosa is a potential maintaining factor of the disorder (Schmidt & Treasure, 2006). It is operationalized through the dimensions of expressed emotion (EE), which are emotional overinvolvement (EOI) and critical comments (CC). EOI and CC are negative predictive factors for individuals’ outcome in the context of anorexia nervosa (Eisler et al., 2000). However, few studies have taken interest in the relationship between the experience of caregiving and the EE among parents of individuals suffering from AN, especially at illness onset.  The aim of this thesis is to draw a specific portrait of parents of adolescents hospitalized for anorexia nervosa at the beginning of the illness and to better understand the relationship between their experience of caregiving, their EE and other elements of their perspective: illness perception, psychological distress, parental sense of competence and perception of family functioning. Fifty mothers and 38 fathers have answered several self-report questionnaires at the first hospitalization of their adolescent who received a diagnosis of restrictive anorexia nervosa during the last three months. Results of the second article show that the aspects of caregiving experience are significantly correlated to the dimensions of EE. Sense of loss was the most significant contributor of the caregiving experience to EOI for both parents. Dependency for mothers and positive experiences for fathers were the second most significant contributors to EOI. Difficult behaviours were the most significant contributor to CC for both parents. The need for backup for mothers and not reporting a good relationship with their child for fathers were the second most significant contributor to CC. The analysis of the third article allowed observing a mediation effect of psychological distress on the link between negative aspects of caregiving and EOI for both parents. Mediation effects of illness perception and family satisfaction on the link between negative aspects of caregiving and CC were also observed for both parents. The discussion of this thesis elaborates on the results found, including the similarities and differences between mothers and fathers. It underlines the importance of offering early intervention to parents of adolescents suffering from anorexia nervosa. It also suggests clinical applications based on the results, identifies the strengths and limits of the study and defines perspectives for future research.

Keyphrases: Parent, Expressed emotion, Experience of caregiving, Anorexia nervosa