Adolescents obèses : évaluation de l’image du corps,de l’estime de soi,de l’anxiété et de la dépression

Background

Adolescence is identified as a critical period for obesity and its complications.

Objective

To evaluate body image, self-esteem, anxiety and depression in obese adolescents.

Methods

Hundred and six obese adolescents benefited from an exploration of body image (Body Prominence, BPQ; Figure Rating Scale, FRS; Questionnaire of Body Preoccupation, QPC), self-esteem (Self-Esteem Scale, SES), anxiety (Revised children Manifest Anxiety Scale, RCMA-S), depression (Center for Epidemiologic studies–Depression Scale, CES-D).

Results

Globally, body image is disturbed. The BPQ shows a level of body consciousness greater in girls. Concerning the choice of the perceived figure, boys position themselves more frequently than girls in plump figures. For wished figures, girls choose more slim figures. However, there is no sex difference concerning body dissatisfaction that is relatively important for both sexes. The QPC indicates that girls have higher body preoccupation level than boys with specific focus on certain body area according to sex. The SES indicates that one out of two adolescents shows a low self-esteem and according to the RCMA-S, one out of three shows a high anxiety level without sex difference. Moreover, from the CES-D, one out of five adolescents, more frequently girls, exhibits a moderate to severe depression.

Conclusion

These results, with a differential interpretation (statistical vs clinical), partly confirm the data from the literature, and underline the need to perform a comprehensive investigation of body image, self-esteem, anxiety and depression in obese adolescents. In order to optimize the quality of the management provided to these youths, we proposed to physicians a pragmatic guide as “the somato-psychic pyramid”. It is important to remind that while escaping from the rule of the body fat regulation, obese adolescents may demonstrate a transgression and an adaptative marginalization.     

Estime de soi et démobilisation scolaire des adolescents

Objective

The objective of this research is to identify the psychological processes underlying the phenomenon of school demobilization and highlight the protective factors of dropping out, with particular attention to the impact of self-esteem of adolescents.

Methods

We proceeded to the award and the statistical validation of two scales (self-esteem and school mobilization) with a sample of 405 college students for the testing of our hypothesis, with linear regression analyzes.

Results

The results support the hypothesis that self-esteem has an effect on school mobilization. More self-esteem is high, especially the so socio-emotional and academic self, more school mobilization is strong, suggesting that emotional control but also the assessment that the young because of his academic skills, would manage the process of competition and struggle for social recognition that college students are confronted by the expression of strong mobile on the school and knowledge.

Conclusion

In conclusion, the results of this research suggest that self-esteem is a preventive dimension of demobilization school. They underline the importance of questioning earlier in adolescents, their school mobilization, conceived as a co-construction, by differentiating the dimensions of the report to the school's relation to knowledge and engagement in school work, taking into account their self-esteem.     

Réflexions à propos des effets de sollicitation interactive induits par le corps de l’enfant

The authors propose some reflections about the child's body and its associated subjective experiences, based on the idea that the body is a critical element of the interaction process and acts as a trigger and attractor of interactions. Theoretical analyses and observations of young normal children during exchanges with their mother, and also of children with a clinical condition (child hyperactivity disorder or infantile autism), have shown that an infant's body movement concentrates the mother's attention and actions, while jointly acting as an identity base for the child by way of the self-representation process rooted in bodily actions and interactions and their coenesthesia. It appears that the self-representation of a child cannot be separated from his/her actions with another person and representations of that person, and as such, it is indissociable from the affective relationship.     

Placements dans l’enfance et devenir à l’âge adulte : insertion générale et qualité de vie liée à la santé

Background

Child welfare literature underlines a higher prevalence of health problems and psychiatric disabilities in fostered young people than in the general population. Questions remain about their social integration and health in the long term: Which risk factors continue to alter their pathway? Which protective factors have minimized a problematic psychosocial adaptation over time?

Purpose

A follow-up study in the past was conducted on a SOS children's village on 123 young people who had been reared for more than 3 years and left care after the age of 14. A survey was mailed to these adults aged 23–50 years old, followed by face-to-face interviews. All relevant institutional files were analysed. Attrition rates were very low in this high-risk population. An overall score of social integration aggregates data regarding: occupational situation, family life, relationships, general psychosocial state. Health-related quality of life (Duke Profile) was analyzed by means of multiple dimensions including mental and social health, self-esteem, depression and disability. Multivariate analyses by logistic regression were used to examine the specific roles of decisive factors on social integration.

Key findings

At a mean age of 36.5 years, two thirds were well integrated socio-economically, only one out of five had psychosocial problems. Three factors increased the risk of poor socioeconomic integration: accumulation of parental risk factors, having been placed with two or more siblings’ groups and persisting mental health problems when leaving care. The quality of life was significantly associated with a better perception of social and mental health and with self-esteem. It varied positively, taken into account with professional integration, relationships and supportive environment, and negatively according to past adversities: parental domestic violence, maltreatment, and persisting mental health problems. Except from disabilities and to a lesser degree sociability, globally, these former fostered population did not seem different from counterparts in terms of health measures, anxiety and depression.

Implications

Results highlight the importance of continuity and stability in placement. For the professionals, it is necessary to give more attention to the question of rearing together several groups of siblings. Persisting mental health problems during placement and when leaving care would suggest a vital need for the staff to identify and to implement intensive, appropriate therapeutic care.     

Dépressivité maternelle au post-partum et symptomatologie du bébé à trois mois : l’effet modérateur de l’alliance familiale et de la satisfaction conjugale

Mood disturbances are frequent in the perinatal period. Mothers may present a “subthreshold” depression or even a diagnosed postpartum depression. This “depressiveness” is related to parenting behavior disruptions, to mother–child relationship disturbances and as a consequence they hamper the behavioral, cognitive and affective development of the child. However, several factors may buffer the negative effect of maternal depressiveness. The study presented in this paper assesses to what extent family alliance and marital satisfaction moderate the link between maternal depressiveness and child development. Fifty-seven families took part to the study with a 3-month-old infant. Depressiveness in mothers was assessed through self-reported questionnaire and diagnosis interview. Family alliance was assessed in the Lausanne Trilogue Play. Marital satisfaction and child symptoms were assessed by mothers through questionnaires. Results show that (i) the level of depressiveness in our sample is consistent with the prevalence in the general population, (ii) there is a link between maternal depressiveness and child symptoms, (iii) these links are indeed moderated by marital satisfaction, as a buffering factor, and by family alliance, as an aggravating factor. These results show the necessity to take into account the relational context of the mother in order to understand to what condition maternal mood disturbances may affect the development of the child.     

Coping, suicidalité et trouble de personnalité limite à l’adolescence

Borderline personality disorder is the most important independent suicidal risk factor during adolescence. Recently, the evaluation of suicidal risk has been studied in a different manner, with a greater emphasis on protective factors including coping strategies. This article has a dual purpose. Firstly, from the study of recent literature data, the article stresses the interest of studying and developing coping strategies for suicidal adolescents with borderline personality disorder. Secondly, the preliminary results of a study focused on the coping profile of suicidal adolescents with borderline personality disorder are described. According to results applicable to parts of the complete sample, suicidal adolescents have a different coping profile depending on whether or not they suffer from a borderline personality disorder. Through a theoretical and innovative model integrating both risk and protective factors applied to the results of the present study, developing the productive coping strategies (protective factor) of these adolescents could decrease the intensity of certain dimensions (such as emotional instability and impulsivity) of the borderline personality disorder construct (vulnerability factor) and thus suicidal risk.     

Relations sociales entre pairs à l’adolescence et risque de désinvestissement scolaire

Objective

This paper emphasizes the variety of peer relationships and their impact on the psychological and social-emotional development of adolescents of their attachment to school. In greater detail, this study analyzes the impact of social status on school commitment/disengagement within suburban schools (socially disadvantaged areas). We define social status as the social position of a person in a group: popular, rejected, lonely profile, etc. We study it based on the integration of an adolescent to a peer group, on the acknowledgment than he gets back, on the quality of his relationships with the other members of the group and on the fact he is/is not able to curb the peer pressure.

Methods and population

We asked 186 adolescents, pupils of a suburban school (58% of them are girls and 42% are boys). Most families live on low (or medium) incomes with a low educational attainment. A Decreasing Hierarchical Classification (DHC, Alceste, a method which consists of providing clusters by bringing them together according to their similarity) was used to identify five adolescents’ profiles: “followers/aggressive”, “popular”, “rejected”, “lonely” and “estimates”. This approach allowed us to set up typical adolescent profiles based on their social status and illustrated with their school disengagement.

Results

It was revealed that adolescents with “extreme” relationships (profiles: famous, aggressive or rejected) are those experiencing more difficulties at school. Their relationships are based either on power, on research for conformity or on strong emotional dependence. This leads them to bad school behaviors (practicing other activities at school, inattention, or being passive during class) because of their values too far from school requirements. Adolescents who have balanced and satisfying relationships succeed better. The support and the security from peers make them more cognitively available during class. The adolescents who do not belong to any group are also good performers: this way, they avoid social pressure so that they can concentrate on school activities.

Conclusion

After all, these results underlie that the social status of a adolescents in his group of peers can generate individual problems affecting his personality, his self-esteem, his sociability, his values and, as a consequence, his whole school journey.     

Symptomatologie dépressive à l’adolescence : rôle de la personnalité et de la conscience émotionnelle

Aim of the study

The aim of the study was to analyze the relating contribution of personality dimensions referring to Cloninger's model and emotional awareness to depressive symptoms intensity, in a community sample of adolescents. Our purpose was also to investigate the mediating role of the emotional awareness on the personality-depression relationship.

Method

A sample of 372 school students completed the following questionnaires: the Tridimensional Personality Questionnaire (TPQ), the Level of Emotional Awareness Scale (LEAS), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Correlationnal and multiple hierarchical regressions analysis confirmed the existence of direct links between each personality dimensions and depression, and the partial mediating effect of emotional awareness, but only for the novelty seeking and the harm avoidance dimensions.

Conclusion

Our results confirm the relationships observed in previous research between emotion awareness and depression on one hand, and between personality and depression on the other hand. They highlight the major role played by personality and emotional processing in the vulnerability to present depressive symptoms. The importance of taking in account and assess the emotional processing in the adolescent's depression clinical support is discussed.     

L’impact du cannabis à l’adolescence sur la transition psychotique de l’adulte

It is now well known that cannabis can precipitate the onset of psychosis. The epidemiological studies have shown that the increased risk is significant from ‘recreational’ consumptions (ten times exposure at the age of 18), but the effect is more important with higher doses (dose-dependent effect) and more marked in adolescent (with a two-fold increase of exposure at the age of 15 compared to 18). The effect is also dependent on the composition in cannabinoids: delta-9-tetrahydrocannabinol have psychotomimetic effects while cannabidiol has anxiolytic and possibly antipsychotic. This question is timely since some production of cannabis includes genetic modifications that tend to decrease the level of cannabidiol. Cannabis interferes with endogeneous cannabinoides systems, involved in the maturation processes at adolescence, and adolescence seems a critical period of sensitivity to the deleterious effects of cannabis. The recent literature in human and animal have demonstrated that exposure to cannabis at adolescence can result in chronic deleterious effect on cognition in adulthood. While the reliable data are compelling, we now need to disseminate these informations in an appropriate way, without militant excess but without complaisance. It is also needed to identify the markers that shall alert the environment of the adolescent or young adults and identify subjects at risk of complications when exposed to cannabis. It is already established that exposure at adolescence should not be minimized since adolescence per se appears as a risk factor for chronic cognitive deleterious effect and sometimes psychotic complications, even after relatively minor exposure.     

L’usage de Facebook et les enjeux de l’adolescence : une étude qualitative

Objectives

In the last years, a growing concern seems to emerge regarding psychological disturbance that could result from Internet use. Social-networking websites and particularly Facebook are currently very popular and important communication medium for adolescents and young people. This qualitative study focused on adolescents’ investment on their Facebook profile. The aims of this study were: (1) to better understand Facebook use issues among adolescents and young people; (2) to detect conflicts regarding adolescence that might appear on Facebook; (3) and to compare adolescent and young people use.

Method

A semi-structured interview was conducted on 20 adolescents (age ranged from 11 to 21 years old) in order to explore Facebook use as well as parents’ and peers’ relationship. Interviews were transcribed in their entirety and thematic analyses were performed.

Results

Thematic analyses highlighted that adolescents do not use Facebook for creating new intimate relationship, but rather to maintain relationship already existing with peers in offline life and to make social experiment. Adolescence issues appeared through adolescents and parents relationship, and self-image. Some participants reported parental intrusions on their Facebook use, and 35% wanted to protect their intimacy/privacy. Half of the sample posted self-promoting pictures. Furthermore, 70% reported waiting for positive feedbacks when they posted items on Facebook. Four participants reported irrational beliefs linked to “friend's” responses and comments. Facebook use in adolescents is not so different from young people, except for some type of pictures, and for intimacy towards parents.

Conclusion

For adolescents, Facebook is a communication medium used for extending daily relationship and communications. Adolescents do not use this social network to create intimate relationship. It is rather network communications than dyadic relationship. It is a place of social experience, where adolescents experiment rivalry, jealousies, betrayal, and also social support, and positive or negative self-image. Adolescents show on Facebook a particular self-image. Facebook use in adolescents and parental position underline adolescents’ autonomy. However, problematic or inappropriate use of Facebook in adolescents has to be carefully considered. Future research is needed to identify the long-term psychopathological consequences of Facebook use. Longitudinal studies could provide in-depth examination of potential problems, leading to identification and development of preventative strategies.     

L’examen psychologique de l’enfant : pratique et déontologie

Psychological assessment of children is a difficult task and is sometimes underestimated by clinicians who fear to be used as technicians rather than psychologists. The aim of this article is to show the relevance and beneficial aspects of a psychological assessment when performed in a scientific and ethical framework. Psychological assessment is viewed as a privileged encounter between a child presenting problems and an expert in child development, psychopathology and assessment. Distinct parts of assessment are described: preliminary interview with the parents and the child, choice of test battery, feedback. Feedback to the child and parents, often neglected because time-consuming, is a key element of assessing. It enables the child (and parents) to feel directly concerned and taken seriously, to understand the outcome of the procedure, to reflect on personal difficulties and assets, to find hope in future development. When the feedback is performed before the final report is written, it enables psychologists to adjust their interpretations, their language and their recommendations.     

Représentation de soi chez des adolescents ayant un frère ou une sœur autiste

Objective

Authors propose clinical research data about psychic functioning of adolescent siblings of children with autism. Literature review shows that the main purpose is about adolescent development with atypical environment.

Methods

Clinical scales and personality tests give information about self-esteem, anxiety, self-image, narcissism, body image. Samples comparisons, clinical group of adolescent of siblings versus control group of typical adolescent. Statistic method and clinical analyses are given to discuss clinical data.

Results

Self-image is perturbed but adaptative functioning is generally observed in the clinical group. A real psychic suffer exists for adolescents of siblings that can be described by means of three process screening self-image, nevertheless it does not clearly appear during childhood and adolescenthood.     

Violence du fantasme incestueux à l’adolescence et traumatisme pubertaire

Objective

In this paper, we try to demonstrate how pubertal fantasies work on the adolescent and mostly foster the crossing of the adolescent experience when they are repressed. Repression reveals at the same time instincts strength and power of ego's defense mechanisms standing against it. Psychic conflict guarantees this instinctual activity's elaboration. But when these fantasies invade these teenagers’ psychic life, when they overflow it for lack of being repressed enough, they can in this way contribute to wandering moments, or even to the appearance of serious development disorders.

Methods

Reflection spreads in this paper from a clinical case presentation retracing some moments of the psychotherapy of a teenager battling against powerful incestuous fantasies. The case methodology permits clinic presentation and comments, which enlighten some of its aspects. The long-term therapeutic follow-up of this teenager permits to bring out some fundamental points regarding his ways of psychic functioning.

Results

The adolescence process dynamic appears from the angle of the instinctual violence acting like a trauma, which could lead to an acting out, a collapse or a perverse development, as it is the case for the teenager presented here and as it is seen more generally in the more fragile subjects. But the adolescence process, when the ego defenses are sufficiently well formed, when the latency has been able to find its place, generally also permits an elaboration of this same pubertal violence, transformed then into a creativity source.

Perspective

The parental narcissistic support role turns out decisive when the adolescent's psychological containing ability reveals itself insufficient to treat the influx of the somatic and psychological excitations caused by the entry in the puberty. When the adolescent's mechanisms of defense were not enough able to constitute during childhood and that the parental narcissistic support is failing, the therapist role consists in supporting the teenager in his ability to face his pubertal feelings, to reconstruct his defenses before any attempt of analysis of his psychic life. We suggest thinking of the entry in the therapeutic work with the fragile adolescents on a narcissistic plan as a time of construction of the ego defenses.     

Troubles sémantiques et pragmatiques du langage : intérêt de l’analyse linguistique en psychiatrie et cadres pathologiques

Semantic and pragmatic disorders (SPD) of language are usually described in psychiatric adult trouble (schizophrenia, mania and dementia). In children, they are associated with pervasive developmental disorders (PDD) in connection with symbolic capacity deficiency. In this paper, the current knowledge of functional and formal aspects of language is presented. The different clinical aspects of specific language impairments (SLI) and the previous linguistic analysis in psychiatry are reported. The recent advances in psycholinguistic support the notion that SPD may result from both psychiatric and linguistic troubles. Indeed, the psycholinguistic and the different aspects of SLI provide evidence for both semantic and pragmatic ability troubles either primitive or secondary to SLI. Therefore, they should not be considered exclusively as psychiatric signs, although secondary psychopathologic troubles may be associated to SLI. This conclusion is supported by two case reports.     

Le devenir des idées en pédopsychiatrie, à travers l’histoire de l’autisme

The history of autism can serve as a model for the understanding of the history of child psychiatry. One can observe the controversies between the inborn or acquired nature of the child psychic troubles, between the primacy of psychiatric care or education, between handicap or disease and about the specificity of the child psychopathology. The 19th century was dominated by the educational model. The goals were, first, to civilize wild children, then to develop by education the mind of idiotics, imbeciles, mentally retarded children, ranged on a one-dimension scale of intellectuel level. At the turn of the century, under the influence of psychoanalysis but also of a more humanistic conception of psychiatry, psychopathology has developed as a new approach, against the pessimistic view of heredity, giving birth to the new concept of infantile autism included in the more general frame of infantile psychosis and fostering the development of various forms of psychotherapy articulated with educative methods. After World War II, in France, the movement of “sector public child psychiatry” has represented a major trend in favor of social and psychological reintegration of abnormal children. Nowadays, parents have received some of psychodynamic theories as a way of making them responsible of their child pathology. They ask for a turn towards mere education and fight against the therapeutic methods. This backward movement may, by neglecting the need for care and therapy, hinder a regard for the emotional life of the child and be detrimental for his/her evolution. Under the pressure of the families exaction, the influence of drug industry, the financial shortage due to economic conditions, child psychiatry is in need of more historical knowledge in order to insure its transmission and its ethics.     

Tentatives de suicide graves et répétées,et vicissitudes du travail de séparation à l’adolescence. Réflexions théoriques à partir d’un cas clinique

Clinicians who work with hospitalized teenagers often face some young patients’ relentless suicidal determination: these patients seem to have sentenced themselves to death. For several months, sometimes years, no one manages to revoke this incomprehensible capital punishment. This painful conviction that they are unworthy often comes with depressive affects that resist on a long-term basis, despite the combination of antidepressants and a psychotherapeutic approach. Thinking is too stressful: they long to suspend any psychic life, to stop the emergence of any desire and to end any relational impulse. They keep trying to stay in a factitious world, far from real life requirements, as a temporary alternative to death. Through the anaesthesia it produces, the use of drugs offers them a strong protection from their pain. The regressive search for a feeling of lacking psychic differentiation seems to confirm a defect of development within the first phase of the separation individuation process. Narcissistic vulnerability is often underlined in most psychopathological studies concerning suicide attempts during teenage years. Combined with the incapacity to endure any loss, this last element seems to imply that a “relationship of encroachment” exists between the subject and its environment, as well as a persistence of a broad area of lacking differentiation within the maternal imago. From this theoretical point of view, suicidal gestures from these patients are often understood as desperate and paradoxical attempts to reach their boundaries, to maintain their identity and to “withdraw themselves from the object of alienation”. These relevant interpretations hide the “search of a narcissistic state of undifferentiated union” that F. Ladame highlighted during the psychoanalytical counselling of numerous young and seriously suicidal patients. Through this article, we propose to try and re-examine the theoretical concepts related to the ups and downs of the psychic separation work needed by teenagers, particularly for those who went through serious suicide attempts. The presentation of a particularly difficult clinical situation will help us bring context to our subject. The uncompromising posture of this young patient seems to give credence to the hypothesis claiming that the active pursuit of death may be a way to reconnect with an undifferentiated state. In the case of our teenager, everything is going as if his disappearance was the only way to escape from the torments of a separate consciousness, and therefore recover the unconditional love from primary objects through the guise of a fusion fantasy. How can we guide adolescents caught in this narcissistic trap? The therapeutic challenge could be to guide them through the elaboration of the shame attached to their sexual body and of the ambivalent feelings they experience towards their parents. The aim would be to allow them be less dependent on their defensive way to support this deadly quest of symbiotic union with the “primary object”.