The Role of Food in the Family Relationships of Adolescents With Anorexia Nervosa and Bulimia in Northeastern Brazil: A Qualitative Study Using Photo Elicitation.

Family components can play roles both as protective factors and maintenance mechanisms of eating disorders. We aimed to investigate the role of food in the family relationships of adolescents with anorexia nervosa and bulimia in northeastern Brazil. Using photo elicitation, a visual narrative method that gives insight into the participants' perspective through photograph, we conducted semi-structured interviews with 26 people: four teenage girls with anorexia, four with bulimia, eight mothers, four fathers, five grandmothers, and one sister. Data were analyzed using the principles of Interpretative Phenomenological Analysis, which highlighted the following themes: control of the parent-adolescent relationship through food; food as a mean of experiencing parental presence-absence; food as the focus of conflict in the nuclear family, and food as a source of three-generational conflict. Food seemed to be a means for teens and parents to express physical suffering and psychological violence. Moreover, mourning appeared to influence the girls' relationships with food. Conflict in these families is not focused solely on food, but extends to other subjects, and teenagers' emotional reactivity concerning their relationship with their parents and food during family mealtimes varied. These features reinforced the cultural aspect and influences of eating experiences among adolescent girls with eating disorders. Remarkable disparities exist in the generations' views on what rules and rituals these adolescents must follow at meals. These disparities can obfuscate generational boundaries in these families. Our data reinforce the need to focus on the adolescent's autonomy in the family setting and on family identity as related to food among three generations. These findings necessitate a reorganization of boundaries between these generations.

Development of a patient rated scale for mental health global state for use during humanitarian interventions.

OBJECTIVE: We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old). METHODS: We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection. RESULTS: The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S. CONCLUSIONS: The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.

Os bebês não esquecem nada - e menos ainda a violência que sofrem / Babies do not forget - anything less the violence they sufferToo many daily traumas in all cultures

Em toda parte as crianças são consideradas preciosas e busca-se protegê-las e encontrar a melhor maneira de fazer com que possam crescer harmoniosamente. No entanto, em toda parte fazem-nas sofrer traumas no dia a dia. Analisaremos num primeiro momento os grandes trabalhos em antropologia, psicologia e psicanálise sobre as interações dos bebês com seus pais. Mostraremos a seguir como fazemos sofrer às crianças violências no quotidiano, tanto em diferentes lugares do mundo como também no exílio, e defenderemos um acolhimento atencioso, dedicado e transcultural em nossos consultórios e na vida.(AU)

Everywhere children are considered precious and we try to protect them and find the right way to grow them harmoniously. Yet everywhere, they are subjected to traumas on a daily basis. We will first analyze the major works in anthropology and psychology and psychoanalysis on the interactions between babies and their parents. We will then show how children are subjected to everyday violence in different parts of the world and in exile, and we will advocate for caring and transcultural care for children in our consultations and in life.(AU)

A clínica transcultural: cuidando da parentalidade no exílio / The transcultural clinic: Caring of parenthood in exile

As famílias desenraizadas podem se perder nos caminhos traçados pelo exílio. Fatores genéticos, culturais e ambientais podem afetar o equilíbrio psíquico desses migrantes, principalmente quando confrontados a doenças ou sofrimentos inexplicáveis em seus filhos. A migração e o desenraizamento podem implicar perdas das raízes ligadas às tradições, deixando as famílias desprovidas de suas bagagens interpretativas e explicativas, necessárias à realização de leituras culturais dos sofrimentos psíquicos e físicos de seus filhos, sobretudo quando estes são considerados especiais. Este artigo propõe uma reflexão sobre tais questões, a partir de um estudo de caso, resultante da experiência da primeira autora em uma clínica interdisciplinar, como exige o enquadre transcultural, que se faz variável e complementar, respeitando a diversidade cultural. Observam-se, ainda, os discursos etiológicos construídos sobre esses sofrimentos psíquicos, que invadem o desenvolvimento da criança e o equilíbrio familiar.

Uprooted families can get lost in the ways of exile. Genetic, cultural and environmental factors can affect the psychic balance of these migrants, especially when faced with unexplained illness or suffering in their children. Migration and uprooting may involve loss of roots linked to traditions, leaving families deprived of their interpretive and explanatory baggage, which are necessary for the cultural readings of their child's psychic and physical suffering, sometimes considered as special. We propose a reflection on these issues, based on a case study, resulting from the experience of the first author with an interdisciplinary clinic, as required by the transcultural framework, which becomes variable and complementary, respecting cultural diversity. We also observe the etiological discourses constructed on these psychic sufferings that invade the development of the child and the family balance.

A qualitative study of the role of food in family relationships: An insight into the families of Brazilian obese adolescents using photo elicitation.

Obesity in adolescence is a major public health issue in Brazil. The relation between food and family plays an important role in both prevention and treatment, although its precise effect has not been clearly established. The purpose of this study is to investigate the meanings of food for Brazilian obese adolescents and their parents. Semi-structured interviews were conducted with 19 individuals from two medical centers in Fortaleza-CE, Brazil: seven adolescents with obesity (six girls and one boy aged between 12 and 18 years) and their parents (seven mothers, four fathers and one grandmother). The researchers used photo elicitation for the interview; that is, one photograph taken by each adolescent was used to evoke the statements we analyze here, according to Interpretative Phenomenological Analysis. The results were categorized into two principal superordinate themes. The first described the role of food in the parent-child relationship and the second, the organization of the family group. Results show that food reinforces the adolescents' dependence on their parents and the conflicts related to parental control of their food and what they can eat. The interrelations between food and family dynamics must be considered in developing therapeutic strategies for Brazilian obese adolescents and their families. These strategies must include siblings as well as grandparents.

Psicoterapia transcultural da migração / Migration transcultural psychotherapy / Psychothérapie transculturelle des migrants / La psicoterapia transcultural con los inmigrantes

O tratamento psicológico em situação transcultural nos mostra algumas questões específicas. Neste artigo propomos construir as bases da clínica transcultural com sujeitos imigrantes, expondo os principais elementos necessários à adaptação do enquadramento terapêutico, bem como os princípios, indicações e as limitações da consulta clínica transcultural.(AU)

The psychological treatment in a transcultural situation shows us some specific issues. In this article we propose to build the foundations of the transcultural clinic with immigrants, exposing the main elements required for adapting the therapeutic framework, as well as the principles, indications and the limitations of the transcultural clinical consultation.(AU)

Le traitement psychologique en situation transculturelle nous montre certaines questions spécifiques. Dans cet article, nous proposons de construire la base de la clinique transculturelle avec des sujets migrants, en exposant les éléments qui se rendent nécessaires à l'adaptation du cadre thérapeutique, ainsi que les principes, indications et les limitations de la consultation transculturelle.(AU)

El tratamiento psicológico en situación intercultural pone en discusión diversos temas específicos. En este artículo nos proponemos a construir las bases de temas clínicos transculturales con los inmigrantes, exponiendo los elementos necesarios para adaptar el marco terapéutico y también los principios, indicaciones y limitaciones de la consulta clínica transcultural.(AU)

Psicoterapia transcultural da migração / Migration transcultural psychotherapy / Psychothérapie transculturelle des migrants / La psicoterapia transcultural con los inmigrantes

O tratamento psicológico em situação transcultural nos mostra algumas questões específicas. Neste artigo propomos construir as bases da clínica transcultural com sujeitos imigrantes, expondo os principais elementos necessários à adaptação do enquadramento terapêutico, bem como os princípios, indicações e as limitações da consulta clínica transcultural...

The psychological treatment in a transcultural situation shows us some specific issues. In this article we propose to build the foundations of the transcultural clinic with immigrants, exposing the main elements required for adapting the therapeutic framework, as well as the principles, indications and the limitations of the transcultural clinical consultation...

Le traitement psychologique en situation transculturelle nous montre certaines questions spécifiques. Dans cet article, nous proposons de construire la base de la clinique transculturelle avec des sujets migrants, en exposant les éléments qui se rendent nécessaires à l'adaptation du cadre thérapeutique, ainsi que les principes, indications et les limitations de la consultation transculturelle...

El tratamiento psicológico en situación intercultural pone en discusión diversos temas específicos. En este artículo nos proponemos a construir las bases de temas clínicos transculturales con los inmigrantes, exponiendo los elementos necesarios para adaptar el marco terapéutico y también los principios, indicaciones y limitaciones de la consulta clínica transcultural...

Prise en charge des dyades mère traumatisée-bébé: une contrainte à la pensée et à la pratique / Tratando mães traumatizadas e seus bebês: os desafios da teoria e a prática / Treating traumatized mothers and their children: the need for improvement / Tratando a madres traumatizadas y a sus bebés: los desafíos de la teoría a la práctica

Dans le champ de la protection de l’enfance, la prise en charge de certaines dyades mère-bébé met en difficultés les professionnels et on constate une mise en échec des suivis. L’objectif est de montrer qu’il faut penser un soin plus adapté pour ces dyades. Au travers de la présentation d’une situation clinique et de son suivi, les auteurs montrent l’impact des traumas vécus par une mère dans son pays d’origine sur le développement de son bébé né en France, et de quelles façons ces traumas contaminent également les professionnels prenant en charge la dyade. Les contre-transferts négatifs peuvent créer parfois des divergences de points de vue dans les prises en charge et mettre en échec le soin proposé aux dyades mère-bébé. Ces contre-transferts témoignent d’un “partage du traumatisme”...(AU)

No campo da proteção da infância, o atendimento de algumas díades mãe-bebê coloca em dificuldade os professionais de saúde, e podemos constatar o fracasso de parte desses acompanhamentos. O objetivo deste artigo é trazer contribuições para o atendimento mãe-bebê. A partir da apresentação de um caso clínico, os autores buscam evidenciar o impacto dos traumas vivenciados por mães em seu país de origem sobre o desenvolvimento do seu bebê nascido na França, país de acolhida. Mas, não apenas, pois diremos que o trauma contamina igualmente os professionais de saúde que atendem à díade mãe-bebê. A força dos laços contratransferenciais negativos podem levar a uma divergência de abordagem e contribuem para o fracasso dos atendimentos centrados na díade mãe-bebê. Esses efeitos de contratransferência dão testemunho de um “compartilhamento do trauma”. Esses atendimentos fazem parte de uma pesquisa sobre as modalidades de transmissão do trauma mãe-bebê. Nesta pesquisa, em que estão envolvidos inúmeros pesquisadores clínicos, buscamos pensar as interações mãe-bebê, a transmissão do trauma e a dinâmica mãe-bebê-pesquisador. A análise da contratransferência do pesquisador permite o acesso à instância do vivido do bebê. Nosso objetivo é de facilitar o atendimento clínico e de contribuir para a prática dos professionais que acompanham a díade mãe-bebê.(AU)

Regarding child welfare, health care professionals sometimes face difficulties when they take care of certain mother-child dyads, which may result in partial care failure. A clinical picture is used to illustrate the impacts of traumas experienced by mothers in their home countries on the development of their babies, who were born in France. However, those traumas also seem to contaminate health care professionals in charge of those dyads. The impact of negative counter transferential bonds may result in conflicts regarding approaches and result in mother-child dyad care failure. Those effects of counter-transference reveal a kind of “trauma sharing”. That type of care is part of a research that involves a large number of clinical researchers and analyzes the modes of transmission of traumas between mother and child. We focused on the mother-child interaction, trauma transmission, and the mother-baby-researcher relationship. Analyzing the researcher’s countertransference helps accessing the instance of the child’s experience. We aim to facilitate clinical care and to support professional care of those mother-child dyads.(AU)

En el campo de la protección de la infancia, la atención de ciertos dúos madre-bebé, pone en aprietos a los profesionales de la salud, y podemos constatar el fracaso en el seguimiento de parte de estos casos. El objetivo de este artículo es traer contribuciones en lo relacionado con la atención madre-bebé. Desde la presentación de una situación clínica y de su seguimiento, los autores muestran el impacto que tienen los traumas vividos por una madre en su país de origen en el desarrollo de su bebé nacido en Francia, país de acogida. Sin embargo, no solamente, una vez que diremos que estos traumas contaminan también a los profesionales de la salud que le hacen el seguimiento a estos casos. La fuerza de los lazos contratransferenciales negativos, puede inducir a una divergencia en el abordaje y contribuyen en el fracaso de la atención a los dúos madre-bebé. Estas contratransferencias dan testimonio de una “trauma compartido”. Estos seguimientos hacen parte de una investigación relacionada a la transmisión del trauma madre-bebé. Esta investigación implica a numerosos investigadores clínicos, que trabajan en el análisis de las interacciones madre-bebé y en la dinámica del trío: madre-bebé-investigador. El análisis de la contratransferencia del investigador permitiría acceder a lo vivido por el bebé. Nuestro objetivo es facilitar la atención clínica y contribuir a la práctica de los profesionales que acompañan a los dúos madre-bebé.(AU)

Prise en charge des dyades mère traumatisée-bébé: une contrainte à la pensée et à la pratique / Tratando mães traumatizadas e seus bebês: os desafios da teoria e a prática / Treating traumatized mothers and their children: the need for improvement / Tratando a madres traumatizadas y a sus bebés: los desafíos de la teoría a la práctica

Dans le champ de la protection de l’enfance, la prise en charge de certaines dyades mère-bébé met en difficultés les professionnels et on constate une mise en échec des suivis. L’objectif est de montrer qu’il faut penser un soin plus adapté pour ces dyades. Au travers de la présentation d’une situation clinique et de son suivi, les auteurs montrent l’impact des traumas vécus par une mère dans son pays d’origine sur le développement de son bébé né en France, et de quelles façons ces traumas contaminent également les professionnels prenant en charge la dyade. Les contre-transferts négatifs peuvent créer parfois des divergences de points de vue dans les prises en charge et mettre en échec le soin proposé aux dyades mère-bébé. Ces contre-transferts témoignent d’un “partage du traumatisme”. Ce suivi est mis en lien avec une recherche qui est menée actuellement sur les modalités de transmission du trauma mère-bébé. Cette recherche implique de nombreux chercheurs-cliniciens qui travaillent à l’analyse des interactions mère-bébé et de la dynamique triadique: mère-bébé-chercheur. L’analyse du contre-transfert du chercheur permettrait d’accéder au vécu du bébé. Le but de cette recherche est d’améliorer le soin, et d’aider au mieux les professionnels accompagnant les dyades mère-bébé.

No campo da proteção da infância, o atendimento de algumas díades mãe-bebê coloca em dificuldade os professionais de saúde, e podemos constatar o fracasso de parte desses acompanhamentos. O objetivo deste artigo é trazer contribuições para o atendimento mãe-bebê. A partir da apresentação de um caso clínico, os autores buscam evidenciar o impacto dos traumas vivenciados por mães em seu país de origem sobre o desenvolvimento do seu bebê nascido na França, país de acolhida. Mas, não apenas, pois diremos que o trauma contamina igualmente os professionais de saúde que atendem à díade mãe-bebê. A força dos laços contratransferenciais negativos podem levar a uma divergência de abordagem e contribuem para o fracasso dos atendimentos centrados na díade mãe-bebê. Esses efeitos de contratransferência dão testemunho de um “compartilhamento do trauma”. Esses atendimentos fazem parte de uma pesquisa sobre as modalidades de transmissão do trauma mãe-bebê. Nesta pesquisa, em que estão envolvidos inúmeros pesquisadores clínicos, buscamos pensar as interações mãe-bebê, a transmissão do trauma e a dinâmica mãe-bebê-pesquisador. A análise da contratransferência do pesquisador permite o acesso à instância do vivido do bebê. Nosso objetivo é de facilitar o atendimento clínico e de contribuir para a prática dos professionais que acompanham a díade mãe-bebê.

Regarding child welfare, health care professionals sometimes face difficulties when they take care of certain mother-child dyads, which may result in partial care failure. A clinical picture is used to illustrate the impacts of traumas experienced by mothers in their home countries on the development of their babies, who were born in France. However, those traumas also seem to contaminate health care professionals in charge of those dyads. The impact of negative counter transferential bonds may result in conflicts regarding approaches and result in mother-child dyad care failure. Those effects of counter-transference reveal a kind of “trauma sharing”. That type of care is part of a research that involves a large number of clinical researchers and analyzes the modes of transmission of traumas between mother and child. We focused on the mother-child interaction, trauma transmission, and the mother-baby-researcher relationship. Analyzing the researcher’s countertransference helps accessing the instance of the child’s experience. We aim to facilitate clinical care and to support professional care of those mother-child dyads.

En el campo de la protección de la infancia, la atención de ciertos dúos madre-bebé, pone en aprietos a los profesionales de la salud, y podemos constatar el fracaso en el seguimiento de parte de estos casos. El objetivo de este artículo es traer contribuciones en lo relacionado con la atención madre-bebé. Desde la presentación de una situación clínica y de su seguimiento, los autores muestran el impacto que tienen los traumas vividos por una madre en su país de origen en el desarrollo de su bebé nacido en Francia, país de acogida. Sin embargo, no solamente, una vez que diremos que estos traumas contaminan también a los profesionales de la salud que le hacen el seguimiento a estos casos. La fuerza de los lazos contratransferenciales negativos, puede inducir a una divergencia en el abordaje y contribuyen en el fracaso de la atención a los dúos madre-bebé. Estas contratransferencias dan testimonio de una “trauma compartido”. Estos seguimientos hacen parte de una investigación relacionada a la transmisión del trauma madre-bebé. Esta investigación implica a numerosos investigadores clínicos, que trabajan en el análisis de las interacciones madre-bebé y en la dinámica del trío: madre-bebé-investigador. El análisis de la contratransferencia del investigador permitiría acceder a lo vivido por el bebé. Nuestro objetivo es facilitar la atención clínica y contribuir a la práctica de los profesionales que acompañan a los dúos madre-bebé.

[Breaking the silence in Colombia to resist violence 2/2]. / Briser le silence en Colombie pour résister a la violence 2/2.

The war in Columbia is the source of permanent and widespread violence, of which the civilian population is the main victim. Medical-psychological teams from Médecins Sans Frontières France worked in Tolima, a region particularly affected by the conflict, between 2001 and 2008, and were able to study the complexity of the forms of violence and their consequences. While the consequences for individuals, analysed in part one, are devastating, the impact of the conflict on society and families provides a better understanding of this society and its generalised violence.

[Breaking the silence in Colombia to resist violence 1/2]. / Briser le silence en Colombie pour résister à la violence 1/2.

The war in Columbia is the source of permanent and widespread violence, of which the civilian population, notably rural, is the main victim. What are the effects of the conflict's violence on individuals and on society? Medical-psychological teams from Médecins Sans Frontières France worked in Tolima, a region particularly affected by the conflict, between 2001 and 2008, and were able to study the complexity of the forms of violence and their consequences. This article is the first of two presenting an analysis backed up by personal accounts.

[Care for young children who have suffered a tragic event]. / La prise en charge de jeunes enfants victimes d'un événement traumatique.

Children are regularly faced with traumatic events, whether these are disasters (tsunami, floods, earthquakes), accidents (transport, domestic) or intentional acts (war, ill treatment). The care provided for young Haitian children following the earthquake in January 2010 offers an insight into specific intervention methods, the treatment of post-traumatic disorders and the effects of trauma on those working with them.

The Colombian conflict: a description of a mental health program in the Department of Tolima.

Colombia has been seriously affected by an internal armed conflict for more than 40 years affecting mainly the civilian population, who is forced to displace, suffers kidnapping, extortion, threats and assassinations. Between 2005 and 2008, Médecins Sans Frontières-France provided psychological care and treatment in the region of Tolima, a strategic place in the armed conflict. The mental health program was based on a short-term multi-faceted treatment developed according to the psychological and psychosomatic needs of the population. Here we describe the population attending during 2005-2008, in both urban and rural settings, as well as the psychological treatment provided during this period and its outcomes.We observed differences between the urban and rural settings in the traumatic events reported, the clinical expression of the disorders, the disorders diagnosed, and their severity. Although the duration of the treatment was limited due to security reasons and access difficulties, patient condition at last visit improved in most of the patients. These descriptive results suggest that further studies should be conducted to examine the role of short-term psychotherapy, adapted specifically to the context, can be a useful tool to provide psychological care to population affected by an armed conflict.

Os ingredientes da parentalidade / The ingredients of parenthood

Não nascemos pais, tornamo-nos pais... A parentalidade se fabrica com ingredientes complexos. Alguns deles são coletivos, mudam com o tempo: outros são históricos, jurídicos, sociais e culturais. Outros são mais íntimos, privados, conscientes ou inconscientes, pertencem a cada um dos dois pais enquanto pessoas e enquanto futuros pais, ao casal, à própria história de cada um. Aqui se joga o que é transmitido e o que se esconde, os traumas infantis e a maneira pela qual cada um os cicatrizou. resta uma outra série de fatores que pertencem à própria criança que transforma seus genitores em pais. Alguns bebês são mais bem dotados do que outros: alguns nascem em condições que tornam essa tarefa mais fácil, outros, por suas condições que tornam essa tarefa mais fácil, outros, por suas condições de nascimento (prematuridade, sofrimento neonatal, handicap físico ou psíquico...) devem vencer vários obstáculos e desenvolver estratégias múltiplas e custosas para entrar em relação com adulto siderado. A partir da clínica trans-cultural este texto analise esses diferentes níveis de construção e as modalidades terapêuticas possíveis, quando aparecem os percalços da parentalidade(AU)