Notre hypothèse de travail est qu’une meilleure connaissance du devenir des patientes souffrant d’anorexie mentale devrait contribuer à la prévention des rechutes et des complications et permettrait d’évaluer l’efficacité des traitements. L’évaluation actuelle du devenir de l’anorexie mentale s’appuie classiquement sur l’étude de la survenue d’évènements objectifs, qui ne reflètent qu’imparfaitement la réalité du devenir des patientes en termes de vécu subjectif. Nous proposons ici la construction d’un outil d’évaluation du devenir de l’anorexie mentale basé essentiellement sur la perception des patientes. La méthodologie utilisée a reposé sur : (1) la conduite d’entretiens sur le mode de l’association libre auprès de 30 patientes anorexiques mentales ; (2) l’analyse de leurs contenus étayée par les hypothèses préexistantes et les hypothèses nouvelles soulevées par l’expression du vécu des patientes pour dégager des thèmes à inventorier ; (3) la construction d’un autoquestionnaire à partir du développement de chaque thème en plusieurs questions reprenant les mots des patientes. L’utilisation de ce nouvel outil est proposée dans des études épidémiologiques prospectives ultérieures pour une évaluation scientifique du devenir des patientes, afin de comparer l’efficacité des différents traitements et de mieux prévenir les complications futures.

Our working hypothesis is that a better insight into the outcome of patients suffering from anorexia nervosa should contribute to preventing relapses and further complications and assessing treatment efficiency. Through anorexia nervosa, the patients express the difficulty they have to view themselves as specific subjects.

The current classic outcome evaluation is based on the study of objective events, which only partially reflect the reality of the patients’ outcome at a subjective level. The objective of this study was to set up a new assessing instrument of the outcome of patients suffering from anorexia nervosa, essentially based on the patients’ perception of their experience.

The methodology used has been based on: (1) the conduct by the main investigator of unstructured interviews using “free association”, with the help of an interview guide. The anorexia nervosa patients were recruited among those who were hospitalized on an isolation contract, or among outpatients under a psychiatrist/psychoanalyst’s supervision, aged over 25years old so that they may have started their reproductive life. The study included 30 patients; (2) the analysis of the interview contents backed by preexisting hypotheses and by new ones suggested by the expression of the patients’ perception, so as to set up an inventory of new themes; (3) the construction of a self-administered questionnaire starting from the development of each theme into several questions taking up the patients’ own words and offering 4 possible answers (disagree completely, disagree, agree, quite agree).

The analysis of the interviews contents has led to the development of 11 themes. The self-administered questionnaire includes a total of 124 items stemming from the development of each theme into between 9 and 16 items that were mixed in the version submitted to patients.

This original interpretation of the outcome of the patients through their experience provides a better understanding of their relation to desire and pleasure, and consequently of the evolution of their subjectivity. By integrating several aspects of the disease expression, our instrument constitutes an alternative to the combination of several non-specific tools in anorexia nervosa. It thus avoids the atomization of the pathology and respects the specificity of its structure. The analysis of the disease function in the emergence of their subjectivity rather than the static observation of its symptoms has led to the development of new themes.

The validation of this new methodological approach of the follow-up of anorexia nervosa based on the patients’ perception of the evolution of their disease, aside from anthropometrical or physiological parameters, will have to be tested on a new population of patients. A quantitative score will be developed in association with the self-administered questionnaire. Its use in further epidemiological studies will enable a scientific assessment of the patients’ outcome, and better prevent further complications and relapses, by screening patients with a pejorative risk. The ultimate aim is to improve these patients’ care.