L’émergence récente de troubles des conduites alimentaires, hors de pays occidentaux, fait poser l’hypothèse d’un syndrome lié aux changements socioculturels rapides à l’échelle individuelle ou sociétale. La variabilité des symptômes en fonction du contexte culturel influence le traitement. Cette étude vise à explorer l’expérience de patientes chinoises hospitalisées pour un trouble des conduites alimentaires et celle de leurs parents, afin de préciser l’effet du contexte culturel chinois sur le trouble.

Étude qualitative reposant sur des entretiens semi-directifs auprès de 13 jeunes filles hospitalisées en Chine et de 11 de leurs parents analysés à l’aide de l’Interpretative Phenomenological Analysis.

Les inquiétudes concernant la maigreur et la santé sont de véritables catalyseurs de la recherche de soins. L’opposition entre les croyances parentales sur les facteurs de bonne santé et les symptômes alimentaires des jeunes filles génère une incompréhension forte entre générations. Les troubles alimentaires sont associés à des modifications profondes des modalités éducatives traditionnelles portées par les parents.

Les résultats mettent en évidence les interactions complexes entre le contexte culturel et la clinique des troubles alimentaires, et plus largement le fonctionnement global des adolescentes. Les changements socioculturels rapides en Chine ont pour conséquences des différences intergénérationnelles importantes, notamment entre les modalités éducatives traditionnelles et le besoin d’autonomisation des jeunes qui nécessitent un travail familial spécifique. La prise en compte des éléments culturels est nécessaire pour la compréhension des troubles des conduites alimentaires et pour développer des approches thérapeutiques pertinentes et adaptées au contexte.

Recent tendencies show a stabilization in Western countries of the incidence of anorexia nervosa but an increase in Asian countries where it used to be lower. The emergence of these diseases in non-Western countries suggests a culture change syndrome on an individual or societal scale. The great number of changes having occurred in China in the past decades would favor the occurrence of eating disorders. A variability of symptoms of eating disorders can be observed depending on the cultural background which also influences the treatment. There are few studies that exist within an Asian context, and they mostly focus on the care.

In this study, we intend to explore the experience of Chinese female patients hospitalized for an eating disorder and the experience of their parents: their relationship with the symptoms, with their health and their understanding of the disease, in order to identify the impact of the Chinese cultural context upon the disorder.

It is an observational, phenomenological and qualitative study. A purposive sampling was formed from a clinical population group of young teenagers and women, coming from various areas of China and hospitalized in the specialized Psychosomatic Department of Shanghai Mental Health Center, in August and December 2017. The degree of urbanization, the regions and ages categories were wide-ranging, allowing us to maximize the richness of the data assessing the disease and care representations. Two semi-structured interviews were realized with the participants, then with one or both parents. The interviews were realized with an evaluative interview guide by the same researcher together with a Chinese psychology student in order to clarify the translation and the interpretation of the cultural elements expressed by the participants. The analysis was based on the Interpretative Phenomenological Analysis. Two researchers read the interview transcripts several times, identified themes then connections between the themes to build a set of meta-themes depicting the narratives. Every meta-theme was linked with its corresponding themes which necessitated during the analysis constant back and forth between the analytical data and the source material.

Thirteen female patients and 11 parents took part in the study. The patients were between 12 and 31 years of age. They showed a wide range of eating disorders: restrictive anorexia, anorexia nervosa, or bulimia nervosa. Their Body Mass Index at the time of the interview ranged from 11 to 22. Three meta-themes emerged from the analysis: concerns about thinness and health are real catalysts for seeking care, the opposition between parental beliefs about factors of good health and eating symptoms in young girls, and changes in parenting and traditional educational methods induced by eating symptoms. These different themes highlight the fear of thinness and good health being powerful therapeutic levers in China, the intergenerational agreements and disagreements on the factors of good health with the parental experience of consideration around the eating disorder of their daughter, and an impact of traditional educational modalities on the family relational aspects that change with the disorder.

Exploring the experience of young Chinese girls or women suffering from eating disorders highlights the complex interactions between the cultural and clinical context of eating disorders. Weight loss is experienced with great difficulty by the young women of our study, who report somatic symptoms and worry about their thinness. Our results show the central position occupied by maintaining oneself in good health in China, for parents and teenagers alike. This allows a quick reliance on healthcare. The intergenerational differences in China are increased by the rapid changes occurring within Chinese society which can cause conflicts and particularly violent struggles. Its younger generations are becoming more and more globalized. These results provide further evidence that eating disorders are culture change syndromes. The therapeutic impact of our results is twofold. On the individual level, there are therapeutic cultural levers linked with Chinese culture, and they have to be sought in all cultures. The therapeutic education of Chinese patients must be centered on the somatic consequences of the disease in order to increase the adherence to the care. On the familial level, the therapeutic approaches centered on intergenerational conflicts must be developed.

The rapid sociocultural changes in China are causing important intergenerational differences, notably between traditional educational modalities and the need for independence of young people who require specific familial therapy. The cultural elements must be taken into account in order to understand eating disorders and to develop relevant therapeutic approaches.