A relação de cuidado e seus significados para adolescente com transtorno alimentar e seus pais: um estudo de caso à luz da psicanálise winnicottiana
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Data
2020-05-22
Autores
Cambuí, Heloisa Aguetoni
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Universidade Estadual Paulista (Unesp)
Resumo
Os transtornos alimentares em adolescentes constituem parcela significativa da demanda clínica da atualidade. Tratam-se de modalidades de sofrimento e de adoecimento humano que se constituem com base em um modelo etiológico multifatorial composto pela inter-relação de fatores familiares, individuais, sociais e biológicos, cuja complexidade se configura como problema de saúde pública e, ainda, um desafio para a compreensão teórica e o manejo clínico psicológico. A questão central deste estudo é a associação entre as relações de cuidados parentais e a manifestação dos transtornos alimentares em adolescentes. Pressupõe-se que as relações de cuidado entre os pais e o filho(a) perpassam, inevitavelmente, as relações alimentares e contribuem para a constituição da saúde mental ou, ainda, para distorções e fraturas no processo de desenvolvimento emocional que podem predispor o indivíduo à vulnerabilidade psicopatológica própria dos transtornos alimentares. Deste modo, este estudo buscou compreender os significados e as experiências afetivo-emocionais associados às relações de cuidado na perspectiva de uma adolescente acometida por bulimia nervosa e seus pais. Trata-se de um estudo de caso descritivo com enfoque qualitativo, orientado pelo método psicanalítico. Os instrumentos utilizados para a coleta de dados foram a entrevista clínica semiestruturada aplicada individualmente a cada membro da tríade e o Procedimento de Desenhos-Estórias com Tema, usado como recurso mediador dialógico, tendo como foco a profundidade das experiências associadas às relações de cuidado. O registro do encontro com os participantes foi feito por meio da produção de narrativas psicanalíticas que, por sua vez, foram qualitativamente analisadas de acordo com a Teoria dos Campos de Herrmann, que serviu como suporte metodológico do estudo, tendo como referencial teórico a psicanálise winnicottiana. Deste modo, foram identificados campos de sentido afetivo-emocional mais amplos compostos pelo universo de significados e de experiências pessoais acerca das relações de cuidado para a unidade familiar e também para cada membro da tríade. Os dados encontrados permitiram identificar que as relações de cuidado da tríade famíliar são ambivalentes, caóticas e inconstantes. Os significados emocionais atribuídos pela adolescente aos cuidados maternos se organizam em torno da privação, inflexibilidade e distanciamento físico e emocional. Já os cuidados paternos se configuraram como afetuosos, mas distantes após a puberdade. O conjunto de significados e das experiências afetivo-emocionais dos pais revela as dificuldades, o adoecimento e a presença de aspectos transgeracionais sobre as relações de cuidado com a filha. Os dados identificados revelam que as recorrentes falhas no processo de realização dos cuidados físico-afetivos pelo conjunto mãe-pai, em um momento precoce de constituição do desenvolvimento emocional, podem concorrer para a precariedade do processo simbólico e para a fragilidade da constituição psíquica e dos limites psicossomáticos, predispondo o indivíduo à vulnerabilidade psicopatológica circunscrita aos transtornos alimentares. O estudo contribui com conhecimento sobre as relações de cuidados que podem se configurar como fatores etiológicos para a precipitação e a manutenção da BN, fornecendo subsídios teórico-práticos no âmbito preventivo, interventivo e de promoção de saúde à pacientes com transtornos alimentares e seus familiares.
Eating disorders in adolescents constitute a significant portion of the current clinical demand. These are modalities of suffering and human illness that are based on a multifactorial etiological model composed by the interrelation of family, individual, social and biological factors, which complexity is configured as a public health problem and still a challenge for theoretical understanding and clinical psychological management. The central issue of this study is the association between parental care relationships and the manifestation of eating disorders in adolescents. It is assumed that the care relationships between the parents and the child inevitably permeate dietary relationships and contribute to the constitution of mental health or, still, to distortions and fractures in the emotional development process that may predispose the individual to the psychopathological vulnerability inherent in eating disorders. Thus, this study aimed to understand the meanings and affective-emotional experiences associated with care relationships from the perspective of a teenager with bulimia nervosa and her parents. This is a descriptive case study with a qualitative approach, guided by the psychoanalytic method. The instruments used for data collection were the semi-structured clinical interview applied individually to each member of the triad and the Procedure of Drawings-Stories with Theme, used as a dialogical mediating resource, focusing on the depth of the experiences associated with care relationships. The registration of the meeting with the participants was made through the production of psychoanalytic narratives that, in turn, were qualitatively analyzed according to Herrmann's Multiple Fields Theory, which served as the methodological support of the study, having Winnicott's psychoanalysis as the theoretical framework. In this way, broader fields of affective-emotional sense were identified, composed of the universe of meanings and personal experiences about care relationships for the family unit and also for each member of the triad. The data found allowed to identify that the care relationships of the family triad are ambivalent, chaotic and inconstant. The emotional meanings attributed by the teenager to maternal care are organized around deprivation, inflexibility and physical and emotional distance. Paternal care, on the other hand, was configured as affectionate, but distant after puberty. The set of meanings and the affectiveemotional experiences of the parents presented the difficulties, the illness and the presence of transgenerational aspects about the care relationships with the daughter. The identified data reveal that the recurrent failures in the process of carrying out physical-affective care by the mother-father group, in an early moment of constitution of the emotional development, may contribute to the precariousness of the symbolic process and to the fragility of the psychic constitution and psychosomatic limits, predisposing the individual to the psychopathological vulnerability circumscribed to eating disorders. The study contributes with knowledge about the care relationships that can be configured as etiological factors for the precipitation and maintenance of BN, providing theoretical-practical subsidies in the preventive, interventional and health promotion scope to patients with eating disorders and their families.
Eating disorders in adolescents constitute a significant portion of the current clinical demand. These are modalities of suffering and human illness that are based on a multifactorial etiological model composed by the interrelation of family, individual, social and biological factors, which complexity is configured as a public health problem and still a challenge for theoretical understanding and clinical psychological management. The central issue of this study is the association between parental care relationships and the manifestation of eating disorders in adolescents. It is assumed that the care relationships between the parents and the child inevitably permeate dietary relationships and contribute to the constitution of mental health or, still, to distortions and fractures in the emotional development process that may predispose the individual to the psychopathological vulnerability inherent in eating disorders. Thus, this study aimed to understand the meanings and affective-emotional experiences associated with care relationships from the perspective of a teenager with bulimia nervosa and her parents. This is a descriptive case study with a qualitative approach, guided by the psychoanalytic method. The instruments used for data collection were the semi-structured clinical interview applied individually to each member of the triad and the Procedure of Drawings-Stories with Theme, used as a dialogical mediating resource, focusing on the depth of the experiences associated with care relationships. The registration of the meeting with the participants was made through the production of psychoanalytic narratives that, in turn, were qualitatively analyzed according to Herrmann's Multiple Fields Theory, which served as the methodological support of the study, having Winnicott's psychoanalysis as the theoretical framework. In this way, broader fields of affective-emotional sense were identified, composed of the universe of meanings and personal experiences about care relationships for the family unit and also for each member of the triad. The data found allowed to identify that the care relationships of the family triad are ambivalent, chaotic and inconstant. The emotional meanings attributed by the teenager to maternal care are organized around deprivation, inflexibility and physical and emotional distance. Paternal care, on the other hand, was configured as affectionate, but distant after puberty. The set of meanings and the affectiveemotional experiences of the parents presented the difficulties, the illness and the presence of transgenerational aspects about the care relationships with the daughter. The identified data reveal that the recurrent failures in the process of carrying out physical-affective care by the mother-father group, in an early moment of constitution of the emotional development, may contribute to the precariousness of the symbolic process and to the fragility of the psychic constitution and psychosomatic limits, predisposing the individual to the psychopathological vulnerability circumscribed to eating disorders. The study contributes with knowledge about the care relationships that can be configured as etiological factors for the precipitation and maintenance of BN, providing theoretical-practical subsidies in the preventive, interventional and health promotion scope to patients with eating disorders and their families.
Descrição
Palavras-chave
Transtornos da alimentação, Cuidado parental, Adolescente, Psicanálise, Winnicott, Eating disorders, Parental care, Adolescent, Psychoanalysis