CAMBUÍ, H. A. A relação de cuidado e seus significados para adolescente com transtorno alimentar e seus pais: um estudo de caso à luz da psicanálise winnicottiana [The care relationship and its meanings for adolescents with eating disorders and their parents: a case study in the light of Winnicottian psychoanalysis]. 433 f. Doctoral Thesis – Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências, Bauru (SP), 2020.
Available on: http://hdl.handle.net/11449/192857
Abstract: 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 (BN) 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 Thematic Drawing-and-Story Procedure, 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 us 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 affective-emotional 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.