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Structure d'attachement dans la dermatite atopique

Abstract : Atopic dermatitis is an inflammatory skin disorder which usually appears before the age of five, and heals naturally little by little after adolescence in over 90% of cases. Why this spontaneous improvement occurs is not clearly established for this multi-factor skin disorder, for which the etiopathology has yet to be determined (immune system maturity?).There is a clear relationship between this pathology and the psyche: major psychological repercussions affecting the quality of life, aggravation or triggering of skin reactions due to stress, alleviation of lesions using psychotherapy. Observation of patterns of attachment is important in the field of psychopathology, but is not often undertaken in the domain of organic pathology. We studied the patterns of attachment for 80 adults having suffered from atopic dermatitis during childhood, 40 of them had been cured since adolescence, the other 40 continued to suffer from outbreaks of eczema. Attachment was evaluated using a self-completion questionnaire (CAMIR by PIERRE HUMBERT) and the attachment interview was graded using the Q-SORT method, by KOBAK. We also measured the associated psychopathological symptoms using the SCL90-R scale, level of anxiety using SPIELBERGER’s state-trait-anxiety inventory (STAIY), and coping measurement using the WCC-R scale devised by VITALIANO. Total IgE was measured. Patients suffering from atopic dermatitis that began before the age of 3 years are not more insecure than patients whose skin disorder started later in life. This meant that there were possibly no repercussions on the pattern of attachment for cases of atopic dermatitis that had appeared in the first years of life, contrary to all reports regarding a chronic pathology appearing early in life. This implies that caring for the skin has a positive effect on the mother-child relationship. On the other hand, adults suffer from major repercussions of atopic dermatitis later on in life: increased sense of preoccupied insecurity in terms of representations of attachment, increased scores in all the psychopathological dimensions measured, and an anxious need for outside support. These repercussions are even more serious when IgE is high, but this is not solely connected with the gravity of the illness. Adults suffering from persistent atopic dermatitis are basically more insecure than those who are cured: if long-term stability in the pattern of attachment is considered, this study could place pattern of attachment as a possible predictive disposition factor in the evolution of atopic dermatitis. The security score of cured patients is all the greater when IgE is normal. The existence of an interaction between the attachment pattern and the system for adapting to stress has been suggested, since they are both dependent on development. The role played by IgE remains to be determined. In terms of health psychology, the pattern of attachment could be considered as a disposition factor likely to influence the evolution of a skin disorder.
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Thierry Sage. Structure d'attachement dans la dermatite atopique. Psychologie. Université de Bourgogne, 2011. Français. ⟨NNT : 2011DIJOL018⟩. ⟨tel-00748142⟩

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