Processus addictif : psychopathologie et neurobiologie

Abstract : This thesis, fit into the framework of clinical psychopathology, proposes an articulation between data of the neurosciences and the practice met in a CSAPA.The first part is devoted to the phenomenology of the addicting process with its successive phases that end in a request of care as a response to the final alienation produced by drug use. This request of care is, generally, at first, a request for a substitution treatment, which sometimes comes along with a psychological follow-up.In the second part, the hypothesis on the addiction’s genesis regarding the narcissistic vulnerability spotted in patients and their neurobiological bases is examined. Drug use would be a way to make arise the true self, thus overcoming the defensive system set up to protect oneself from traumas induced by the first environment. A first detailed clinical example represents an attempt to establish the existence of trauma, including of transgenerational origin, and the associated unrelenting course of addiction. Other clinical cases are examined, centered on a different aspect or on a specific moment of the support encounters, in order to illustrate other aspects of the addicting process. The neurobiological impact of traumas is also developed, that allows to articulate it with several concepts, particularly those of Winnicott.The third part proposes several functions to the addiction (defensive and anti-depressive roles, emotional regulation) with clinical examples and the neuroscientific bases currently known. Although experience in the psychoanalytical clinic is at a level of complexity much higher than what is currently accessible to the neurosciences, most of the research in this domain stay in line with psychological understanding of the addicting process.Finally, a hypothetical model of addiction in drugs and the most sensitive points concerning the therapeutic support are outlined.
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Hélène Pin-Scarna. Processus addictif : psychopathologie et neurobiologie. Psychologie. Université Bourgogne Franche-Comté, 2017. Français. ⟨NNT : 2017UBFCC015⟩. ⟨tel-02282376⟩

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