Pub Date : 2025-12-01Epub Date: 2025-10-28DOI: 10.1016/j.evopsy.2025.09.002
Mathilde Cœur (Psychologue clinicienne, Doctorante) , Alexandra Laurent (Professeure en psychologie clinique et psychopathologie, Psychologue clinicienne) , Thomas Denise (Docteur en sociologie) , Laurent Martin-Lefevre (Médecin en médecine intensive et réanimation) , Nancy Kentish-Barnes (Docteur en sociologie) , Jean Reignier (Professeur en médecine intensive et réanimation)
Objective
Controlled DCD (Maastricht category 3: donation after circulatory death) is a procedure that brings together intensive care providers and procurement coordinators at the intersection between end of life and organ procurement. The aim of this study was to explore the experiences of intensive care and coordination staff with controlled DCD, with a view to identifying the psychological and relational issues encountered by healthcare professionals when applying this procedure.
Methods
We performed a qualitative, observational, and multicentric study using a focus group technique. We had three focus groups that included 23 healthcare professionals working in intensive care or procurement coordination who had participated in controlled DCD. The interviews were recorded and transcribed for thematic analysis.
Results
The qualitative analysis of the interviews highlighted three major dimensions of the focus groups’ experiences. (1) Clearly defined end of life: the technical nature of the procedure led professionals to focus on the organ rather than on the patient, generating feelings of guilt and discomfort. (2) Confused boundary between life and death: temporal overlap and rapid changes in the patient's status created ambiguities in identity and ethics. (3) Challenges in collaborations between intensive care providers and procurement coordinators: prescribed roles (care vs. retrieval) often appeared to be porous, requiring practical adjustments. Nevertheless, healthcare professionals relied on protective points of reference to maintain their professional bearings: attributing meaning to death via organ donation, the presence of relatives, temporal separation between end-of-life support and organ retrieval, and fostering cooperative practices between teams.
Discussion
Controlled DCD disrupts caregiving by introducing tension between the act of caring for the patient versus caring for the organ. This shift undermines professional identity, exposes teams to ethical conflicts, and fosters defensive distancing mechanisms. However, the presence of family, rituals, and attunement between teams are resources that helped restore the nature of caregiving and construct a subjective framework. Cooperation that respects task differentiation appears to protect healthcare professionals from the risk of desubjectivation and supports the creation of meaning from the procedure.
Conclusion
Our study shows that controlled DCD changes the nature of caregiving. However, healthcare professionals draw upon support resources that help them create meaning from the procedure and provide important avenues for reflection to aid teams in the procedure's application.
{"title":"Enjeux psychologiques du prélèvement d’organes Maastricht III au sein des équipes de réanimation et de coordination : étude prospective et qualitative","authors":"Mathilde Cœur (Psychologue clinicienne, Doctorante) , Alexandra Laurent (Professeure en psychologie clinique et psychopathologie, Psychologue clinicienne) , Thomas Denise (Docteur en sociologie) , Laurent Martin-Lefevre (Médecin en médecine intensive et réanimation) , Nancy Kentish-Barnes (Docteur en sociologie) , Jean Reignier (Professeur en médecine intensive et réanimation)","doi":"10.1016/j.evopsy.2025.09.002","DOIUrl":"10.1016/j.evopsy.2025.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>Controlled DCD (Maastricht category 3: donation after circulatory death) is a procedure that brings together intensive care providers and procurement coordinators at the intersection between end of life and organ procurement. The aim of this study was to explore the experiences of intensive care and coordination staff with controlled DCD, with a view to identifying the psychological and relational issues encountered by healthcare professionals when applying this procedure.</div></div><div><h3>Methods</h3><div>We performed a qualitative, observational, and multicentric study using a focus group technique. We had three focus groups that included 23 healthcare professionals working in intensive care or procurement coordination who had participated in controlled DCD. The interviews were recorded and transcribed for thematic analysis.</div></div><div><h3>Results</h3><div>The qualitative analysis of the interviews highlighted three major dimensions of the focus groups’ experiences. (1) Clearly defined end of life: the technical nature of the procedure led professionals to focus on the organ rather than on the patient, generating feelings of guilt and discomfort. (2) Confused boundary between life and death: temporal overlap and rapid changes in the patient's status created ambiguities in identity and ethics. (3) Challenges in collaborations between intensive care providers and procurement coordinators: prescribed roles (care vs. retrieval) often appeared to be porous, requiring practical adjustments. Nevertheless, healthcare professionals relied on protective points of reference to maintain their professional bearings: attributing meaning to death via organ donation, the presence of relatives, temporal separation between end-of-life support and organ retrieval, and fostering cooperative practices between teams.</div></div><div><h3>Discussion</h3><div>Controlled DCD disrupts caregiving by introducing tension between the act of caring for the patient versus caring for the organ. This shift undermines professional identity, exposes teams to ethical conflicts, and fosters defensive distancing mechanisms. However, the presence of family, rituals, and attunement between teams are resources that helped restore the nature of caregiving and construct a subjective framework. Cooperation that respects task differentiation appears to protect healthcare professionals from the risk of desubjectivation and supports the creation of meaning from the procedure.</div></div><div><h3>Conclusion</h3><div>Our study shows that controlled DCD changes the nature of caregiving. However, healthcare professionals draw upon support resources that help them create meaning from the procedure and provide important avenues for reflection to aid teams in the procedure's application.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 716-728"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-10DOI: 10.1016/j.evopsy.2025.06.005
Dario Alparone (Docteur en Psychopathologie et Docteur européen en criminologie, Maître de Conférences en Psychologie Clinique et Psychopathologie) , Giorgia Tiscini (Professeure de psychopathologie clinique)
Objective
The objective of our article was to explore and clarify the psychoanalytic concept of the death drive from the perspective of clinical practice and certain discoveries in contemporary neuroscience.
Methods
Drawing on the classical Freudian concept of the death drive and the field of affective neuroscience, including neuropsychoanalysis and its most recent discoveries, it is possible to reinterpret certain clinical phenomena such as addiction and masochism, including those associated with neurotic symptoms.
Results
Our objective was to offer an original interpretation of these clinical manifestations by establishing a novel dialogue between the fields of psychoanalysis and neuroscience, underscoring the central role of affectivity in individual development.
Discussion
Trauma in primary relationships can influence individual development by inducing neurophysiological needs that may push people to adopt addictive behaviors. Emotional trauma and primary relationship issues seem to be linked to a somewhat paradoxical search for instinctual satisfaction, as exemplified by addictions or even certain forms of masochism.
Conclusion
The dialogue established between the fields of psychoanalysis and neuroscience appeared to be quite fruitful, allowing for a unique understanding of clinical phenomena such as addiction. Drawing on affective neuroscience, we arrived at a new understanding and a new use of the epistemologically problematic Freudian concept of the death drive.
{"title":"La pulsion de mort à la lumière des neurosciences affectives : actuelles sur l’addiction entre neurosciences et psychanalyse","authors":"Dario Alparone (Docteur en Psychopathologie et Docteur européen en criminologie, Maître de Conférences en Psychologie Clinique et Psychopathologie) , Giorgia Tiscini (Professeure de psychopathologie clinique)","doi":"10.1016/j.evopsy.2025.06.005","DOIUrl":"10.1016/j.evopsy.2025.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of our article was to explore and clarify the psychoanalytic concept of the death drive from the perspective of clinical practice and certain discoveries in contemporary neuroscience.</div></div><div><h3>Methods</h3><div>Drawing on the classical Freudian concept of the death drive and the field of affective neuroscience, including neuropsychoanalysis and its most recent discoveries, it is possible to reinterpret certain clinical phenomena such as addiction and masochism, including those associated with neurotic symptoms.</div></div><div><h3>Results</h3><div>Our objective was to offer an original interpretation of these clinical manifestations by establishing a novel dialogue between the fields of psychoanalysis and neuroscience, underscoring the central role of affectivity in individual development.</div></div><div><h3>Discussion</h3><div>Trauma in primary relationships can influence individual development by inducing neurophysiological needs that may push people to adopt addictive behaviors. Emotional trauma and primary relationship issues seem to be linked to a somewhat paradoxical search for instinctual satisfaction, as exemplified by addictions or even certain forms of masochism.</div></div><div><h3>Conclusion</h3><div>The dialogue established between the fields of psychoanalysis and neuroscience appeared to be quite fruitful, allowing for a unique understanding of clinical phenomena such as addiction. Drawing on affective neuroscience, we arrived at a new understanding and a new use of the epistemologically problematic Freudian concept of the death drive.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 729-747"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-19DOI: 10.1016/j.evopsy.2025.05.001
Alexiane Cocqueret (Doctorante (ED566)) , Elisa Eugene (Master Sport et Expertise de la Performance de Haut Niveau) , Alexandre Legendre (Maître de Conférence) , Bernard Andrieu (Professeur des universités)
<div><h3>Objectives</h3><div>In the scientific literature, injury is most often understood as no more than a physical functional limitation and, therefore, as strictly negative. However, as we discuss here, there is also an effect on psychological integrity. The entire body appears to be impacted, both physically and psychologically, as an injury can simultaneously influence self-esteem, body image, and confidence in one's body schema. We first interviewed circus artists during an exploratory study, and we then interviewed elite athletes (EAs) for a case study. The goal was to characterize their respective experiences of injury to analyze the various effects of injury from the prism of bodies facing the extreme.</div></div><div><h3>Methodology</h3><div>We conducted semi-structured interviews with four EAs in combat sports (two female judokas, one male judoka, and one female fencer, with a mean age of 26 years [standard deviation<!--> <!-->=<!--> <!-->1 year]). These interviews were recorded, transcribed, and anonymized. As a first step, participants produced an awareness drawing, where they could visually represent the state of their bodies and its association with their injury history. The instructions for creating this drawing were minimally restrictive so as to encourage the most spontaneous representations possible.</div></div><div><h3>Results</h3><div>The results of the exploratory study highlighted certain positive aspects of injury, such as the opportunity to slow down a rhythm of life that is extremely intense, exhausting, or even detrimental given the demands of performance as well as the opportunity to foster self-learning during and after recovery. In the case study, the EAs represented their various, often numerous injuries through awareness drawing, which, in tandem with the subsequent explanatory interview, spurred greater bodily and mental awareness. Experiences of shared injury were frequently associated with the normalization of pain, reinforced by the fact that rest periods were kept minimal because of internal and external pressures. In this context, the first injury stood out due to its emotional impact and implications, as it often marked a significant turning point in the athlete's life. It had the possibility to become an opportunity for personal development through the specific skills it fostered, such as the development of an “injury radar”, or the specific skills it helped enhance, like resilience.</div></div><div><h3>Discussion</h3><div>The results of these two studies highlight that injuries can have certain benefits for EAs, despite injuries being typically regarded as functional limitations. Looking beyond the difficulties extensively documented in the literature, injury can prompt self-reflection and an assessment of one's practices, which can prove beneficial. Some EAs used this moment to reconsider their sporting career and objectives, while others perceived their practices as evolving through successive injuries.
{"title":"Dessiner ses blessures sportives : une reconfiguration psychologique et affective de son corps émersif","authors":"Alexiane Cocqueret (Doctorante (ED566)) , Elisa Eugene (Master Sport et Expertise de la Performance de Haut Niveau) , Alexandre Legendre (Maître de Conférence) , Bernard Andrieu (Professeur des universités)","doi":"10.1016/j.evopsy.2025.05.001","DOIUrl":"10.1016/j.evopsy.2025.05.001","url":null,"abstract":"<div><h3>Objectives</h3><div>In the scientific literature, injury is most often understood as no more than a physical functional limitation and, therefore, as strictly negative. However, as we discuss here, there is also an effect on psychological integrity. The entire body appears to be impacted, both physically and psychologically, as an injury can simultaneously influence self-esteem, body image, and confidence in one's body schema. We first interviewed circus artists during an exploratory study, and we then interviewed elite athletes (EAs) for a case study. The goal was to characterize their respective experiences of injury to analyze the various effects of injury from the prism of bodies facing the extreme.</div></div><div><h3>Methodology</h3><div>We conducted semi-structured interviews with four EAs in combat sports (two female judokas, one male judoka, and one female fencer, with a mean age of 26 years [standard deviation<!--> <!-->=<!--> <!-->1 year]). These interviews were recorded, transcribed, and anonymized. As a first step, participants produced an awareness drawing, where they could visually represent the state of their bodies and its association with their injury history. The instructions for creating this drawing were minimally restrictive so as to encourage the most spontaneous representations possible.</div></div><div><h3>Results</h3><div>The results of the exploratory study highlighted certain positive aspects of injury, such as the opportunity to slow down a rhythm of life that is extremely intense, exhausting, or even detrimental given the demands of performance as well as the opportunity to foster self-learning during and after recovery. In the case study, the EAs represented their various, often numerous injuries through awareness drawing, which, in tandem with the subsequent explanatory interview, spurred greater bodily and mental awareness. Experiences of shared injury were frequently associated with the normalization of pain, reinforced by the fact that rest periods were kept minimal because of internal and external pressures. In this context, the first injury stood out due to its emotional impact and implications, as it often marked a significant turning point in the athlete's life. It had the possibility to become an opportunity for personal development through the specific skills it fostered, such as the development of an “injury radar”, or the specific skills it helped enhance, like resilience.</div></div><div><h3>Discussion</h3><div>The results of these two studies highlight that injuries can have certain benefits for EAs, despite injuries being typically regarded as functional limitations. Looking beyond the difficulties extensively documented in the literature, injury can prompt self-reflection and an assessment of one's practices, which can prove beneficial. Some EAs used this moment to reconsider their sporting career and objectives, while others perceived their practices as evolving through successive injuries.","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 581-600"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-29DOI: 10.1016/j.evopsy.2025.10.003
Pascale Gavelle Doctorante UPCité (Psychologue clinicienne) , Marcela Gargiulo (Professeure de psychologie, Psychologue clinicienne à l’Institut de myologie) , Manuella De Luca (Professeure de psychologie clinique et psychopathologie, Responsable du service d’enseignement clinique, Membre de l’unité de recherche PCPP « Psychologie clinique, psychopathologie, psychanalyse » (URP 4056) Directrice de recherche dans l’école doctorale 3CH 261)
Objectives
Self-perception and the gaze of others are central in clinical work with children and adolescents who have visible differences, such as cleft lips and palates. Integrating their unique facial features into their self-image is a major part of their medical and surgical journey, and the process influences their psychological and social well-being. Our objective is to provide a theoretical foundation to the clinicians who care for these patients, with a view to helping clinicians better identify the factors that contribute to the development of self-image that integrates the face. This work is of particular importance in the field of craniofacial diagnoses and will serve both clinical needs and future research in this area of study.
Methods
This article explores key concepts in the literature, such as body image, self-image, self-perception, self-concept, and body satisfaction, both in general and specifically in children with cleft conditions. We reviewed French and international publications, seeking to clarify terms, highlight theoretical links, summarize assessment tools, and identify gaps.
Results
Our narrative review of the literature underscored the frequent overlap of the terms used and the lack of theoretical references and research when it comes to the topic of integrating the face into self-image. We examined the psychological challenges faced by children with cleft lips and palates as they form their identities and their relationships with their bodies and faces. Our work emphasizes the sensitivity of their gaze when turned toward their anatomical parts affected by the cleft and the risk of depression related to excessive discrepancies between the real face and the ideal face.
Discussion
An emphasis was placed on early life experiences, particularly the “mirror stage,” during which reciprocal gazes shared with caregivers provide children with an image of themselves. Emphasis was also placed on the impact of dissatisfaction with one's appearance and negative social interactions. All these factors occur at the crossroads of the work between psychologists, surgeons, and patients, such that surgery is truly restorative.
Conclusion
Recent research recommends using a mixed-methods approach, with interviews, questionnaires, and projective tests, to explore the integration of the face into self-image. It is also recommended that parental support occur from the moment of diagnosis, that a tailored approach to the child's surgical requests be provided, and that additional support be furnished following surgery.
{"title":"L’intégration du visage dans l’image de soi chez l’enfant et l’adolescent porteur de fente labio-palatine : Conceptualisation et évaluation","authors":"Pascale Gavelle Doctorante UPCité (Psychologue clinicienne) , Marcela Gargiulo (Professeure de psychologie, Psychologue clinicienne à l’Institut de myologie) , Manuella De Luca (Professeure de psychologie clinique et psychopathologie, Responsable du service d’enseignement clinique, Membre de l’unité de recherche PCPP « Psychologie clinique, psychopathologie, psychanalyse » (URP 4056) Directrice de recherche dans l’école doctorale 3CH 261)","doi":"10.1016/j.evopsy.2025.10.003","DOIUrl":"10.1016/j.evopsy.2025.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Self-perception and the gaze of others are central in clinical work with children and adolescents who have visible differences, such as cleft lips and palates. Integrating their unique facial features into their self-image is a major part of their medical and surgical journey, and the process influences their psychological and social well-being. Our objective is to provide a theoretical foundation to the clinicians who care for these patients, with a view to helping clinicians better identify the factors that contribute to the development of self-image that integrates the face. This work is of particular importance in the field of craniofacial diagnoses and will serve both clinical needs and future research in this area of study.</div></div><div><h3>Methods</h3><div>This article explores key concepts in the literature, such as body image, self-image, self-perception, self-concept, and body satisfaction, both in general and specifically in children with cleft conditions. We reviewed French and international publications, seeking to clarify terms, highlight theoretical links, summarize assessment tools, and identify gaps.</div></div><div><h3>Results</h3><div>Our narrative review of the literature underscored the frequent overlap of the terms used and the lack of theoretical references and research when it comes to the topic of integrating the face into self-image. We examined the psychological challenges faced by children with cleft lips and palates as they form their identities and their relationships with their bodies and faces. Our work emphasizes the sensitivity of their gaze when turned toward their anatomical parts affected by the cleft and the risk of depression related to excessive discrepancies between the real face and the ideal face.</div></div><div><h3>Discussion</h3><div>An emphasis was placed on early life experiences, particularly the “mirror stage,” during which reciprocal gazes shared with caregivers provide children with an image of themselves. Emphasis was also placed on the impact of dissatisfaction with one's appearance and negative social interactions. All these factors occur at the crossroads of the work between psychologists, surgeons, and patients, such that surgery is truly restorative.</div></div><div><h3>Conclusion</h3><div>Recent research recommends using a mixed-methods approach, with interviews, questionnaires, and projective tests, to explore the integration of the face into self-image. It is also recommended that parental support occur from the moment of diagnosis, that a tailored approach to the child's surgical requests be provided, and that additional support be furnished following surgery.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 679-699"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-03-27DOI: 10.1016/j.evopsy.2025.02.004
Patrick Chemla (Psychiatre honoraire des hôpitaux, psychanalyste)
{"title":"Pour une approche psychanalytique des « Transitions de genre ». À propos de… « Devenir trans de l’analyste », de Nicolas Evzonas","authors":"Patrick Chemla (Psychiatre honoraire des hôpitaux, psychanalyste)","doi":"10.1016/j.evopsy.2025.02.004","DOIUrl":"10.1016/j.evopsy.2025.02.004","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 748-753"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-24DOI: 10.1016/j.evopsy.2025.10.004
Pascale Gavelle Doctorante UPCité (Psychologue clinicienne) , Marcela Gargiulo (Professeure de psychologie, Psychologue clinicienne à l’Institut de myologie) , Manuella De Luca (Professeure de psychologie clinique et psychopathologie, Responsable du service d’enseignement clinique, Membre de l’unité de recherche PCPP « Psychologie clinique, psychopathologie, psychanalyse » (URP 4056) Directrice de recherche dans l’école doctorale 3CH 261)
Objectives
Self-perception and the gaze of others are central in clinical work with children and adolescents who have visible differences, such as cleft lips and palates. Integrating their unique facial features into their self-image is a major part of their medical and surgical journey, and the process influences their psychological and social well-being. Our objective is to provide a theoretical foundation to the clinicians who care for these patients, with a view to helping clinicians better identify the factors that contribute to the development of self-image that integrates the face. This work is of particular importance in the field of craniofacial diagnoses and will serve both clinical needs and future research in this area of study.
Methods
This article explores key concepts in the literature, such as body image, self-image, self-perception, self-concept, and body satisfaction, both in general and specifically in children with cleft conditions. We reviewed French and international publications, seeking to clarify terms, highlight theoretical links, summarize assessment tools, and identify gaps.
Results
Our narrative review of the literature underscored the frequent overlap of the terms used and the lack of theoretical references and research when it comes to the topic of integrating the face into self-image. We examined the psychological challenges faced by children with cleft lips and palates as they form their identities and their relationships with their bodies and faces. Our work emphasizes the sensitivity of their gaze when turned toward their anatomical parts affected by the cleft and the risk of depression related to excessive discrepancies between the real face and the ideal face.
Discussion
An emphasis was placed on early life experiences, particularly the “mirror stage,” during which reciprocal gazes shared with caregivers provide children with an image of themselves. Emphasis was also placed on the impact of dissatisfaction with one's appearance and negative social interactions. All these factors occur at the crossroads of the work between psychologists, surgeons, and patients, such that surgery is truly restorative.
Conclusion
Recent research recommends using a mixed-methods approach, with interviews, questionnaires, and projective tests, to explore the integration of the face into self-image. It is also recommended that parental support occur from the moment of diagnosis, that a tailored approach to the child's surgical requests be provided, and that additional support be furnished following surgery.
{"title":"Integration of the face into self-image by children and adolescents with cleft conditions: Conceptualization and evaluation","authors":"Pascale Gavelle Doctorante UPCité (Psychologue clinicienne) , Marcela Gargiulo (Professeure de psychologie, Psychologue clinicienne à l’Institut de myologie) , Manuella De Luca (Professeure de psychologie clinique et psychopathologie, Responsable du service d’enseignement clinique, Membre de l’unité de recherche PCPP « Psychologie clinique, psychopathologie, psychanalyse » (URP 4056) Directrice de recherche dans l’école doctorale 3CH 261)","doi":"10.1016/j.evopsy.2025.10.004","DOIUrl":"10.1016/j.evopsy.2025.10.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Self-perception and the gaze of others are central in clinical work with children and adolescents who have visible differences, such as cleft lips and palates. Integrating their unique facial features into their self-image is a major part of their medical and surgical journey, and the process influences their psychological and social well-being. Our objective is to provide a theoretical foundation to the clinicians who care for these patients, with a view to helping clinicians better identify the factors that contribute to the development of self-image that integrates the face. This work is of particular importance in the field of craniofacial diagnoses and will serve both clinical needs and future research in this area of study.</div></div><div><h3>Methods</h3><div>This article explores key concepts in the literature, such as body image, self-image, self-perception, self-concept, and body satisfaction, both in general and specifically in children with cleft conditions. We reviewed French and international publications, seeking to clarify terms, highlight theoretical links, summarize assessment tools, and identify gaps.</div></div><div><h3>Results</h3><div>Our narrative review of the literature underscored the frequent overlap of the terms used and the lack of theoretical references and research when it comes to the topic of integrating the face into self-image. We examined the psychological challenges faced by children with cleft lips and palates as they form their identities and their relationships with their bodies and faces. Our work emphasizes the sensitivity of their gaze when turned toward their anatomical parts affected by the cleft and the risk of depression related to excessive discrepancies between the real face and the ideal face.</div></div><div><h3>Discussion</h3><div>An emphasis was placed on early life experiences, particularly the “mirror stage,” during which reciprocal gazes shared with caregivers provide children with an image of themselves. Emphasis was also placed on the impact of dissatisfaction with one's appearance and negative social interactions. All these factors occur at the crossroads of the work between psychologists, surgeons, and patients, such that surgery is truly restorative.</div></div><div><h3>Conclusion</h3><div>Recent research recommends using a mixed-methods approach, with interviews, questionnaires, and projective tests, to explore the integration of the face into self-image. It is also recommended that parental support occur from the moment of diagnosis, that a tailored approach to the child's surgical requests be provided, and that additional support be furnished following surgery.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages e11-e30"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-26DOI: 10.1016/j.evopsy.2025.07.004
Erwann Jacquot (Ostéopathe, Ingénieur pédagogique, Doctorant I3SP) , Aline Paintendre (Maîtresse de conférences) , Bernard Andrieu (Professeur des universités)
Objective
Osteopathy is the most popular alternative healthcare practice in France. To update and improve this practice, which is already part of patient care pathways, it is necessary to explore and understand bodily damage via a central idea in osteopathy: somatic dysfunction.
Methods
First-person data were collected using a consciousness drawing approach followed by explanatory interviews. During their first two years of osteopathic studies, students engage in a reflective practice around somatic dysfunction. This study utilized a qualitative method with a thematic analysis of the above interviews and drawings.
Results
The thematic analysis identified the existence of four axes: the reading of the bodily injury, the materialization of the bodily injury, the transition from local bodily injury to global bodily injury, and the impact of the bodily injury on the osteopath in the context of emerging intercorporeality. There were three categories of drawings: (drawings) of consciousness, drawings (of) consciousness, and drawings of (consciousness).
Discussion
Exploring knowledge about somatic dysfunction has highlighted that mixed epistemology is needed to propose a model of osteopathic clinical practice that incorporates elements of a biopsychosocial approach. Touch seems to allow the identification of intercorporeality in the experiences of the therapist and patient, thanks to an emersive clinical experience of the body.
Conclusion
This study explores the knowledge and theories of osteopathic students in early training. Their conception of somatic dysfunction was expressed through several drawings of consciousness and through a narrative arising from bodily reflexivity. This work seems conducive to the better integration of psychosocial criteria and a holistic understanding of the body, with a view to enhancing the contribution of osteopathic touch as care within a patient-centered approach.
{"title":"Le dessin ostéopathique des atteintes corporelles : une clinique émersive","authors":"Erwann Jacquot (Ostéopathe, Ingénieur pédagogique, Doctorant I3SP) , Aline Paintendre (Maîtresse de conférences) , Bernard Andrieu (Professeur des universités)","doi":"10.1016/j.evopsy.2025.07.004","DOIUrl":"10.1016/j.evopsy.2025.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>Osteopathy is the most popular alternative healthcare practice in France. To update and improve this practice, which is already part of patient care pathways, it is necessary to explore and understand bodily damage via a central idea in osteopathy: somatic dysfunction.</div></div><div><h3>Methods</h3><div>First-person data were collected using a consciousness drawing approach followed by explanatory interviews. During their first two years of osteopathic studies, students engage in a reflective practice around somatic dysfunction. This study utilized a qualitative method with a thematic analysis of the above interviews and drawings.</div></div><div><h3>Results</h3><div>The thematic analysis identified the existence of four axes: the reading of the bodily injury, the materialization of the bodily injury, the transition from local bodily injury to global bodily injury, and the impact of the bodily injury on the osteopath in the context of emerging intercorporeality. There were three categories of drawings: (drawings) of consciousness, drawings (of) consciousness, and drawings of (consciousness).</div></div><div><h3>Discussion</h3><div>Exploring knowledge about somatic dysfunction has highlighted that mixed epistemology is needed to propose a model of osteopathic clinical practice that incorporates elements of a biopsychosocial approach. Touch seems to allow the identification of intercorporeality in the experiences of the therapist and patient, thanks to an emersive clinical experience of the body.</div></div><div><h3>Conclusion</h3><div>This study explores the knowledge and theories of osteopathic students in early training. Their conception of somatic dysfunction was expressed through several drawings of consciousness and through a narrative arising from bodily reflexivity. This work seems conducive to the better integration of psychosocial criteria and a holistic understanding of the body, with a view to enhancing the contribution of osteopathic touch as care within a patient-centered approach.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 635-665"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-05DOI: 10.1016/j.evopsy.2025.07.002
Marie Agostinucci (Maitresse de conférences, psychomotricienne et chercheuse) , Sylvain Hanneton (Maitre de conférences) , Bernard Andrieu (Professeur des universités, directeur)
Introduction
This study focused on body image after a moderate-to-severe traumatic brain injury (TBI), several years after the accident. It explored body representation by examining body dissatisfaction, body appreciation, and self-discrepancy. A particular emphasis was placed on body functionality. The aim was to determine how people reappropriate and rediscover their bodies after an accident causing TBI.
Methods
The design of the study was qualitative. We used the Body Appreciation Scale-2 (BAS-2) to assess positive body image and conducted a semi-structured interview asking about global body image and physical abilities. We recruited 15 people with moderate-to-severe TBI who are disabled according to the Glasgow Outcome Scale (GOS; score of 2–3). Their accident had to have occurred at least 2 years ago.
Results
Motor impairments were associated with dissatisfaction related to unfavorable comparisons with the previous self or normative ideals. However, such dissatisfaction could coexist with a positive body image. Participants also experienced body acceptance and appreciation in association with preserved or reacquired abilities. When this positive body image was present, abilities were compared with those of the post-TBI self in the earliest stages of recovery, with those in a situation where there was a worse prognosis, or with those of people with a greater level of disability; in some cases, there was no comparison. The individuals’ knowledge of their own limits and capacities was based both on their search for physical experiences and their dynamics of introspection.
Discussion
Body image dissatisfaction after TBI may be characterized by the loss of functional abilities. Dissatisfaction appears to mainly result from comparisons with the previous self or ableist standards. However, a form of body acceptance may occur, characterized by satisfaction with functional recovery and the preservation of autonomy.
Conclusion
Over the course of their lives, individuals rely on a wide variety of bodily experiences to update their opinions and knowledge of themselves. These processes contribute to a positive body image.
{"title":"Image du corps après un traumatisme crânien : une (re)découverte du corps après l’accident ?","authors":"Marie Agostinucci (Maitresse de conférences, psychomotricienne et chercheuse) , Sylvain Hanneton (Maitre de conférences) , Bernard Andrieu (Professeur des universités, directeur)","doi":"10.1016/j.evopsy.2025.07.002","DOIUrl":"10.1016/j.evopsy.2025.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>This study focused on body image after a moderate-to-severe traumatic brain injury (TBI), several years after the accident. It explored body representation by examining body dissatisfaction, body appreciation, and self-discrepancy. A particular emphasis was placed on body functionality. The aim was to determine how people reappropriate and rediscover their bodies after an accident causing TBI.</div></div><div><h3>Methods</h3><div>The design of the study was qualitative. We used the Body Appreciation Scale-2 (BAS-2) to assess positive body image and conducted a semi-structured interview asking about global body image and physical abilities. We recruited 15 people with moderate-to-severe TBI who are disabled according to the Glasgow Outcome Scale (GOS; score of 2–3). Their accident had to have occurred at least 2 years ago.</div></div><div><h3>Results</h3><div>Motor impairments were associated with dissatisfaction related to unfavorable comparisons with the previous self or normative ideals. However, such dissatisfaction could coexist with a positive body image. Participants also experienced body acceptance and appreciation in association with preserved or reacquired abilities. When this positive body image was present, abilities were compared with those of the post-TBI self in the earliest stages of recovery, with those in a situation where there was a worse prognosis, or with those of people with a greater level of disability; in some cases, there was no comparison. The individuals’ knowledge of their own limits and capacities was based both on their search for physical experiences and their dynamics of introspection.</div></div><div><h3>Discussion</h3><div>Body image dissatisfaction after TBI may be characterized by the loss of functional abilities. Dissatisfaction appears to mainly result from comparisons with the previous self or ableist standards. However, a form of body acceptance may occur, characterized by satisfaction with functional recovery and the preservation of autonomy.</div></div><div><h3>Conclusion</h3><div>Over the course of their lives, individuals rely on a wide variety of bodily experiences to update their opinions and knowledge of themselves. These processes contribute to a positive body image.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 619-634"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-23DOI: 10.1016/j.evopsy.2025.06.001
Benoît Verdon (Psychologue clinicien, psychanalyste, professeur de psychologie clinique)
<div><h3>Objectives</h3><div>Understanding the psychic distress associated with the body's vagaries necessitates an exploration of the body's investment in fantasy. The body's robustness or fragility, its active and passive potentialities, its openness and closedness, penetrability and impenetrability, uprightness and sagging are all sources of representations and affects that transcend the objectivation of actual symptoms, illnesses, accidents, and disabilities. Moreover, the fear of being vulnerable, deficient, or ill is often heightened by the experience of aging, agedness, and the apprehension around cerebral decline, of particular concern among those who are growing older. Our aim was to focus on distinguishing the psychic representations of the body that are challenged by the widely shared experience of memory impairments that have not been confirmed as pathological by medical and neuropsychological assessments. This approach allowed us to understand how the psychic functioning of patients who worry about presenting prodromes or symptoms of cerebral pathologies mobilizes representations of bodily afflictions, revealing signs of narcissistic sensitivity and fragility as well as of fantastical conflicts.</div></div><div><h3>Methods</h3><div>The Rorschach test has generated substantial research results on the psychic processes involved in representing the body and the dynamic interplay between narcissistic and objectal investments in various types of psychopathological organization and clinical contexts. In this study, the test was administered to women and men who spontaneously sought consultation for memory issues, after having been informed that neither neuropsychological nor medical tests had confirmed any identifiable cerebral etiology able to explain their daily memory impairments. By focusing our study on representations of the body and its afflictions, we could identify both the vulnerabilities and strengths of different forms of primary identification that potentially shape identity stability and unity; the establishment of solid yet flexible internal and external boundaries; and the sensitivity to containment or fragmentation. Additionally, we observed the vulnerabilities and strengths of different forms of secondary identification, where body representations are more organized around bisexuality and sexual differences, reflecting sensitivity to notions of lack, size, and the body's function as active or passive, robust or powerless.</div></div><div><h3>Results</h3><div>For some patients, the issue of envelope porosity emerged as a salient and central concern. Their narcissistic vulnerabilities make them particularly sensitive to memory lapses, analogous to breaches in the bodily envelope through which contents might escape, thus compromising identity integrity, the solidity of differentiation, as well as the stability of self-esteem and of the investment therein. For other patients, representations of bodily afflictions were more cl
{"title":"Représentations psychiques des atteintes du corps en contexte de vieillissement. Apports du test de Rorschach à la compréhension psychodynamique de la plainte cognitive","authors":"Benoît Verdon (Psychologue clinicien, psychanalyste, professeur de psychologie clinique)","doi":"10.1016/j.evopsy.2025.06.001","DOIUrl":"10.1016/j.evopsy.2025.06.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Understanding the psychic distress associated with the body's vagaries necessitates an exploration of the body's investment in fantasy. The body's robustness or fragility, its active and passive potentialities, its openness and closedness, penetrability and impenetrability, uprightness and sagging are all sources of representations and affects that transcend the objectivation of actual symptoms, illnesses, accidents, and disabilities. Moreover, the fear of being vulnerable, deficient, or ill is often heightened by the experience of aging, agedness, and the apprehension around cerebral decline, of particular concern among those who are growing older. Our aim was to focus on distinguishing the psychic representations of the body that are challenged by the widely shared experience of memory impairments that have not been confirmed as pathological by medical and neuropsychological assessments. This approach allowed us to understand how the psychic functioning of patients who worry about presenting prodromes or symptoms of cerebral pathologies mobilizes representations of bodily afflictions, revealing signs of narcissistic sensitivity and fragility as well as of fantastical conflicts.</div></div><div><h3>Methods</h3><div>The Rorschach test has generated substantial research results on the psychic processes involved in representing the body and the dynamic interplay between narcissistic and objectal investments in various types of psychopathological organization and clinical contexts. In this study, the test was administered to women and men who spontaneously sought consultation for memory issues, after having been informed that neither neuropsychological nor medical tests had confirmed any identifiable cerebral etiology able to explain their daily memory impairments. By focusing our study on representations of the body and its afflictions, we could identify both the vulnerabilities and strengths of different forms of primary identification that potentially shape identity stability and unity; the establishment of solid yet flexible internal and external boundaries; and the sensitivity to containment or fragmentation. Additionally, we observed the vulnerabilities and strengths of different forms of secondary identification, where body representations are more organized around bisexuality and sexual differences, reflecting sensitivity to notions of lack, size, and the body's function as active or passive, robust or powerless.</div></div><div><h3>Results</h3><div>For some patients, the issue of envelope porosity emerged as a salient and central concern. Their narcissistic vulnerabilities make them particularly sensitive to memory lapses, analogous to breaches in the bodily envelope through which contents might escape, thus compromising identity integrity, the solidity of differentiation, as well as the stability of self-esteem and of the investment therein. For other patients, representations of bodily afflictions were more cl","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 4","pages":"Pages 567-579"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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