Trauma and Adolescence, Communications, Emmanuel Kosadinos author

8/14/2019 Trauma and Adolescence, Communications, Emmanuel Kosadinos author

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THURSDAY JULY 615HOO - 16H30Culpabilityof the inteNenants, of the patient's environment and

of the psychiatriccare givingstaffscould be a factorenforcingthataspect.

These adolescent patients are systematically asked to consult asecond time on the site of emergency care after the end of a shortperiod hospitalization in Department for Adults and they are ques-tionned following a semi-directive method on their personal expe-rience of emergency care and hospitalization.

Interiorization of this experience and conscious integration whichoccur, seem to witness that itis not foreign body at work intheirpsychological life.FREE COlVIMUNICATION 6ATRAU1VlA,ADOLESCENCE ANDPATHOGENESIS OF BORDERLINEPERSONALITY DISORDER

. MADEDDU F., LINGIARDI V.,BANZULLI L., l\'lAFFEI C., ORLMTII1\1J A.Empiricalesearchhasconfirmedhe clinicalindingaboutthepresenceof traumaticantecedentsuringchildhoodin adolescentandadultborderlinepatients.Ludolph1990)showedheseindingsin a BPDsampleof adolescents.erry(1993)underlinedhatchild-hoodabusesoneof themajoretiologicactorintheadultdevelop-mentof BPD.Sucheventsaremainlyphysicalandsexualabusebutalsoa disturbedamilialenvironment,often describedasneglect.Otherauthors(Westen,1990)notedthat these eventsmayalsooccurandcontinueduringadolescence.ovingfromthoseconside-rations,wecanlookatadolescences: 1)a stagewereadiagnosisof BPDcouldbe linkedto a traumaticevent; 2)a crucialdevelo-

pmentalphaseowardanadultdiagnosisf BPDweremitigantac-torsor theprosecutionf traumaticeventsplayanimportantrole.Inthepresentstudytheauthorsdiscussroblemsoncerning:a)definitionof traumaticeventandtraumaticenvironment;b) diffe-rent impactof traumaticevents/environmentt differentdevelo-pmentalphases;c)influenceof individualconstitutionalactorsand

environmentalprotectiveactorson the developmentof BPD; d)controversiesntheadultandadolescentisgnosisf BPD.LudolphSet al.(1990)TheBorderlineDiagnosisnAdolescence: symptomsnddevelopmentalistory.AmericanJournalofPsychia-try, 147-4,470-476.ParryCJandHermanJ.(1993)Traumaanddefensentheetio-logyof borderlinepersonalitydisorderin Borderlinepersonalitydisorder etiologyandtreatment,J.Parised.)APApress,Washing-tonDCWestenD. (1990)Towardsa revisedheoryof borderlineobjectrelations:contributionof empiricalesearch.nternationalournalofPsychoanalysis,1, 661-693.

FREE COMMUNICATION 7ACOPING STRATEGIES AND .L\tlENTALHEALTH: A COlVIPARATIVE STUDY OFA CLINICAL GROUP AND ACOlVINIUNITY SAlVIPLE.lVI.DUMONT, B. PLANCHEREL,M. BO~IGNINI, O. HALFON

Earlyadolescences a developmentalperiodcharacterizedyimportantandrapidpsychologicalndphysicaladjustments.Thewayonedealswith differentminor(dailyhassles)ndmajor(lifeevents)sourcesof stressdependspartiallyon copingstrategies.hisresearchieswithinthe broaderscopeof studiesshowingthat thereisarelationbetweenmentalhealthandcopingstrategie~.Thisstudyhastwo mainobjectives:to identifysimilaritiesnddifferencesn copingstylesbetweenearlyadolescentsromthecom-munitygroupandearlyadolescentsf a clinicalgroup; to testthemediatingoleof copingon the relationshipetweenstressminorandmajor)andmentaldisturbances.Datawerecollectedroma communitygroupin Lausanne,ntheFrench-speakingartof SwitzerlandN=223)and47outpatientsofthe sameagefromaclinicalgroup.ThequestionnaireseasuringcopingstrategiesA-Cope,AdolescentCopingOrientationro Pro-blemExperiences;Patterson,McCubbinandNeedle,1983),dailyhasslesAdolescentHasslesnventory;Boboandal. (1986),andlifeeventsSwearingenndCohen,1985)havebeentranslatedn Fren-ch,pre-testedandvalidatedor thisstudy.Mentalhealthhasbeenevaluatedby the GHQ(GeneralHealthQuestionnaire,Goldberg,1986)andthequestionnaireanteSUPEA1993).Ourfindingsshowthatthesubjectsof thecommunitygroupsol-vetheir problemsusingmorefamilyrelationships,ryingto improve,crying,sleepingor goingshopping,whereashesubjectsof theclini-calgroupreactby avoidingstrategiesstayingawayfrom home,ridingaround)or gettingprofessionalounselling.Our resultsalsoput in evidencea clearrelationbetweendifferentstylesof copingstrategiesndmentalhealthnotablyor anxiety.Theseesultswill bediscussedntermsof copingstrategieswhichwouldseNeasastressbufferin connectionwithmajoror minorstressesndpsychologicaldisturbances.FREE COMl\tJUNICATION BADISSOCIATIVE IDENTITY DISORDERIN ADOLESCENCE: CLINICALI}\J,!STIGATION AND TRAUlVIAHISTORIES OF 17CASES.HAlvlDITUTKUN,MD ;SALIH ZOROGLU, MD ;L. ILHAN YARGIC, lVID ;VEDA TSAR, lVID.DissociativedentityDisordersDID),ormermultiplepersonalit}

disorder,sa complexandchronicdissociativeisordercharacterizecbydisturbancesf identityandmemory.tisconsideredo beaposttraumaticsyndromeof childhoodorigin,causedbyseverechildhoO{traumaticexperiencesuchassexualandphysicalabuse.DIDisnovconsideredto be more common that previouslyimagined.It has Iwide rangeof symptomprofileand requiresan indexof suspicionb'the clinicianin order to bedisgnosed.Soit mayeasilybeoverlookedWe present here sociodemographiccharacteristics,clinicalfeeturesand traumahistoriesof 17adolescentswith dissociativedentitdisorder.Theywere inteNiewed bythe authors20.4 timeson aver,ge. 14of the caseswerefemale and 3 weremale. Meanageof thpatientswas 15.5(rande14-18).Clinicalevaluationrevealedthat thmajority of the patients manifested headache,fainting, conversicsymptoms,amnesias,behaviorproblems,suicideattempts,selfmu!

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FRIDAY JULY 715HOO- 16H30d'autres formes de pathologie, surtout nevrotiques.Nous pensonsque cettesymptomatologiepourrait etre interpreteecomme le refletd'une tentative frenetique et inappropriee de reorganisation,lorsquecette reorganisations'opereauxdepensdu moi et qui devradesormaisapprendrea conjoindredes elementstotalement incom-patibles,entre-deux-systemesymbolique.(ecI temoignede I'in-certitudeet d'un certainmalaiseque peuventeprouver lessoignantsface a desjeunes qui proviennent d'une autre culture; les instru-ments conceptuelshabituelsne paraissentplussuffisantspour uneevaluationcorrecte.FREE COMMUNICATION 3A

FROi\l TRAUi\;lA TO PAIN: DOUBLEJOURNEY OF THE Ei\lIGRANT ADO-LESCENTALBERTO GHILARDI,PAOLA 1\1A1'"\"FREDIAt thismomentthephenomenonof theemigrationegardsalltheworldpopulation,especiallyecausef emigrationof theextra-europeanandeasteuropeanpopulationo the centralEurope.Thissituationinvolvessinglesand families,youngpeopleand adoles-cents.Oftenthecausedependson hardsocialandpoliticalproblems(wars,wretchedness,pidemics),othe traumaof emigrationaddsup to alreadydifficultfeelings.All thissituationcouldturn intosocialmaladaptationactingout), andmentalproblems(panic,anxiety,loneliness),ftendiagnosticatedsuprootpathology.Therestheriskthiskindof phenomenologicalisgnosisouldbetranslatedntoa therapeuticprojectto facilitatethe takerootin a newplace,

in themeaningof adaptationo actualife,forgettingthepastexpe-rienceof the potentiallyraumaticuproot.Usingsomeclinicalillustrations,we would liketo showas,inthesecases,he therapeuticprocesscouldgivethe shape,nto thesetting,of anemigrationof thetherapeuticoupleo theadolescentoriginatingcountry,andalsoas,ina secondime,canbepossibleofacilitateand increasehe processesf adaptationo the newlifereality,hroughasecondemigrationo thenewcountry.All thispermitsthe adolescenthe mentalrepresentationndtheworkingthroughof a partof hishistoryandof hisSelf,whichthetraumahadfrozenanddepleted.Wewantto underlinehatthedifferentethnicand/orculturaloriginof the couplepatient-therapisthasgottherapeuticefficacityo facilitatehekeepintouch,bytrans-lationina commonclinicalanguageof two differentgeographicallyrealities,hetraumadoesn'tpermitthepatiento integratepsycholo-gically.Youcanobtainit workingintothesamepsychologicalxpe-rienceof emigration,ntendingo rescuepartsof theSelflostbytheadolescent.At theendwe underlineasthe solvingof thetraumagivesspaceo provementalpain.FREE COMMUNICATION 4AAFFILIATION AND INITIATION ADO-LESCENCE AND PSYCHOTHERAPY INA CROSS CULTURAL SITUATIONl\1ARINA PAPAGEORGIOUTheinitiationitesfor adolescentsntraditionalsocietiesrecomplexraumaticechniquesf decomposingndreconstructing

the individualdentitywhosefinalityisto obtainthe metamorphosisof thesubjectandaffiliatehimto a newenvelope, groupof mem-bersthatsharehe samereferencesndtransmita culturalidentity.As likethe birth ritesthat aimto incorporatea childandalsothefuneralritesthataimto transformadeceacedn ancestorandfoundthe groupmemoryandcontinuity,the initiationritesareculturalcontainerso passromfiliationo affiliation.Inacrossculturalcontext,moreoftenmigrantscannottransmittheancestors'egacy,becausef thebreakingoff in theirownfilia-tion. Childrenof migrantsaresplitedbetweentwo heterogenousculturalramesnotableto beinternalizedotanyof them.Theado-lescencerisisandcrucialquestionsaboutsamenessnddifference(sexuality,dentifications,lliances)eadthemto psychoticdisordersorto searchor traumaticactingout solutions.Inanethnopsychiatricrameoffamilypsychotherapyherapeuti-calproposalsimto activatesignificantandpertinentepresentationsof thepatients'originculturesuchaspossessionyancestors,eniesof natureorprotectorspirits.Fortheadolescenthisisalogicalaffi-liativenductionhatleadsupto theaccomplishmentf aninitiationriteanda changementf familyinteractions.heparentscanmodifytheirown wayto negociateiliationslinksandruptures(infringe-ments,complicatedmourning,raceor lineconflictsandsecrets)norderto restorehecontinuityandcohesionof generations.FREE COMMUNICATION SATRAUi\lA IN FAJ.\lILYHISTORY A1~DDEVELOPlVIENT OF PSYCHOSIS IN A16YEAR OLD POLITICAL REFUGEE: ACASE REPORTE.MJ.vl.KOSADINOSLauraD.migratedromHaitito Francettheageof3, togetherwith hermotherandoldersisterandgrew in a remotesuburbanareaof Paris.Theentirefamily(1moresisterand3 brothers)wereaccordedhepoliticalefugeestatus.Sheandhersisterhadearlyschoolproblems.Hersisterknewprostitutionat the ageof 14.Laurawasoftenabsentfromclass,wanderedwith juvenilegangs,wassuspectedor prostitution.Shedidn'tacceptauthority,wasaggressive,asbeatenbyherpeersandher elderbrothers.Thelast2 yearsshefollowedspecialschoolunsuccessfully.heSocialServicesouldnotdomuchbecausef the

family'sbadcooperation.Laura'smothersaidshehadbeenpersecutednHaitibydictatorDuvalier'smiliciaswho torturedherand killedherhusbandandfatherof herchildrenhesameyearLaurawasborn.ThisdeathhasbeenkeptsecretromLauraowhomit wastoldthat herfatherwentaway,neitheralivenordead.Atrtheageof 15shewentonatripwithhermotherto Guyanatomeetherfather'srelativesndwasthereinitiatedo vaudouritesbya sectleader.Returningbackshedevelopeddeasof referen-ceanda fewmonthslatera psychoticsyndromefeelingof beingdoubledandhallucinationsommandingherbodymovements).hewastreated15 daysn GeneralHospitaland75 daysin PsychiatricHospitalbeforethesesymptomsisappeared.

Thiscasellustratesomemecanismsmpliedn psychosis.rau-mainthe familyhistoryscorrelatedo whatremainssecreto the

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- .. Ilia.FRIDAY JULY 715HOO - 16H30subjecthusexcludinganysymbolisation.Thesymptomseveala regressiono transitivismndto themir-rorstageasformulatedbyJacquesacan.Theappearancef psychoticiseasen Lauragaveto the familytheopportunityo revealheirhistoryo thetherapistsandto colla-boratewith theMentalHealthandSocialServicesnorderto establi-sha realisticehabilitationrojector Laura.FREE COMMUNICATION 6A

TRAUlVIATIC FACTORS IN THEFRENCH INTEGRATIVE PATTERNSCHOOLA. FROTTIN,ASSOCIATION LA NOUVELLE FORGECREIL FRANCEFrancewasa countryof immigrationduringmanyyears.Twokindsof immigrantshavecomeintoFrance.Someof themcametoFranceattr-actedythesearchof ajob.Theeconomiceasonsthemainexplanation.heycamefromNorthAfricaandtheformerfren-chcolonies.Theyaregenerallypoorandfor manyof themfew inser-ted in their culturaltraditions.Otherimmigrantscamefor political

reasonsrefugees),romViet-Nam,ran,andrecentlyromex-Yugo-slavia.Manychildrenbornin France,r havingeft theirparent'scoun-try veryyoung,areovertheir childhoodcorrectlyadaptedto theFrenchwayof life, havingearnthabits,Frenchanguage,eryhel-

pedbythe school,mportantactorof integrationhroughthe lear-ningof nationalvalues,history,humanrights...Wemeetin consultationentersmanyteenagerswho becomeunableto studywithout understandinghy, younsterswho assertanexacerbatedeelingof ethnicbond,an importantnvestmentnreligiousor culturalnterestselatedo theirorigins;someof themcommitantisocialctions.Itseemshat beyondheoppositionagainstheparentaligures,the schoolitselfdoesnot allowthem to negociatebetweentvvo

valuesystemserceivedsantagonist.Clinicalexemplesry to showhowa shortfamilyhelpcanbebroughtby the psychiatrist.n our center,a theaterclubenhancesfrequentlyheabilityo expressing,o enactingsuchdifficultfeelings.FREE COMMUNICATION 7A

THE CHRONIC ATTACHlVIENTDISORDER - RISK FACTOR FOR THETRAUMA OF YOUNG ADOLESCENTSIN ROMANIA

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ASSOC. PROF. TIBERIU lVIIRCEA, MD PHDUNIVERSITY OF MEDICINE ANDPHARMACY, TIMISOARA, ROMAL'IIAAnykindofattachmentdisorderwhichappearsnthefirstchild-hoodcouldbefoundasdifferentormsin adolescence,swellasin

thematurityperiod.Inthe EasternEuropeanountries,hecommunistegimeconsi-deredtheweeklynurseryor the nurserywith prolongprogramasaformof socialprotecticm,whichcanallowthemothero work.Tho-

se institutions,accordingto their working styleand the staff consti-tute, in fact, laboratoriesfor producing reactiveattachmentdisor-der,for childrenbetween0-2 years,to successivegenerations.

The author identifies and put into discussionforms of attach-ment disorderthat appearin adolescenceespeciallyo thoseyoungwho were brought up in nurseries),he impactof the vulnerabiliza-tion modificationsduring the traumadue to socialpost revolutiona-ry modifications,and the crossingof the presenttransition period inRomania.

FREE COMMUNICATION SACO1VLVlUNITYLIFE AS A SPACEBET\VEEN REPETITION ANDELABORATIONTill'JGUY DE FOYTheTherapeuticCenterfor Adolescents*welcomes,duringanaveragedurationof 3 to 6 months,a dozenyoungpeoplewhosepsychologicalroblemsanddifficultiesin communicatingustifyaseparationromthefamilyor institutionnalndschoolenvironment.TheCenteracklesheproblemsromthreedifferentangles:1.communityife2.workshops3.workwithfamiliesFromour clinicalexperienceat the Center,we aregoingtodemonstratehe levereffectof communityife,bothin its indivi-dualaspectscreationof an ownarea,responsibilityaking,identity

search)anditscollectiveaspectslearningof the encounter,hedif-ference,he limits).Wewould liketo presentourwork throughthisvisionof thecommunityifeasan environmentwhereonecanfind possibilities(aswellasdifficulties)o repeathismisbehaviours,o rememberhetraumahatcausedt,andtoelaboratenewpossibilitiesf life.* TheTherapeuticCenterorAdolescents5tLucHospital-Brus-sels-CatholicUniversityfLouvainProf.VanMeerbeeck

FREE COMl\tIUNICATION 9ACAIVIBODIA 1975 - 1978 :CLINIC OF TERRORPH. AUBY, A.M. PEZOUS, P. MORONDespitehe recognitionhatrepetitionof physicalndpsycholo-gicaltraumatismsmaycuaseseriousphysicalandemotionalmpair-ments,especiallynadolescence,esssknwonabouthesymptomsshownbythe survivorsof massviolence.Duringthe KhmerRougeregime,rom1975to 1978,cambodianpeopleunderwentperhapsthemostviolentandfar-reachingf allmodernrevolutions,nwhichanestimatedoneto threemillionofapopulationof sixto sevenmil-lionCambodianserekilled.Thepsychologicalequelaeof thesetraumaticexperiencesanbepresentedn termsof clinicof terror.All thedatareviewedofthe internationalmedicaliteratureandof the evidencesgivenby

cambodianautobiographiesreconcordant,howingthat all thecambodiannationwasthrownin a regimeof terror.Onthebasisofour clinicalpsychiatricexperiencewith South-EastAsianrefugees,particularlyKhmersivingincampson thekhmer-thaiborder,andofmedicaliteratureandtestimonies,e suggestelationshipsfspeci-


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FRIDAY JULY 715HOO- 16H30d'autres formes de pathologie, surtout nevrotiques. Nous pensonsque cette symptomatologie pourrait etre interpretee comme le refletd'une tentative frenetique et inappropriee de reorganisation,lorsque cette reorganisation s'opere aux depens du moi et qui devradesormais apprendre a conjoindre des elements totalement incom-patibles, entre-deux-systemes symbolique. Ceci temoigne de I'in-certitude et d'un certain malaise que peuvent eprouver les soignantsface a des jeunes qui proviennent d'une autre culture; les instru-ments conceptuels habituels ne paraissent plus suffisants pour uneevaluation correcte.

FREE COMMUNICATION 3AFROi\1 TRAUl\lA TO PAIN: DOUBLEJOURNEY OF THE El\lIGRANT ADO-LESCENTALBERTO GHILARDI,PAOLA lVIM"FREDIAt thismoment the phenomenon of the emigrationregardsall

the world population, especially because of emigration of the extra-european and east european population to the central Europe. Thissituation involves singles and families, young people and adoles-cents. Often the cause depends on hard social and politicalproblems(wars, wretchedness, epidemics), so the trauma of emigration addsup to already difficultfeelings. Allthis situation could turn into socialmaladaptation (acting out), and mental problems (panic, anxiety,loneliness), often diagnosticated as uproot pathology. There istheriskthis kind of phenomenological disgnosis could be translated intoa therapeutic project to facilitate the take root in a new place,inthe meaning of adaptation to actual life,forgetting the past expe-rience of the potentially traumatic uproot.

Using some clinical illustrations, we would liketo show as, inthese cases, the therapeutic process could give the shape, into thesetting, of an emigration of the therapeutic couple to the adolescentoriginating country, and also as, ina second time, can be possible tofacilitate and increase the processes of adaptation to the new lifereality,through a second emigration to the new country.

All this permits the adolescent the mental representation andthe working through of a part of his history and of his Self, whichthe trauma had frozen and depleted. We want to underline that thedifferent ethnic and/or cultural origin of the couple patient-therapisthas got therapeutic efficacityto facilitate the keep intouch, bytrans-lation in a common clinicallanguage of two different geographicallyrealities,the trauma doesn't permit the patient to integrate psycholo-gically.You can obtain it working into the same psychological expe-rience of emigration, intending to rescue parts of the Selflost by theadolescent. At the end we underline as the solving of the traumagives space to prove mental pain.

FREE COlYIMUNICATION 4AAFFILIATION AND INITIATION ADO-LESCENCE AND PSYCHOTHERAPY INA CROSS CULTURAL SITUATIONMARINA PAPAGEORGIOUTheinitiationitesfor adolescentsntraditionalsocietiesre

complexraumaticechniquesf decomposingndreconstructing

the individualidentitywhose finality is to obtain the metamorphosisof the subjectand affiliate him to a new envelope,a group of mem-bersthat sharethe samereferencesand transmit a cultural identity.As like the birth rites that aim to incorporate a child and alsothefuneral ritesthat aimto transforma deceacedin ancestorand foundthe group memory and continuity, the initiation rites are culturalcontainersto passfrom filiation to affiliation.

In a crosscultural context,more often migrantscannottransmitthe ancestors'legacy,becauseof the breakingoff in their own filia-tion. Children of migrants are splited between two heterogenousculturalframesnot able to be internalizednot anyof them. Theado-lescencecrisisand crucialquestionsabout samcenessnd difference(sexuality,identifications,alliances)lead them to psychoticdisordersor to searchfor traumaticactingout solutions.

In an ethnopsychiatricrameof family psychotherapyherapeuti-calproposalsaimto activatesignificantandpertinent representationsof the patients'origin culturesuchaspossessionby ancestors,geniesof natureor protector spirits.Forthe adolescentthis is a logicalaffi-liativeinduction that leadsup to the accomplishmentof an initiationriteanda changementof family interactions.Theparentscanmodifytheir own way to negociate filiations links and ruptures (infringe-ments,complicatedmourning, race or line conflicts and secrets)inorderto restorethe continuity andcohesionof generations.FREE COMMUNICATION SATRAUl\lA IN Ffu\'lILY HISTORY ANDDEVELOPl\'lENT OF PSYCHOSIS IN A16YEAR OLD POLITICAL REFUGEE: ACASE REPORTE1\iM..KOSADINOSLauraD.migratedromHaitito Franceat theageof 3, together

with her mother and older sisterand grew in a remote suburbanareaof Paris.Theentirefamily(1moresisterand3 brothers)wereaccordedthe politicalrefugeestatus.

Sheand her sisterhad early school problems. Her sister knewprostitution at the age of 14. Laurawas often absentfrom class,wandered with juvenile gangs,was suspectedfor prostitution. Shedidn't acceptauthority,wasaggressive,wasbeatenby herpeersandher elder brothers. The last 2 years she followed special schoolunsuccessfully.TheSocialServicescouldnot do muchbecauseof thefamily'sbadcooperation.

Laura'smothersaidshehad beenpersecutedin Haitiby dictatorDuvalier's miliciaswho tortured her and killed her husband andfather of herchildrenthe sameyearLaurawasborn.Thisdeath hasbeenkept secretfrom Laurato whom it wastoldthat herfather went away,neitheralivenor dead.

Atr the ageof 15shewent on a trip with her motherto Guyanato meether father's relativesandwas there initiated to vaudouritesby a sectleader.Returningbackshedevelopedideasof referen-ce and a few months later a psychoticsyndrome(feelingof beingdoubled and hallucinationscommandingher bodymovements).Shewas treated 15 daysin GeneralHospitaland 75 daysin PsychiatricHospitalbefore thesesymptomsdisappeared.Thiscase illustratessomemecanismsimplied in psychosis.Trau-ma in the familyhistoryiscorrelatedto what remainssecretto the

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THURSDAY JULY 615HOO-16H30-- ~--~ ~.._~-_._--------------._----FREE CONllVlUNICATION 3ATHE FUTURE OF SUICIDALADOLESCENTS COiVIPARED TO ACONTROL GROUPLAURENT A., FOUSSARD N.JBOUCHARLAT J.,DEBRU~OST lVI.Objective:Thisfollow-upstudy examinedthe social, medica!

and psychologicaloutcome of 587 childrenandadolescentshospita-lizedat the Central UniversityHospital(CHU)in Grenoblefollowingattempted suicidebetween 1982and 1993.Method and materials: The death rate was obtained directlyfrom state civilservices,whilst the social.medica!and psycho!ogicaloutcome was assessed through auto-questionnaire distributed bypost to adolescents,parents and generaJpractitioners. The resultswere compared with a control population (N=273)constituted ofpatients hospitalized on paediatric or stomatology wards. The twopopulations were matched for age, sex and hospitalization penod.Results:Thedeath rate calculatedfrom446 suicidaladolescentsand 223 controlswas foundto be2,6% and 0,9% respectively.Thetotal suicidalrecurrence known for 282 suicidalwas 34%. The num-ber"of responses to auto-questionnaires was 43% in the suicidalgroup and 64% in the control group. After matching the twogroups, the social,medicaland psychologicalparameterswere eva-luated in 221 suicidal patients and 105 centrol subjects. The meanage was 14,8+ 1J and 14,4+ 1,9yearsold respectivelyat the timeof hospitalizationand 20 + 3,4 and20;2 + 3,2 in1993.Theaveragetime lapsein the studywas6 years,2 months. Significantdifferenceswere found in the foHowingparametersusing the Chi-Squaretest:scolaritywasvvorsein the suicidalgroup,andalcoholicconsumptionwassignificantlygreater; the numberof psychiatrichospitalizationsand mental health consultationswas also greater. Socialisationasmeasuredin the auto-questionnairewas also worse in the suicidalgroup. However, no significantdifferencewas found concerningother parameterssuchas family life, employment, invaliditybenefit,sick-benefit,or psychotropicmedication.Discussionand conclusion:whilst certainresultstend to be reas-suring for the future of suicidal adolescents, other results are somew-hat alarming.The latter in themsetvesjustify the current efforts indiscerningprimarilywhich suicidalchildrenand adolescentsrequirefoiiow-up treatmentoverprolongedperiodsof time, andsecondlytoascertaineffective treatmentsadapted to the individualneeds.FREE COl\t1L\lI.UNICATION 4A

TRAUlYIA, SUICIDE AND CARE-SETTINGCAULE-DUCLER E.} PR LAFLAQUIERE A'JDR. PONll'VIEREAU X.TheU.M.P.A.J.A.Medico-psychologicalUnit for AdolescentsandYoungA.dults),unby Dr.Pommereau,fferssuicidaladoles-'

centsandyoungadultsa short hospitalization9 daysonaverage)allowinga medical,psychologicalndsocialappraisalof theircrisis.Thishospitalizationepresentsspecificplaceandtimeof transitionbetweenEmergenoJareUnitsandotheravailableealthandsocio-educationalstructures.In responseo thiscontextof crisiscommonto all in-patients,

the containingdimensionof the setting occupies in this respect aprotective shield function in relation to internal (instinctual)andexterna!(factual)excesses.HowEver,workingwith the crisisin thewaywe proposedoes not involveonly this immediateact of protec-tion. We are alsoconcernedwith the stimulatingaspectof thistypeof residential care.

Clinicalexperiencerevealsthat the stimulation resultingfrom atherapeuticsetting cannot be workedout duringthe hospitalizationperiodalone, and this ftay must be viewedas the first stage of atrauma, which fits intO.and resonatesalongthe traumatic chainofthe subject's history.

Themaintherapeutic relevanceof thisbriefhospitalizationistheemotional emphasison the suicidalact, which largelypreventsthedenialof psychologicalinimization that veryoften occurssponta-neouslyand revealstherefore a major riskofthe act being repeated.The hospitalization, on the other hand, does tend, paradoxically,ikeanytraumaticexperience, bothto fix the adolescent in his suicideattempt and to facilitate the revivalof his psychicself-historicizingbecauseof thelivelystimulationitarouses.

This mode! of a sufficiently traumatic hospitalization, canaccount for the obserJationof a significantlyhigher compliancetopsychotherapy after a stay at UMPAJA : the emotional stimulusgenerated by the short hospitalization leads up to and prepares forthe later stages of psychotherapy, of deferred action, of workingthrough the trauma.

Finally,we developthe hypothesisthat the therapeuticaspectofthis hospitalizationplayson the concomitantactorsof the suicidaladolescent' recognized traumatic vulnerabilityand the traumaticdimension - controlled for the most pa/1- of the setting.Wesuggestthat the therapeutic efficiency of this hospitalization is due to theconstanttension betvveenits potentiallytraumatic dimensionand itscontainingdimension.We thus underline the relevanceof the analo-gy between the care given and the psychicfunctioning of thepatientsconcerned.FREE COl\tll\IUNICATION SA

EiVIERGENCY CONSULTATION ANDPSYCHIATRIC HOSPITALIZATION:ARE THEY TRAUlYIATIC DURINGADOLESCENCE ?lNTERESTOF APOST-HOSPITALIZATION EVALUATIONP. LAJ.'JA, E. KOSADINOS, C. VEDRENNE,lYl.J. GUEDJThedeCISIonoaddressnadolescento psychiatriconsultationor evento hospitalizehimin a psychiatryepartmentsveryoftenthe resultof an inpassor the consequenceof behaviourdisorders.Accompanyingr addressingo consultationmpliesculpabilityandtherapeuticchoicesuffersthe displacementf that culpabilityratheronedetail.raumatism,ccordingo FERENCZI,hostudiestasoccuringetweenhildandadult,sinrelationwiththe adult'sculpability.Experiencef receivingpatients.nterveningncrisisor evenhos-

pitalizinghemin AdultPsychiatryDepartmentaspracticedat theCPOA(PsychiatricConsultationor ReceptionandOrientationinEmergency),bligesusto questionourselvesnthe eventuallyrau-maticaspectof ourpracticeor theadolescents.

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THURSDAY JULY 615HOO - 16H30Culpability of the inteNenants, of the patient's environment and

of the psychiatriccaregiving staffscouldbe a factorenforcingthataspect.These adolescent patients are systematically asked to consult asecondtime on the site of emergency care after the end of a short

period hospitalizationin Departmentfor Adu!tsand they are ques-tionned followinga semi-directivemethod on their personalexpe-rienceof emergencycafeand hospitalization.

Interiorizationof thisexperienceand consciousintegrationwhichoccur,seemto witnessthat it is not foreign body}}at work in theirpsychologicallife.FREE CO1VIIVIUNICATION 6ATRAUlVL\, ADOLESCENCE ANDPATHOGENESIS OF BORDERLINEPERSONALITY DISORDERlVlADEDDU F., LINGIARDI V.,BA1~ZULLI L., lVlAFFEI C., ORLAl'


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FRIDAY JULY 715HOO ... 16H30cl'autresformes de pathologie, surtout nevrotiques.Nous pensonsque cettesymptomatologiepourrait etre interpn?teecomme 'e refletd'une tentative frenetique et inappropriee de reorganisation,lorsqueceUereorganisations'opereaux depensdu moiet quidevradesormaisapprendrea conjoindredes elementstotafement incom-patibles,entre-deux-systemesymbolique)}.Cecitemoignede 1'in-certitudeEt d'un certainmalaiseque peuventeprouverlessoignantsface a desjeunes qui proviennent d'une autre culture; les instru-mentsconceptuelshabituelsne paraissentplus suffisantspour uneevaluationcorrecte.FREE COlVl1"lUNICATION 3A

FROlVI TRAUIViA TO PAIN: DOUBLEJC)URNEY OF THE ElVlIGRANT ADO-LESCENTALBERTO GHILARDI,PAOLA NLt\1~FREDIAt thismomenftEe-phenomenon of the emigration regardsail

the world population, especiallybecauseof emigrationof the ex:tra-europeanand eastEuropeanpopulation to the central Europe.Thissituation involvessingles and families, young people and adoles-cents.Often the causedependson hardsocialand politicalproblems(wars,wretchedness,epidemics),so the trauma of emigrationaddsup to alreadydifficult feelings.At!this situationcould turn into socialmaladaptation (acting out), and mental problems (panic,anxiety,loneliness),often diagnosticatedoSUprootpathology/).There istheriskthiskindof phenomenologicalisgnosisouldbe translatediotoa therapeuticprojectto facilitatethe takeroot in a new place),in the meaningof adaptation to actuallife, forgetting the past expe-rienceof the potentiallytraumaticuprooV>.

Usingsome clinical illustrations,we INould like to show as, inthese cases, the therapeutic process could give the shape, into thesetting, of an emigration of the therapeutic couple to the adolescentoriginatingcountry,and alsoas,ina secondtime,can be possibletofacilitateand increasehe processesf adaptationo the new lifereaiity, througha secondemigrationto the newcountry.

AI!this permits the adolescent the mental representation andthe working through of a part of his historyand of his Self,whichthetraumahadfrozenand depleted.Wewant to underlinethat thedifferentethnicand/of culturaloriginof the couplepatient-therapisthas got therapeuticefficacityto facilitatethe keepintouch, bytrans-lation in a comrnon clinicallanguage of two different geographicallyrealities,he trauma doesn't permitthe patientto integratepsycholo-gically.Youcan obtainitworkinginto the same psychologicalexpe-rienceofemigration,intendingto rescuepartsof the Selflostbytheadolescent.,[\tthe end we underlineas the solvingof the traumagivesspaceto provementalpain.FREE COlVlNIUI~ICATION 4AAFFILIATION AND INITIATION ADO-LESCENCE AND PSYCHOTHER.A.PY INA CROSS CULTURAL SITUATIONlVlARINAPAPAGEORGIOUThe initiation rites for adolescentsin traditional societies are

complex traumatic techniques of decomposingand reconstructing

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the individual identitywhose finaJityis to obtain the metamorphosisof the subjectandaffiliate him to a new envelope,a group of mem-bersthat sharethe samereferencesand transmit a cultural identity.As like the birth ritesthat aim to incorporate a child and alsotherunera!ritesthat aimto transforma deceacedin ancestorandfoundthe group memory and continuity, the initiation rites are culturalcontainersto passfrom filiationto affiHation.

Ina crosscultural context,moreoften migrantscannot transmitthe ancestors' legacy,becauseof the breakingoff in theirownfilia-tion. Childrenof migrantsare splited between two heterogenouscultura!framesnot able to be internalizednot anyof them. Theado-lescencecrisisand crucialquestionsabout samenessand difference(sexuality, identifications,lliances)eadthemto psychoticdisordersortosearchfor traumaticactingout solutions.

!n an ethnopsychiatric frame of familypsychotherapyherapeuti-calproposalsimto activate significantandpertinent representationsof the patients'originculture suchas possessionbyancestors,geniesof natureor protEctorspirits.Forthe adolescentthis isa logicalaffi-liativeinduction that leadsup to the accomplishmentof an initiationriteanda changementoffamilyinteractions.heparentscanmodifytheir own way to negociate filiations links and ruptures (infringe-ments,compiicatedmourning, raCEor line conflicts and secrets)inorder to restorethe continuity and cohesion of generations.FREE COlYL.\fUNICATIONSATRl\UNL'\ IN FAlYlILYHISTORY ANDDEVELOPNIENT OF PSYCHOSIS IN A16YEA.ROLD POLITICAL REFUGEE: ACASE REPORT1\'11'\:1.KOSADINOSLauraD.migratedfrom Haiti to Franceat the age of 3, together

with her mother and older sister and grew in a remote suburbanareaof Paris.Theentirefamily(1 moresisterand3 brothers)wereaccordedthe politicalrefugeestatus.

Sheand her sisterhad early school problems.Hersisterknewprostitution at the age of 14. Laurawas often absent from class,wanderedwith juvenile gangs, was suspectedfor prostitution-Shedidn't acceptauthority,wasaggressive,wasbeatenby herpeers andher eider brothers. The last 2 years she followed special schoolunsuccessfully. TheSocialServicescould notdomuchbecausef thefamily'sbad cooperation.Lama's mother said shehad been persecuted in Haiti bydictatorDuva!ier's mific ias who tortured her and killedher husband andrather of her children the same year Laurawas born.

This death has been kept secret from Laurato whom it was toldthat her father went away, neither alivenor dead.

Atr the age of 15 she went on a trip with her mother to Guyana{{tomeet her father's relatives and was there initiated to i


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FRIDAY JULY 715HOO = 16H30subject thus excluding any symbolisation.Thesymptomsreveala regressionto transitivismand to the mir-ror stage as formulated byJacques Lacan.Theappearanceof psychoticdiseasein Lauragavetothefamilythe opportunityto revealtheir historyto the therapistsand to colla-boratewith theMentalHealthand SocialServicesn order to establi-

sh a realisticrehabilitationprojectfor Laura.FREE COMl\tlUNICATION 6./\TRAU1\1lATIC FACTORS IN THEFRENCH INTEGRATIVE PATTER1"JSCHOOLA. FROTTIN,ASSOCIATION LA NOuVELLE FORGE-- -CREIL FRAl'.TCEFrancewas a country of immigration during manyyears.Twokindsof irnmigrantshavecomeinto France.Someof them cameto

Franceattfacted by the searchof a job. Theeconomicreasonis themainexplanation.Theycamefrom North Africaand the former fren-ch colonies.Theyaregenerallypoor andfor manyof them few ioser-ted in their cultural traditions. Other immigrants camefor politica!reasons(refugees),from Viet-Nam,Iran,and recentlyfrom ex-Yugo-slavia. .Manychildrenborn in France,or having!eft their parent'sCOW1-

try very young, are over their childhood correctly adapted to theFrenchway of life, havinglearnt habits,Frenchlanguage,veryhel-ped by the schoof,important factor of integrationthrough the lear-ning of national'lalues,history, human rights...Wemeet in consultationcentersmany teenagerswho becomeunableto study without understandingwhy, younsterswho assert

an exacerbatedfeeling of ethnic bond, an important investmentinreligiousor cultural interestsrelatedto their origins; some aTthemcommit antisocialactions.

It seemsthat beyondheoppositionagainstthe parentalfigures,the school itself does not allow them to negociate between twovaluesystemsperceivedasantagonist.

Clinicalexemplestry to show how a short family help can bebrought by the psychiatrist.In our center, a theaterdub enhancesfrequentlythe abilityto expressing,o enactingsuchdifficult feelings.FREE COMMUNICATION 7ATHE CHRONIC ATTACHlVIENTDISORDER - RISK FACTOR FOR THETRAUMA OF YOUNG ADOLESCENTSIN ROlVlANIAASSOC. PROF. TIBERIU lVHRCEA, IVID PHDUNIVERSITY OF IVIEDIClNE ill'JDPHARMACY, TIMISOA.1U\, ROIV1AL'HA,b.,nyindof attachmentdisorderwhichappearsnthefirstchild-hoodcouldbefoundasdifferentformsinadolescence,sweBasin

thematurityperiod.IntheEasternEuropeanountries,hecommunistegimeconsi-deredtheweeklynurseryor the nurserywith prolongprogramasaformof socialprotecticm,hichcanallowthemothertowork.Tho-

se institutions,accordingto their working styleand the staff c onsti-tute, infact, laboratoriesfor producing reactiveattachmentdisor-der,for childrenbetween0-2 years,to successive generations.The author identifies and put into discussion forms of attach-

ment disorder that appear in adolescenceespeciallyo those youngwhowere brought up innurseries),the impactofthe vulnerabiuza-tion modificationsduring the traumaduetosocialpost revolutiona-rymodifications,and the crossingof the present transitionperiod inRomania.FREE COMMUNICATION 8ACOlVI1VIUNITY LIFE AS A SPACEBETWEEN REPETITION ANl;ELABORATIONTANGUY DE FOYTheTherapeuticCenterfor Adolescents*welcomes,during anaveragedurationof 3 to 6 months,a dozenyoungpeoplewhosepsychologicalroblemsanddifficultiesincommunicatingustifyaseparationromthefamilyorinstitutionnalndschoolenvironment.TheCenteracklesheproblemsromthreedifferentangles:1.{(communityife2.workshops3.workwithfamiliesFromour dinical experienceat the Center,we aregoingtodemonstratehe {devereffectof communityife,both in its indivi-dualaspectscreationof anown area,responsibilityaking,identitysearch)anditscoHectivespectslearningof the encounter,he dif-ference,he limits).Wewould liketo presentourwork throughthisvisionof thecommunityifeasan environmentwhereonecanfind possibilities(aswellasdifficulties)o repeathismisbehaviours,o rememberhetraumathatcausedt,andtoelaborateewpossibilitiesflife.* TheTherapeuticCenterforAdolescentsStLucHospital-Brus-

sels-CatholicUniversityof Louvain-PraY.VanMeerbeeckFREE COMMUNICATION 9ACANIBODIA 1975 - 1978 :CLINIC OF TERRORPH. AUBY, A.lVI.PEZOUS, P. lVI0RONDespitethe recognitionthat repetitionof physicaland psycholo-

gicaltraumatismsmaycuaseseriousphysicaland emotional impair-ments' especiallyn adolescence,essis knwonabout the symptomsshown bythe survivorsaTmassviolence. During the KhmerRougeregime,from 1975 to 1978,cambodianpeopleunderwentperhapsthe mostviolentand far-reachingof aHmodern revolutions, inwhichan estimatedone to threemillionof a populationofsixto sevenmil-lion Cambodians were killed.

The psychologicalsequelaeof these traumaticexperiencescanbe presented in termsof clinicof terroD>.Anthe datareviewedofthe international medical literature and of the evidencesgiven bycambodian{{autobiographiesare concordant, showing that all thecambodian nation was thrown in a regime of terror. On the basisofour clinical psychiatricexperiencewith South-EastAsian refugees,particularly Khmers livingin camps on the khmer-thaiborder, andofmedica!literatureand testimonies, we suggest relationships of speci-

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Trauma and Adolescence, Communications, Emmanuel Kosadinos author