Psychopathology and Narrativity in Childhood Obesity

The study of the psychopathology of obese children offers only partial data which cannot wholly account for the etiology of child obesity. In clinical work, it is imperative for us not to separate the psychopathological approach from cultural, social and biological approaches in order to achieve a global understanding of the issue. First, we will examine the contribution of cognitive behavioral theories. According to the externality hypothesis, obese children are more sensitive to external stimuli than to internal ones (hunger, satiety...). On the other hand, the conscious food restraint theory states that there is a link between that externality and chronic food deprivation. Second, we will examine the contribution of psychoanalytical theories. For infants, orality is predominant during the first stages of psychic life, given that it condenses various notions such as the need for food, autoerotic pleasure and object relations in the works of S. Freud. The notion of orality also enables K. Abraham, M. Klein and D. W. Winnicott to theorise the differentiation between ego and object. In children, an excessive cathexis of orality can precipitate a rupture of the energetic balance – food intake is superior to energy output – whether it follows a regressive movement in reaction to oedipal desires or a narcissistic defence of self image. Finally, numerous works link the early food experiences of obese children to a psychosomatic hypothesis : a constant offer of too much food might have a synergistic echo with the baby’s inability to discriminate his own internal stimuli. As a result, he will be deprived of the ability to have his own personal experiences of hunger and satiety. Alexithymia, frequently described in psychosomatic pathologies, could be connected to an abnormal development of narrativity. As regards this subject, we will discuss recent results about narrativity among 23 obese children between 3 and 6 years of age. The study of early food experiences based on the model developed by S. Lebovici seems to be a fruitful approach for future research concerning the psychopathology of child obesity.