Rencontre en liaison d’un « jeune majeur isolé étranger », polytraumatisé psychique / An “unaccompanied young adult” with complex post-traumatic disorder met in psychiatry liaison: A case-report

Author(s): Maude LUDOT ; Rahmeth RADJACK ; Marie Rose MORO

http://dx.doi.org/10.1016/j.neurenf.2015.01.005

Résumé

Nous présentons l’observation clinique d’Anis, « jeune majeur isolé étranger » d’origine tunisienne, âgé de 18 ans, souffrant d’un état de stress post-traumatique. Ce trouble s’inscrit dans les suites d’un parcours migratoire semé d’embûches et marqué par le décès de plusieurs membres de sa famille. Nous avons rencontré Anis en service d’orthopédie, dans le cadre de la liaison organisée par la maison des adolescents rattachée à un hôpital parisien. Cette hospitalisation de semaine avait pour but la prise en charge diagnostique et thérapeutique d’une tumeur située au niveau de la cuisse gauche. Cette observation soulève tout d’abord la question de la pathologie psycho-traumatique dans un contexte migratoire. Nous discuterons la psychopathologie et l’impact du diagnostic tumoral, pouvant permettre dans l’après-coup, l’élaboration du traumatisme migratoire. Par la suite, nous nous intéresserons à la question du trouble de la personnalité borderline : comment peut-il se penser dans les suites d’une migration traumatique ? Nous verrons comment la migration et l’intégration culturelle peuvent participer à une construction identitaire en faux-self. Puis, nous développerons, en gardant en toile de fond le contexte migratoire, la notion de « Complex Post-Traumatic-Stress-Disorder », décrit par Herman (1993) pour rendre compte de la possibilité de remaniements de la personnalité dans les suites d’une histoire traumatique.

Mots clés

Migration; État de stress post-traumatique; Traumatisme migratoire; Faux-self; Trouble de personnalité borderline

Abstract

Clinical case

We report the clinical case of Anis, an 18-year-old “unaccompanied foreign young major” from Tunisia, suffering from Post-Traumatic-Stress-Disorder. This condition seems to be related with the migratory course characterized by the death of several family members during the sinking of their clandestine boat. We met Anis in orthopaedics department, within the framework of the consultation liaison psychiatry, part of the missions the adolescent psychiatry department is doing in a Paris Hospital. Anis was staying in the weekly in-patient unit in order to diagnose and treat – in surgery – a tumour, localised at the left thigh.

Diagnostic and psychopathology discussion

First, this case addresses the issue of Post-Traumatic-Stress-Disorder within a migratory context. Indeed, the study of pre-migration, migration and post-migration experiences is essential for understanding psychopathology. Key concepts such as “traumatic seduction through images”, “migratory trauma” and “aftermath” will be developed. We will see that the tumour’s discovery could represent an additional trauma, which can finally allow an elaboration of the migratory trauma aftermath. We could explore several aspects in this case feature of the consultation liaison psychiatry, specific support of cross-cultural consultations etc. We chose to focus our interest on the issue of borderline personality disorder. As a matter of fact, Anis has some traits of a borderline personality disorder, like impulsivity, affective and relational instability, intense anger, suicidal behaviours and dissociative symptoms. How can we understand this disorder within the migratory context ? It will make us consider how migration and cultural integration can lead to an identity construction in false-self. Finally, we will suggest the use of “Complex Post-Traumatic-Stress-Disorder”, a concept first drawn by Herman’s (1993) so as to describe personality changes in the consequences of traumatic history.

Conclusion

This clinical case has enabled to in-depth discuss a psycho-traumatic pathology within a migratory context. The notion of “Complex Post-Traumatic-Stress-Disorder” has been developed in order to understand the possibility of personality changes in our patient. Our liaison psychiatry work was short-lived and comes at a particular moment in the history of the patient: a tumour (still unclear prognosis) was diagnosed and seems to activate the previous trauma, related with migration.

Keywords

Migration; Post-traumatic-stress-disorder; Migratory trauma; False-self; Borderline personality disorder

Tags: Tunisia, France, Young adults, Adolescents, Youth, Unaccompanied minors, PTSD, Complex PTSD, Traumatic life events

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s