Institute of Family Therapy

Abstract Background. Health-Related Quality of Life (HRQoL) in patients with chronic kidney disease (CKD) is significantly affected, regardless of the stage of the disease, as regards the physical, psychological and social functioning dimension. Big-Five personality traits can affect patients’ HRQoL and willingness to take treatment options. Illness denial consists of denial of negative emotions, resistance to change and conscious avoidance. No study investigated illness denial and personality traits simultaneously. We investigated the role of illness denial and Big-Five personality traits in the domains of HRQoL in predialysis patients with CKD.Methods. One hundred adults (mean age: 75.87 years) with CKD participated. Poorer HRQoL can predict a higher risk of hospitalization and mortality, and broadly a worse adjustment to the dialytic therapy. Thus, a clearer knowledge of the psychological variables associated with a worse HRQoL in the predialysis stage might improve the interventions planning. The Kidney Disease Quality of Life Short form (KDQOL-SF), the Italian version of Ten Item Personality Inventory (I-TIPI), the Illness Denial Questionnaire (IDQ), and the State-Trait Anxiety Inventory Form-Y (STAI-Y) were administered. Results. Illness denial was associated with increased HRQoL in symptoms, effect, burden of kidney disease and cognitive functions domains, and it was a predictor of higher HRQoL in the last three domains mentioned above. Extraversion was related to better work status and sexual function; agreeableness was linked to elevated cognitive function, quality of social interaction and sexual function; conscientiousness was related to better sexual function; neuroticism was linked to improved cognitive and sexual functions; in the end, openness to experience was related to fewer symptoms and problems.Conclusions. This is the first study which simultaneously assessed Big-Five personality traits and illness denial in different domains of HRQoL of CKD patients. Personalised psychological interventions aimed at improving HRQoL in this population might focus on specific illness denial processes and personality traits.

This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN. Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents. Adolescents with early-onset eating pathology were significantly more likely to report an earlier age of menarche than those developing the disorder at the typical age, and were found to have a different pathway of symptom development. Increased awareness of this may help identify those particularly at risk for developing an early-onset of eating pathology.

This article describes how family therapists can routinely address the important, but often overlooked, issue of how some children may play parental roles in families. In some situations such as inadequate or absent parenting, a child is drawn into the parental subsystem and becomes identified as a ‘little parent’ in a process known as parentification. As well as gaining competence in caring, this experience may also become destructive to children in a number of ways. This includes loss of childhood and, as children are unable to fulfil the parental role adequately, low self‐esteem, depression and other symptoms. The concept of family attachment scripts is used to understand the implications of a child crossing adult/child boundaries which can lead to looking after parents and siblings. Family therapy techniques help to redress the role reversal and enable the parents to take appropriate responsibility in the family. Work also focuses on how to prevent transmission of parentification down the generations. Therapists have often been parental children. How this can influence their work is illustrated by a specific case.

SUMMARY The paper presents a discussion between two therapists—one female, the other male, one a clinical psychologist and the other a psychiatrist, one working in an institution and the other in a private practiceeach surviving the suicide of a client. It discusses what helped

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Although childhood psychiatric disorders are commonly seen in general practice, only a few children in the community gain access to professional help. Whether a child is referred or not depends on various factors to do with the child and family and others, such as what the GP expects from the referral. Severity per se is not the only referral determinant. Whether GPs know what the child psychiatric services in the area have to offer could also be expected to affect referral (Markantonakis & Mathai, 1990). We are aware of the need for general practitioners to be made more aware of the services that we have to offer.