Psychological factors associated with severe abuse of the Hemodialysis diet.

Thirty-one maintenance hemodialysis patients were observed for a six-month period. Seven of these patients (22.6%) were severe and persistent abusers of the hemodialysis diet. Because there are serious, even lethal, consequences of the sequelae of hemodialysis diet abuse such as fluid overload and/or hyperkalemia, this finding demands explanation. All seven severe abusers were men and, as a group, their current life situation was devoid of typical adult male gratifications. Their developmental histories indicated major difficulties with resolution of dependency/independency conflicts. Statistical analysis of demographic data and extensive psychiatric interviews support this. The author postulates that severe abuse of the hemodialysis diet results in part from the combination of unresolved dependency conflict, unfavorable current environmental circumstances, and a dependency-provoking treatment regimen. Severe abuse of the hemodialysis diet may serve an adaptive function by allowing at least some gratification in one area of the lives of these patients who suffers severe deprivation.