A developmental-psychodynamic model for diabetic control

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This paper elaborates a psychodynamic-developmental model as a framework for understanding the wide range of adaptive and maladaptive responses to the self-care requirements of diabetes. Early life experience participates with other factors in influencing the ease with which diabetics implement diabetic control. This model emphasizes the importance of the mother-child interaction during the second phase of development, the toddler phase, at which time the child begins to establish a sense of autonomy and control over his own body and its functions, with bowel training viewed as a paradigm for body control. It is postulated that certain types of mothers such as controlling-intrusive mothers, overprotective mothers, or guilty, indifferent, or rejecting mothers create problems for the child related to the development of autonomy and the sense of comfortable and pleasurable control over his bodily functions. Conflicts generated during this period are reactivated with the onset of diabetes and lead to difficulty in implementing control. In some situations where conflicts with the caretaker figure were predominantly limited to aspects of control, trusting relations acted as a substrate for change and improvement in control in a supportive medical environment. Specific management recommendations based upon this model are presented.