Psychological adjustment to end-stage renal disease and the implications of denial

Denial has been thought of as a primitive defense mechanism, although in the medically ill population there is some indication that it may promote adaptation. In this study the authors examined the relationship of denial and psychological adaptation in 63 end-stage renal disease (ESRD) patients. While all patients had similar levels of global dysfunction, the patients with low denial scores had significantly greater interpersonal sensitivity and greater mood and sleep dysfunction than did those with high denial scores. The inability of some ESRD patients to use denial-like processes can be understood from a cognitive-behavioral perspective. This may have treatment implications for mood dysfunction in this group.