Psychodynamics in Diabetes: the Relevance of Deepening the Symbolic in Treatment Adherence

Among chronic diseases, diabetes is recognized as amajor health risk negatively affecting the quality of life, with significant morbidity and mortality rates (World Health Organization, 2018), which is expected to rise to 552 million people by 2030, leading to considerable health expenditures (Whiting et al., 2011; Khan et al., 2020). Given its long-lasting nature and risky complications, diabetes requires continuous self-care including being active, eating healthily, taking medication, monitoring symptoms, solving problems, reducing risks, and healthy coping (Di Biase et al., 1997; Glasgow et al., 2008), thus making diabetes management and treatment adherence relevant challenges. In this regard, depressive and anxiety symptoms are often reported by patients with diabetes because of the disease-related distress including worry about complications, fear of hypoglycemia, and guilt feelings about uncontrolled blood glucose (Nouwen, 2015; Sartorius, 2018; Shinkov et al., 2018; Wardian et al., 2018). Overall, this difficulty complying with the stressful rigors of diabetes and required lifestyle changes tends to worsen glycemic control, resulting in higher hemoglobin A1c levels and less optimal outcomes (Whithorth et al., 2016; Egan et al., 2017; Fukuda and Mizobe, 2017; Graham et al., 2020; Schmitt et al., 2021). Therefore, to promote higher patient self-care and treatment adherence, a primary task for healthcare professionals is reducing diabetes distress by improving patients’ skills at regulating negative emotions (Coccaro et al., 2021). Emotion awareness and management in diabetes care are based on the capacity to deal with feelings and thoughts on both conscious and unconscious levels (Ivinson, 1995). From such a perspective, a psychodynamic approach can provide a significant contribution to a better understanding of the patient’s emotional life. This article provides some basic psychodynamic insights with a practical value, focusing on the concepts of alexithymia, defense mechanisms, loss, mourning, and transference–countertransference dynamics in the therapeutic relationship. This may also help medical and nursing professions dealing with diabetes care to reconsider patient difficulties and communication through a new lens, thus improving clinical observation and care.