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OBJECTIVES: Current research studies reveal many protective and risk factors for relapse among patients with schizophrenia. The main aim of this study was to make an attempt at identifying the relationship between sense of coherence, self-influence on the disease course and quality of life determined by patients' suffering from schizophrenia current state of health. METHODS: The study involved 50 patients, diagnosed with schizophrenia by the ICD-10 criteria, who were/ were not suffering from relapse in 2-year period from last hospitalization. In order to measure sense of coherence, self-influence on the disease course and quality of life, patients were asked to complete: Sense of Coherence Scale (SOC-29), Brief Measure to Assess Perception of Self-Influence on the Disease Course - Version for Schizophrenia and Sense of the Quality of Life Questionnaire. RESULTS: Statistical analysis revealed no differences in sense of coherence, perception of self-influence on the disease course and quality of life among patient with relapse or during remission. Nevertheless, the relation between sense of coherence and quality of life was observed in both groups. Patients who were suffering from relapse had their metaphysical (spiritual) quality of life also correlated with perception of self-influence on the disease course. CONCLUSIONS: This pilot study leads to conclusion that sense of coherence - along with its manageability and meaningfulness components - may be closely related to psychophysical, psychosocial and subjective quality of life for patients suffering from schizophrenia, both in long remission and currently experiencing a relapse.

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Many people are interested in BDSM practices. Some people practice and others fantasize about participating in these practices. Several elements are related to BDSM practices that are usually unaccepted in a close relationship, such as a strong dependence of one partner on the other or inflicting pain. BDSM practitioners create various relationships, and in a broader context, their communities. From a clinical perspective, an important issue is whether BDSM relation is consensual and serves the personal and relationship development or it can be a premise for the diagnosis of a paraphilic disorder, or recognizing abuse or mechanism of trauma repetition Adequate understanding of the behaviors that may be described by a patient practicing BDSM requires, however, getting to know the specifics of such relationships. The mental and sexual health professional would be able then to evaluate them adequately, without referring to a subjective norm or bias on stereotype or prejudice.

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OBJECTIVES: The aim of the research was to study the narrative of BDSM practitioners (sadism and masochism - S/M, bondage and discipline - B&D) and to attempt to describe how they interpret and define their practices and what significance they have in their life. METHODS: Qualitative methodology - grounded theory - has been used in the study. The sample consisted of 12 individuals aged 20-49 who identified with BDSM practices. The data have been collected through intensive interviews with participants. RESULTS: Based on the language analysis of the interviews, researchers established categories related to identity and the definition of BDSM. Subsequently, the initial model of the process of defining one's own sexuality in BDSM practicing individuals was proposed. CONCLUSIONS: The research showed stages of the process of defining and accepting their sexuality in BDSM practicing individuals and multifaceted identification with their BDSM roles. The initial stage of the development of identification with BDSM was gender identity and sexual orientation. The participants defined their sexuality by either the identification with their roles in BDSM practices (not only as a form of sexual activity, but also in every-day life) or assuming such roles temporarily. It seems that defining their identity by the persons practicing BDSM is not an either-or between "identity" or a "role", but can be seen as continuum.

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Attempts at unifying the diagnostic and therapeutic procedures for transgender individuals experiencing gender dysphoria were first undertaken in Poland in the 1980s. Since then, there has been a change in the perception of transgenderism, almost paradigmatic, expressed in subsequent editions of the diagnostic systems (DSM, ICD), which is also associated with the fundamental changes in the principles of conducting trans-specific healthcare. This triggered the need to formulate recommendations for specialists practicing in Poland, which would at least partly reflect the evolution of views and guidelines on clinical care in transgender adults seeking help due to gender dysphoria.

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BACKGROUND: Minority stress is an important risk factor for sexual problems in gay and bisexual men. It remains unclear whether and to what extent this stress is associated with the sexual quality of life in these groups. AIM: To investigate the significance of minority stress as a factor explaining the sexual quality of life in gay and bisexual men. METHODS: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple regression analysis was used to investigate the importance of minority stress in explaining the sexual quality of life in a group of 1,486 non-heterosexual men in the context of other predictors, including demographics, the level of current sexual function, sexual patterns and experiences, and mental and physical health. We used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. The level of sexual functioning was evaluated using 2 scales, the International Index of Erectile Functioning and the Premature Ejaculation Diagnostic Tool. Data on the remaining predictors were obtained using a survey that we developed. MAIN OUTCOME MEASURES: The men's sexual quality of life as rated on the Sexual Quality of Life Scale for Men was a dependent variable. RESULTS: Internalized homophobia (ß = -0.28; P < .001) and sexual minority negative events (ß = -0.09; P < .001) were statistically significant predictors of sexual quality of life in non-heterosexual men. Internalized homophobia (ß = -0.28; P < .001) and erectile function (ß = 0.29, P < .001) turned out to be the strongest predictors. Sexual orientation (gay vs bisexual) and its interactions with individual processes of minority stress were statistically nonsignificant. CLINICAL IMPLICATIONS: To evaluate and improve the sexual quality of life of non-heterosexual men, it is necessary to consider not only their sexual function, but also the minority stress they experience, particularly internalized homophobia. STRENGTHS & LIMITATIONS: The major strengths of the study include a large sample size, a comprehensive assessment of minority stress, and the previously understudied Central European cultural context. The major limitations are the nonrepresentative sampling, retrospective data collection, and cross-sectional design. CONCLUSION: Internalized homophobia predicts poorer sexual quality of life in gay and bisexual men in Poland. Grabski B, Kasparek K, Müldner-Nieckowski L, et al. Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress. J Sex Med 2019;16:860-871.

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This paper will discuss the character of sexual relationships between women, considering their social and cultural context. The problem is still little known also to experts dealing with mental and sexual health. This may have serious consequences for the process of correct diagnosis of sexuality-related issues reported by those women. The article focuses on selected factors that have an impact on the character of this group's sexual function. Those factors include sex, heteronormativity and homophobia, as well as social messages related to female sexuality and sexual relationships established by women. The authors take up and subject to critical examination also the issue of "lesbian bed death" and fusion in same-sex relationships established by women. Towards the end, there is a holistic model by Heather L. Armstrong and Elke D. Reissing that describes sexual problems of women who have sexual contact with other women. The authors consider the issues brought up herein to be significant from the clinical point of view. Acknowledgement thereof by professionals dealing with mental and sexual health may contribute to extensive reflection over sexual and relationship problems of women who have sex with women, as well as to providing more efficient help to this group.

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OBJECTIVES: The aim of the study was to show the differences in declared therapeutic goals and priorities, and in concerns about the therapeutic process, between LGB (lesbians, gays and bisexual people) people and psychotherapists. METHODS: Participants from both groups fulfilled semi-structured questionnaire, which was anonymously available on-line through the link sent together with the invitation to participate in the study. LGB people were contacted through the biggest Internet site for non-heterosexual people in Poland. The invitation was also sent to the psychotherapists, members of the Polish Psychiatric Association. The questions and responses in both versions of the questionnaire were formulated in that way, so as to enable adequate comparisons. RESULTS: The two most important therapeutic goals for respondents in both groups were: help in the acceptance of sexual orientation and emotional support with the difficulties of living in a hostile environment. The most common concerns for LGB people were that psychotherapists might attempt to change their sexual orientation, whereas for psychotherapists, the most common concern was that they would be helpless in the face of the social situation of LGB people. CONCLUSIONS: Psychotherapists and LGB people basically agreed upon the therapeutic aims of psychotherapy. The adverse social situation of non-heterosexual people in Poland is a source of their concerns about the psychotherapeutic relations. On the other side the concerns of psychotherapists seem to correspond to some degree with the concerns of LGB people. They both reflect the society, which still struggles with heterosexism and homophobia.

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The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.

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This article aims to present controversy surrounding current desire disorder criteria listed in DSM IV. Developed by Masters and Jonhson in 1996, completed later by Kaplan in 1974, the human sexual response cycle which is the basis for contemporary desire disorder criteria, in some aspects stands in opposition to the results of the newest research. This paper presents evidence to change the DSM criteria suggested by Basson and analyzes recent proposals for DSM V criteria for consideration of these arguments.

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The issues of mental health and psychological well-being of sexual minorities have become one of the ponderable scientific questions in recent years. Not only do they attract the attention of psychiatrists, psychologists or sexologists, but also of public health professionals. It is because psychiatric disorders in sexual minorities are not only the source of individual suffering and dysfunction, but also a big and so far unappreciated social problem. The research results in this field were mostly unreliable in the past, because they were based on the false paradigm, assuming that homosexuality unquestionably belongs in the realms of psychopathology. This became a major selection bias in which researchers tried to draw conclusion upon the mental status of the hole population of homosexual people only from studies of clinical populations. New studies analyse the mental status of this relatively big social group implementing data from epidemiological population-based studies, which allows the more realistic assessment of the problem. In this work we presented new data indicating the elevated risk of psychiatric disorders within the sexual minorities. The problem was discussed in the context of living in the reluctant and hostile environment (minority stress exposure).

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The results of the researches show that the prevalence of emotional problems among homosexual persons is higher in comparison with the general population. However, homosexual orientation should not be treated as a reason for that, which is stressed by the greatest associations of mental health, basing on research. The question of the causes of increased prevalence of mental disorders among members of the sexual minorities remains without a clear answer. The theory of minority stress seems to be a very interesting explanation. It integrates a variety of risk factors, which may influence the stress level. In the article we try to explain this concept, hoping that it will be useful in understanding the situation of homosexual people.

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The authors discuss stage models of gay and lesbian identity formation first proposed during the 1970s within affirmative approaches to homosexuality. The process of developing homosexual identity is characterized here with linearly ordered stages distinguished around major developmental events leading to new self-definition. Among many stage proposals the authors have chosen and presented two: by Vivienne Cass and Susan McCarn with Ruth Fassinger. The presented models were analysed in terms of their usefulness in therapeutic practice aimed at promoting the formation of gay identity, for which they have been originally designed. An important part of this discussion is evaluation of the accuracy of developmental process descriptions contained in stage models.

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AIM: The paper presents results of research concerning attachment patterns and anxiety in adolescents suffering from mixed disorders of conduct and emotions. METHOD: Both clinical and control group completed the Parental Bonding Instrument and State-Trait Anxiety Inventory. The first questionnaire measures parental style as perceived by the child, it consists of two scales: care and control. The second one the temporary condition of "state anxiety" and the more general and long-standing quality of "trait anxiety". RESULTS: The study revealed that adolescents from the clinical group perceive their parents as less protective than the control. Adolescents from the clinical group revealed also a higher level of anxiety, both as a state and as a trait. CONCLUSIONS: The basic conclusion is that there are differences between groups in family functioning--adolescents from the clinical group received less protection from parents, which may influence their behaviours aimed at providing them more safety.

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AIM: The paper presents results of research concerning attachment patterns and aggressive behaviours in adolescents suffering from mixed disorders of conduct and emotions. METHOD: Both the clinical and the control group completed Parental Bonding Instrument and Polish version of Buss-Durkee Inventory. The first questionnaire measures parental style as perceived by the child, it consists of two scales: care and control. The second one measures some dimensions of aggression. RESULTS: The study revealed that adolescents from the clinical group perceive their parents as less protective than the control. It showed very weak relations between relations with the parents and expression of aggression. These results are discussed. CONCLUSIONS: The basic conclusion is that there are differences between groups in family functioning--adolescents from the clinical group received less protection from their parents what may influence their behaviours aimed at providing them more safety. Results concerning the relation between family relations and aggression indicate that future research must take into consideration other social relations of adolescents.

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AIM: The aim of the study was comparison of perception of attachment patterns between adolescent girls suffering from anorexia nervosa (restrictive type), bulimia nervosa and healthy peers. Moreover, we tried to find the differences between the groups in self-esteem and identification with the culture-defined sex role. METHOD: We examined 40 patients with anorexia, 32 with bulimia and 63 girls from the comparison group. Three questionnaires were used: Parental Bonding Instrument, The Culture-Free Self-Esteem Inventory and Psychological Sex Inventory. RESULTS: Results indicate that the parents' emotional commitment in relations with daughters from the clinical sample is weaker, and they are controlled by parents more then those from the control group. In all groups, the mothers' emotional commitment correlates positively with daughters' social self-esteem. In the anorectic group, fathers' control correlates negatively with daughters' identification with the culture-defined feminine role. In the bulimic group, fathers' emotional commitment correlates positively with self-esteem as well as daughters' identification with the culture-defined masculine role. CONCLUSIONS: The results concerning the bonds between the ED patients and their parents indicating dysfunctions of the bonds are generally consistent with the data from literature. Additionally they show the relationship between quality of the bonds between the patients and parents and its influence on development of self-evaluation and a sense of feminity/masculinity in anorectic and bulimic girls.

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While working with homosexual couples, professionals have to recognize specific conditions they live in and the characteristics of their relation dynamics. Patterns elaborated for working with heterosexual couples are often useless in the case of homosexual couples and may even lead to a misunderstanding of their behaviours. This especially refers to the roles they play in the couples, the problem of acceptance of their sexuality, experiences connected with the process of sexual orientation disclosure and others. Taking into consideration differences between homosexual and heterosexual couples is crucial while dealing with their problems.

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When working with homosexuals, it is very important to take into consideration the social and cultural context in which they live. It influences both the problems experienced by them and the process of revealing these problems. It is crucial for professionals who help them. If they are not aware of their own prejudices, their relations with patients are disturbed and the process of treatment is impeded.

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Emotional disturbances in children and adolescents may be explained basing on different aetiological theories. One of them is the attachment theory created by Bowlby. It stresses the relationships between the characteristic of children's relations with caregivers and their behaviours, which might be described as symptoms in certain circumstances. Attachment behaviours should not be treated as the only explanation of disturbances but rather as a risk factor. Another advantage of the theory is that it might be helpful in the integration of different theories referring to the aetiology of emotional disturbances, taking into consideration both intrapsychic and interpersonal factors.

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AIM: The paper presents results of research concerning the differences in some aspects of self-image between female adolescents with anorexia nervosa (who meet criteria of DSM-IV) and their healthy peers. METHOD: Each group consisted of 30 individuals. They completed the Offer Self-Image Questionnaire for Adolescents (OSIQ). It is a self-descriptive personality test that can be used for measuring the adjustment of adolescents between the ages of thirteen and nineteen. RESULTS: The study revealed some interesting differences between groups. They refer mainly to emotional aspects of their functioning. CONCLUSIONS: The basic conclusion is that self-image of anorectic girls is much more disturbed than of the healthy girls. Significant differences are presented and discussed according to the literature.

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AIM: The paper presents results of research concerning the differences in self-esteem and their relations with self-image in female adolescents with anorexia nervosa (who meet criteria of DSM-IV) and their healthy peers. METHOD: Every group consisted of 30 individuals. They completed the Culture-Free Self-Esteem Inventory, which enables measuring the self-esteem in three aspects: general self-esteem, personal self-esteem and social self-esteem. RESULTS: The study revealed lower self-esteem in girls suffering from anorexia nervosa than in the control group. CONCLUSIONS: Lower self-esteem of anorectic girls is connected with their emotions toward themselves and their social relations.

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