Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders.

BACKGROUND: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user's perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. OBJECTIVE: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. METHODS: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. RESULTS: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. CONCLUSIONS: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered.

Validation of the Italian Version of the Telepresence in Videoconference Scale (TVS) in a Sample of Psychologists and Psychotherapists During the COVID-19 Pandemic.

OBJECTIVE: Telepresence may play a fundamental role in establishing authentic interactions and relationships in online psychological interventions and can be measured by the Telepresence in Videoconference Scale (TVS), which was validated only with patients to date. This post hoc study aimed to validate the Italian version of the TVS with mental health professionals. METHOD: The Italian TVS was included in an online survey, whose primary aim was to assess the experiences of Italian psychologists and psychotherapists with online interventions during the first wave of the COVID-19 pandemic and was filled in by 296 participants (83.4% females, mean age = 42 years old). RESULTS: Exploratory factor analysis supported the original factor structure only partially because the scale 'Absorption' (i.e., the feeling of losing track of time), as it was formulated, did not measure telepresence. Correlations were also explored between the TVS scales and some survey items pertaining to intimacy and emotional closeness to patients, comfort and positive as well as negative experiences with online interventions. CONCLUSION: The TVS may be a useful tool to measure physical and social telepresence in online interventions, both in patients and in professionals.

Patient experiences of people with leg ulcers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic affected the care of people with chronic leg ulcers (CLUs). AIMS: To understand how people with CLUs perceived illness, health care and the public health emergency during the second wave of the COVID-19 pandemic. METHODS: Twenty people attending a wound care clinic in Northern Italy participated in semi-structured interviews and a thematic analysis was conducted using the software Atlas.ti 9. FINDINGS: Results show that most of the participants evaluated their healthcare experience as positive but differed in their perceptions of the changes brought about by the pandemic according to their varied illness experiences and perceived social support. Participants were grouped in four trajectories that provided insight into the construction of personalised support strategies for people with CLUs. CONCLUSION: These results may help inform healthcare interventions and policies in the care of long-term conditions such as CLUs during a widespread emergency in future.

Social Support and Help-Seeking Among Suicide Bereaved: A Study With Italian Survivors.

BACKGROUND: Research over how suicide survivors approach services is limited. Aims: This cross-sectional study explores the psychological state and perceived social support of Italian survivors, including those who have not sought for help, and investigates differences for gender or kinship with the departed. Methods: Rule-based system (RBS) analyses identified relationships between social support and reported formal/informal help-seeking behavior. One-hundred thirty-two (103F; 27M) suicide survivors (53 having never sought for support) answered an anonymous online survey. Life satisfaction, wellbeing, perceived social support, suicidal ideation and formal/informal help-seeking were investigated. Results: RBS analysis identified different help-seeking behaviors: survivors lacking social support may avoid reaching a psychologist and prefer GPs, look for advice in online forums and rely on people out of their narrower network such as co-workers. Conclusion: These unique study's results offer insight to identify which specific areas would be fruitful to investigate while assessing social support in bereaved individuals.

The Interplay Between Strictness of Policies and Individuals' Self-Regulatory Efforts: Associations with Handwashing During the COVID-19 Pandemic.

BACKGROUND: Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA). PURPOSE: This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions. METHODS: The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection). RESULTS: Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring. CONCLUSIONS: When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation.

Sexual and Reproductive Health in Women with Pulmonary Hypertension: A Qualitative Study.

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevation in pulmonary artery pressure causing progressive symptoms: shortness of breath, fatigue, and a decline in functional ability. Research on the impact of PAH on sexual and reproductive health was sparse. The aim of this study is to explore sexual and reproductive health of women with PAH in relation to their illness experience. Twenty-five women with PAH participated in semistructured interviews. A thematic analysis was conducted on the transcripts using the ATLAS.ti software. Four main themes were identified: illness experience, intimate relationship, sexuality, and attitudes toward pregnancy. Results showed that illness changed women's self-perception, couples' relationship, sexuality, and the idea of an eventual pregnancy. The relationship with the partner was usually indicated as an important resource, whereas communication with health care professionals was a critical but also potential key resource for the future. Results point to the need for intervention strategies to support women with PAH and help them make aware choices. Moreover, intervention strategies may inform health care interventions and policies for tackling the challenges posed by this illness.

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked. METHODS: An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not. RESULTS: The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others. CONCLUSIONS: Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.

Media Use During the COVID-19 Pandemic: Cross-sectional Study.

BACKGROUND: Throughout the pandemic, the general population was encouraged to use media to be kept informed about sanitary measures while staying connected with others to obtain social support. However, due to mixed findings in the literature, it is not clear whether media use in such a context would be pathogenic or salutogenic. OBJECTIVE: Therefore, the associations between COVID-19-related stressors and frequency of media use for information-seeking on trauma- and stressor-related (TSR) symptoms were examined while also investigating how social media use for support-seeking and peritraumatic distress interact with those variables. METHODS: A path model was tested in a sample of 5913 adults who completed an online survey. RESULTS: The number of COVID-19-related stressors (ß=.25; P<.001) and extent of information-seeking through media (ß=.24; P=.006) were significantly associated with the severity of TSR symptoms in bivariate comparisons. Associations between levels of peritraumatic distress and both COVID-19-related stressors and information-seeking through media, and social media use for support- and information-seeking through media were found (ßCOVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; ßseeking information: Peritraumatic Distress Inventory=.70, P<.001; ßseeking information-seeking support=.04, P<.001). CONCLUSIONS: Results suggest that exposure to COVID-19-related stressors and seeking COVID-19-related information through the media are associated with higher levels of peritraumatic distress that, in turn, lead to higher levels of TSR symptoms. Although exposure to the stress of the COVID-19 pandemic may be unavoidable, the frequency of COVID-19-related information consumption through various media should be approached with caution.

End-of-life care after the legal introduction of advance directives: A qualitative study involving healthcare professionals and family caregivers of patients with amyotrophic lateral sclerosis.

BACKGROUND: Advance care planning and advance directives play a key role in the care of life-threatening illnesses such as amyotrophic lateral sclerosis. AIM: The aim of the present study is to explore how the introduction of these features by law improves the experience of end-of-life care. DESIGN: Five focus groups were conducted in Italy 1 year after the new law on advance directives was introduced. SETTING/PARTICIPANTS: Purposive sampling was used to recruit 24 health professionals and 23 family caregivers of patients with amyotrophic lateral sclerosis, for a total of 47 participants. RESULTS: The thematic analysis, conducted through the use of ATLAS.ti software, identified four thematic areas: best practices, managing difficulties, care relationships and proposals. The results indicated a lack of organization, collaboration and continuity on the part of healthcare services and professionals, a lack of information on palliative care, advance care planning, and advance directives. End-of-life care is often left to the good will of the individual professional. Difficulties can also derive from ethical dilemmas concerning end-of-life decision-making and from a lack of communication and relationships between health professionals, patients and their families. CONCLUSION: The introduction of advance directives by law has not been sufficient to improve end-of-life care. In order to make legal regulation effective, the organization of healthcare services needs to be improved and clearer procedures have to be implemented and shared with patients and families.

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries.

BACKGROUND: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). METHODS: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. RESULTS: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. CONCLUSIONS: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic. TRIAL REGISTRATION: Clinical Trials.Gov, # NCT04367337.

The experience of living with rheumatoid arthritis: A qualitative metasynthesis.

AIMS AND OBJECTIVES: To develop a model of understanding of how rheumatoid arthritis (RA) affects daily life based on a third-order interpretation of qualitative findings. BACKGROUND: Rheumatoid arthritis is a chronic condition subject to a progressive deterioration of joints, limiting the ability to move and causing severe impairment in patients' lives. DESIGN: A qualitative metasynthesis. METHODS: CINHAL, ProQuest, PsycINFO, PubMed, SCOPUS and Web of Science databases were searched for relevant studies applying appropriate criteria. Screening and selection of studies were performed following the PRISMA guidelines and the PRISMA checklist was completed. Thirty-eight qualitative articles were retrieved: in total, 17 were excluded for failing to meet inclusion criteria, and 21 were considered for synthesis. Data analysis followed a third-order interpretation of data for synthesising qualitative research. RESULTS: Findings led to the creation of a model consisting of two overarching categories: "rheumatoid arthritis impact on life domains" and "Confronting the illness," and two cross-sectional codes: "Health" and "Independence and normality." CONCLUSION: This meta-study provides a model that is both inclusive of participants' own viewpoint and solidly grounded in a health psychology model. RELEVANCE TO CLINICAL PRACTICE: The model can be highly informative for both practitioners and researchers in developing tailored interventions of support and prevention.

Online counseling: An exploratory survey of Italian psychologists' attitudes towards new ways of interaction.

OBJECTIVE: Online counseling may be defined as an interaction between users and mental health professionals that takes place through computer mediated communication technology. This study aimed to investigate the attitudes of Italian psychologists towards different aspects of online counseling provided via email, chat, forums, and videoconference. METHOD: An online questionnaire was administered to a sample of 289 licensed psychologists in the Veneto Region (Italy) in order to collect opinions, preferences, and intentions to use online modalities, along with prior knowledge and practice experiences. RESULTS: Only 18.3% of the respondents had previous experience with online counseling. Overall, the majority of psychologists (62.6%) were favorable towards online counseling, but they also had several reservations about the provision of online diagnosis and therapeutic interventions. Results showed a consistent lack of clarity regarding ethical and penal issues concerning online modalities. CONCLUSIONS: More efforts must be directed to deepening the application of new technologies in the field of psychology in order to enable an ethical and professional practice of online counseling in Italy.

When the woman gets violent: the construction of domestic abuse experience from heterosexual men's perspective.

AIMS AND OBJECTIVES: To promote a critical approach on the conceptualisation of domestic violence by investigating the experience of abuse on the part of men who are victims of domestic violence by their female partners. BACKGROUND: Media attention and prevention programmes relating to domestic violence have mainly focused on women as the victims and men as the perpetrators. The underlying idea is that violence is predominantly physical and a prerogative of men. This conceptualisation of violence reduces the opportunities for the consideration of different modalities of abuse. DESIGN: Discourse analysis within a qualitative approach. METHODS: Semistructured interviews with 20 Italian men who claimed to have been abused by their female partners were conducted via Skype and analysed with the software atlas.ti. The grounded theory methodology was used to avoid imposing external points of view. Personal data were collected; in particular, their occupational level was compared to their partners' to assess the social power within the couple. RESULTS: Because of their strong endorsement of social and cultural values, participants showed a protective attitude towards their partners and imputed their violent acts to fragility or an external condition. Emotional distress emerged due to the isolation and subsequent inability to seek help. Although the physical violence reported is severe, the psychological violence was indicated as more damaging. CONCLUSION: Gaining an understanding of how men experience domestic abuse offers an opportunity to provide better prevention and intervention for them and other family members at risk of abuse. RELEVANCE TO CLINICAL PRACTICE: The study identifies gaps in service provision generated by a lack of information or perceived prejudice towards abused men. The role of the nurse in supporting male victims is discussed, and future applications for treatments and prevention plans are proposed.

Illness trajectories in patients with amyotrophic lateral sclerosis: How illness progression is related to life narratives and interpersonal relationships.

AIMS AND OBJECTIVES: To identify illness trajectories in amyotrophic lateral sclerosis by analysing personal, social and functional dimensions related to amyotrophic lateral sclerosis progression. BACKGROUND: Previous studies have considered some psychological distinct variables that may moderate illness progression, but no research has combined an extensive qualitative understanding of amyotrophic lateral sclerosis patients' psychological characteristics and illness progression. DESIGN: A mixed-methods approach was used to combine quantitative and qualitative measures. Illness progression was assessed through a longitudinal design. METHODS: Eighteen patients with amyotrophic lateral sclerosis attending a Neurology Department in northern Italy participated in the study. Semi-structured interviews to explore personal experience, and dependency grids to assess the distribution of dependency; ALSFRS-R and neuropsychological screening were, respectively, used to measure physical and cognitive impairment. To assess the progression of the disease, ALSFRS-R was re-administered after 8 months and mortality rate was considered. Data were analysed using the grounded theory approach. RESULTS: Illness progression changed according to the perception of the disease, the trust placed in medical care, self-construction and the distribution of dependency. Based on these categories, cases that had similar experiences were grouped, and four illness trajectories were identified: aggressiveness, threat, constriction and guilt. CONCLUSION: The findings suggest that it is possible to identify different illness trajectories in amyotrophic lateral sclerosis. RELEVANCE TO CLINICAL PRACTICE: Personalised intervention strategies may be construed based on the different trajectories identified.

Becoming ex-obese: narrations about identity changes before and after the experience of the bariatric surgery.

AIMS AND OBJECTIVES: This exploratory research investigates obese patients' beliefs and expectations before and one year after bariatric surgery. Changes and resistance to change in the identity system, in the perception of the body, in relationships and in the quality of life were of particular interest. BACKGROUND: Although bariatric surgery represents a promising treatment for obesity, nevertheless, it is still under utilised. This may be because, either the intervention is not always easily accessible or because very little is known about its psychological implications. DESIGN: Open answers provided by participants were analysed through discourse analysis. METHODS: A semi-structured interview about the exchanges in self-representations through time was administered to 30 Italian women, 15 of whom were obese before surgery and 15 were ex-obese, one year after surgery. RESULTS: The research shows that those participants who have already been operated on are generally satisfied with the results obtained; however, they faced considerable difficulties in adapting their identity to their new body. Participants reported that even one year after surgery they still thought, behaved and related to others as though they were still obese, and only after a change in awareness did they become able to realise they are now ex-obese. CONCLUSIONS: This paper contributes to the understanding of the unrealistic expectations of patients before surgery compared with the real changes in their lives, as well the difficulties they still faced one year later. More studies in evaluating how bariatric patients live with this long-term condition are recommended to foster patient-centered care. RELEVANCE TO CLINICAL PRACTICE: Health professionals should also help people to face the difficulties of the postsurgery period, which are linked to the acceptance of the new body and of the new emerging self-image in relationships with others.

Family Functioning as a Constituent Aspect of a Child's Chronic Illness.

This study explored how family functioning may contribute to trace a child's illness trajectory. We conducted semi-structured interviews with 33 parents of children in care at a hospice in northern Italy. We also examined the medical records of the children, and interviewed the physician who cared for them. Data analysis was based on the grounded theory approach. Different illness progressions corresponded to the different ways with which families experienced the illness: possibility, focus on illness, denial, and anger. Clinical interventions should involve the whole family and take into account their role in the construction of illness trajectories.

The family experience of living with a person with amyotrophic lateral sclerosis: a qualitative study.

Living with a person with amyotrophic lateral sclerosis (ALS) is a complex and difficult experience. Most research involves only the primary caregiver and uses a quantitative approach. The aim of this study was to explore the experience of family members who live with ALS patients until their death. In-depth, semi-structured interviews were conducted with 13 family members of ALS patients now deceased. Transcripts were analysed using interpretative phenomenological analysis. Three main themes were identified: "Meaning of ALS," including the peculiarity of ALS and its comparison with other illnesses, the explanation of ALS, emotions, coping strategies, personal change and difficult choices; "Family relationships," including centripetal vs. centrifugal forces, role changes, ALS as a family disease, ALS as a family solution, openness towards the outside world; and "Healthcare context," including access to services, information and humanization. One finding was that families of a person with ALS need more supportive interaction and information during the patients' illness and their end-of-life. This study is an invitation to understand families' experience and subsequently help them to find new ways to cope with the situation.

How the burden of caring for a patient in a vegetative state changes in relation to different coping strategies.

OBJECTIVE: To differentiate the burden of caregivers of patients in a vegetative state (VS) on the basis of different coping strategies and prolonged grief. METHODS: An observational multi-centre study was conducted with 61 caregivers of VS patients hospitalized in specialized units in Italy. The Anxiety and Depression Short Scale, the Prolonged Grief 12 and Family Strain Questionnaire were used to measure caregivers' burden and the Coping Orientations to Problem Experiences to identify the coping strategies used by caregivers. A hierarchical cluster analysis was carried out to group the data and a comparison between clusters was conducted. RESULTS: Caregivers were grouped in two clusters defined by the major proximity among the cases of the same group and the major distance from the cases of the other group. The first group was characterized by lower levels of anxiety, depression, family strain and prolonged grief. This group mainly used coping strategies referring to three factors: Social Support, Positive Attitude and Problem Oriented. The second group showed higher levels of anxiety, depression, family strain and prolonged grief and used the Avoidance strategies more than the first group. CONCLUSIONS: The burden of providing care to a VS patient is mediated by a range of factors including the different coping strategies adopted by caregivers. Support for these caregivers should take this consideration into account and should be subsequently personalized.

Forbidden games: the construction of sexuality and sexual pleasure by BDSM 'players'.

This study aims to explore personal meanings related to the constructs 'sexuality' and 'sexual pleasure' in people who choose to write in forums and blogs about their own experience with Bondage and Discipline, dominance and submission, and Sadism and Masochism (BDSM). We carried out semi-structured online interviews with 343 people, of whom 50 (24 women and 26 men) claimed to practise or to have practised BDSM, in order to investigate participants' definitions of their sexual experiences and the construction of sexuality and sexual pleasure from their personal point of view and from the perspective of the opposite sex. Data were analysed according to Grounded Theory methodology. Questions concerning the 'normality' or the 'deviance' of participants' sexual practices were reflected in the answers of the majority of BDSM practitioners. Sexuality was construed as a 'game' with specific rules, and 'pleasure' was associated with extremely intense experiences. The relationship between the partners was considered fundamental, as it gave meaning to the sexual practice. Both dominant and dominated roles were found to be tightly linked to the possession and management of power between partners, which either confirms or reverses the social construction of traditional male and female roles.