Table 2.

Reciprocal effects of adolescent development and cystic fibrosis

	Effect of CF on development	Effect of development on chronic illness
Biological	Delayed puberty Short stature Reduced bone mass accretion Malnutrition secondary to inadequate intake due to increased caloric requirement of disease or anorexia	Increased caloric requirement may worsen disease control Increased insulin resistance at puberty may cause diabetes/worsen diabetic control
Psychological	Infantalization Adopt sick role Egocentricity persists later Impaired development of sense of sexual/attractive self (men) in view of delayed puberty and low weight Relationship with food affected Issues around ideal body weight – increased risk of eating disorders May be prone to depression/anger	Increasing independence can lead to poor adherence Poor adherence and disease control due to poor abstract thinking and planning Self concept of bullet-proof Reject medics like parents Risk-taking behaviours
Social	Reduced independence when should be separating from parents Social isolation (segregation from peers, missing school, illness-related fatigue, medication time, rejected from peers or have fantasies of rejection, admissions, treatment) Segregation from other CF friends May lead to vocational failure identity concerns as future uncertain Failure of peer and couple relationships	Associated health risk behaviours Chaotic eating habits → malnutrition smoking, alcohol, drug use, sexual risk-taking common and may be exaggerated in view of limited life span