Prediction of Psychosomatic Symptoms Based on an Invalidating Environment with the Mediating Role of Alexithymia in Individuals with Generalized Anxiety Disorder
Keywords:
invalidating environment, alexithymia, psychosomatic symptoms, generalized anxiety disorderAbstract
The aim of the present study was to predict psychosomatic symptoms based on an invalidating environment with the mediating role of alexithymia in individuals with generalized anxiety disorder. The research method was descriptive–correlational using a structural equation modeling design. A total of 300 individuals with generalized anxiety disorder who had referred to counseling centers in Tehran in 2025 were selected through convenience sampling and completed the Patient Health Questionnaire, the Toronto Alexithymia Scale, and the Childhood Invalidating Environment Scale. Data analysis was performed using structural equation modeling in SPSS 26 and AMOS 26. The findings indicated that the relationship between an invalidating environment and psychosomatic symptoms was positive and significant (β = 0.35, p < .01). In addition, alexithymia played a mediating role in the relationship between an invalidating environment and psychosomatic symptoms (β = 0.30, p < .01). Therefore, it can be concluded that an invalidating environment affects psychosomatic symptoms in individuals with generalized anxiety disorder both directly and indirectly through the mediating role of alexithymia. It is suggested that psychologists and therapists apply appropriate therapeutic interventions, including dialectical behavior therapy and emotional self-regulation training, to reduce alexithymia and, consequently, mitigate the impact of childhood invalidating environments on psychosomatic symptoms.
Downloads
References
1. Mishra AK, Varma AR, Varma A. A Comprehensive Review of the Generalized Anxiety Disorder. Cureus. 2023;15(9). doi: 10.7759/cureus.46115.
2. Henning M, Subic-Wrana C, Wiltink J, Beutel M. Anxiety disorders in patients with somatic diseases. Biopsychosocial Science and Medicine. 2020;82(3):287-95. doi: 10.1097/PSY.0000000000000779.
3. Koh KB. Stress and Somatic Symptoms. Cham: Springer; 2018.
4. Sekhon H, Allali G, Beauchet O. The association of anxio-depressive disorders and depression with motoric cognitive risk syndrome: results from the baseline assessment of the Canadian longitudinal study on aging. Geroscience. 2019;41(4):409-18. doi: 10.1007/s11357-019-00093-z.
5. Pratama R, Murni AW. Unraveling the Pathways: A Meta-Analysis Exploring the Biopsychosocial Mechanisms Linking Psychosomatic Symptoms and Systemic Lupus Erythema tosus. Bioscientia Medicina: Journal of Biomedicine and Translational Researc h. 2025;9(2):6410-24.
6. Han C, Pae CU, Patkar AA, Masand PS, Kim KW, Joe SH, et al. Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients. Psychosomatics. 2009;50(6):580-5. doi: 10.1176/appi.psy.50.6.580.
7. Shobe Z, Feizi A, Afshar H, Hassanzadeh Keshteli A, Adibi P. Identifying Psychosomatic Disorder Profiles and Their Relationship with Psychological Problems in a Large Iranian Adult Population. Journal of Mazandaran University of Medical Sciences. 2016;26(137):82-94.
8. Schaarschmidt ML, Schmieder A, Umar N, Terris D, Goebeler M, Goerdt S, et al. Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes. Archives of dermatology. 2011;147(11):1285-94. doi: 10.1001/archdermatol.2011.309.
9. Linehan MM. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
10. Robertson CD, Kimbrel NA, Nelson-Gray RO. The Invalidating Childhood Environment Scale (ICES): Psychometric properties and relationship to borderline personality symptomatology. Journal of Personality Disorders. 2013;27(3):402-10. doi: 10.1521/pedi_2012_26_062.
11. Rahmati F. The Mediating Role of Self-Compassion, Distress Tolerance, and Impulsivity in the Relationship between Eating Attitude and Eating Behavior with the Childhood Invalidating Environment in Adults: Shahid Beheshti University of Medical Sciences; 2022.
12. Comijs HC, Van Exel E, van der Mast RC, Paauw A, Oude Voshaar R, Stek ML. Childhood abuse in late-life depression. Journal of affective disorders. 2013;147(1-3):241-6. doi: 10.1016/j.jad.2012.11.010.
13. Riem MM, Doedée EN, Broekhuizen-Dijksman SC, Beijer E. Attachment and medically unexplained somatic symptoms: The role of mentalization. Psychiatry research. 2018;268:108-13. doi: 10.1016/j.psychres.2018.06.056.
14. Silva T. Parental Alienation: In the Child's Worst Interest. IntechOpen2022.
15. Boafo YDUF, Danquah EKAMM, Nandjui A, Hema EBRFW, Bailey B. Long-term management of crop raiding by elephants around Kakum Conservation Area in southern Ghana. Pachyderm. 2004;37:45-55. doi: 10.69649/pachyderm.v37i1.1203.
16. Gargiulo ÁJ, Colombini A, Trovato A, Oddo S, Puddington M. Comparative study of perceived invalidating environment and stress coping strategies between patients with drug resistant epilepsy and functional dissociative seizures. Seizure: European Journal of Epilepsy. 2024;119:128-34. doi: 10.1016/j.seizure.2024.05.018.
17. Holmes A, Marella P, Rodriguez C, Glass ID, Goerlich KS. Alexithymia and cutaneous disease morbidity: a systematic review. Dermatology. 2022;238(6):1120-9. doi: 10.1159/000524736.
18. Elahimanesh H, Shahgholian M, Abdollahi M-H, Rajabi F. Predicting Emotional Suppression Based on Alexithymia and Type D Personality in Patients with Cardiovascular Disease. The Journal of Shahid Sadoughi University of Medical Sciences. 2021;29(8):3989-4001. doi: 10.18502/ssu.v29i8.7660.
19. Badaye A, Vaziri S, Lotfi Kashani F. The Contribution of Emotion Regulation, Defense Mechanisms, and Attachment in Predicting Psychosomatic Symptoms with the Moderation of Gender and Distress Level. Journal of the Medical Council of the Islamic Republic of Iran. 2021;39(1):30-8.
20. Mahmoudi M, Saberi H, Bashardoust S. Predicting Psychological Distress Based on Childhood Trauma with the Mediating Role of Alexithymia. Advances in Cognitive Science. 2022;24(3):41-56.
21. Xu L, Shi J, Li C. Addressing Psychosomatic Symptom Distress with Mindfulness-Based Cognitive Therapy in Somatic Symptom Disorder: Mediating Effects of Self-Compassion and Alexithymia. Frontiers in Psychiatry. 2024;15:1289872.
22. Loehin JC. Latent variable models: An introduction to factor, path, and structural equation analysis: Psychology Press; 2004.
23. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2023.
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2026 Zeinab Hajirahimkhan (Author); Seifollah Rahmani; Mahmoud Goudarzi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
