A
Roghayeh Asgarnejad; Atefeh Hojjati
Abstract
Objective: Breast cancer is the most prevalent malignancy among women worldwide, and its experience significantly elevates the likelihood of developing somatization symptoms, thereby imposing substantial healthcare costs (Arnold et al., 2022; Moran et al., 2023). Identifying factors influencing these ...
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Objective: Breast cancer is the most prevalent malignancy among women worldwide, and its experience significantly elevates the likelihood of developing somatization symptoms, thereby imposing substantial healthcare costs (Arnold et al., 2022; Moran et al., 2023). Identifying factors influencing these symptoms is therefore imperative. Personality organization, as a foundational psychological construct, plays a pivotal role in psychosomatic responses to stress, with specific personality traits demonstrably linked to mental health outcomes and adaptation processes in cancer patients (Kovács et al., 2021; Cerezo et al., 2020). Conversely, somatization frequently stems from an inability to directly express negative emotions, a process exacerbated by "entrapment", a psychological state commonly observed in cancer populations and associated with particular personality dimensions such as neuroticism (Çetin & Varma, 2021; Chen et al., 2022). Despite existing evidence, prior research has predominantly focused on direct relationships between Five-Factor Model personality traits and psychosomatic outcomes, exhibiting two critical limitations: first, neglecting the comprehensive theoretical framework of "personality organization," and second, failing to examine the mediating role of entrapment as a key mechanism in chronic cancer-related stress responses. This research gap is particularly pronounced among Iranian women with breast cancer, who face unique cultural challenges (Hosseini et al., 2023). Consequently, the present study employs structural equation modeling to investigate the relationship between personality organization and somatization symptoms, incorporating entrapment as a mediating variable. The primary objective is to determine whether these variables collectively predict somatization symptoms in this population. Method: This fundamental research utilized a descriptive-correlational design. The statistical population comprised all women diagnosed with breast cancer attending Shahid Tajrish Hospital in Tehran during the Iranian calendar years 1402–1403 (2023–2024). Adhering to structural equation modeling principles (Kline, 2012), a sample size of 200 participants was determined and selected via purposive sampling based on predefined inclusion and exclusion criteria. Assessment instruments included the Stress Symptom Checklist (Cheng & Hamid, 1996) for measuring somatization, the Personality Organization Questionnaire (Kernberg, 2002), and the Entrapment Questionnaire (Gilbert & Allan, 1998). The validity and reliability of these tools have been established in both international and Persian-language studies (Shaker, 2018; Ghamarani et al., 2013; Cheng & Hamid, 1995). Following informed consent acquisition, data were collected through self-report questionnaires. Data analysis employed descriptive and inferential statistical methods, specifically path analysis within a structural equation modeling framework using SPSS and AMOS software. This analytical approach enabled examination of direct and indirect relationships among personality organization, entrapment, and somatization symptoms within a cohesive theoretical model. Results: Personality organization demonstrated a significant positive direct effect on entrapment (standardized coefficient β = 0.593, p <.001). Both entrapment (β=0.264, p=.005) and personality organization (β=0.473, p<.001) exhibited significant direct effects on somatization symptoms. Bootstrap testing (Table 1) revealed a significant indirect effect of personality organization on somatization symptoms through entrapment (β=0.156, p=.014), confirming that diminished personality organization intensifies entrapment, subsequently amplifying somatization symptoms at the 5 percent significance level.Conclusion: This study demonstrates that deficits in personality organization predict somatization symptoms in women with breast cancer both directly and indirectly through the mediating role of entrapment. These findings suggest that individuals with maladaptive personality structures lack effective emotion regulation and stress-processing mechanisms, leading them to suppress psychological distress related to their illness and unconsciously manifest it as physical pain or fatigue (Lipowski, 1988). Within this pathway, entrapment functions as a critical missing link: personality disorganization fosters perceptions of helplessness and being trapped by the disease (O'Connor & Portzky, 2018), thereby intensifying the conversion of psychological suffering into physical symptoms. Consistent with prior research (Hosseini et al., 2023; Kang et al., 2023), these results underscore the necessity of transcending purely biological perspectives on cancer. Practically, therapeutic interventions should extend beyond physical symptom management to address personality structure reconstruction and reduction of entrapment feelings. Approaches such as Emotion-Focused Therapy or Cognitive-Behavioral Therapy may disrupt the vicious cycle of somatization by facilitating direct emotional expression and restoring perceived control (Çetin & Varma, 2021). Although limitations exist, including the cross-sectional design and uncontrolled clinical variables, this model provides a valuable framework for developing integrated psychosomatic care protocols tailored to the Iranian cultural context, where direct expression of psychological distress often encounters social barriers.
