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.
A
Hossein Haji Ali Akbari; Abbas Mokhtari
Abstract
Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility ...
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Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility in patients with IBS. Irritable bowel syndrome is considered one of the most prevalent functional gastrointestinal disorders and is characterized by persistent alterations in bowel habits, such as diarrhea, constipation, or a combination of both, accompanied by abdominal pain and discomfort. A defining feature of this disorder is the absence of identifiable structural or biochemical abnormalities in routine clinical examinations and laboratory tests. In other words, despite the substantial impact of these symptoms on patients’ quality of life, no clear organic cause has been established. In recent years, numerous studies have examined the influence of psychological factors on the experience and exacerbation of IBS symptoms. Findings from this body of research indicate a close association between IBS and variables such as perceived stress, pain catastrophizing, anxiety sensitivity, cognitive flexibility, and emotion regulation. Patients with IBS commonly experience high levels of psychological distress, anxiety, and mood disturbances in addition to physical pain, which can substantially diminish their overall life satisfaction. Method: The present study adopted a descriptive–correlational design and was conducted using structural equation modeling (SEM) with a path analysis framework. The target population included all individuals who were diagnosed with irritable bowel syndrome (IBS) by a gastroenterologist, based on endoscopic and colonoscopic examinations, and who referred to gastroenterology clinics and medical centers in Isfahan, Iran, during 2025. Participants were recruited using a convenience sampling method. Although there is no universally accepted guideline for determining sample size in SEM studies, methodological recommendations generally suggest a minimum of 200 participants to ensure adequate statistical power and model stability. Accordingly, an initial sample of 225 patients with IBS, aged 20 to 75 years, was recruited. After screening the data, 25 cases were excluded due to incomplete questionnaire responses. Consequently, data from 200 participants were retained for the final analyses. Data were collected using a battery of standardized self-report instruments, including the IBS Symptom Severity Questionnaire (Solati, 2008), the Perceived Stress Scale (Cohen et al., 1983), the Satisfaction with Life Scale (Diener et al., 1985), the Pain Catastrophizing Questionnaire (Rahmati et al., 2017), the Anxiety Sensitivity Index (Reiss & Peterson, 1986), the Emotion Regulation Questionnaire (Gross & John, 2003), and the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010). Data analyses were conducted using Pearson’s correlation coefficients and structural equation modeling with path analysis. All statistical analyses were performed using SPSS (Version 26) and AMOS (Version 24). Results: The results of the path analysis indicated that IBS symptom severity had a significant positive direct effect on pain catastrophizing (β=.25, p<.01) and anxiety sensitivity (β=.49, p<.01). However, the direct effect of IBS symptom severity on life satisfaction was not statistically significant (β = .03, p = .555). In addition, perceived stress demonstrated a significant positive direct effect on anxiety sensitivity (β= .18, p<.01), pain catastrophizing (β=.18, p<.01), and ife satisfaction (β = .21, p <.01). Thedirct effect of pain catastrophizing on emotion regulation was not significant (β=.02, p=.727). I contrast, emotion regulation had a significant positive direct effect on life satisfaction (β=.24, p<.01). Furthermore, anxiety sensitivity did not have a significant direct effect on cognitive flexibility (β=−.11, p=.106). However, cognitive flexibility showed a significant positive direct effect on life satisfaction (β=.23, p<.01). Overall, the findings supported the hypothesized structural model, confirming the proposed relationships among the study variables.Conclusion: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility as mediating variables. The results indicated that the proposed model demonstrated good fit. Findings showed that the severity of IBS symptoms directly increased pain catastrophizing and anxiety sensitivity but had no direct effect on life satisfaction. This suggests that the mere presence of physical symptoms does not necessarily reduce patients’ life satisfaction; rather, such reductions occur through intermediary psychological processes. According to cognitive pain processing and emotion regulation theories, individuals who focus on the negative aspects of physical symptoms and appraise them as threatening experience more intense pain and lower quality of life. Similar results have been reported by Carter et al. (2017), indicating that individuals with functional gastrointestinal disorders who experience high levels of stress and anxiety report lower quality of life. Considering the study’s findings and the significant role of mediating variables, it is essential to develop workshops and programs aimed at enhancing adaptive coping skills, such as problem-solving, mindfulness, and acceptance, for this population.
