Novelty Seeking and Harm Avoidance in Somatic Symptom Disorder: The Mediating Role of Alexithymia
Downloads
Objective: Somatic symptom disorder (SSD) is strongly shaped by personality and emotional-processing factors. This study tested a model in which novelty seeking (NS) and harm avoidance (HA) predict SSD directly and indirectly through alexithymia.
Methods and Materials: In a cross-sectional design, 252 students from Isfahan University of Medical Sciences were recruited. Participants completed Temperament and Character Inventory subscales for NS and HA, the 20-item Toronto Alexithymia Scale, and the Patient Health Questionnaire–15 as an index of SSD severity. Data were analyzed using structural equation modeling in AMOS 24. Model fit was evaluated with χ²/df, CFI, GFI, and RMSEA, and indirect effects were tested with 5000-sample bootstrapping and 95% confidence intervals.
Findings: NS and HA were positively associated with both alexithymia (β = 0.31 and 0.39, p < .001) and SSD (β = 0.21 and 0.26, p < .001). Alexithymia also predicted higher SSD scores (β = 0.38, p < .001). Indirect effects from NS and HA to SSD through alexithymia were significant (β = 0.12 and 0.15, p < .001), indicating partial mediation. The model showed good fit (χ²/df = 2.18, CFI = 0.95, GFI = 0.93, RMSEA = 0.05) and explained 27% of the variance in alexithymia and 41% in SSD.
Conclusion: Alexithymia partly explains how high NS and HA increase vulnerability to SSD. Assessing temperament and targeting emotional awareness and labeling in psychotherapy may help reduce somatic symptom burden in at-risk individuals.
Downloads
Akaishi, T., Abe, M., Masaura, A., Tanaka, J., Takayama, S., Numata, T., Suzuki, S., Ohsawa, M., & Ishii, T. (2021). Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls. Journal of Family Medicine and Primary Care, 10(2), 1021-1027. https://doi.org/10.4103/jfmpc.jfmpc_1100_20
Bagby, M., Taylor, G. J., & Ryan, D. (1986). Toronto Alexithymia Scale: Relationship with personality and psychopathology measures. Psychotherapy and Psychosomatics, 45(4), 207-215. https://doi.org/10.1159/000287950
Burgess Moser, M., Johnson, S. M., Dalgleish, T. L., Lafontaine, M. F., Wiebe, S. A., & Tasca, G. A. (2016). Changes in relationship‐specific attachment in emotionally focused couple therapy. Journal of marital and family therapy, 42(2), 231-245. https://doi.org/10.1111/jmft.12139
Celikel, F. C., Kose, S., Cumurcu, B. E., Erkorkmaz, U., Sayar, K., Borckardt, J. J., & Cloninger, C. R. (2009). Cloninger's temperament and character dimensions of personality in patients with major depressive disorder. Comprehensive psychiatry, 50(6), 556-561. https://doi.org/10.1016/j.comppsych.2008.11.012
Cicek, A. U., Ucuz, İ., Abanoz, E., Sarı, S. A., Karaca, S. N., & Dombaycı, Ö. (2022). Self-Esteem, Emotional And Behavioral Problems and Psychopathology In Children With Somatic Symptoms and Related Disorders. Cumhuriyet Medical Journal, 44(2), 172-180. https://doi.org/10.7197/cmj.1122235
Conversano, C., Marchi, L., Ciacchini, R., Carmassi, C., Contena, B., Bazzichi, L. M., & Gemignani, A. (2018). Personality traits in fibromyalgia (FM): does FM personality exists? A systematic review. Clinical practice and epidemiology in mental health: CP & EMH, 14, 223. https://doi.org/10.2174/1745017901814010223
Evren, C., Cagil, D., Ulku, M., Ozcetinkaya, S., Gokalp, P., Cetin, T., & Yigiter, S. (2012). Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients. Comprehensive psychiatry, 53(6), 860-867. https://doi.org/10.1016/j.comppsych.2012.01.002
Gatta, M., Angelico, C., Rigoni, F., Raffagnato, A., & Miscioscia, M. (2022). Alexithymia and psychopathological manifestations centered on the body: somatization and self-harm. Journal of clinical medicine, 11(8), 2220. https://doi.org/10.3390/jcm11082220
Hemmati, A., Rezaei, F., Rahmani, K., Komasi, S., Miettunen, J., Amianto, F., & Clark, L. A. (2024). Meta-analytic review of temperamental correlates of the five-factor model and hierarchical taxonomy of psychopathology domains. Indian Journal of Psychological Medicine, 46(3), 208-220. https://doi.org/10.1177/02537176231210396
Huang, W.-L., Chen, T.-T., Chen, I.-M., Chang, L.-R., Lin, Y.-H., Liao, S.-C., & Gau, S. S.-F. (2016). Harm avoidance and persistence are associated with somatoform disorder psychopathology: a study in Taiwan. Journal of Affective Disorders, 196, 83-86. https://doi.org/10.1016/j.jad.2016.02.009
Khalili Moghadam, E., Dehnavi, F., Mirzai, F., Heydari, S., Tapak, S., & Khajeh Hasani Rabari, F. (2024). The Relationship of Post-Traumatic Growth on Resilience with the Mediation of Self-Compassion and Emotional Suppression in Betrayal Trauma. Medical Journal of Mashhad University of Medical Sciences, 67(2), 422-433. https://doi.org/10.22038/mjms.2024.25339
Kline, R. B. (2023). Principles and practice of structural equation modeling. Guilford publications. https://books.google.com/books?id=t2CvEAAAQBAJ&lpg=PP1&ots=sWXES18YgK&dq=Kline%2C%20R.%20B.%20(2023).%20Principles%20and%20practice%20of%20structural%20equation%20modeling.%20Guilford%20publications.&lr=lang_en&pg=PP1#v=onepage&q=Kline,%20R.%20B.%20(2023).%20Principles%20and%20practice%20of%20structural%20equation%20modeling.%20Guilford%20publications.&f=false
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic medicine, 64(2), 258-266. https://doi.org/10.1097/00006842-200203000-00008
Maas genannt Bermpohl, F., & Martin, A. (2025). Efficacy of cognitive behavioral therapy and acceptance-and mindfulness-based treatments in adults with bodily distress–a network-meta-analysis. Psychotherapy and Psychosomatics. https://doi.org/10.1159/000544825
Marder, M. A., Richier, C., Miller, G. A., & Heller, W. (2022). Pandemic onset, individual differences, and dimensional symptoms of depression and anxiety among emerging adults. Emerging Adulthood, 10(4), 1026-1040. https://doi.org/10.1177/21676968221102792
Maroti, D. (2025). Introducing a new specifier for functional somatic disorder: a psychodynamic approach to investigating emotional factors. Frontiers in Psychiatry, 16, 1481405. https://doi.org/10.3389/fpsyt.2025.1481405
Meira, B., Lhommée, E., Schmitt, E., Klinger, H., Bichon, A., Pélissier, P., Anheim, M., Tranchant, C., Fraix, V., & Meoni, S. (2022). Early Parkinson’s disease phenotypes tailored by personality, behavior, and motor symptoms. Journal of Parkinson’s Disease, 12(5), 1665-1676. https://doi.org/10.3233/JPD-213070
Murtaza, G., Mustafa, M., Arshad, D., Tayyab, S., & Shafiq, H. (2023). Prevalence and Severity of Somatic Symptom Disorder among Medical Students in Pakistan. International Journal of Health, Medicine and Nursing Practice, 5(3), 1-11. https://doi.org/10.47941/ijhmnp.1360
Peritogiannis, V. (2015). Sensation/novelty seeking in psychotic disorders: A review of the literature. World journal of psychiatry, 5(1), 79. https://doi.org/10.5498/wjp.v5.i1.79
Petrosini, L., Cutuli, D., Picerni, E., & Laricchiuta, D. (2017). Viewing the personality traits through a cerebellar lens: a focus on the constructs of novelty seeking, harm avoidance, and alexithymia. The Cerebellum, 16, 178-190. https://doi.org/10.1007/s12311-015-0754-9
Rezaei, F., Hemmati, A., Rahmani, K., & Komasi, S. (2020). A systematic review of personality temperament models related to somatoform disorder with main focus on meta-analysis of Cloninger's theory components. Indian Journal of Psychiatry, 62(5), 462-469. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_345_20
Ucuz, I., Cicek, A. U., Celik, M. K., Akan, M., Kesriklioglu, E., Gungor, S., & Ozcan, O. O. (2022). Emotional dysregulation and temperament-character traits in adolescents with functional neurological symptom disorder (conversion disorder). The Journal of nervous and mental disease, 10.1097. https://doi.org/10.1097/nmd.0000000000001746
Xu, L., Shi, J., & Li, C. (2024). Addressing psychosomatic symptom distress with mindfulness-based cognitive therapy in somatic symptom disorder: mediating effects of self-compassion and alexithymia. Frontiers in Psychiatry, 15, 1289872. https://doi.org/10.3389/fpsyt.2024.1289872
Copyright (c) 2025 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
