The Structural Effect of Personality Organization and Object Relations on Medically Unexplained Symptoms and Psychosomatic Pain: The Mediating Role of Mentalization
Keywords:
Personality Organization, Medically Unexplained Symptoms, Mentalization, Structural Equation Modeling, Psychodynamic PsychotherapyAbstract
Objective: The present study aimed to examine the structural relationship between personality organization and object relations with medically unexplained symptoms and psychosomatic pain, considering the mediating role of mentalization.
Methodology: This study was quantitative in nature and conducted using structural equation modeling in a field-based design. The statistical population consisted of 450 individuals (aged 18–45) who visited medical centers in Tehran during 2021–2022, selected through convenience sampling. To measure the variables, five standardized instruments were used: the Inventory of Personality Organization (IPO), the Bell Object Relations and Reality Testing Inventory (BORRTI), the Screening for Somatoform Symptoms (SOMS-2), the Psychosomatic Pain Questionnaire (PSQ), and the Mentalization Questionnaire (MentS). Data analysis was carried out using SPSS-23 and AMOS-22.
Findings: The results indicated that personality organization had a significant and direct positive effect on medically unexplained symptoms (β = 0.697, p < 0.001) and psychosomatic pain (β = 0.711, p < 0.001). Object relations also had a significant and direct positive effect on psychosomatic pain (β = 0.669, p < 0.001), but a significant negative effect on mentalization (β = -0.075, p < 0.001). Additional findings revealed that mentalization had a significant negative effect on medically unexplained symptoms (β = -0.283, p < 0.001), although its effect on psychosomatic pain (β = -0.261) was not statistically significant. Ultimately, the mediating role of mentalization in the relationship between personality organization and medically unexplained symptoms and psychosomatic pain, as well as between object relations and these symptoms, was not supported. The model fit indices indicated an acceptable fit (RMSEA = 0.11, GFI = 0.848, NFI = 0.750, RFI = 0.893).
Conclusion: The structural model fit supports a significant direct effect of personality organization and object relations on medically unexplained symptoms and psychosomatic pain. Furthermore, personality organization also influences these symptoms through the mediating role of mentalization. These findings have practical implications and can inform the design and implementation of psychological interventions for patient populations.
Downloads
References
Al Behbahani, M., & Mohammadi, N. (2007). A Survey of Psychometric Properties of Kernberg's Inventory of Personality Organization. Iranian Journal of Psychology, 42, 185-195. https://www.sid.ir/paper/442914/fa
Bahmani Nia, M., & Sohrabi Shegefti, N. (2024). Comparison of Ego Strength, Defense Mechanisms, and Object Relations in Individuals with Depression and Healthy Individuals. Clinical Psychology and Personality, 22(1), 126-145. https://cpap.shahed.ac.ir/article_4316.html?lang=en
Bell, M. D., Billington, R. J., & Becker, B. R. (1986). A scale for the assessment of object relations: Reliability, validity, and factorial invariance. Journal of Clinical Psychology, 42(5), 733-741. https://doi.org/10.1002/1097-4679(198609)42:5<733::AID-JCLP2270420509>3.0.CO;2-C
Berens, S., Banzhaf, P., Baumeister, D., Gauss, A., Eich, W., Schaefert, R., & Tesarz, J. (2020). Relationship between adverse childhood experiences and illness anxiety in irritable bowel syndrome - The impact of gender. Journal of psychosomatic research, 128, 109846. https://doi.org/10.1016/j.jpsychores.2019.109846
CalSigor, E., Kernberg, O. F., & Clarkin, J. F. (2007). Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology. American Psychiatric Publication, Inc. https://doi.org/10.1176/appi.books.9781615377589
Clarkin, J. F., Levy, K. N., & Schiavi, J. M. (2005). Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders. Clinical Neuroscience Research, 4(5-6), 379-386. https://doi.org/10.1016/j.cnr.2005.03.003
Dimitrijevic, A., Hanak, N., Altaras Dimitrijević, A., & Jolić Marjanović, Z. (2018). The Mentalization Scale (MentS): A Self-Report Measure for the Assessment of Mentalizing Capacity. Journal of Personality Assessment, 100(3), 268-280. https://doi.org/10.1080/00223891.2017.1310730
Farajİ, H. (2024). Investigation of the Relationship Between Borderline Personality Organization and Perceived Abuse Experiences in Romantic Relationships: Moderating Role of Rejection Sensitivity. Journal of Health Sciences and Medicine, 7(3), 259-263. https://doi.org/10.32322/jhsm.1452696
Fink, P., Rosendal, M., & Olesen, F. (2005). Classification of Somatization and Functional Somatic Symptoms in Primary Care. Australian and New Zealand Journal of Psychiatry, 39, 772-781. https://doi.org/10.1080/j.1440-1614.2005.01682.x
Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016). Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire. PLoS One, 11(7), e0158678. https://doi.org/10.1371/journal.pone.0158678
Goldenberg, D. L. (2010). Pain/depression dyad: a key to a better understanding and treatment of functional somatic syndromes. The American Journal of Medicine, 123(8), 675-682. https://doi.org/10.1016/j.amjmed.2010.01.014
Hadi-Nejad, H., Tabatabaei, M., & Dehghani, M. (2014). A Preliminary Study of the Validity and Reliability of Bell Object Relations and Reality Testing Inventory. Iranian Journal of Psychiatry and Clinical Psychology, 20(2), 162-169. https://www.sid.ir/paper/17110/en
Kernberg, O. F. (1976). Object Relations Theory and Clinical Psychoanalysis. New York, Jason Aronson. https://books.google.com.fj/books?id=D-2UHatqAUEC&source=gbs_navlinks_s
Kline, R. B. (2016). Principles and Practice of Structural Equation Modeling, 4th Edition. New York, NY: Guilford Press. https://psycnet.apa.org/record/2015-56948-000
Luyten, P., Van Houdenhove, B., Lemma, A., Target, M., & Fonagy, P. (2013). Vulnerability for functional somatic disorders: A contemporary psychodynamic approach. Journal of Psychotherapy Integration, 23(3), 250-262. https://doi.org/10.1037/a0032360
Nimnuan, C., Hotopf, M., & Wessely, S. (2001). Medically unexplained symptoms: An epidemiological study in seven specialities. Journal of psychosomatic research, 51(1), 361-367. https://doi.org/10.1016/S0022-3999(01)00223-9
Poshtareh, S., Ebrahimi Moghadam, H., Moradi, H., & allah. (2024). Modeling the Relationship Between Reality Testing and Object Relations with Psychological Well-being Through the Mediation of Defense Mechanisms in Grief Disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS), 5(3), 147-158. https://doi.org/10.61838/kman.jayps.5.3.16
Ruscheweyh, R., Marziniak, M., Stumpenhorst, F., Reinholz, J., & Knecht, S. (2009). Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain, 146(1-2), 65-74. https://doi.org/10.1016/j.pain.2009.06.020
Salman Nasab, A., Yusefi, R., & Yagubi, H. (2024). Comparison of Personality Organization in People with Dark and Bright Personality Traits. Iranian Journal of Neurodevelopmental Disorders, 2(4), 28-35. https://doi.org/10.61838/kman.jndd.2.4.4
Schulz, E., Zherdin, A., Tiemann, L., Plant, C., & Ploner, M. (2012). Decoding an individual's sensitivity to pain from the multivariate analysis of EEG data. Cerebral Cortex, 22(5), 1118-1123. https://doi.org/10.1093/cercor/bhr186
Seydi, M., Rahimian Boogar, I., & Talepasand, S. (2019). Determining Risky Driving according to the Constructs of Mentalization and Personality Organization with the Modifying Role of Aggressive Driving. Iranian Journal of Psychiatry, 14(4), 274-282. https://doi.org/10.18502/ijps.v14i4.1977
Sharp, C., & Kalpakci, A. (2015). Mentalization in borderline personality disorder: From bench to bedside. Personality disorders, 6(4), 347-355. https://doi.org/10.1037/per0000106
Stumpf, A., Schneider, G., & Ständer, S. (2018). Psychosomatic and psychiatric disorders and psychologic factors in pruritus. Clinics in Dermatology, 36(6), 704-708. https://doi.org/10.1016/j.clindermatol.2018.08.015
Summers, F. (2024). Object relations theories and psychopathology: A comprehensive text. Routledge. https://doi.org/10.4324/9781003265795
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 محدثه حسن کار یاری, مجتبی انصاری شهیدی , اسحق رحیمیان بوگر , فردین مرادی منش (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
