مدل‌یابی معادلات ساختاری علائم جسمانی‌سازی بر اساس سازمان شخصیت با توجه به نقش واسطه‌ای احساس گرفتاری در زنان مبتلا به سرطان پستان

عسگرنژاد, رقیه; حجتی, عاطفه

doi:10.30473/hpj.2026.75902.6328

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	مدل‌یابی معادلات ساختاری علائم جسمانی‌سازی بر اساس سازمان شخصیت با توجه به نقش واسطه‌ای احساس گرفتاری در زنان مبتلا به سرطان پستان
روانشناسی سلامت
مقالات آماده انتشار، پذیرفته شده، انتشار آنلاین از تاریخ 20 شهریور 1405 اصل مقاله (1.7 M)
نوع مقاله: علمی- پژوهشی
شناسه دیجیتال (DOI): 10.30473/hpj.2026.75902.6328
نویسندگان
رقیه عسگرنژاد¹؛ عاطفه حجتی^* ²
¹گروه روانشناسی بالینی، دانشگاه آزاد اسلامی، واحد علوم پزشکی قم، قم، ایران.
²گروه روانشناسی بالینی، دانشگاه آزاد اسلامی، واحد علوم پزشکی قم، قم، ایران
چکیده
مقدمه: پژوهش حاضر با هدف اصلی مدل‌یابی معادلات ساختاری علائم جسمانی سازی بر اساس سازمان شخصیت با توجه به نقش واسطه‌ای احساس گرفتاری در زنان مبتلا به سرطان پستان انجام شد. روش: این پژوهش توصیفی-همبستگی از نوع مدلیابی معادلات ساختاری بود. جامعه آماری شامل تمام زنان مبتلا به سرطان پستان دارای پرونده در بیمارستان شهدای تجریش شهر تهران در سال 1402-1403 بود. از میان جامعه آماری نمونه‌ای به تعداد 200 نفر در نظر گرفته شد که به شیوه نمونه گیری هدفمند به پژوهش وارد شدند. سپس چک لیست نشانگان استرس (SSC) چنگ و حامید (1996)، پرسشنامه سازمان شخصیت (POQ) کرنبرگ (2002) و پرسشنامه احساس گرفتاری (EQ) گیلبرت و آلن (1998) میان شرکت کنندگان توزیع شد. بعد از تکمیل پرسشنامه‌ها، برای توصیف داده‌ها از روش‌های آمار توصیفی و برای آزمون فرضیات از آزمون معادلات ساختاری به شیوه تحلیل مسیر از طریق نرم افزارهای SPSS و AMOS استفاده شد. یافته‌ها: نتایج نشان داد که سازمان شخصیت با ضریب استاندارد 473/0 و احساس گرفتاری با ضریب استاندارد بتا 263/0 اثر مثبت و معناداری در سطح 05/0 بر علائم جسمانی‌سازی داشته است. همچنین متغیر سازمان شخصیت با ضریب استاندارد 156/0 اثر غیر مستقیم و معناداری بر علائم جسمانی سازی با میانجی‌گری احساس گرفتاری داشته است. در نهایت متغیر سازمان شخصیت با ضریب استاندارد 593/0 اثر مثبت و مستقیمی در سطح 05/0 بر احساس گرفتاری داشته است. نتیجه‌گیری: بر این اساس می‌توان نتیجه گرفت سازمان شخصیت به‌طور مستقیم و از طریق نقش میانجی احساس گرفتاری، تأثیر معناداری بر علائم جسمانی‌سازی در زنان مبتلا به سرطان پستان دارد.
کلیدواژه‌ها
احساس گرفتاری؛ سازمان شخصیت؛ سرطان پستان؛ علائم جسمانی
عنوان مقاله [English]
Equation Modeling of Somatization Symptoms Based on Personality Organization Considering the Mediating Role of Entrapment in Women with Breast Cancer
نویسندگان [English]
Roghayeh Asgarnejad¹؛ Atefeh Hojjati²
¹Department of Clinical Psychology, Qom Medical Sciences Branch, Islamic Azad University, Qom, Iran
²Department Of Clinical Psychology, Qom Medical Sciences Branch, Islamic Azad University, Qom, Iran.
چکیده [English]
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.
کلیدواژه‌ها [English]
breast cancer, entrapment, personality organization, somatization symptoms

مراجع
Abdel-Fadee, N. A., Zanaty, M. M., Kamal, A. M., Hassan, M. A., & Taha, M. (2023). Personality, Defense Mechanisms and Psychological Distress in Women with Breast Cancer. Journal of Pharmaceutical Negative Results, 14(2).‌ https://doi.org/10.21608/ejhm.2022.241954 Akça, E., Akça, Z. N. D., & Yıldız, M. (2023). The Relationship Between Somatization and Depression Types: Comparison of Unipolar Depression and Bipolar Depression. Clinical and Experimental Health Sciences, 13(2), 243-249.‌ https://doi.org/10.33808/clinexphealthsci.1181402 Arnold, M., Morgan, E., Rumgay, H., Mafra, A., Singh, D., Laversanne, M., ... & Soerjomataram, I. (2022). Current and future burden of breast cancer: Global statistics for 2020 and 2040. The Breast,66,15-23.‌ https://doi.org/10.1016/j.breast.2022.08.010 Ayubi, E., Bashirian, S., & Khazaei, S. (2021). Depression and anxiety among patients with cancer during COVID-19 pandemic: a systematic review and meta-analysis. Journal of Gastrointestinal Cancer, 52(2), 499-507. (in Persian)‌ https://doi.org/10.1007/s12029-021-00643-9 Bach, A., Knauer, K., Graf, J., Schäffeler, N., & Stengel, A. (2022). Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review. World Journal of Psychiatry, 12(4),623.‌ https://doi.org/10.5498/wjp.v12.i4.623 Berben, J. A., Miseré, R. M., Schop, S. J., & van der Hulst, R. R. (2023). The influence of personality on health complaints and quality of life in women with breast implants. Aesthetic Surgery Journal,43(2),245-252. https://doi.org/10.1093/asj/sjac247 Burton, C., Fink, P., Henningsen, P., Löwe, B., Rief, W., & Euronet-Soma Group. (2020). Functional somatic disorders: discussion paper for a new common classification for research and clinical use. BMC medicine, 18, 1-7.‌ https://doi.org/10.1186/s12916-020-1505-4 Cerezo, M. V., Blanca, M. J., & Ferragut, M. (2020). Personality profiles and psychological adjustment in breast cancer patients. International Journal of Environmental Research and Public Health, 17(24), 9452.‌ https://doi.org/10.3390/ijerph17249452 Çetin, Ş., & Varma, G. S. (2021). Somatic Symptom disorder: historical process and biopsychosocial approach. Psikiyatride Guncel Yaklasimlar,13(4),790-804.‌ https://doi.org/10.18863/pgy.882929 Chen, Y., Yu, K., Xiong, J., Zhang, J., Zhou, S., Dai, J., ... & Wang, S. (2022). Suicide and accidental death among women with primary ovarian cancer: a population-based study. Frontiers in medicine, 9, 833965.‌ https://doi.org/10.3389/fmed.2022.833965 Cheng, T. A., & Hamid, P. (1996). Psychiatric morbidity and Asian culture: the British Chinese. Acta Psychiatrica Scandinavica, 93(2), 117-120. Cheon S. H. (2012). Relationships among Daily Hassles, Social Support, Entrapment and Mental Health Status by Gender in University Students. Korean journal of women health nursing, 18(3), 223–235. https://doi.org/10.4069/kjwhn.2012.18.3.223 Choi, H., & Shin, H. (2023). Entrapment, Hopelessness, and Cognitive Control: A Moderated Mediation Model of Depression. In Healthcare (Vol. 11, No. 8, p. 1065). MDPI.‌ https://doi.org/10.3390/healthcare11081065 Ghadiri, F.; Abdolmohammadi, K. & Soleimani, A. (2019). Prediction of Somatic Symptom(somatization) on the Basis of Defensive style and Emotion regulation in University Students. Rooyesh. 8(3), 227-234. (in Persian) 20.1001.1.2383353.1398.8.3.14.4 Gilbert, P., & Allan, S. (1998). The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view. Psychological medicine, 28(3), 585-598.‌ DOI: https://doi.org/10.1017/S0033291798006710 Guimond, A. J., Ivers, H., & Savard, J. (2019). Clusters of psychological symptoms in breast cancer: is there a common psychological mechanism? Cancer Nurs. 43, 343–353. https://doi.org/10.1097/ncc.0000000000000705 Hosseini S, Salehi M, Jadidi M, & Aghili M. (2023). The Mediating Role of cognitive Emotion Regulation Explaining the Casual Relationship between Personality Traits and Fear of Cancer Recurrence in Breast Cancer Survivors. ijbd; 16 (2):4-21. (in Persian) 20.1001.1.17359406.1402.16.2.1.4 Jones, R. R., Fisher, J. A., Medgyesi, D. N., Buller, I. D., Liao, L. M., Gierach, G., ... & Silverman, D. T. (2023). Ethylene oxide emissions and incident breast cancer and non-Hodgkin lymphoma in a US cohort. JNCI: Journal of the National Cancer Institute, 115(4), 405-412.‌ https://doi.org/10.1093/jnci/djad004 Kang, W., Whelan, E., & Malvaso, A. (2023, August). Understanding the Role of Cancer Diagnosis in the Associations between Personality and Life Satisfaction. In Healthcare (Vol. 11, No. 16, p. 2359). MDPI.‌ https://doi.org/10.3390/healthcare11162359 Kerber, A., Gewehr, E., Zimmermann, J., Sachser, C., M. Fegert, J., Knaevelsrud, C., & Spitzer, C. (2023). Adverse childhood experiences and personality functioning interact substantially in predicting depression, anxiety, and somatization. Personality and Mental Health, 17(3), 246-258.‌ https://doi.org/10.1002/pmh.1578 Kernberg, O. F. (2002). Psychoanalytic contributions to psychiatry. Archives of General Psychiatry,59(6),497-498.‌ https://doi.org/10.1001/archpsyc.59.6.497 Kline, R. B. (2012). Assumptions in structural equation modeling. Handbook of structural equation modeling, 111, 125.‌ https://doi.org/10.1080/10705511.2012.687667 Kovács, L. N., Schmelowszky, Á., Galambos, A., & Kökönyei, G. (2021). Rumination mediates the relationship between personality organization and symptoms of borderline personality disorder and depression. Personality and Individual Differences,168,110339.‌ https://doi.org/10.1016/j.paid.2020.110339 Levi-Belz, Y., & Zerach, G. (2018). Moral injury, suicide ideation, and behavior among combat veterans: The mediating roles of entrapment and depression. Psychiatry research, 269, 508-516.‌ https://doi.org/10.1016/j.psychres.2018.08.105 Li, S., Yaseen, Z. S., Kim, H. J., Briggs, J., Duffy, M., Frechette-Hagan, A., ... & Galynker, I. I. (2018). Entrapment as a mediator of suicide crises. BMC psychiatry, 18(1), 1-10.‌ https://doi.org/10.1186/s12888-018-1587-0 Lipowski, Z. J. (1988). Somatization: the concept and its clinical application. The American journal of psychiatry, 145(11), 1358-1368.‌ https://doi.org/10.1176/ajp.145.11.1358 Ma, H., & Miller, C. (2021). Trapped in a double bind: Chinese overseas student anxiety during the COVID-19 pandemic. Health communication, 36(13), 1598-1605.‌ https://doi.org/10.1080/10410236.2020.1775439 Macina, C., Bendel, R., Walter, M., & Wrege, J. S. (2021). Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review. Journal of Psychosomatic Research, 151,110646.‌ https://doi.org/10.1016/j.jpsychores.2021.110646 Mirzaeiyan Gizehroud, S; Monirpour, N; Akbari, M; Zargham Hajebi, M & Dabbagh, N. (2022). The structural model of the quality of life of women with breast cancer based on D-type personality with the mediating role of disease perception. Journal of the Faculty of Medicine, Mashhad University of Medical Sciences, 65(4). (in Persian) 10.22038/mjms.2022.66518.3924. Miyoshi, M., Takanashi, R., Taguchi, K., Yoshida, T., Kurita, K., & Shimizu, E. (2025). Neurodevelopmental and personality traits of somatic symptom disorder: A cross‐sectional study. Psychiatry and Clinical Neurosciences Reports, 4(1), e70082.‌ doi: 10.1002/pcn5.70082 Moran, J. K., Jesuthasan, J., Schalinski, I., Kurmeyer, C., Oertelt-Prigione, S., Abels, I., ... & Schouler-Ocak, M. (2023). Traumatic life events and association with depression, anxiety, and somatization symptoms in female refugees. JAMA network open, 6(7), e2324511-e2324511. https://doi.org/10.1001/jamanetworkopen.2023.24511 Muniz, N. M., Silva, T. M., Barbosa, D. S., Bezerra, L. P., & Braz, M. C. (2021). The role of personality traits in entrapment and suicidal ideation in young adults. Journal of Affective Disorders, 288, 133-139. doi: 10.1016/j.jad.2021.03.029. O’Connor, R. C., & Portzky, G. (2018). The relationship between entrapment and suicidal behavior through the lens of the integrated motivational–volitional model of suicidal behavior. Current opinion in psychology, 22, 12-17.‌ https://doi.org/10.1016/j.copsyc.2017.07.021 O’Connor, R. C., & Williams, J. M. G. (2014). The relationship between positive future thinking, brooding, defeat and entrapment. Personality and Individual Differences, 70, 29-34.‌ https://doi.org/10.1016/j.paid.2014.06.016 Owen, R., Dempsey, R., Jones, S., & Gooding, P. (2018). Defeat and entrapment in bipolar disorder: exploring the relationship with suicidal ideation from a psychological theoretical perspective. Suicide and Life‐Threatening Behavior,48(1),116-128.‌ https://doi.org/10.1111/sltb.12343 Razagh Pour, M., & Hoseinzadeh, A. A. (2019). The mediating role of Cognitive Emotion Regulation Strategies in the relationship between personality traits with somatization symptoms of female university students. Quarterly of Applied Psychology, 13 (2): 295-316. (in Persian) 10.29252/apsy.13.2.295. Razaghpour, M. & Hosseinzadeh, A. (2019). The mediating role of Cognitive Emotion Regulation Strategies in the relationship between personality traits with somatization symptoms of female university students. Quarterly Journal of Applied Psychology, 13(2), 295-316. (in Persian) 10.29252/apsy.13.2.295. Teismann, T., & Brailovskaia, J. (2020). Entrapment, positive psychological functioning and suicide ideation: A moderation analysis. Clinical psychology & psychotherapy, 27(1), 34-41.‌ https://doi.org/10.1002/cpp.2403 van der Gaag, M., Eurelings‐Bontekoe, L., Ising, H., & van den Berg, D. (2019). Ultrahigh risk for developing psychosis and psychotic personality organization. Early intervention in psychiatry, 13(3),673-676.‌ https://doi.org/10.1111/eip.12687 Velasco-Durantez, V., Cruz-Castellanos, P., Hernandez, R., Rodriguez-Gonzalez, A., Fernandez Montes, A., Gallego, A., ... & Jiménez-Fonseca, P. (2024). Prospective study of predictors for anxiety, depression, and somatization in a sample of 1807 cancer patients. Scientific reports, 14(1), 3188.‌ https://doi.org/10.1038/s41598-024-53212-y. Zhang, Y., Ding, X., Chen, J., Liu, Y., Wang, G., & Hu, D. (2023). Moderating effects of suicide resilience and meaning in life on the association between entrapment and suicidal ideation in Chinese patients with ovarian cancer: a cross-sectional study. BMC psychiatry, 23(1), 585.‌ https://doi.org/10.1186/s12888-023-05057-4 .
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مدل‌یابی معادلات ساختاری علائم جسمانی‌سازی بر اساس سازمان شخصیت با توجه به نقش واسطه‌ای احساس گرفتاری در زنان مبتلا به سرطان پستان