Structural Relationships between Alexithymia and Perfectionism with the Mediating Role of Anxiety Sensitivity in Predicting Obsessive-Compulsive Disorder in Students

Document Type : Original Article

Authors

1 PhD Student in Counseling, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili , Ardabil, Iran.

2 PhD student in Clinical Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran.

3 Professor, Department of Counseling, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.

4 Associate Professor, Department of Psychology, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran.

10.22075/jcp.2024.34232.2897

Abstract

Background: The present study aimed to investigate the structural relationships between alexithymia and perfectionism with the mediating role of anxiety sensitivity in predicting obsessive-compulsive disorder (OCD) in students.
Method: The design of this study is quantitative in nature. The research method is descriptive-correlational and was conducted through structural equation modeling. The statistical population in this study included all high school students in Khorramabad during the academic year 2023-2024. The sampling method used was cluster random sampling. The research instruments included the Revised Obsessive-Compulsive Inventory (OCI-R), the Perfectionism Inventory (PI), the Anxiety Sensitivity Index (ASI), and the Toronto Alexithymia Scale (TAS-20). Descriptive findings were analyzed using SPSS26 software and inferential findings were analyzed using AMOS24 software.
Results: The direct effect of maladaptive perfectionism (β=0.36, p<0.001) and alexithymia (β=0.31, p<0.001) on obsessive-compulsive disorder was significant. Additionally, the direct effect of maladaptive perfectionism (β=0.43, p<0.001) and alexithymia (β=0.48, p<0.001) on anxiety sensitivity was significant. The indirect effect of maladaptive perfectionism and alexithymia on obsessive-compulsive disorder through the mediation of anxiety sensitivity was also significant (β=0.15, p<0.03 and β=0.168, p<0.001, respectively), and the model fit was confirmed.
Conclusion: The results showed that maladaptive perfectionism and alexithymia significantly predict OCD symptoms through anxiety sensitivity. The conceptual model of the study had a good fit (CFI=0.98, RMSEA=0.05), indicating that the hypothetical structure of the model effectively explained the relationships between the variables. Therefore, psychological interventions aimed at reducing anxiety sensitivity and managing perfectionism and alexithymia can be effective in reducing OCD symptoms.

Keywords

Main Subjects


  1. منابع

    1. Norozi N, Najafi M. The Mediating Role of Attachment Styles and Negative Affect in the Relationship between Childhood Trauma and Obsessive-Compulsive Symptoms. Journal of Clinical Psychology. 2023;15(3).
    2. Johansen EB. Therapists' Experiences Working with Women of Color with Borderline Personality Disorder: Widener University; 2020.
    3. Jalal B, Chamberlain SR, Sahakian BJ. Obsessive‐compulsive disorder: etiology, neuropathology, and cognitive dysfunction. Brain and behavior. 2023;13(6):e3000.
    4. Han H. The impact of obsessive-compulsive disorder on high school students’ school life. International Journal of New Developments in Education. 2023;5(1).
    5. Angelo NL, Brullo G, Marsiglia A, Tirelli A, Piroddi E, Viti C, et al. Romantic relationship obsessive-compulsive doubts, perfectionism, and DSM-5 personality traits in LGB people: a comparison with heterosexual individuals. Frontiers in Psychology. 2024;15:1187179.
    6. Association AP. Diagnostic and statistical manual of mental disorders. Text revision. 2000.
    7. Robbins TW, Vaghi MM, Banca P. Obsessive-compulsive disorder: puzzles and prospects. Neuron. 2019;102(1):27-47.
    8. Kumar A, Somani A. Dealing with Corona virus anxiety and OCD. Asian journal of psychiatry. 2020;51:102053.
    9. Chakraborty A, Karmakar S. Impact of COVID-19 on obsessive compulsive disorder (OCD). Iranian journal of psychiatry. 2020;15(3):256.
    10. Taube-Schiff M, Rector NA, Young R, Larkin P, Richter MA. Filling the gap for obsessive-compulsive disorder services in Canada: Implementing an intensive care program. The Journal of Nervous and Mental Disease. 2020;208(1):38-47.
    11. Gutierrez R, Hirani T, Curtis L, Ludlow AK. Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms. BMC psychology. 2020;8:1-7.
    12. Ivarsson T, Melin K, Wallin L. Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD). European child & adolescent psychiatry. 2008;17:20-31.
    13. Goerlich KS. The multifaceted nature of alexithymia–a neuroscientific perspective. Frontiers in psychology. 2018;9:363018.
    14. Mahapatra A, Sharma P. Association of Internet addiction and alexithymia–A scoping review. Addictive behaviors. 2018;81:175-82.
    15. Xu P, Opmeer EM, van Tol M-J, Goerlich KS, Aleman A. Structure of the alexithymic brain: A parametric coordinate-based meta-analysis. Neuroscience & Biobehavioral Reviews. 2018;87:50-5.
    16. Faramarzi Rad B, Zare Bahramabadi MZ. Predicting emotional alexithymia based on emotional information processing with the mediation of emotional self-disclosure in married people. Journal of Psychological Science. 2023;22(129):1733-46.
    17. Kim ST, Seo JH, Park CI, Kim HW, Boo YJ, Kim H, et al. Core clinical symptoms and suicidal ideation in patients with obsessive–compulsive disorder: A network analysis. Psychiatry and Clinical Neurosciences. 2023;77(2):110-7.
    18. Haspolat NK, Ağırkan M, Eşkisu M. Psychological symptoms among adolescents: Latent class analysis of parental attitudes, psychological needs, self‐regulation, and alexithymia. Psychology in the Schools. 2024;61(3):920-41.
    19. Tamrchi S, Rabiee M, Dolatshahi B. Investigating Parenting Styles and Relationship Obsessive-compulsive Disorder Symptoms: The Mediating Role of Alexithymia. Practice in Clinical Psychology. 2024;12(2):165-78.
    20. Abd-Elhamed MME, Hady RFA, Mahmoud SF, Mohamed BES. Alexithymia, resilience and suicidal ideation among patients with obsessive–compulsive disorder. Middle East Current Psychiatry. 2023;30(1):86.
    21. Aldawash FM. Alexithymia as a predictor of Behavioral symptoms in a non-clinical sample. 2023.
    22. Slade PD, Owens RG. A dual process model of perfectionism based on reinforcement theory. Behavior modification. 1998;22(3):372-90.
    23. Tan JST. The mediating role of self-compassion in the relationship between trait perfectionism and psychological resilience among Filipino university students. Cogent Psychology. 2023;10(1):2168424.
    24. Woodlee D, Ingle WK. Classified Staff and the Implementation of Positive Behavior Interventions and Supports: A Case Study. Journal of Education Human Resources. 2023(aop):e20220009.
    25. Casale S, Fioravanti G, Ghinassi S. Applying the Self-Determination Theory to explain the link between perceived parental overprotection and perfectionism dimensions. Personality and Individual Differences. 2023;204:112044.
    26. Molnar DS, Thai S, Blackburn M, Zinga D, Flett GL, Hewitt PL. Dynamic changes in perfectionism dimensions and psychological distress among adolescents assessed before and during the COVID‐19 pandemic. Child Development. 2023;94(1):254-71.
    27. Hewitt PL, Kealy D, Mikail SF, Smith MM, Ge S, Chen C, et al. The efficacy of group psychotherapy for adults with perfectionism: A randomized controlled trial of dynamic-relational therapy versus psychodynamic supportive therapy. Journal of Consulting and Clinical Psychology. 2023;91(1):29.
    28. Hummel J, Cludius B, Woud ML, Holdenrieder J, Mende N, Huber V, et al. The causal relationship between perfectionism and negative affect: Two experimental studies. Personality and Individual Differences. 2023;200:111895.
    29. Johann AF, Feige B, Hertenstein E, Nissen C, Benz F, Steinmetz L, et al. The effects of cognitive behavioral therapy for insomnia on multidimensional perfectionism. Behavior therapy. 2023;54(2):386-99.
    30. Jowett GE, Stanger N, Madigan DJ, Patterson LB, Backhouse SH. Perfectionism and doping willingness in athletes: The mediating role of moral disengagement. Psychology of Sport and Exercise. 2023;66:102402.
    31. Callaghan T, Greene D, Shafran R, Lunn J, Egan SJ. The relationships between perfectionism and symptoms of depression, anxiety and obsessive-compulsive disorder in adults: a systematic review and meta-analysis. Cognitive Behaviour Therapy. 2024;53(2):121-32.
    32. Sher A, Wootton BM, Paparo J. A preliminary investigation of the mediating roles of self‐compassion and emotion dysregulation in the relationship between maladaptive perfectionism and obsessive‐compulsive behaviors. Journal of Clinical Psychology. 2024.
    33. Hu P, Liang P, Liu X, Ouyang Y, Wang J. Parenting styles and obsessive-compulsive symptoms in college students: the mediating role of perfectionism. Frontiers in Psychiatry. 2023;14:1126689.
    34. Kaçar-Başaran S, Arkar H. Common vulnerability factors in obsessive-compulsive and major depressive disorders: a transdiagnostic hierarchical model. Current Psychology. 2023;42(10):8414-24.
    35. Redden SA, Mueller NE, Cougle JR. The impact of obsessive-compulsive personality disorder in perfectionism. International Journal of Psychiatry in Clinical Practice. 2023;27(1):18-24.
    36. Richard A, Dunkley DM. Self-Critical Perfectionism and Anxious and Depressive Symptoms Over Two Years: Moderated Mediation Models of Anxiety Sensitivity and Experiential Avoidance. Behavior Therapy. 2024.
    37. mmamel cb. perfectionistic self presentation as a predictor of anxiety sensitivity among university students. african journal for the psychological studies of social issues. 2023;26(2).
    38. Hosseini SN, Sabet M, Dortaj F, Shomali A. Prediction of Mobile Phone Addiction Based on Metadiagnostic Factors (Emotional Dysregulation, Metacognitive Beliefs and Uncertainty Intolerance) and Anxiety. Islamic Life Journal. 2023;6(4):328-39.
    39. Qi J, Rappaport LM, Cecilione J, Hettema JM, Roberson-Nay R. Differential associations of distress tolerance and anxiety sensitivity with adolescent internalizing psychopathology. Journal of Clinical Child & Adolescent Psychology. 2019.
    40. Besson M, Forget B. Cognitive dysfunction, affective states, and vulnerability to nicotine addiction: a multifactorial perspective. Frontiers in psychiatry. 2016;7:179425.
    41. Hatami Nejad, M., Mikaeili, N., Sadeghi Niri, E. Modeling the Role of Parent-Child Conflict in Predicting Social Anxiety with the Mediation of Anxiety Sensitivity. Journal of Family Relations Studies, 2024; 4(14): 4-13.
    42. Gharib Bolouk M, Mikaeili N, Basharpoor S. Predicting sleep quality in adolescents based on dysfunctional beliefs and attitudes about sleep, neuroticism, internet addiction, and anxiety sensitivity mediated by emotion regulation strategies and mindfulness. Journal of psychologicalscience. 2022;21(116):21-38.
    43. Geyer RB, Dreyer-Oren SE, Das A, Clerkin EM. Distressed drinking: the moderating impact of distress tolerance on the relation between anxiety sensitivity, panic symptoms, and alcohol use and problems. Journal of studies on alcohol and drugs. 2023;84(6):928-35.
    44. Hatami Nejad M, mirderikvand f, sepahvandi m. Structural Relationships of Anxiety Sensitivity and Sense of Coherence with Readiness to Use Substances in College Students: The Mediating Role of Difficulty in Emotion Regulation. Research on Addiction. 2024;17(70):149-74.
    45. Hatami Nejad M, Mir F, Sepahvand M. Developing a Model of Readiness to Use Drugs in Lorestan University Students Based on Anxiety Sensitivity and Sensation Seeking with the Mediating Role of Negative Affectivity: A Descriptive Study. Journal of Rafsanjan University of Medical Sciences. 2024 Jul 10;23(4):222-36.
    46. Rueppel M, Becker HC, Iturra-Mena A, Bilek EL, Monk CS, Phan KL, et al. Obsessive–Compulsive Symptoms: Baseline Prevalence, Comorbidity, and Implications in a Clinically Anxious Pediatric Sample. Child Psychiatry & Human Development. 2024:1-12.
    47. Zhang B, Li X, Deng H, Tan P, He W, Huang S, et al. The relationship of personality, alexithymia, anxiety symptoms, and odor awareness: a mediation analysis. BMC psychiatry. 2024;24(1):185.
    48. Samantaray NN, Mishra A, Singh AR, Sudhir PM, Singh P. Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting. Journal of Affective Disorders. 2023;324:92-101.
    49. Tulacı RG, Kasal Mİ. The Relationship Between Family Accommodation and Anxiety Sensitivity in Obsessive-Compulsive Disorder. Cureus. 2023;15(8).
    50. Polat H, Kartal F, Uğur K. Relationship between obsessional dissociation and family adjustment and anxiety sensitivity in individuals with obsessive-compulsive disorder. Cukurova Medical Journal. 2023;48(3):1033-43.
    51. Ahmadi E, Yousefi R, Babaei Aqje Kohal H. The mediating role of obsessive-compulsive symptoms in the relationship between self-esteem and cyberchondria in students. Journal of Clinical Psychology. 2024;15(3):27-36.
    52. Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological assessment. 2002;14(4):485.
    53. Ghassemzadeh H, Khamseh A, Ebrahimkhani N. Demographic variables and clinical features of obsessive-compulsive disorder in Iran: A second report. Obsessive-compulsive disorder research. 2005:243-71.
    54. Hill RW, Huelsman TJ, Furr RM, Kibler J, Vicente BB, Kennedy C. A new measure of perfectionism: The Perfectionism Inventory. Journal of personality assessment. 2004;82(1):80-91.
    55. hejazi a, hashemi s. The prediction of emotional exhaustion based on the dimensions of teachers' excitement and excitement. Journal of Research in Educational Systems. 2020;14(48):145-60.
    56. Hill AP, Donachie T. Not All Perfectionism Cognitions Are Multidimensional: Evidence for the Perfectionism Cognitions Inventory–10. Journal of Psychoeducational Assessment. 2020;38(1):15-25.
    57. Floyd M, Garfield A, LaSota MT. Anxiety sensitivity and worry. Personality and Individual Differences. 2005;38(5):1223-9.
    58. Assayag Y, Bernstein A, Zvolensky MJ, Steeves D, Stewart SS. Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment. Cognitive behaviour therapy. 2012;41(1):51-62.
    59. Taylor GJ, Bagby RM, Parker JD. Disorders of affect regulation: Alexithymia in medical and psychiatric illness: Cambridge University Press; 1999.
    60. Foroughi AA, Mohammadpour M, Khanjani S, Pouyanfard S, Dorouie N, Parvizi Fard AA. Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3). Trends in Psychiatry and Psychotherapy. 2019;41.
    61. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of psychosomatic research. 1994;38(1):23-32.

    62. Besharat MA. Toronto Alexithymia Scale: Questionnaire, Instruction and Scoring (Persian Version). 2013