ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Psychopathology
This article is part of the Research TopicTransdiagnostic approach in studying mental health conditions: The contribution of fundamental and translational brain research for precise interventionsView all 5 articles
Alexithymia Mediates the Pathway from Negative Life Events to Somatic Symptoms: A Cross-sectional Study in a Psychosomatic Outpatient Sample
Provisionally accepted
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Introduction: Somatic Symptom Disorder (SSD), characterized by distressing and functionally impairing physical symptoms without adequate medical explanation, imposes substantial personal and socioeconomic burdens. While negative life events (NLEs) and alexithymia (difficulty identifying/describing emotions) are established risk factors for somatic symptoms, their interrelationships and underlying mechanisms remain inadequately explored. This study investigated whether alexithymia mediates the pathway between NLEs and somatic symptoms in a clinical sample. Methods: A cross-sectional analysis was conducted with 523 psychosomatic outpatients (65.2% female, mean age 41.45 ± 12.36 years) from Peking Union Medical College Hospital (2020-2025). Participants completed: 1) the Life Events Scale (LES) to assess NLE stress burden, 2) the Toronto Alexithymia Scale (TAS-26) to measure alexithymia (focusing on Difficulty Identifying Feelings [DIF] and Difficulty Describing Feelings [DDF]), and 3) the Patient Health Questionnaire-15 (PHQ-15) to quantify somatic symptom severity. Pearson correlations, linear regression, and mediation analyses (controlling for age/gender) examined relationships and mediating effects. Results: NLEs and alexithymia were significantly correlated with somatic symptoms (r = 0.330 and r = 0.369, respectively, p<0.01). Linear regression confirmed both as significant predictors, explaining 11% and 13.6% of somatic symptom variance, respectively. Alexithymia subscales DIF (β = 0.220, p<0.001) and DDF (β = 0.141, p = 0.014) contributed significantly, while externally oriented thinking (EOT) did not. Crucially, mediation analysis revealed alexithymia partially mediated the NLEs-somatic symptoms pathway (indirect effect: B = 0.0028, 95% CI[0.001, 0.005]), accounting for 16.25% of the total effect. A bidirectional mediation effect was also observed, with NLEs mediating 11.9% of the alexithymia-somatic symptoms relationship. Conclusion: Alexithymia significantly mediates the relationship between NLEs and somatic symptoms in psychosomatic outpatients, though its effect size (16.25%) suggests additional multifactorial pathways. Conversely, NLEs also partially mediate the alexithymia-symptom relationship, indicating complex bidirectional dynamics. Clinically, interventions targeting both alexithymia and NLE exposure may alleviate somatic symptom burden.
Keywords: Negative life events, alexithymia, Somatic symptoms, Mediating effect, Outpainting
Received: 06 Aug 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Chen, Ma, Cao and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jing Wei
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