Razi Journal of Medical Sciences

fa از تمایزهای هیجانی تا طبقه‌بندی‌های تشخیصی: بازطبقه‌بندی روان‌تحلیلی اختلالات روان‌تنی From Affective Distinctions to Diagnostic Categories: Reclassifying Psychosomatic Disorders Psychoanalytically روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: اختلالات روان‌تنی اغلب در چارچوب روانکاوی، به‌ویژه مکاتب پاریس و روابط ابژه لندن، مطالعه شده‌اند. بااین‌حال، این اختلالات معمولاً به‌عنوان یک گروه همگن در نظر گرفته می‌شوند و تفاوت‌های روان‌شناختی میان سرطان، بیماری‌های خودایمنی و اختلالات عملکردی نادیده گرفته می‌شود. این مطالعه با هدف بررسی ویژگی‌های روان‌شناختی متمایز سه گروه اختلال روان‌تنی و ارزیابی نقش آلکسیتیمیا، عاطفه آشکار ضمنی (مثبت و منفی)، و خشم صفت-حالت در تمایز این گروه‌ها انجام شد. روش کار: این مطالعه مقطعی روی ۵۶ شرکت‌کننده (۱۴ نفر در هر گروه) از بیماران مراجعه‌کننده به کلینیک‌های تخصصی گوارش و افراد سالم انجام شد. شرکت‌کنندگان به‌صورت هدفمند انتخاب و پس از غربالگری معیارهای ورود و خروج در چهار گروه (سرطان کولورکتال، بیماری کرون، سندرم روده تحریک‌پذیر و سالم) دسته‌بندی شدند. داده‌ها با پرسشنامه‌های مقیاس عواطف مثبت و منفی، پرسشنامه عواطف مثبت و منفی ضمنی، پرسشنامه حالت-صفت خشم و پرسشنامه آلکسیتیمیا تورنتو گردآوری و با تحلیل تشخیصی و آزمون تعقیبی تحلیل شدند. یافته‌ها: بیماران مبتلا به سرطان کولورکتال بالاترین سطح آلکسیتیمیا را داشتند که نشان‌دهنده دشواری در نمادسازی هیجانات است. بیماران مبتلا به بیماری کرون بیشترین خشم صفت و بیماران مبتلا به سندرم روده تحریک‌پذیر بالاترین عاطفه منفی ضمنی را نشان دادند. در عواطف آشکار تفاوت معناداری مشاهده نشد. نتیجه‌گیری: این الگوهای هیجانی متمایز، فرضیه تفاوت روان‌شناختی و روان‌تحلیلی اختلالات روان‌تنی را تأیید می‌کند و نشان می‌دهد که هر یک از این اختلالات با مکانیسم های هیجانی و دفاعی خاصی مرتبط‌اند. این یافته‌ها می‌تواند در طراحی مداخلات روان‌درمانی هدفمند و بازنگری در مفهوم‌پردازی تشخیصی بیماران روان‌تنی مفید باشد.</div> <div style="text-align: justify;"> Background & Aims: Psychosomatic disorders are conditions in which emotional and psychological factors play a substantial role in the onset, maintenance, or exacerbation of physical illnesses. Despite extensive psychoanalytic exploration of psychosomatic phenomena—particularly through the seminal works of the Paris Psychosomatic School and the Object Relations School in London—many empirical studies still conceptualize psychosomatic disorders as a homogeneous diagnostic category. Such oversimplification neglects the heterogeneity and potentially distinct psychodynamic mechanisms underlying different types of psychosomatic conditions, such as Colorectal cancer (CRC), Crohn’s disease (CD), and irritable bowel syndrome (IBS). Accurate classification of psychosomatic disorders is crucial for optimizing treatment planning and improving patient outcomes, as different emotional mechanisms may necessitate different therapeutic approaches. Despite theoretical models, few empirical studies have systematically tested these psychodynamic distinctions in clinical populations. The present study was designed to examine whether these disorders exhibit unique emotional and psychological profiles that justify distinct classification. Building upon psychoanalytic theory and incorporating insights from psychoneuroimmunological research, the study aimed to investigate key emotional variables—including alexithymia, implicit and explicit affect, and trait-state anger—as potential differentiators among psychosomatic subgroups. Ultimately, the research sought to propose an emotion-based and psychodynamically informed model for distinguishing cancer, autoimmune, and functional psychosomatic disorders, thereby contributing to more nuanced conceptualization and targeted therapeutic interventions. Methods: This cross-sectional, comparative study was conducted with a total of 56 participants, evenly divided into four groups: patients diagnosed with CRC, CD, IBS, and a healthy control group. Participants were recruited through purposive sampling from specialist medical clinics and screened according to stringent inclusion and exclusion criteria specific to each condition. The inclusion criteria for the clinical groups required a confirmed diagnosis for at least six months and absence of severe psychiatric comorbidities, while controls were selected based on the absence of chronic physical or psychiatric illness. All participants completed assessments in a quiet, private room under the supervision of a trained clinical psychologist, ensuring standardization and reducing response bias. Potential confounding factors such as medication status, comorbidities, and demographic variables were recorded and statistically controlled where applicable. Data collection was carried out in controlled clinical settings to minimize external influences on psychological assessment. Psychological variables were measured using four validated psychometric instruments. The 20-item Toronto Alexithymia Scale (TAS-20) assesses difficulties in identifying and describing emotions and a tendency toward externally oriented thinking. The Positive and Negative Affect Schedule (PANAS) evaluates self-reported explicit emotional states over the preceding weeks. The Implicit Positive and Negative Affect Test (IPANAT) measures unconscious affective tendencies through associative word ratings, offering insight into emotional processes beyond conscious awareness. The State-Trait Anger Expression Inventory-2 (STAXI-2) distinguishes between stable, trait-based anger and situational, reactive anger, as well as anger expression versus suppression. All measures demonstrated strong internal consistency in this sample, with Cronbach’s alpha ranging between 0.81 and 0.90. Data analysis was performed using SPSS-26. Descriptive statistics summarized the sample characteristics and variable distributions. One-way ANOVA tests were conducted to examine differences among groups, followed by post-hoc Tukey tests to determine pairwise comparisons where significant effects were found. Finally, discriminant analysis was employed to assess the predictive power of the psychological variables in accurately classifying participants into their diagnostic categories, providing both statistical rigor and practical applicability. Results: The findings demonstrated significant differences in emotional profiles across the three psychosomatic groups. Patients with CRC scored highest on alexithymia (M = 66.57), followed closely by CD (M = 67.01), with IBS (M = 55.46) and controls (M = 46.53) scoring significantly lower. Although the difference between CRC and CD was not statistically significant (p > 0.05), both groups showed significantly higher alexithymia compared to IBS and controls (p < 0.001). This supports psychoanalytic conceptualizations, particularly those of the Paris School, suggesting that patients with more structurally impaired conditions such as cancer and autoimmune diseases exhibit profound difficulties in affect symbolization and mentalization, manifesting somatically. Implicit negative affect was highest in the IBS group (M = 4.49), surpassing CD (M = 4.28), CRC (M = 4.09), and controls (M = 3.06). The difference between IBS and the other clinical groups was statistically significant (p < 0.001), whereas differences between CRC and CD were negligible. These results are consistent with psychoanalytic theories that functional disorders like IBS are characterized by unconscious, but symbolizable, emotional conflict, reflecting a less severe structural impairment. Trait anger was highest among CD patients (M = 26.28), exceeding CRC (M = 24.07), IBS (M = 19.71), and controls (M = 17.35). The difference between CD and both IBS and controls was statistically significant (p < 0.01), and the difference between CD and CRC was also significant (p < 0.05). These findings align with psychoneuroimmunological perspectives linking suppressed, unprocessed anger to heightened inflammatory responses, suggesting a psychodynamic mechanism in autoimmune pathogenesis. No statistically significant differences emerged among groups in explicit affect as measured by PANAS, underscoring the limitation of relying solely on conscious self-reports to distinguish psychosomatic subtypes and emphasizing the importance of implicit and trait-based assessments. The discriminant analysis demonstrated that the combination of alexithymia, implicit negative affect, and trait anger correctly classified 85% of participants into their respective groups. This model demonstrated high specificity and sensitivity in distinguishing among the clinical subgroups, providing strong evidence for its diagnostic utility. Wilks’ Lambda indicated significant discriminative power for alexithymia (Λ = 0.76, p < 0.001), implicit affect (Λ = 0.68, p < 0.01), and trait anger (Λ = 0.62, p < 0.05). Notably, alexithymia was most effective in differentiating cancer and autoimmune groups, whereas implicit affect was the strongest predictor of functional disorders like IBS. Conclusion: The results substantiate a psychoanalytically informed classification of psychosomatic disorders based on distinct emotional profiles. CRC was characterized predominantly by high alexithymia and impaired symbolization, CD by unresolved trait anger linked to immune dysregulation, and IBS by elevated implicit negative affect reflective of unconscious conflict and less severe structural deficit. These findings carry significant theoretical and clinical implications. Theoretically, they lend empirical support to the psychoanalytic distinction between structural and functional disorders, providing evidence that such distinctions are not merely conceptual but reflected in measurable psychological variables. From a clinical perspective, they highlight the necessity of tailoring psychotherapeutic and psychobiological interventions to the emotional functioning and representational capacities unique to each subgroup, facilitating more effective and individualized care. Moreover, these findings offer guidance for training clinicians in recognizing subtle emotional patterns that inform psychodynamic case formulations and intervention planning. Importantly, this study bridges psychoanalytic and psychoneuroimmunological perspectives, demonstrating their complementary contributions to understanding mind-body interactions in illness. Interdisciplinary collaboration between psychoanalysts, immunologists, and behavioral scientists is recommended to further elucidate these complex interactions and to develop integrative treatment models. Future research should extend these findings by incorporating larger, more diverse samples, exploring neurobiological and immunological markers in conjunction with psychological assessments, and evaluating the impact of targeted psychodynamic interventions on both psychological and somatic outcomes in psychosomatic disorders. </div> روان‌تنی, آلکسیتیمیا, عاطفه Psychosomatic Disorders, Alexithymia, Affect 1 9 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8584-1&slc_lang=fa&sid=1 Mohsen Saadat محسن سعادت 3900319475328460088929 0009-0004-2637-2977 No PhD Student of Clinical Psychology, Shiraz University, Shiraz, Iran دانشجوی دکتری روان‌شناسی بالینی، دانشگاه شیراز، شیراز، ایران Mahdi Reza Sarafraz مهدی رضا سرافراز Msarafraz@shirazu.ac.ir 3900319475328460088930 3900319475328460088930 Yes Associate Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran دانشیار، گروه روان‌شناسی بالینی، دانشگاه شیراز، شیراز، ایران Habib Hadianfard حبیب هادیان فرد 3900319475328460088931 3900319475328460088931 No Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran استاد، گروه روان‌شناسی بالینی، دانشگاه شیراز، شیراز، ایران Mahdi Imani مهدی ایمانی 3900319475328460088932 3900319475328460088932 No Assistant Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran استادیار، گروه روان‌شناسی بالینی، دانشگاه شیراز، شیراز، ایران