The Structural Model of Depression in Patients with Irritable Bowel Syndrome Based on Internalized Maladaptive Object Relations: The Mediating Role of Defense Mechanisms
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Objective: This study tested a structural model in which internalized maladaptive object relations influence depressive symptoms in patients with irritable bowel syndrome (IBS) through different styles of defense mechanisms.
Methods and Materials: In this cross-sectional study, 351 adults with clinician-diagnosed IBS (153 men, 198 women; 18–65 years) were recruited from healthcare centers in Tehran in 2022–2023 using purposive sampling. Participants completed the Bell Object Relations and Reality Testing Inventory, the Defense Style Questionnaire-40, and the 7-item Beck Depression Inventory for Primary Care. Data were screened for normality and outliers, then analyzed using Pearson correlation, confirmatory factor analysis, and path analysis with maximum likelihood estimation. Model fit was evaluated with CMIN/DF, GFI, AGFI, CFI, and RMSEA indices.
Findings: Object-relations dimensions (egocentricity, alienation, insecure attachment, and social incompetence) were significantly associated with both defense styles and depression. The final model showed good fit (CMIN/DF = 2.81, GFI = 0.99, AGFI = 0.96, CFI = 0.99, RMSEA = 0.06) and explained 36% of the variance in depression. Mature and immature defenses were the strongest direct predictors of depression (protective and risk, respectively), whereas neurotic defenses showed a weaker, inverse association. All object-relations dimensions affected depression only indirectly via defense styles; no direct paths from object relations to depression remained significant.
Conclusion: These findings highlight defense mechanisms as key psychological pathways linking maladaptive object relations to depressive symptoms in IBS. Targeting defensive functioning alongside early relational patterns may be important in psychotherapeutic interventions for this population.
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