The Mediating Role of Alexithymia in the Relationship between Maladaptive Object Relations Patterns and Depression

Objective: Depression is a prevalent psychological condition that severely impacts quality of life. Psychodynamic theories highlight early interpersonal experiences and maladaptive object relations as key factors in vulnerability to psychopathology. Alexithymia, characterized by difficulty identifying and expressing emotions, is a transdiagnostic risk factor strongly linked to depression. This study examines the mediating role of alexithymia in the relationship between maladaptive object relations and depression. Method : This cross-sectional study used a path-analysis method. A total of 245 dormitory students (145 males and 100 females) from Iran University of Medical Sciences were selected via two-stage cluster sampling. Data were collected using the Bell Object Relations and Reality Testing Inventory (BORRTI), Toronto Alexithymia Scale (TAS-20), and Beck Depression Inventory-Short Form (BDI-S). Pearson correlation, regression analysis, and the Sobel test were conducted using SPSS version 20. Results: Path analysis showed significant direct effects of maladaptive object relations (alienation, insecure attachment, egocentricity, social incompetence) on both alexithymia (β = 0.395-0.444, P < 0.001) and depression (β = 0.365-0.562, P < 0.001). Alexithymia also directly affected depression (β = 0.176-0.287, P ≤ 0.003). Indirect effects of alexithymia in the relationship between object relations and depression ranged from 0.077 to 0.113, with all paths significant per the Sobel test. Conclusion: Alexithymia significantly mediates the relationship between maladaptive object relations and depression, suggesting that early unhealthy relational patterns may foster depression by impairing emotional awareness. Therapeutic interventions should focus on enhancing emotional processing to promote sustainable recovery.