How psychological distress translates into psychogenic pruritus: Alexithymia, body awareness, and coping in a...

Psychogenic pruritus represents a condition where psychological distress (mild psychological maladjustment arising from stress, adaptation difficulties, or interpersonal conflict) manifests as physical symptoms through emotional processing deficits. The sequential mechanisms involving alexithymia and body awareness, and how coping strategies moderate these pathways in collectivistic cultures, remain underexplored.

A cross-sectional study of 115 Pakistani adults with psychogenic pruritus used validated measures to assess psychological distress, alexithymia, body awareness, coping strategies, and pruritus severity. Two structural equation models tested moderated sequential mediation, comparing emotion-focused versus problem-focused coping as moderators.

Both models explained substantial variance in pruritus severity (R² = 0.791 and 0.789). Psychological distress showed significant direct effects on pruritus (β = 0.793 and 0.794, p < 0.001) and indirect effects through sequential mediation of alexithymia and body awareness (β = 0.128, 95% CI [0.065, 0.207]; β = 0.130, 95% CI [0.064, 0.209]). Body awareness fully mediated the relationship between alexithymia and pruritus (β = 0.198 and 0.199, p < 0.001). Emotion-focused coping significantly moderated the distress-alexithymia pathway (β = -0.169, p = 0.009) with significant conditional indirect effects (β = -0.109, 95% CI [-0.200, -0.032]), while problem-focused coping showed no significant moderation (β = -0.059, p = 0.676) or conditional indirect effects (β = -0.039, 95% CI [-0.157, 0.208]).

Psychological distress influences psychogenic pruritus through sequential emotional processing and body perception pathways. Emotion-focused coping strategies buffer these pathways more effectively than problem-focused approaches in Pakistani populations, suggesting interventions targeting emotional awareness within culturally adapted frameworks may disrupt the distress to pruritus cycle.