Trauma and gastrointestinal symptoms in patients with gastroesophageal reflux disease: the role of emotional processing and mentalization.

Abstract

Aim: This study seeks to determine, for the first time, whether these mechanisms account for the indirect effects of trauma on gastrointestinal symptom severity within a psychosomatic framework.

Background: Gastroesophageal reflux disease (GERD) is one of the most common disorders of the digestive system, and various psychological factors may contribute to its development and exacerbation. The present study will examine these factors within a unified analytical model. Specifically, the study aimed to examine a path analysis model of the relationship between trauma and gastrointestinal symptoms in patients with GERD, with a focus on the mediating roles of emotional processing and mentalization.

Methods: This cross-sectional study included 207 people with gastroesophageal reflux disease referred to Tehran Behbood Clinic, aged 18 to 60 years, selected through convenience sampling. The study was carried out between September and October 2024. The subjects completed the Gastrointestinal Symptom Rating Scale (GSRS), Mentalization Questionnaire (MQ), Childhood Trauma Questionnaire, and Emotional Information Processing Questionnaire (EIPQ). Data were analyzed using path analysis in R (lavaan package) with the Maximum Likelihood Robust (MLR) estimator to account for non-normality. Model fit was evaluated using chi-square, CFI, TLI, RMSEA, and SRMR, and direct, indirect, and total effects were calculated to examine the mediating role of emotional processing and mentalization.

Results: Trauma had a significant direct effect on gastrointestinal symptoms (β = 0.242, p < 0.001). Emotional processing significantly mediated this relationship (indirect effect β = 0.039, p < 0.05). Mentalization did not show a significant direct or mediating effect on gastrointestinal symptoms (β = 0.074, p = 0.255). Model fit indices indicated excellent fit (CFI = 1.000, TLI = 1.198, RMSEA = 0.000, SRMR = 0.003).

Conclusion: Based on the findings, it can be concluded that trauma and emotional processing predict gastrointestinal symptoms in patients with gastroesophageal reflux disease and need to be considered in therapeutic interventions.