Alexithymia mediates the pathway from negative life events to somatic symptoms: a cross-sectional study in a psychosomatic outpatient sample

Introduction Somatic Symptom Disorder (SSD), characterized by distressing and functionally impairing physical symptoms without adequate medical explanation, imposes substantial personal and socioeconomic burdens. While negative life events (NLEs) and alexithymia (difficulty identifying/describing emotions) are established risk factors for somatic symptoms, their interrelationships and underlying mechanisms remain inadequately explored. This study investigated whether alexithymia mediates the pathway between NLEs and somatic symptoms in a clinical sample. Methods A cross-sectional analysis was conducted with 523 psychosomatic outpatients (65.2% female, mean age 41.45 ± 12.36 years) from Peking Union Medical College Hospital (2020-2025). Participants completed: 1) the Life Events Scale (LES) to assess NLE stress burden, 2) the Toronto Alexithymia Scale (TAS-26) to measure alexithymia (focusing on Difficulty Identifying Feelings [DIF] and Difficulty Describing Feelings [DDF]), and 3) the Patient Health Questionnaire-15 (PHQ-15) to quantify somatic symptom severity. Pearson correlations, linear regression, and mediation analyses (controlling for age/gender) examined relationships and mediating effects. Results NLEs and alexithymia were significantly correlated with somatic symptoms (r = 0.330 and r = 0.369, respectively, p