Emotional Alexithymia as a Mediator Between Body Image Concerns and Marital Quality of Life in Post-mastectomy Breast Cancer Patients

Background: Breast cancer often requires mastectomy, leading to psychological distress and reduced quality of life. Objectives: This study examined the mediating role of alexithymia, specifically its 3 dimensions, in the relationship between body image concerns and marital quality of life in post-mastectomy patients. Methods: This cross-sectional study enrolled 120 married women (aged 20 - 50) with stage I – II breast cancer who had undergone mastectomy at Shohada Tajrish Hospital, Tehran, in 2024; participants completed 3 validated self-report questionnaires: The Toronto Alexithymia Scale (TAS-20), the Body Image Concern Inventory (BICI), and the Revised Dyadic Adjustment Scale (RDAS). Data were analyzed using descriptive statistics, Pearson’s correlations, and path analysis in SPSS and AMOS, with ethical approval obtained and informed consent secured from all participants. Results: Body image concerns were directly associated with lower marital quality of life (β = –0.300, P = 0.003) and with higher alexithymia, particularly difficulty identifying feelings (β = 0.609, P < 0.001). Only difficulty identifying feelings significantly mediated this relationship (β = –0.240, P = 0.024). Notably, externally oriented thinking showed a positive direct association with marital quality of life (β = 0.239, P = 0.001). Conclusions: Body image concerns following mastectomy impair marital quality of life, primarily through impaired emotional identification. The unexpected positive role of externally oriented thinking suggests context-dependent functions of alexithymia traits. Findings support the integration of emotion-focused psychological support into surgical care pathways.