This investigated the role of anxiety as a risk factor in increasing of emotional-behavioral problems among adolescents. Also, the study examined the serial mediation path from anxiety to emotional-behavioral problems through dependency and alexithymia.
In this study, 79.63% of the adolescents showed emotional-behavioral problems when compared with the normal group. The clinical samples showed more emotional and behavioral problems. These findings were consistent with previous studies where participants with emotional-behavioral disorders showed increased multidimensional anxiety levels [40], alexithymia [41–42], and dependence[43–44]. However, significant differences were not reported for peer problems in both the normal and clinical samples.
This study explored the relationship between multidimensional anxiety, alexithymia, dependence and emotional-behavioral problems in adolescents. Consistent with previous studies, adolescents with anxiety symptoms have shown increased emotional-behavioral problems [45–48], and multidimensional anxiety. Negative personalities are positive predictors of adolescent emotional-behavioral problems [22].
Adolescents with anxiety often exhibit comorbid symptoms of emotional-behavioral problems [54–56]. Immature personality factors are also risk factors for emotional-behavioral problems in adolescents. Alexithymia is conceptualized as a personality trait that is normally distributed in the population and is associated with an increased risk of psychopathology [49]. In this study, alexithymia was significantly associated with poor interpersonal relationships. Also, high alexithymia subjects are reported to show increased interpersonal relationship problems, attachment insecurity, avoidant behavior and suicidal behavior [50–52]. Adolescents with alexithymia exhibit some impairment in emotional expression and emotional recognition and increased introversion. Also, they show distorted cognition and inhibited behavior during interpersonal relationships, which may further exacerbate emotional-behavioral problems. Dependency is an immature, non-mutually satisfying personality trait. Previous studies have reported that the abnormal group with psychological behavior show increased dependence [53]. Therefore, alexithymia and dependency personalities may be risk factors for adolescents' emotional-behavioral problems.
Additional research shows that anxiety not only directly affects adolescents' emotional-behavioral problems but also indirectly affects them through the mediating effects of dependency and alexithymia. The mediating effect includes three paths: (1) the mediating path through alexithymia; (2) the mediating path through dependency; and (3) the chain mediating path through dependency and alexithymia.
These study findings revealed that alexithymia and dependent personality are factors that play an important mediating role in the relationship between anxiety and emotional-behavioral problems in adolescents, and these findings were consistent with previous research [57]. A negative personality trait is one of the main mediating variables of emotional-behavioral problems and can partly explain abnormal emotional-behavioral problems [61]. Inappropriate personality traits impair the ability to regulate adolescents' emotions, and this could lead to increased emotional-behavioral problems. Recent studies have reported an association between alexithymia with immature ego defense styles, which implies a relatively primitive way of dealing with emotional problems [58]. Previous studies also indicate that anxiety is interrelated with alexithymia [59–60], and participants with emotional-behavioral problems showed more dependency personality traits [43].
This study investigates the relationship among adolescent anxiety, alexithymia, dependency and emotional-behavioral problems to provide evidence for preventive interventions for adolescents at risk of emotional-behavioral problems. Some factors are considered to increase the prevalence of emotional-behavioral problems in adolescents including parental and individual factors [62–63]. Mature personality trait also reduces emotional-behavioral problems.