Journal of Applied Psychological Research

Examining the Relationship between Cloninger’s Personality Dimensions, Pain Perception, Treatment Adherence, and Emotion Dysregulation in Women with Endometriosis: A Network Analysis Approach

Document Type : Research Paper

Authors

1 Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

2 Associate Professor, Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

3 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.

Abstract

This study aimed to examine the relationship between Cloninger’s personality dimensions, pain perception intensity, treatment adherence, and emotion dysregulation in women with endometriosis. This applied, cross-sectional research with a quantitative approach was conducted on a convenience sample of 180 women diagnosed with endometriosis. Data were collected using the Temperament and Character Inventory (TCI-56), the Visual Analog Scale (VAS), the Morisky Medication Adherence Scale (MMAS), and the Difficulties in Emotion Regulation Scale (DERS). Data were analyzed using R software and the BOOTNET package through psychological network analysis. The results indicated that high harm avoidance and low self-directedness were significantly associated with higher pain perception and greater emotion dysregulation, and played an important role in predicting treatment adherence. Network analysis revealed a complex structure of interrelations and identified central nodes such as emotion dysregulation and persistence. These findings suggest that personality traits and emotion regulation play a central role in the psychological experiences of patients. Therefore, designing individualized interventions that focus on improving emotional regulation and modifying maladaptive personality traits may contribute to enhancing patients’ quality of life. The insights from this study can be valuable in developing more effective treatments and improving psychological outcomes for women with endometriosis.

Keywords

ترحمی، ف.، خادم، س.، فرج پور، آ.، و بیضایی، ح. (1397). بررسی روایی و پایایی نسخه فارسی سنجش رضایتمندی بیماران از مراقبت های بیهوشی (IOWA): نتیجۀ رضایتمندی بیماران با درد. مجله علوم اعصاب شفای خاتم، 6(2)، 53-60. http://dx.doi.org/10.29252/shefa.6.4.53  
دهقان، م.، دهقان نیری، ن.، و ایرانمنش، ص. (1393). روان‌سنجی نسخۀ فارسی مقیاس تبعیت دارویی موریسکی. همایش سراسری راهکارهای ارتقاء کیفیت خدمات پرستاری و مامایی، دانشگاه علوم پزشکی و خدمات بهداشتی و درمانی شهید صدوقی یزد، 14-12 اسفند 1393. https://sid.ir/paper/861603/fa
کاویانی، ح.، و پورناصح، م. (1384). اعتباریابی و هنجارسنجی پرسشنامۀ سرشت و منش کلونینجر TCI در جمعیت ایرانی. مجلۀ دانشکده پزشکی دانشگاه علوم پزشکی تهران، 63(2)، 98-89. http://tumj.tums.ac.ir/article-1-1033-fa.html
فلاحی، و.، نریمانی، م.، و عطادخت، ا. (1400). خصوصیات روان‌سنجی فرم کوتاه مقیاس دشواری در تنظیم هیجان (DERS-16): در گروهی از نوجوانان ایرانی. ماهنامه علمی پژوهشی دانشگاه علوم پزشکی شهید صدوقی یزد، 29(5)، 3735-3721. http://dx.doi.org/10.18502/ssu.v29i5.6772
صارمی، ا.، و ناطقی، م. ر. (1401). طبقه‌بندی اندومتریوز: یک مرور ساختاریافته. مجله تحقیقات پزشکی صارم (دانشنامه صارم در طب باروری)، 7(3)، 195-201. http://dx.doi.org/10.61186/sjrm.7.3.195
References
Bijur, P. E., Silver, W., & Gallagher, E. J. (2011). Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine, 8(12), 1153–1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13. https://doi.org/10.1002/wps.20375
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608
Ciuluvica Neagu, C., Amerio, P., & Grossu, I. V. (2020). Emotional Dysregulation Mechanisms in Psychosomatic Chronic Diseases Revealed by the Instability Coefficient. Brain sciences, 10(10), 673. https://doi.org/10.3390/brainsci10100673
Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50(12), 975-990. https://psycnet.apa.org/doi/10.1001/archpsyc.1993.01820240059008
Culley, L., Law, C., Hudson, N., Denny, E., Mitchell, H., Baumgarten, M., & Raine-Fenning, N. (2013). The social and psychological impact of endometriosis on women's lives: A critical narrative review. Human Reproduction Update, 19(6), 625-639. https://doi.org/10.1093/humupd/dmt027
De Graaff, A. A., D’Hooghe, T. M., Dunselman, G. A., Dirksen, C. D., Hummelshoj, L., & Simoens, S. (2013). The significant effect of endometriosis on physical, mental and social wellbeing: Results from an international cross-sectional survey. Human Reproduction, 28(10), 2677–2685. https://doi.org/10.1093/humrep/det284
Dehghan, M., Dehghan Niri, N., & Iranmanesh, S. (2014). Psychometric properties of the Persian version of the Morisky Medication Adherence Scale. National Conference on Strategies for Improving the Quality of Nursing and Midwifery Services. https://sid.ir/paper/861603/fa (In Persian)
Falahi, V., Narimani, M., & Atadokht, A. (2021). Psychometric properties of the short form of the Difficulties in Emotion Regulation Scale (DERS-16): In a sample of Iranian adolescents. Scientific-Research Monthly of Shahid Sadoughi University of Medical Sciences, 29(5), 3721-3735. http://dx.doi.org/10.18502/ssu.v29i5.6772 (In Persian)
Fisher, E., Heathcote, L. C., Eccleston, C., Simons, L. E., & Palermo, T. M. (2018). Assessment of pain anxiety, pain catastrophizing, and fear of pain in children and adolescents with chronic pain: A systematic review and meta-analysis. Journal of Pediatric Psychology, 43(3), 314–325. https://doi.org/10.1093/jpepsy/jsx103
Garcia‐Fontanals, A., García‐Blanco, S., Portell, M., Pujol, J., Poca‐Dias, V., García‐Fructuoso, F., ... & Deus, J. (2016). Cloninger's psychobiological model of personality and psychological distress in fibromyalgia. International Journal of Rheumatic Diseases, 19(9), 852-863. https://doi.org/10.1111/1756-185X.12473
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Harrison, M., Watkins, C., & Beecham, J. (2017). Medication adherence in patients with chronic pain: Implications for health outcomes and costs. Pain Management Nursing, 18(5), 243–250. https://doi.org/10.1016/j.pmn.2017.02.073
Horne, A. W., & Saunders, P. T. K. (2019). Medical and psychological impact of endometriosis. Nature Reviews Endocrinology, 15(11), 666–678. https://doi.org/10.1038/s41574-019-0255-2
Johnson, N. P., Hummelshoj, L., & World Endometriosis Society Montpellier Consortium. (2013). Consensus on current management of endometriosis. Human Reproduction, 28(6), 1552–1568. https://doi.org/10.1093/humrep/det050
Kaviani, H., & Poor Naseh, M. (2005). Validation of Temperament and Character Inventory (TCI) in Iranian sample: Normative data. Tehran University Medical Journal (TUMJ), 63(2), 89-98. http://tumj.tums.ac.ir/article-1-1033-en.html (In Persian)
Koechlin, H., Coakley, R., Schechter, N., Werner, C., & Kossowsky, J. (2018). The role of emotion regulation in chronic pain: A systematic literature review. Journal of Psychosomatic Research, 107, 38–45. https://doi.org/10.1016/j.jpsychores.2018.02.002
Lumley, M. A., Neely, L. C., & Burger, A. J. (2007). The Assessment of Alexithymia in Medical Settings: Implications for Understanding and Treating Health Problems. Journal of Personality Assessment, 89(3), 230–246. https://doi.org/10.1080/00223890701629698
Moradi, M., Parker, M., Sneddon, A., Lopez, V., & Ellwood, D. (2014). Impact of endometriosis on women’s lives: A qualitative study. BMC Women's Health, 14(1), 1-12. https://doi.org/10.1186/1472-6874-14-123
Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension, 10(5), 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
Nooham, M., Laux, J. M., & Cribbs, J. (2011). Treatment adherence and the role of personality traits in chronic conditions. Journal of Health Psychology, 16(8), 1151–1163. https://doi.org/10.1177/1359105311402404
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, diagnosis and clinical management. Current Obstetrics and Gynecology Reports, 6(1), 34–41. https://doi.org/10.1007/s13669-017-0187-1
Poppe, C., Crombez, G., Devulder, J., Hanoulle, I., Vogelaers, D., & Petrovic, M. (2011). Personality traits in chronic pain patients are associated with low acceptance and catastrophizing about pain. Acta clinica Belgica, 66(3), 209–215. https://doi.org/10.2143/ACB.66.3.2062549
Rodríguez-Lozano, D. C., Meza-Rodríguez, M. d. P., Cruz-Orozco, O.P. … & Camacho-Arroyo, I. (2022). Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain. BMC Women's Health, 22, 525. https://doi.org/10.1186/s12905-022-02066-5
Saremi, A., & Nateghi, M. R. (2022). Classification of endometriosis: A structured review. Saram Medical Research Journal (Saram Encyclopedia of Reproductive Medicine), 7(3), 195–201. http://dx.doi.org/10.61186/sjrm.7.3.195 (In Persian)
Tarahomi, F., Khadem, S., Farajpour, A., & Beizaie, H. (2018). Validity and reliability examination of the Persian version of the IOWA satisfaction with anesthesia scale: The result of patient satisfaction with pain. Shefaye Khatam, 6(4), 53-60. http://dx.doi.org/10.29252/shefa.6.4.53 (In Persian)
Van Stein, K., Schubert, K., Ditzen, B., & Weise, C. (2023). Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. Journal of Clinical Medicine, 12(12), 4056. https://doi.org/10.3390/jcm12124056
Venditti, R. A., Neely, M. C., & Turner, A. P. (2023). Psychological barriers to treatment adherence in women with chronic illness: A systematic review. Women's Health Reports, 4(2), 87–95. https://doi.org/10.1089/whr.2023.0054
Vitale, S. G., La Rosa, V. L., Rapisarda, A. M. C., & Laganà, A. S. (2017). Impact of endometriosis on quality of life and psychological well-being. Journal of Psychosomatic Obstetrics and Gynaecology, 38(4), 317–319. https://doi.org/10.1080/0167482X.2016.1244185
Zautra, A. J. (2006). Emotions, Stress, and Health. New York: Oxford University Press. https://doi.org/10.1093/oso/9780195133592.003.0011
Journal of Applied Psychological Research
Volume 16, Issue 4
December 2025
Pages 19-34
  • Receive Date: 12 June 2025
  • Revise Date: 19 July 2025
  • Accept Date: 19 August 2025
  • First Publish Date: 17 September 2025
  • Publish Date: 22 December 2025