Cultural Obstacles in Emotion Expression among Patients with Somatic Symptom Disorder (SSD) in an Iranian Sample: A Qualitative Study

Introduction: Numerous studies have indicated the role of unexpressed emotions in Somatic Symptoms Disorder (SSD). There are also many studies demonstrating a high prevalence rate of SSD in Iran. Literature suggests that due to cultural issues in Iran, it is difficult directly expressing emotions. Therefore, the issue of emotion expression contributes to a high prevalence of SSD in Iran. To address this issue, the aim of this study was to discover cultural obstacles in emotional expression among patients with SSD in an Iranian sample. Method: A qualitative conventional content analysis was conducted on the data collected from 17 individual in depth interviews with SSD patients, and mental health professionals who were recruited throughout a purposive and theoretical sampling. The sample was derived from the statistical population of SSD patients who were referred to mental health professionals at therapeutic centers in Tehran, Iran. Results: Three themes were emerged as the obstacles of emotion expression in SSD patients in the context of the Iranian culture: 1) Overgenderizing emotions 2) Internalized ban of expressing emotions towards parents and other authorities 3) Difficulties with expressing positive emotions. Conclusion: It seems that SSD patients in Iran have difficulties directly expressing their emotions, regarding the four aforementioned cultural barriers identified in this study.