Depressive Symptoms Mediate the Relationship between Emotional Cutoff and Type 2 Diabetes Mellitus

  • Ami CohenEmail author
  • Ora Peleg
  • Amira Sarhana
  • Shany Lam
  • Iris Haimov
Full length manuscript



Differentiation of self is a family systems construct defined as the ability to balance intimacy and autonomy and to separate instinctually driven emotional reactions and thoughtfully considered goal-directed functioning. In theory, low differentiation of self is reflected by four components: a low tendency to take an I-position in relationships (i.e., to own one’s thoughts and feelings); emotional cutoff from others; a greater tendency to fuse with others; and a tendency towards emotional reactivity. Low differentiation of self is associated with anxiety and depression, which are risk factors for type 2 diabetes mellitus. The current study examines the relationship between differentiation of self and type 2 diabetes mellitus.


Individuals with type 2 diabetes mellitus (N = 107) and healthy individuals (N = 145) completed the Differentiation of Self Inventory-Revised (DSI-R), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI-II).


Compared with healthy individuals, participants with type 2 diabetes had more severe depressive symptoms, higher levels of emotional cutoff, and a lower tendency to take an I-position, but had similar levels of trait anxiety, emotional reactivity, and fusion with others (factor analysis revealed these factors were not separable in the current sample and thus were merged into a single construct). Importantly, the severity of depressive symptoms mediated the relationship between emotional cutoff and being in the type 2 diabetes study group rather than the healthy group.


These findings suggest a new perspective on the role of psychological patterns in type 2 diabetes mellitus development and progression.


Type 2 diabetes Differentiation of self Emotional cutoff I-position Depression Trait anxiety 



The authors wish to thank Paula S. Herer, biostatistician, MSc, MPH, for her contribution to the statistical analyses.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12529_2019_9816_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)


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Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  1. 1.Department of PsychologyThe Max Stern Yezreel Valley CollegeEmek YezreelIsrael
  2. 2.Department of Counseling and EducationThe Max Stern Yezreel Valley CollegeEmek YezreelIsrael

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