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



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.

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

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Correspondence to Ami Cohen.

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Cohen, A., Peleg, O., Sarhana, A. et al. Depressive Symptoms Mediate the Relationship between Emotional Cutoff and Type 2 Diabetes Mellitus. Int.J. Behav. Med. 26, 591–599 (2019).

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