According to estimates from the Institute for Health Metrics and Evaluation, approximately 12.5% of the global population was living with an anxiety disorder in 2023, with prevalence rates varying significantly by region, age, and socioeconomic status (Dattani et al., 2023). Social anxiety disorder is characterized by a persistent, unreasonable fear of being negatively evaluated by other people in social situations such as public speaking or speaking to unfamiliar people (Reta et al., 2020). Social anxiety disorder incidence rates among college students are rising, with anxiety now being the primary concern for mental health professionals treating this population—a trend corroborated by the growing number of affected students (Center for Collegiate Mental Health, 2020, 2022).

 

Parental psychological control, a dysfunctional parenting style defined by the use of guilt induction, love withdrawal, and emotional manipulation to intrude upon children’s thoughts and behaviors, has emerged as a key contributor to maladaptive social–emotional development (Barber et al., 2002; Pérez et al., 2021). Empirical evidence has consistently demonstrated a positive association between parental psychological control and elevated levels of social interaction anxiety in children and adolescents (Lazaros, 2024; Li & Zheng, 2025; Qian et al., 2022).

 

Alexithymia, also known as emotional blindness, is a personality feature in which an individual has difficulty experiencing, identifying, understanding, and expressing their emotions (Darvishi et al., 2025). It has been recognized as a risk factor for social anxiety, with research consistently demonstrating a positive association between alexithymia and social interaction anxiety symptoms in children (Ertekin et al., 2025; Kano & Fukudo, 2013; Preece et al., 2024).

 

Loneliness, defined as a distressing emotional state resulting from a discrepancy between desired and actual social relationships (Eres et al., 2021; Perlman & Peplau, 1981), is another potent correlate of social interaction anxiety disorder. Previous studies have shown that prolonged feelings of loneliness can lead to increased levels of anxiety and depression (Darvishi et al., 2025; Maes et al., 2019; Meltzer et al., 2012).

 

In this study we developed a chain mediation model in which we proposed that psychological control would indirectly predict social interaction anxiety disorder through the sequential mediators of alexithymia and loneliness. We examined how parental psychological control, alexithymia, and loneliness contribute to social interaction anxiety disorder in a nonclinical population, which has significant implications for early intervention and prevention strategies. Drawing on existing research, we formulated the following hypotheses:

Hypothesis 1: Parental psychological control will predict college students’ social interaction anxiety disorder.

Hypothesis 2: Parental psychological control will predict college students’ social interaction anxiety disorder through the mediator of alexithymia.

Hypothesis 3: Parental psychological control will predict college students’ social interaction anxiety disorder through the mediator of loneliness.

Hypothesis 4: Alexithymia and loneliness will play a chain mediating role in the relationship between parental psychological control and college students’ social interaction anxiety disorder.

 

The proposed research model is outlined in Figure 1.

We recruited 1,000 participants from three universities located in Liaoning Province, China, distributing questionnaires through both online and offline channels to maximize the response rate and accommodate the preferences of the participants. Of these participants, 927 (92.70%) provided valid responses. Participants ranged in age between 18 and 22 years. We did not collect data on the mean and standard deviation of participants’ ages. Further demographic data are presented in Table 1.

Between March and June 2025, we recruited participants through campus bulletin boards and provided them with a detailed information sheet outlining the study’s objectives to ensure their full understanding of the research. Informed consent was obtained from all participants and we advised them that they were free to withdraw from the study if they felt uncomfortable. The study strictly complied with the ethical guidelines stipulated in the Declaration of Helsinki (2013 revision) and its subsequent amendments, and the study protocol was approved by the ethical board of our university.

The Chinese version (Q. Wang et al., 2007) of the Parental Psychological Control Scale (Olson et al., 2002) consists of 18 items and encompasses three dimensions: love withdrawal (five items, e.g., “If I do something that my parents don’t like, they will appear cold and unfriendly”), guilt induction (10 items, e.g., “My parents told me all the sacrifices they made for me”), and conditional approval (three items, e.g., “My parents told me that what they want me to do is the best for me, and I shouldn’t have any doubts about these things”). Items are rated on a 5-point Likert scale ranging from 1 = extremely inconsistent to 5 = extremely consistent. Higher scores indicate a higher level of parental psychological control. Cronbach’s alpha in this study was .94. Additionally, the scale showed good fit indices, χ²/df = 1.640, goodness-of-fit index (GFI) = .973, adjusted goodness-of-fit index (AGFI) = .965, normed fit index (NFI) = .980, incremental fit index (IFI) = .992, comparative fit index (CFI) = .992, Tucker–Lewis index (TLI) = .991, root-mean-square error of approximation (RMSEA) = .026.

 

The Toronto Alexithymia Scale is a 20-item, self-administered questionnaire developed by Bagby et al. (1994) and translated into Chinese by Zhu et al. (2015). It is widely used to measure alexithymia in China (Chen & Yao, 2025; Shi et al., 2025; G. Wang et al., 2025). The scale comprises three dimensions: difficulty describing feelings (five items, e.g., “I find it difficult to describe my feelings with appropriate words”), difficulty identifying feelings (seven items, e.g., “I often can’t figure out how I feel”), and externally oriented thinking (eight items, e.g., “I like to talk to others about their daily activities rather than their feelings”). Items are rated on a 5-point Likert scale where 1 = strongly disagree and 5 = strongly agree. The total alexithymia score is the sum of responses to all 20 items. The scale uses cutoff scoring: ≤ 51 = no alexithymia, 52–60 = possible alexithymia, and ≥ 61 = alexithymia. While Ni and Fang (2025) identified limitations in specific items of the Chinese version of the Toronto Alexithymia Scale, their study did not invalidate the scale’s overall utility but instead provided empirical evidence for its cultural adaptation and refinement among Chinese adolescents. Cronbach’s alpha in our study was .95, and the scale showed good fit indices, χ²/df = 2.072, GFI = .962, AGFI = .952, NFI = .975, IFI = .987, CFI = .958, TLI = .985, RMSEA = .034.

 

The UCLA Loneliness Scale (Russell et al., 1980) is a widely recognized tool in social psychology designed to measure loneliness and social isolation. D. F. Wang (1995) developed the Chinese version of this scale, which comprises 20 items rated on a 4-point Likert scale ranging from 1 = never to 4 = always. Items 1, 5, 6, 9, 10, 15, 16, 19, and 20 are reverse scored, such that higher overall scores indicate greater feelings of loneliness: 20–34 = a low degree of loneliness, 35–49 = a moderate degree of loneliness, 50–64 = a moderately high degree of loneliness, and 65–80 = a high degree of loneliness. In this study, the Cronbach’s alpha coefficient was .97, composite reliability (CR) was .96, and average variance extracted (AVE) was .60. The scale showed good fit indices, χ²/df = 3.438, GFI = .946, AGFI = .933, NFI = .959, IFI = .971, CFI = .971, TLI = .967, RMSEA = .051.

 

The Social Interaction Anxiety Scale (Mattick & Clarke, 1998) is designed to measure the level of anxiety an individual experiences during social interactions. The Chinese version of this scale was developed by Ye et al. (2007), and it consists of 20 items rated on a 5-point Likert scale ranging from 0 = not at all characteristic of me to 4 = extremely characteristic of me. Items 5, 9, and 11 are reverse scored, then all items are summed to form a total score ranging from 0 to 80. Scores of 36 or greater are clinically significant and suggest probable social interaction anxiety. In this study, Cronbach’s alpha was .97, CR was .97, and AVE was .59. The scale showed good fit indices, χ²/df = 4.963, GFI = .924, AGFI = .906, NFI = .944, IFI = .955, CFI = .955, TLI = .950, RMSEA = .063.

We conducted a correlation analysis to explore the relationships between the four main variables of parental psychological control, alexithymia, loneliness, and social interaction anxiety disorder. A structural equation model was subsequently constructed with Amos 24.0 to evaluate the mediating roles of alexithymia and loneliness in the association between parental psychological control and social interaction anxiety disorder.

As shown in Table 2, the variance inflation factor values of all variables were less than 10 and the tolerance values were greater than .50, indicating that the model was not significantly affected by multicollinearity.

The results of the correlation analysis showed that there were statistically significant positive correlations between parental psychological control and alexithymia, loneliness, and social interaction anxiety disorder (see Table 3).

We used Amos 24.0 to construct a structural equation model to analyze the individual mediating effects of alexithymia and loneliness, along with the chain mediation effect of alexithymia and loneliness, in the relationship between parental psychological control and social interaction anxiety disorder. The test results showed that the model had good fit indices, χ²/df = 2.299, AGFI = .900, GFI = .909, TLI = .957, CFI = .959, IFI = .959, NFI = .929, RMSEA = .037. The research model and path coefficients between the variables are shown in Figure 2.

As shown in Table 4, parental psychological control demonstrated a significant positive predictive effect on social interaction anxiety disorder among college students, supporting Hypothesis 1. Parental psychological control had a significant positive predictive effect on alexithymia; meanwhile, alexithymia also demonstrated a significant positive predictive effect on social interaction anxiety disorder, supporting Hypothesis 2. Parental psychological control had a significant positive predictive effect on loneliness, and loneliness, in turn, positively predicted social interaction anxiety disorder, supporting Hypothesis 3. Furthermore, parental psychological control sequentially predicted alexithymia, which, in turn, predicted loneliness, ultimately contributing to social interaction anxiety disorder among college students, supporting Hypothesis 4.

Furthermore, we employed a bootstrapping analysis to test the proposed mediating effects. As shown in Table 5, the direct effect of parental psychological control on social interaction anxiety disorder was significant, estimate = .290, 95% confidence interval (CI) [0.171, 0.401]. We also identified three indirect effects within the model, all of which were significant. Indirect effect 1: parental psychological control → alexithymia → social interaction anxiety disorder, effect value = .129, 95% CI [0.087, 0.184]. Indirect effect 2: parental psychological control → loneliness → social interaction anxiety disorder, effect value = .057, 95% CI [0.017, 0.092]. Indirect effect 3: parental psychological control → alexithymia → loneliness → social interaction anxiety disorder, effect value = .033, 95% CI [0.009, 0.061].

This study comprehensively examined the associations among parental psychological control, alexithymia, loneliness, and social interaction anxiety disorder in college students. We found that parental psychological control was a significant predictor of social interaction anxiety disorder. Parental psychological control often involves tactics like guilt induction or conditional love, which erode emotional security and lead to difficulties in identifying, expressing, and managing emotions (Li & Zheng, 2025; Qian et al., 2022).

 

Indirect effect 1 demonstrated that alexithymia mediated the relationship between parental psychological control and social interaction anxiety disorder. The culmination of alexithymia-driven deficits may manifest as social interaction anxiety disorder, characterized by intense fear of negative evaluation and avoidance of social interactions (Preece et al., 2024). Neurobiological evidence further supports that alexithymia is associated with reduced amygdala reactivity to emotional stimuli, impairing the ability to adaptively process social threats (Kano & Fukudo, 2013).

 

Indirect effect 2 revealed that loneliness served as a partial mediator of the relationship between parental psychological control and social interaction anxiety disorder. Higher levels of parental psychological control can hinder children’s development of autonomy and self-identity, leading to feelings of loneliness (Pérez et al., 2021). Students who report feelings of loneliness are significantly more likely to experience anxiety, depression, and suicidal ideation (Darvishi et al., 2025).

 

Indirect effect 3 indicated that parental psychological control predicted college students’ social interaction anxiety through the chain mediators of alexithymia and loneliness. Parental psychological control can undermine a child’s emotional development by suppressing authentic self-expression and emotional awareness (Qian et al., 2022), which, in turn, fosters alexithymia (Lazaros, 2024). Over time, alexithymia impairs interpersonal functioning, leading to social withdrawal and loneliness (Ertekin et al., 2025). Loneliness, in turn, intensifies negative self-perceptions (e.g., “I am unworthy of connection”; Maes et al., 2019) and aggravates sensitivity to social rejection (Meltzer et al., 2012), creating a vicious cycle that exacerbates social interaction anxiety.

For college counselors and administrators, our results suggest that interventions should be developed that focus not only on directly addressing students’ social interaction anxiety symptoms but also on improving emotional awareness and expression (i.e., reducing alexithymia; Oakley et al., 2022) and enhancing social connectedness (i.e., reducing loneliness; Eres et al., 2021; Lazaros, 2024). For college students, reducing the risk of social anxiety disorder can be achieved by engaging in emotional self-exploration and expression to better understand and convey inner feelings, fostering social connections through participation in interest-based clubs, and actively seeking support and guidance from counselors, as well as trusted friends or family members.

This study has limitations. The sample comprised Chinese college students, which may restrict the generalizability of the findings. Future research could collect data from college students in different countries and cultural contexts to provide a more comprehensive understanding of social anxiety disorder on a global scale. Further, we employed a cross-sectional research design, preventing us from definitively establishing causal relationships (Savitz & Wellenius, 2023). Longitudinal studies are needed to identify the causal relationships between variables. In addition, we focused only on the chain mediation effect of alexithymia and loneliness in the relationship between parental psychological control and social interaction anxiety disorder, while neglecting a wide range of other potential influencing factors, such as peer effects (Pickering et al., 2020) or socioeconomic status (Salem & Robenson, 2025). Future research could incorporate a more comprehensive set of variables to gain a deeper understanding of the complex etiology of social anxiety disorder.

Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32. https://doi.org/10.1016/0022-3999(94)90005-1

 

Barber, B. K., Bean, R. L., & Erickson, L. D. (2002). Expanding the study and understanding of psychological control. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents (pp. 263–289). American Psychological Association. https://doi.org/10.1037/10422-009

 

Center for Collegiate Mental Health. (2020). 2020 annual report (ED610604). ERIC. https://eric.ed.gov/?id=ED610604

 

Center for Collegiate Mental Health. (2022). 2021 annual report (ED617358). ERIC. https://eric.ed.gov/?id=ED617358

 

Chen, Y., & Yao, Y. S. (2025). The impact of alexithymia on internet addiction among lower-grade medical students: The chain mediating effect of anxiety and self-esteem [In Chinese]. Psychological Monthly, 20(22), 117–120. https://doi.org/10.19738/j.cnki.psy.2025.20.031

 

Darvishi, A., Almani, N., Zarimeidani, F., Rahmati, R., & Raeisi Shahraki, H. (2025). The silent burden: Understanding alexithymia and its correlation with university student depression, anxiety, and stress in a cross-sectional study. Health Science Reports, 8(9), Article e70677. https://doi.org/10.1002/hsr2.70677

 

Dattani, S., Rodés-Guirao, L., Ritchie, H., & Roser, M. (2023). Mental health. Our World in Data. https://ourworldindata.org/mental-health

 

Eres, R., Lim, M. H., Lanham, S., Jillard, C., & Bates, G. (2021). Loneliness and emotion regulation: Implications of having social anxiety disorder. Australian Journal of Psychology, 73(1), 46–56. https://doi.org/10.1080/00049530.2021.1904498

 

Ertekin, E., Koyuncu, A., Ertekin, B. A., & Özyıldırım, I. (2025). Alexithymia in social interaction anxiety disorder: Is there a specific relationship or is it a feature of comorbid major depression? Anadolu Psikiyatri Dergisi, 16(2), 130–137.

 

Kano, M., & Fukudo, S. (2013). The alexithymic brain: The neural pathways linking alexithymia to physical disorders. BioPsychoSocial Medicine, 7(1), Article 1. https://doi.org/10.1186/1751-0759-7-1

 

Lazaros, K. (2024). Parenting styles and their impacts on children: A comparative study. International Journal of Science and Research Archive, 11(1), 765–767. https://doi.org/10.30574/ijsra.2024.11.1.0128

 

Li, Y., & Zheng, P. (2025). Trait resilience protects against social anxiety in college students through emotion regulation and coping strategies. Scientific Reports, 15(1), Article 28143. https://doi.org/10.1038/s41598-025-13674-0

 

Maes, M., Nelemans, S. A., Danneel, S., Fernández-Castilla, B., Van den Noortgate, W., Goossens, L., & Vanhalst, J. (2019). Loneliness and social anxiety across childhood and adolescence: Multilevel meta-analyses of cross-sectional and longitudinal associations. Developmental Psychology, 55(7), 1548–1565. https://doi.org/10.1037/dev0000719

 

Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. https://doi.org/10.1016/S0005-7967(97)10031-6

 

Meltzer, H., Bebbington, P., Dennis, M. S., Jenkins, R., McManus, S., & Brugha, T. S. (2012). Feelings of loneliness among adults with mental disorder. Social Psychiatry and Psychiatric Epidemiology, 48(1), 5–13. https://doi.org/10.1007/s00127-012-0515-8

 

Ni, Y., & Fang, S. (2025). Does the Chinese version of 20-item Toronto Alexithymia Scale (TAS-20-C) measure alexithymia in Chinese young adolescents? Evidence from confirmatory factor analysis, network analysis, and latent profile analysis. BMC Psychology, 13(1), Article 687. https://doi.org/10.1186/s40359-025-03028-w

 

Oakley, B. F. M., Jones, E. J. H., Crawley, D., Charman, T., Buitelaar, J., Tillmann, J., Murphy, D. G., Loth, E., & Eu-AIMS LEAP Group. (2022). Alexithymia in autism: Cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychological Medicine, 52(8), 1458–1470. https://doi.org/10.1017/S0033291720003244

 

Olson, S. F., Yang, C., Hart, C. H., Robinson, C. C., Wu, P., Nelson, D. A., Nelson, L. J., Jin, S., & Wo, J. (2002). Psychological Control Measure [Database record]. APA PsycTests. https://doi.org/10.1037/t26498-000

 

Pérez, J. C., Huerta, P., Rubio, B., & Fernández, O. (2021). Parental psychological control: Maternal, adolescent, and contextual predictors. Frontiers in Psychology, 12, Article 712087. https://doi.org/10.3389/fpsyg.2021.712087

 

Perlman, D., & Peplau, L. A. (1981). Toward a social psychology of loneliness. In R. Gilmour & S. Duck (Eds.), Personal relationships: Vol. 3. Personal relationships in disorders (pp. 31–56). Academic Press.

 

Pickering, L., Hadwin, J. A., & Kovshoff, H. (2020). The role of peers in the development of social anxiety in adolescent girls: A systematic review. Adolescent Research Review, 5(4), 341–362. https://doi.org/10.1007/s40894-019-00117-x

 

Preece, D. A., Mehta, A., Petrova, K., Sikka, P., Pemberton, E., & Gross, J. J. (2024). Alexithymia profiles and depression, anxiety, and stress. Journal of Affective Disorders, 357, 116–125. https://doi.org/10.1016/j.jad.2024.02.071

 

Qian, G., Wu, Y., Wang, W., Li, L., Hu, X., Li, R., Liu, C., Huang, A., Han, R., An, Y., & Dou, G. (2022). Parental psychological control and adolescent social problems: The mediating effect of emotion regulation. Frontiers in Psychiatry, 13, Article 995211. https://doi.org/10.3389/fpsyt.2022.995211

 

Reta, Y., Ayalew, M., Yeneabat, T., & Bedaso, A. (2020). Social anxiety disorder among undergraduate students of Hawassa University, College of Medicine and Health Sciences, Ethiopia. Neuropsychiatric Disease and Treatment, 16, 571–577. http://doi.org/10.2147/NDT.S235416

 

Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. https://doi.org/10.1037//0022-3514.39.3.472

 

Salem, M., & Robenson, J. (2025). The impact of socioeconomic factors on mental health: A conceptual framework. Cureus, 17(7), Article e88244. https://doi.org/10.7759/cureus.88244

 

Savitz, D. A., & Wellenius, G. A. (2023). Can cross-sectional studies contribute to causal inference? It depends. American Journal of Epidemiology, 192(4), 514–516. https://doi.org/10.1093/aje/kwac037

 

Shi, Y. B., Zhan, T. T., Hu, W. Y., Jin, W. J., Zhang, Y. W., & Geng, Y. G. (2025). The impact of the dark triad on stigma toward seeking professional psychological help among college students: A moderated mediation model [In Chinese]. Psychological Research, 18(4), 367–375.

 

Wang, D. F. (1995). A study on the reliability and validity of Russell’s Loneliness Scale [In Chinese]. Chinese Journal of Clinical Psychology, 1(1), 23–25.

 

Wang, G., Shen, Y. H., Ming, L., Guan, C. L., Fu, X., & Ji, C. G. (2025). The mediating role of alexithymia between the intensity of Douyin use and social withdrawal among college students [In Chinese]. Occupational Health, 41(4), 537–541.

 

Wang, Q., Pomerantz, E. M., & Chen, H. (2007). The role of parents’ control in early adolescents’ psychological functioning: A longitudinal investigation in the United States and China. Child Development, 78(5), 1592–1610. https://doi.org/10.1111/j.1467-8624.2007.01085.x

 

Ye, D. M., Qian, M. Y., Liu, X. H., & Chen, X. (2007). Revision of the Social Interaction Anxiety Scale and Social Phobia Scale [In Chinese]. Chinese Journal of Clinical Psychology, 15(2), 115–117.

 

Zhu, Y. X., Hu, B. X., & Qu, B. (2015). The application of the TAS-20 Scale in assessing alexithymia among college students [In Chinese]. Chinese Journal of Health Statistics, 32(4), 704–705.