Anxiety Related to Paternal Relationship Patterns and God-Image Representation: A Descriptive Case Study

Abstract

This descriptive case study aims at examining anxiety as a consequence of pattern of relationships between fathers and how such patterns interact with religious representations of God in the cultural context of Pakistan. A young adult woman was taken through a series of thirty-four biweekly sessions and the data was gathered through the interviews, observation, and Beck Anxiety Inventory. The findings suggest that the client's anxious self-concept was associated with authoritarian paternal patterns characterized by psychological control and moral rigidity, which projected onto a disturbed, ambivalent God-image—perceived as both punitive and protective. Thematic analysis revealed a cyclical pattern where paternal authority fostered internalized guilt, which was then moralized through a religious lens, intensifying anxiety symptoms. This analysis proposes a culturally mediated process wherein expectations regarding filial obedience, family honour, and moralized religiosity are internalized, directly shaping symptom expression and self-assessment. The client’s somatic complaints and spiritual conflicts exemplified this moralized anxiety, where distress was a manifestation of the conflict between individuation and cultural mandates. Lastly, the implications accentuate the necessity for culturally-oriented anxiety treatment within collectivist and patriarchal environments, advocating for therapeutic frameworks that address the reconstruction of internalized authority and religious schemas to foster autonomy without compromising cultural identity.

References

Abu-Raiya, H., Exline, J. J., Pargament, K. I., & Agbaria, Q. (2015). Prevalence, predictors, and implications of religious/spiritual struggles among Muslims. Journal for the Scientific Study of Religion, 54(4), 631–648. https://doi.org/10.1111/jssr.12230

Altaf, Z., Khattak, A. K., & Riaz, A. (2025). Impact of parental psychological control on adolescent anxiety: Mediated by self-esteem among adolescents. Annals of Human and Social Sciences, 6(2), 427–437. https://doi.org/10.35484/ahss.2025(6-II)36

American Psychological Association. (2025). Anxiety. American Psychological Association.

Barber, B. K. (1996). Parental psychological control: Revisiting a neglected construct. Child Development, 67(6), 3296–3319. https://doi.org/10.2307/1131780

Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory. PsycTESTS Dataset. https://doi.org/10.1037/t02025-000

Bornstein, M. H., Putnick, D. L., Lansford, J. E., Al-Hassan, S. M., Bacchini, D., Bombi, A. S., ... & Alampay, L. P. (2017). “Mixed blessings”: Parental religiousness, parenting, and child adjustment in global perspective. Journal of Child Psychology and Psychiatry, 58(8), 880–892. https://doi.org/10.1111/jcpp.12705

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

Bradshaw, M., Ellison, C. G., & Marcum, J. P. (2010). Attachment to God, images of God, and psychological distress in a nationwide sample of Presbyterians. The International Journal for the Psychology of Religion, 20(2), 130–147. https://doi.org/10.1080/10508611003608049

Cherniak, A. D., Mikulincer, M., Shaver, P. R., & Granqvist, P. (2020). Attachment theory and religion. Current Opinion in Psychology, 40, 126–130. https://doi.org/10.1016/j.copsyc.2020.08.020

Ebrahimi, E., & Farouee Firoozi, A. (2016). The impacts of parenting style and perceived childhood attachment on children’s concept of God. Iranian Journal of Psychiatry and Behavioral Sciences, 13(1). https://doi.org/10.5812/ijpbs.1579

Forbes, D. M. (2025). The effect of God’s image on the self concept of pastors’ kids (PKs). Scholars Crossing.

Gorostiaga, A., Aliri, J., Balluerka, N., & Lameirinhas, J. (2019). Parenting styles and internalizing symptoms in adolescence: A systematic literature review. International Journal of Environmental Research and Public Health, 16(17), 3192. https://doi.org/10.3390/ijerph16173192

Kalin, N. H. (2020). The critical relationship between anxiety and depression. American Journal of Psychiatry, 177(5), 365–367. https://doi.org/10.1176/appi.ajp.2020.20030305

Khan, M., & Aslam, N. (2020). Perception of God’s attributes for mental comfort in stressful life events. Foundation University Journal of Psychology, 4(2), 37–45. https://doi.org/10.33897/fujp.v4i2.65

Kirmayer, L. J., & Ryder, A. G. (2016). Culture and psychopathology. Current Opinion in Psychology, 8, 143–148. https://doi.org/10.1016/j.copsyc.2015.10.020

Moleiro, C. (2018). Culture and psychopathology: New perspectives on research, practice, and clinical training in a globalized world. Frontiers in Psychiatry, 9, 366. https://doi.org/10.3389/fpsyt.2018.00366

Morris, T. L., & Oosterhoff, B. (2016). Observed mother and father rejection and control: Association with child social anxiety, general anxiety, and depression. Journal of Child and Family Studies, 25(9), 2904–2914. https://doi.org/10.1007/s10826-016-0448-z

Murray, K. W., Dwyer, K. M., Rubin, K. H., Knighton-Wisor, S., & Booth-LaForce, C. (2013). Parent–child relationships, parental psychological control, and aggression: Maternal and paternal relationships. Journal of Youth and Adolescence, 43(8), 1361–1373. https://doi.org/10.1007/s10964-013-0019-1

Naeem, S. S., Siddiqui, E. U., & Khalid, T. C. (2012). Prevalence and factors associated with irritable bowel syndrome among medical students in Karachi. BMC Research Notes, 5(1), 255. https://doi.org/10.1186/1756-0500-5-255

National Institute of Mental Health. (2024). Anxiety disorders. National Institute of Mental Health.

Njus, D. M., & Scharmer, A. (2020). Evidence that God attachment makes a unique contribution to psychological well-being. The International Journal for the Psychology of Religion, 30(3), 178–201. https://doi.org/10.1080/10508619.2020.1723296

Palkovitz, R. (2019). Expanding our focus from father involvement to father–child relationship quality. Journal of Family Theory & Review, 11(4), 576–591. https://doi.org/10.1111/jftr.12352

Rahman, A., Pathania, B., & Shirodker, A. G. (2025). Dynamics of father-son attachment: Exploring communication patterns and influencing factors. International Journal of Interdisciplinary Approaches in Psychology, 3(6). https://doi.org/10.61113/ijiap.v3i6.1049

Raza, A., & Zainab, H. (2019). Somatization and medically unexplained symptoms – prevalence and correlates among women at Nahaqi – KPK, Pakistan. The Professional Medical Journal, 26(07), 1042–1050. https://doi.org/10.29309/tpmj/2019.26.07.3444

Ren, Y., Wu, X., Zou, S., & Wang, X. (2023). The integral contributions of parental involvement and parenting style to adolescent adjustments: A regression mixture analysis. Current Psychology. Advance online publication. https://doi.org/10.1007/s12144-023-04364-z

Sahithya, B. R., Manohari, S. M., & Vijaya, R. (2019). Parenting styles and its impact on children – a cross cultural review with a focus on India. Mental Health, Religion & Culture, 22(4), 357–383. https://doi.org/10.1080/13674676.2019.1594178

Sahithya, B., & Raman, V. (2021). Parenting style, parental personality, and child temperament in children with anxiety disorders—A clinical study from India. Indian Journal of Psychological Medicine, 43(5). https://doi.org/10.1177/0253717620973376

Saraei, M., & Johnson, K. A. (2023). Disappointment with and uncertainty about God predict heightened COVID-19 anxiety among Persian Muslims. Religions, 14(1), 74. https://doi.org/10.3390/rel14010074

Stuart Parrigon, K. L., & Kerns, K. A. (2015). Family processes in child anxiety: The long-term impact of fathers and mothers. Journal of Abnormal Child Psychology, 44(7), 1253–1266. https://doi.org/10.1007/s10802-015-0118-4

Stulp, H. P., Koelen, J., Schep-Akkerman, A., Glas, G. G., & Eurelings-Bontekoe, L. (2019). God representations and aspects of psychological functioning: A meta-analysis. Cogent Psychology, 6(1), 1647926. https://doi.org/10.1080/23311908.2019.1647926

Yaffe, Y. (2020). Systematic review of the differences between mothers and fathers in parenting styles and practices. Current Psychology, 42(1). https://doi.org/10.1007/s12144-020-01014-6

Yaffe, Y. (2021). A narrative review of the relationship between parenting and anxiety disorders in children and adolescents. International Journal of Adolescence and Youth, 26(1), 449–459. https://doi.org/10.1080/02673843.2021.1980067

Zainab, S., Arzeen, N., & Arzeen, S. (2023). Impact of parental bonding on alexithymia and psychological distress among Pakistani adolescents. International Journal of Psychology and Cognitive Education, 2(1), 21–30. https://doi.org/10.58425/ijpce.v2i1.141