Depersonalization, Emotion Embodiment, and Alexithymia in the General Population.

Metabolic syndrome (MetS) is a cluster of physiological risk factors characterized by abdominal obesity, hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein cholesterol (HDL-C) []. Prevalence estimates vary by diagnostic criteria, with a meta-analysis reporting a global range of 12.5%–31.4% []. MetS is a major risk factor for chronic diseases such as cardiovascular disease, cancer, and cognitive decline []. The pathogenesis of MetS is multifactorial, involving nutritional, environmental, and genetic factors, with lipid metabolism dysregulation, insulin resistance, and chronic inflammation playing central roles []. Also, exposure to unhealthy lifestyle and behavioral factors, including sleep disturbance, suboptimal nutrition, physical inactivity, and substance use, along with population aging, are major contributors [–]. Lifestyle modification has been proposed as an effective strategy for preventing chronic diseases, including MetS []. While previous studies have identified individual risk factors [–], evidence suggests that multiple lifestyle risks should be considered together, as their combined effect is more detrimental than any single factor [, ]. Identifying high-risk groups can inform targeted health promotion strategies []. Most studies to date, including those examining single or combined lifestyle risks [–, , ], have been cross-sectional, highlighting the need for longitudinal studies to better assess causal relationships in the general population []. The healthy lifestyle and behavioral scale (HLBS) is an evidence-based tool encompassing key lifestyle pillars, including sleep, nutrition, physical activity, and substance use [, ]. Grounded in health behavior change theories, including the transtheoretical model, self-determination theory, and the multiple behavior approach, which emphasizes simultaneous modification of multiple health behaviors to maximize overall health benefits [, ]. Through this framework, the HLBS promotes actionable behavior changes that can influence both physical and mental health []. The scale has been widely used to examine associations between lifestyle behaviors and various health conditions such as diabetes, cardiometabolic disorders, neuroendocrine dysfunction, and insulin resistance [, , ]. These conditions are key components of MetS and highlight the importance of comprehensive lifestyle assessment in this context, reinforcing the relevance of multi-behavior frameworks []. Previous studies have also employed questionnaires targeting individual HLBS components [, ]. However, Pangalangan (2024) noted that many validated instruments are limited in scope, addressing only certain HLBS pillars and failing to capture the full framework []. Moreover, many of these instruments were originally developed in Western contexts and subsequently adapted for use in HLBS measurement []. Thus far, few instruments have been specifically developed for lifestyle medicine, and even fewer have undergone rigorous scale development and validation, particularly some Asian populations. In this study, the HLBS is applied within a Taiwanese population, where its psychometric and behavioral relevance has been previously examined [].