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Background: Functional dyspepsia (FD) is a condition commonly seen in gastroenterological practice. The pathophysiology of FD is likely to be multi-factorial and remains incompletely understood. Although evidence for a psychological etiology is growing, few researches have investigated the role of psychological factors in FD disease. The aim of the study was to assess the role of alexithymia, psychiatric symptoms, and defense mechanism in patients with FD., Materials and Methods: In a case-control study, 60 consecutive with established FD referred to gastroenterology and 60 healthy people matched regarding demographic variables were selected. The subjects filled out three questionnaires; Symptom Checklist-90-Revised 40-item Defense Style and 20-item Toronto Alexithymia Scale., Statistical Analysis: Student's t-test and multivariate analysis variance model were used to compare the two groups., Results: Significantly higher scores were found in patients with dyspepsia when compared with controls for most psychiatric symptoms (depression P<0.001, anxiety P<0.001, obsessive-compulsion P<0.001, interpersonal sensitivity P<0.001, psychoticism P<0.001, hostility P<0.001, and total score of psychiatric symptoms P<0.001). Alexithymia symptoms (both (difficulty in identifying feelings and difficulty in describing feelings) was higher in FD patients than healthy individuals (P<0.001). Also, the use of maladaptive defense mechanisms (both neurotic and immature) in FD patients significantly was higher than healthy individuals (P<0.001)., Conclusion: Psychiatric symptoms, alexithymia, and maladaptive defense play significant role in the emergence of FD symptoms. This study proposes that FD patients should be evaluated and treated by departments of gastroenterology and psychiatry.