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Adult attachment style and alexithymia
Personality and Individual Differences 36 (2004) 499–507 www.elsevier.com/locate/paid
Adult attachment style and alexithymia Ornella Montebaroccia,*, Maurizio Codispotib, Bruno Baldaroa, Nicola Rossia a
Department of Psychology, Viale Berti, Pichat n.5., University of Bologna, 40127 Bologna, Italy b Department of General Psychology, via Venezia 8, University of Padova, 35100 Padova, Italy Received 31 July 2002; received in revised form 1 December 2002; accepted 7 February 2003
Abstract The focus of the present study was to investigate the relationship between adult attachment behaviour and alexithymia. Adult attachment behaviour and alexithymic characteristics were assessed using questionnaire methods. In a single session, 301 University students completed an Italian version of the Attachment Style Questionnaire (ASQ) and the Italian version of the 20-Item Toronto Alexithymia Scale. Moderate positive correlations were found among TAS total score and several ASQ subscales such as the Discomfort with Closeness (0.35), the Relationships as Secondary (0.38) and the Need for Approval (0.41). On the other hand, TAS total score and the Confidence subscale of the ASQ showed a moderate negative correlation ( 0.45). These results provide interesting cues. Possible hypothetical explanations of this association are discussed. Further longitudinal researches are needed to better investigate the relationship between the sociocultural environment, deficiencies in mother–child relationship and the ease of confidence in intimacy in adulthood. # 2003 Elsevier Ltd. All rights reserved. Keywords: Attachment Behaviour; Alexithymia characteristics; Family predictors
1. Introduction The aim of the present study is to investigate the relationship between adult attachment behaviour and alexithymia. Adult attachment is the stable tendency of an individual to make substantial efforts to seek and maintain proximity to and contact with one or a few specific individuals, who provide the subjective potential for physical and psychological safety and security. This stable tendency is regulated by internal working models of attachment, which are cognitive–affective–motivational schemata built from the individual’s experience in his or her * Corresponding author. Tel.: +39-051-2091338; fax: +39-051-243086. E-mail address: [email protected] (O. Montebarocci). 0191-8869/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0191-8869(03)00110-7
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interpersonal world. ‘‘Attachment styles’’ refer to particular internal working models of attachment that determine people’s behavioural responses to real or imagined separation and reunion from their attachment figures (Berman & Sperling, 1994). Attachment researchers describe the influence of early attachment experiences on the evolving internal representations of the self and others and have begun to investigate how the ‘‘internal working model’’ of attachment influences future relationships as well as affect regulating strategies in adulthood. There is strong suggestive evidence that the attachment style developed in childhood remains relatively stable across the life span and may even be transmitted between generations (Goldberg, 1991). Research studies (Bowlby, 1969; Bretherton, 1985; Tennant, 1988) on attachment styles in infancy and childhood have confirmed that the sensitivity and responsiveness of the primary caregiver to the child’s emotional states is a major determinant of the way the child learns to regulate distressing affects and to relate to other people. Children who became securely attached experienced an optimal and consistent responsiveness expression and learned that modulated emotional expression has positive outcomes. Deficient care-giving results in insecure patterns of attachment behaviour and impedes the development of effective affect regulating skills. Studies of adolescents and adults (Hindy & Schwarz, 1994; Rothbard & Shaver, 1994) found that those with secure attachment styles report low levels of negative affect and form strong relationships with others to whom they turn for support when emotionally distressed. Individuals with an insecure style of attachment were found to experience less positive affect than those with secure attachments, and also manifested deficits in the ability to self-regulate anxiety, depression and other negative affects (Parker, 1982). Alexithymia is a term used most commonly to describe people who have difficulties recognizing, processing and regulating emotions. Several authors (Haviland, Warren, & Riggs, 2000; Taylor, Bagby, & Parker, 1997) suggest that Alexithymia is a personality trait that places individuals at great risk for several medical and psychiatric disorders (e.g. substance related, panic, posttraumatic stress, somatoform, and eating). A study investigating the relationship between alexithymia and DSM-III-R psychiatric syndromes and personality disorders found no significant associations between alexithymia measured by the Toronto Alexithymia Scale (TAS) and DSM-III-R diagnoses (Bach, de Zwaan, Ackard, Nutzinger, & Mitchell, 1994), on the other hand nevroticism, anxiety and depression are correlated with TAS scores (Deary, Scott, & Wilson 1997; Taylor et al., 1997). Of the large number of studies on alexithymia, many have examined the aetiology of alexithymic characteristics. The alexithymia construct is composed of the following salient features: difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal; difficulty communicating feelings to other people; constricted imagination processes, as evidenced by a paucity of fantasies; and a stimulus-bound, externally orientated cognitive style (Nemiah, Freyberger, & Sifneos, 1976; Taylor, Bagby & Parker, 1991). Several theorists have posited that alexithymia is caused by events occurring in childhood, such as psychic trauma or disturbances in the mother–infant relationship. Recognition and expression of emotion have been found to be associated with family environment and history of childhood maltreatment. Berenbaum and James (1994) examined the family correlates of alexithymia. Children who grow up in environments in which they feel physically and emotionally unsafe and insecure, and in which the expression of emotion is discouraged, would not be expected to learn how to successfully cope with their emotional states, and would consequently be uncomfortable
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experiencing emotions. These difficulties and the lack of role models for the nonthreatening display of emotion may lead to discomfort or ambivalence in expressing feelings. Fukunishi and colleagues (Fukunishi, Sei, Morita, & Rahe, 1999) reported that in a study of college students with mother’s low care, participants expressed alexithymic characteristics, in particular on the alexithymic construct named difficulty communicating feelings. The most important finding of this study is that poor parental bonding is related to the perceived difficulty in articulating feeling. Clearly, affect development and the development of cognitive skills for regulating affects are intimately related to the infant and young child’s relationships with parents, in particular with mother. We suggest that alexithymia not only constitutes an inherent personality aberration but also constitutes a secondary accompaniment of trauma, and also emerges secondarily as a consequence of attachment and bonding failures. A previous study (Troisi, D’Argenio, Peracchio, & Petti, 2001) found that alexithymia was more pronounced in male participants who had patterns of insecure attachment in a sample of patients with clinically significant mood symptoms. The aim of the current study was to extend this finding by examining the relationship between adult attachment style and alexithymia in a sample of male and female university students, and to investigate the role of gender in this relationship.
2. Method 2.1. Participants Subjects included 301 undergraduate students (148 men and 153 women) who were taking an introductory psychology course at the University of Bologna. All participants provided informed consent and received extra credit for participation. Mean age was 22.2 years (S.D.=1.2). 2.2. Measures Subjects completed the following questionnaires in a single session: the Italian version of the Attachment Style Questionnaire (ASQ; Feeney, Noller & Hanrahan, 1994) and the Italian version of the 20-Item Toronto Alexithymia Scale (TAS-20; Bressi et al., 1996). The ASQ (Feeney et al., 1994) is 40-item self-report scale and yields five factor scores: one is a factor representing secure attachment, each of the other four scales represents a particular aspect of insecure attachment. The five-factor solution accounted for 43.3% of the total variance, and yielded the factors of Confidence (in self and others) (a sample item is: ‘‘I feel confident that other people will be there for me when I need them’’), Discomfort with Closeness (‘‘I find it difficult to depend on others’’), Relationships as Secondary (‘‘Achieving things is more important than building relationships’’), Need for Approval (‘‘It’s important to me that others like me’’) and Preoccupation with Relationships (‘‘I worry a lot about relationships’’). A previous study (Feeney et al., 1994) showed that the ASQ demonstrated high levels of internal consistency (Cronbach’s alpha=0.80) and test-retest reliability over a ten–week period (r=0.76). The TAS-20 Scale has a three-factor structure congruent with the concept of alexithymia. Factor one measures Difficulty Identifying Feelings and distinguishing them from bodily
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sensations of emotional arousal. A sample item is ‘‘I am often confused about what emotion I am feeling’’. Factor two assesses Difficulty Communicating Feelings and has items like ‘‘I find it hard to describe how I feel about people’’. Factor three determines the extent of Externally Oriented Thinking with items like ‘‘I prefer to just let things happen rather than to understand why they turned out this way’’. Items 4, 5, 10, 18, and 19 are negatively keyed to help control for the effects of acquiescence and dissonance and these items were reversed scored. Participants were assigned a total TAS-20 score and a score for each of the three factors. Previous studies (Bressi et al., 1996; Taylor et al., 1997) showed that the TAS-20 has good internal consistency (Cronbach’s a=0.81) and test–retest reliability over a 3-week interval (r=0.77).
3. Results In the total sample we found a 8.3% of the alexithymic subjects (TAS-20 scores561), 9.5% in males (4.7% of the total sample) and 7.2% in females (3.7% of the total sample). An ANOVA was performed (gender as between variable) to assess if males and females were different on the five subscales of the ASQ, the three factors of the TAS-20 and the TAS total score. We found a gender effect: F(1, 299)=6.34, P<0.001. As shown in Table 1, female participants scored higher than male participants on the Difficulty Identifying Feelings of the TAS-20 (Ps <0.001). On the other hand, male participants scored higher on the Relationships as Secondary of the ASQ, on the Difficulty Communicating Feelings, and Externally Oriented Thinking of the TAS-20 (Ps <0.05). To examine the relationship among scores on the ASQ and the TAS-20, the data obtained were analysed using Pearson product–moment correlations. Table 2 shows a positive correlation for Discomfort with Closeness (r=0.35, P<0.01), Relationships as Secondary (r=0.38, P<0.01) and Table 1 Tests of between-subjects effects (ANOVA) among the five scales of the Attachment Style Questionnaire (ASQ) and Alexithymia characteristics (TAS-20)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5 TAS-F1 TAS-F2 TAS-F3 TAS-TOT
Males (n=148)
Females (n=153)
F
P
33.35 34.38 16.87 20.64 27.16 13.89 13.72 18.20 45.83
34.14 33.9 14.67 21.49 28.30 15.85 12.72 16.1 44.68
ns ns 16.01 ns ns 10.41 3.94 19.11 ns
ns ns P< 0.001 ns ns P< 0.001 P< 0.05 P< 0.001 Ns
(4.9) (6.02) (5.14) (4.94) (6.05) (5.21) (4.42) (4.26) (10.03)
(4.84) (6.96) (4.36) (4.86) (5.45) (5.34) (4.34) (4.08) (9.93)
Means (and standard deviations) for each scale score in males and females. ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking.
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Table 2 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) (N=301)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.31** 0.29** 0.18** 0.45** 0.42**
0.37** 0.27** 0.29** 0.31** 0.19**
0.29** 0.18** 0.37** 0.07 0.12**
TAS-TOT 0.45** 0.35** 0.38** 0.41** 0.26**
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. * P< 0.05. ** P< 0.01.
Preoccupation with Relationships (r=0.26, P<0.01) of the ASQ and the TAS-20 total score. In addition, we found a significant negative correlation between Confidence of the ASQ and the TAS-20 total score (r= 0.45, P< 0.01). As shown in Tables 3 and 4 the same correlational patterns apply to both women and men participants, with the exception of the correlation between the Preoccupation with Relationships of the ASQ and the Difficulty Communicating Feelings of the TAS-20. Namely, in male participants we found a positive correlations (r=0.34) that was statistically different (Fisher’s Z=2.60; P<0.01) compared with the correlation found in the female group (r=0.05). All the other contrasts between the correlation coefficients found in the two groups were not statistically different (Ps >0.05).
4. Discussion Our findings seems to be consistent with a previous study (Troisi et al., 2001) which found that alexithymia was associated with attachment style in male psychiatric patients. The present study replicated this finding in a sample of male and female university students. In fact, we found moderate positive correlations among TAS total score and several ASQ subscales such as the Discomfort with Closeness, the Relationships as Secondary and the Need for Approval. On the other hand, TAS total score and the Confidence subscale of the ASQ showed a moderate negative correlation. In regard to the different facets of the alexithymia construct, while we found moderate correlations among the Difficulty Identifying and Communicating Feelings subscales of the TAS-20 and the ASQ subscales, the Externally Oriented Thinking subscale of the TAS-20 showed low correlations with the ASQ subscales. This result could be due to the different nature of the TAS-20 factors, namely the Difficulty Identifying and Communicating Feelings subscales are composed of items that ask the participant to evaluate their difficulty to identify or communicate feelings (e.g. I find it hard to describe how I feel about people), while the Externally Oriented Thinking subscale is composed of items that ask the participant about their preferences (e.g. I
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Table 3 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) in males (N=148)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.35** 0.29** 0.30** 0.44** 0.46**
0.36** 0.28** 0.34** 0.34** 0.34**
0.35** 0.21** 0.29** 0.04 0.06
TAS-TOT 0.49** 0.37** 0.43** 0.39** 0.36**
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. ** P< 0.01. Table 4 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) in females (N=153)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.32** 0.31** 0.15 0.43** 0.37**
0.37** 0.25** 0.21* 0.32** 0.05
0.21* 0.14 0.37** 0.16* 0.14
TAS-TOT 0.42** 0.34** 0.32** 0.44** 0.16*
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. * P< 0.05. ** P< 0.01.
prefer to just let things happen rather than to understand why they turned out this way). It is well established that the ‘‘perceived difficulty’’ in identifying and communicating feelings is associated with Neuroticism and negative affectivity that are important consequences of an insecure attachment. On the other hand, it has been suggested that if people who are alexithymic have difficulties in understanding and describing their emotions, they may be unaware of such a deficit and so be unable to report it themselves (Codispoti & Codispoti, 1996), so it would be interesting to investigate the association between alexithymia and attachment style using interview-rated instruments to see if the correlation between the two constructs is due to a bias in their operationalization. Several studies have indicated that multiple factors, like early developmental deficiencies, sociocultural influences and neurobiological deficits play a role in the aetiology and development of alexithymia. According to attachment theorists, quality of attachment and affect regulation in adulthood are closely linked. As a personality trait associated with deficits in the cognitive processing and regulation of affects, alexithymia has been hypothesized to correlate with insecure
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attachment. Normal affect development does not occur when the parents are unable to read the emotional cues of the infant, and fail to function as external regulators of the infant’s emotional states. In addition to a proneness to undifferentiated negative affective states, alexithymic individuals show a limited capacity to experience positive emotions such as joy, happiness and love in their interpersonal relationships. Lacking knowledge of their own emotional experiences, alexithymic individuals cannot readily imagine themselves in another person’s situation and are consequently unempathic and ineffective in modulating the emotional states of others, lacking in self confidence (Goleman, 1995; Krystal, 1988). The findings of this study provide considerable support for the utility of an attachment theory perspective on the complex interactions between adult attachment behaviour, the relationship quality and alexithymic characteristics such as cognitive and affect regulation deficit. Perhaps emotional, behavioural, and problem-solving dysfunction in the family, including maternal alexithymia, interfere with the primary development of introspection, affect awareness, and imagination in childhood. In particular, Lumley and co-workers (Lumley, Mader, Gramzow, & Papineau, 1996) found that externally oriented thinking was related to deficient family behaviour control, and impaired imagination was related to inadequate family problem solving. Thus, children develop specific alexithymia characteristics as a result of parental dysfunction in emotional or cognitive domains. In general, the present study showed that the same correlational patterns apply to women and men, with the exception of the positive correlation between the Preoccupation with Relationships of the ASQ and the Difficulty Communicating Feelings of the TAS-20 that was significant only in the male group. This result seems to suggest the relational nature of the Difficulty Communicating Feelings subscale found in male participants. Our study did not show a gender difference in TAS total score. A similar result was found in a previous Italian study (Pasini, Chiaie, Seripa, & Ciani, 1996) but it must be pointed out that other studies (Parker, Bagby, & Taylor, 1993; Salminen, Saarijarvi, Aarela, Toikka, & Kauhanen, 1999) found that men were alexithymic almost twice as often as women when the study group consisted of older participants from the general population. On the other hand, we found differences between men and women in regard to the different facets of the alexithymia and attachment constructs. Women considered themselves as less able to identify and communicate feelings but less prone to externally oriented thinking and to consider relationships as secondary than men. Finally, several limitations need to be mentioned. The observed relationships in this study were the result of a correlational study, indicating the role of other influences and provoking caution in interpretation. First, from the present study no causal conclusion can be drawn about the association between alexithymia and attachment style. Moreover, it is not clear if insecure attachment contributes to alexithymia or if insecure attachment leads to higher self assessed alexithymia (i.e. a more negative image of one’s meta-emotional abilities) that need not correspond to the person’s actual level of alexithymia, as assessed more objectively. Additionally, this study assessed adult attachment style and alexithymia in university students, the generalization of the findings to younger children, adults or patients is unknown, and the need for longitudinal research to clarify causal models is paramount. Inclusion of observational methods and interview-based assessment of alexithymia would lead to more robust conclusions. Future studies might employ the Adult Attachment Interview to classify attachment styles, as this measure also detects the presence of unresolved trauma (West & Sheldon-Keller, 1994).
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Adult attachment style and alexithymia Ornella Montebaroccia,*, Maurizio Codispotib, Bruno Baldaroa, Nicola Rossia a
Department of Psychology, Viale Berti, Pichat n.5., University of Bologna, 40127 Bologna, Italy b Department of General Psychology, via Venezia 8, University of Padova, 35100 Padova, Italy Received 31 July 2002; received in revised form 1 December 2002; accepted 7 February 2003
Abstract The focus of the present study was to investigate the relationship between adult attachment behaviour and alexithymia. Adult attachment behaviour and alexithymic characteristics were assessed using questionnaire methods. In a single session, 301 University students completed an Italian version of the Attachment Style Questionnaire (ASQ) and the Italian version of the 20-Item Toronto Alexithymia Scale. Moderate positive correlations were found among TAS total score and several ASQ subscales such as the Discomfort with Closeness (0.35), the Relationships as Secondary (0.38) and the Need for Approval (0.41). On the other hand, TAS total score and the Confidence subscale of the ASQ showed a moderate negative correlation ( 0.45). These results provide interesting cues. Possible hypothetical explanations of this association are discussed. Further longitudinal researches are needed to better investigate the relationship between the sociocultural environment, deficiencies in mother–child relationship and the ease of confidence in intimacy in adulthood. # 2003 Elsevier Ltd. All rights reserved. Keywords: Attachment Behaviour; Alexithymia characteristics; Family predictors
1. Introduction The aim of the present study is to investigate the relationship between adult attachment behaviour and alexithymia. Adult attachment is the stable tendency of an individual to make substantial efforts to seek and maintain proximity to and contact with one or a few specific individuals, who provide the subjective potential for physical and psychological safety and security. This stable tendency is regulated by internal working models of attachment, which are cognitive–affective–motivational schemata built from the individual’s experience in his or her * Corresponding author. Tel.: +39-051-2091338; fax: +39-051-243086. E-mail address: [email protected] (O. Montebarocci). 0191-8869/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0191-8869(03)00110-7
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interpersonal world. ‘‘Attachment styles’’ refer to particular internal working models of attachment that determine people’s behavioural responses to real or imagined separation and reunion from their attachment figures (Berman & Sperling, 1994). Attachment researchers describe the influence of early attachment experiences on the evolving internal representations of the self and others and have begun to investigate how the ‘‘internal working model’’ of attachment influences future relationships as well as affect regulating strategies in adulthood. There is strong suggestive evidence that the attachment style developed in childhood remains relatively stable across the life span and may even be transmitted between generations (Goldberg, 1991). Research studies (Bowlby, 1969; Bretherton, 1985; Tennant, 1988) on attachment styles in infancy and childhood have confirmed that the sensitivity and responsiveness of the primary caregiver to the child’s emotional states is a major determinant of the way the child learns to regulate distressing affects and to relate to other people. Children who became securely attached experienced an optimal and consistent responsiveness expression and learned that modulated emotional expression has positive outcomes. Deficient care-giving results in insecure patterns of attachment behaviour and impedes the development of effective affect regulating skills. Studies of adolescents and adults (Hindy & Schwarz, 1994; Rothbard & Shaver, 1994) found that those with secure attachment styles report low levels of negative affect and form strong relationships with others to whom they turn for support when emotionally distressed. Individuals with an insecure style of attachment were found to experience less positive affect than those with secure attachments, and also manifested deficits in the ability to self-regulate anxiety, depression and other negative affects (Parker, 1982). Alexithymia is a term used most commonly to describe people who have difficulties recognizing, processing and regulating emotions. Several authors (Haviland, Warren, & Riggs, 2000; Taylor, Bagby, & Parker, 1997) suggest that Alexithymia is a personality trait that places individuals at great risk for several medical and psychiatric disorders (e.g. substance related, panic, posttraumatic stress, somatoform, and eating). A study investigating the relationship between alexithymia and DSM-III-R psychiatric syndromes and personality disorders found no significant associations between alexithymia measured by the Toronto Alexithymia Scale (TAS) and DSM-III-R diagnoses (Bach, de Zwaan, Ackard, Nutzinger, & Mitchell, 1994), on the other hand nevroticism, anxiety and depression are correlated with TAS scores (Deary, Scott, & Wilson 1997; Taylor et al., 1997). Of the large number of studies on alexithymia, many have examined the aetiology of alexithymic characteristics. The alexithymia construct is composed of the following salient features: difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal; difficulty communicating feelings to other people; constricted imagination processes, as evidenced by a paucity of fantasies; and a stimulus-bound, externally orientated cognitive style (Nemiah, Freyberger, & Sifneos, 1976; Taylor, Bagby & Parker, 1991). Several theorists have posited that alexithymia is caused by events occurring in childhood, such as psychic trauma or disturbances in the mother–infant relationship. Recognition and expression of emotion have been found to be associated with family environment and history of childhood maltreatment. Berenbaum and James (1994) examined the family correlates of alexithymia. Children who grow up in environments in which they feel physically and emotionally unsafe and insecure, and in which the expression of emotion is discouraged, would not be expected to learn how to successfully cope with their emotional states, and would consequently be uncomfortable
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experiencing emotions. These difficulties and the lack of role models for the nonthreatening display of emotion may lead to discomfort or ambivalence in expressing feelings. Fukunishi and colleagues (Fukunishi, Sei, Morita, & Rahe, 1999) reported that in a study of college students with mother’s low care, participants expressed alexithymic characteristics, in particular on the alexithymic construct named difficulty communicating feelings. The most important finding of this study is that poor parental bonding is related to the perceived difficulty in articulating feeling. Clearly, affect development and the development of cognitive skills for regulating affects are intimately related to the infant and young child’s relationships with parents, in particular with mother. We suggest that alexithymia not only constitutes an inherent personality aberration but also constitutes a secondary accompaniment of trauma, and also emerges secondarily as a consequence of attachment and bonding failures. A previous study (Troisi, D’Argenio, Peracchio, & Petti, 2001) found that alexithymia was more pronounced in male participants who had patterns of insecure attachment in a sample of patients with clinically significant mood symptoms. The aim of the current study was to extend this finding by examining the relationship between adult attachment style and alexithymia in a sample of male and female university students, and to investigate the role of gender in this relationship.
2. Method 2.1. Participants Subjects included 301 undergraduate students (148 men and 153 women) who were taking an introductory psychology course at the University of Bologna. All participants provided informed consent and received extra credit for participation. Mean age was 22.2 years (S.D.=1.2). 2.2. Measures Subjects completed the following questionnaires in a single session: the Italian version of the Attachment Style Questionnaire (ASQ; Feeney, Noller & Hanrahan, 1994) and the Italian version of the 20-Item Toronto Alexithymia Scale (TAS-20; Bressi et al., 1996). The ASQ (Feeney et al., 1994) is 40-item self-report scale and yields five factor scores: one is a factor representing secure attachment, each of the other four scales represents a particular aspect of insecure attachment. The five-factor solution accounted for 43.3% of the total variance, and yielded the factors of Confidence (in self and others) (a sample item is: ‘‘I feel confident that other people will be there for me when I need them’’), Discomfort with Closeness (‘‘I find it difficult to depend on others’’), Relationships as Secondary (‘‘Achieving things is more important than building relationships’’), Need for Approval (‘‘It’s important to me that others like me’’) and Preoccupation with Relationships (‘‘I worry a lot about relationships’’). A previous study (Feeney et al., 1994) showed that the ASQ demonstrated high levels of internal consistency (Cronbach’s alpha=0.80) and test-retest reliability over a ten–week period (r=0.76). The TAS-20 Scale has a three-factor structure congruent with the concept of alexithymia. Factor one measures Difficulty Identifying Feelings and distinguishing them from bodily
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sensations of emotional arousal. A sample item is ‘‘I am often confused about what emotion I am feeling’’. Factor two assesses Difficulty Communicating Feelings and has items like ‘‘I find it hard to describe how I feel about people’’. Factor three determines the extent of Externally Oriented Thinking with items like ‘‘I prefer to just let things happen rather than to understand why they turned out this way’’. Items 4, 5, 10, 18, and 19 are negatively keyed to help control for the effects of acquiescence and dissonance and these items were reversed scored. Participants were assigned a total TAS-20 score and a score for each of the three factors. Previous studies (Bressi et al., 1996; Taylor et al., 1997) showed that the TAS-20 has good internal consistency (Cronbach’s a=0.81) and test–retest reliability over a 3-week interval (r=0.77).
3. Results In the total sample we found a 8.3% of the alexithymic subjects (TAS-20 scores561), 9.5% in males (4.7% of the total sample) and 7.2% in females (3.7% of the total sample). An ANOVA was performed (gender as between variable) to assess if males and females were different on the five subscales of the ASQ, the three factors of the TAS-20 and the TAS total score. We found a gender effect: F(1, 299)=6.34, P<0.001. As shown in Table 1, female participants scored higher than male participants on the Difficulty Identifying Feelings of the TAS-20 (Ps <0.001). On the other hand, male participants scored higher on the Relationships as Secondary of the ASQ, on the Difficulty Communicating Feelings, and Externally Oriented Thinking of the TAS-20 (Ps <0.05). To examine the relationship among scores on the ASQ and the TAS-20, the data obtained were analysed using Pearson product–moment correlations. Table 2 shows a positive correlation for Discomfort with Closeness (r=0.35, P<0.01), Relationships as Secondary (r=0.38, P<0.01) and Table 1 Tests of between-subjects effects (ANOVA) among the five scales of the Attachment Style Questionnaire (ASQ) and Alexithymia characteristics (TAS-20)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5 TAS-F1 TAS-F2 TAS-F3 TAS-TOT
Males (n=148)
Females (n=153)
F
P
33.35 34.38 16.87 20.64 27.16 13.89 13.72 18.20 45.83
34.14 33.9 14.67 21.49 28.30 15.85 12.72 16.1 44.68
ns ns 16.01 ns ns 10.41 3.94 19.11 ns
ns ns P< 0.001 ns ns P< 0.001 P< 0.05 P< 0.001 Ns
(4.9) (6.02) (5.14) (4.94) (6.05) (5.21) (4.42) (4.26) (10.03)
(4.84) (6.96) (4.36) (4.86) (5.45) (5.34) (4.34) (4.08) (9.93)
Means (and standard deviations) for each scale score in males and females. ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking.
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Table 2 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) (N=301)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.31** 0.29** 0.18** 0.45** 0.42**
0.37** 0.27** 0.29** 0.31** 0.19**
0.29** 0.18** 0.37** 0.07 0.12**
TAS-TOT 0.45** 0.35** 0.38** 0.41** 0.26**
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. * P< 0.05. ** P< 0.01.
Preoccupation with Relationships (r=0.26, P<0.01) of the ASQ and the TAS-20 total score. In addition, we found a significant negative correlation between Confidence of the ASQ and the TAS-20 total score (r= 0.45, P< 0.01). As shown in Tables 3 and 4 the same correlational patterns apply to both women and men participants, with the exception of the correlation between the Preoccupation with Relationships of the ASQ and the Difficulty Communicating Feelings of the TAS-20. Namely, in male participants we found a positive correlations (r=0.34) that was statistically different (Fisher’s Z=2.60; P<0.01) compared with the correlation found in the female group (r=0.05). All the other contrasts between the correlation coefficients found in the two groups were not statistically different (Ps >0.05).
4. Discussion Our findings seems to be consistent with a previous study (Troisi et al., 2001) which found that alexithymia was associated with attachment style in male psychiatric patients. The present study replicated this finding in a sample of male and female university students. In fact, we found moderate positive correlations among TAS total score and several ASQ subscales such as the Discomfort with Closeness, the Relationships as Secondary and the Need for Approval. On the other hand, TAS total score and the Confidence subscale of the ASQ showed a moderate negative correlation. In regard to the different facets of the alexithymia construct, while we found moderate correlations among the Difficulty Identifying and Communicating Feelings subscales of the TAS-20 and the ASQ subscales, the Externally Oriented Thinking subscale of the TAS-20 showed low correlations with the ASQ subscales. This result could be due to the different nature of the TAS-20 factors, namely the Difficulty Identifying and Communicating Feelings subscales are composed of items that ask the participant to evaluate their difficulty to identify or communicate feelings (e.g. I find it hard to describe how I feel about people), while the Externally Oriented Thinking subscale is composed of items that ask the participant about their preferences (e.g. I
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Table 3 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) in males (N=148)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.35** 0.29** 0.30** 0.44** 0.46**
0.36** 0.28** 0.34** 0.34** 0.34**
0.35** 0.21** 0.29** 0.04 0.06
TAS-TOT 0.49** 0.37** 0.43** 0.39** 0.36**
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. ** P< 0.01. Table 4 Correlations among the five scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics (TAS-20) in females (N=153)
ASQ-F1 ASQ-F2 ASQ-F3 ASQ-F4 ASQ-F5
TAS-F1
TAS-F2
TAS-F3
0.32** 0.31** 0.15 0.43** 0.37**
0.37** 0.25** 0.21* 0.32** 0.05
0.21* 0.14 0.37** 0.16* 0.14
TAS-TOT 0.42** 0.34** 0.32** 0.44** 0.16*
ASQ-F1, Confidence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Difficulty Identifying Feelings; TAS-F2, Difficulty Communicating Feelings; TAS-F3, Externally Oriented Thinking. * P< 0.05. ** P< 0.01.
prefer to just let things happen rather than to understand why they turned out this way). It is well established that the ‘‘perceived difficulty’’ in identifying and communicating feelings is associated with Neuroticism and negative affectivity that are important consequences of an insecure attachment. On the other hand, it has been suggested that if people who are alexithymic have difficulties in understanding and describing their emotions, they may be unaware of such a deficit and so be unable to report it themselves (Codispoti & Codispoti, 1996), so it would be interesting to investigate the association between alexithymia and attachment style using interview-rated instruments to see if the correlation between the two constructs is due to a bias in their operationalization. Several studies have indicated that multiple factors, like early developmental deficiencies, sociocultural influences and neurobiological deficits play a role in the aetiology and development of alexithymia. According to attachment theorists, quality of attachment and affect regulation in adulthood are closely linked. As a personality trait associated with deficits in the cognitive processing and regulation of affects, alexithymia has been hypothesized to correlate with insecure
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attachment. Normal affect development does not occur when the parents are unable to read the emotional cues of the infant, and fail to function as external regulators of the infant’s emotional states. In addition to a proneness to undifferentiated negative affective states, alexithymic individuals show a limited capacity to experience positive emotions such as joy, happiness and love in their interpersonal relationships. Lacking knowledge of their own emotional experiences, alexithymic individuals cannot readily imagine themselves in another person’s situation and are consequently unempathic and ineffective in modulating the emotional states of others, lacking in self confidence (Goleman, 1995; Krystal, 1988). The findings of this study provide considerable support for the utility of an attachment theory perspective on the complex interactions between adult attachment behaviour, the relationship quality and alexithymic characteristics such as cognitive and affect regulation deficit. Perhaps emotional, behavioural, and problem-solving dysfunction in the family, including maternal alexithymia, interfere with the primary development of introspection, affect awareness, and imagination in childhood. In particular, Lumley and co-workers (Lumley, Mader, Gramzow, & Papineau, 1996) found that externally oriented thinking was related to deficient family behaviour control, and impaired imagination was related to inadequate family problem solving. Thus, children develop specific alexithymia characteristics as a result of parental dysfunction in emotional or cognitive domains. In general, the present study showed that the same correlational patterns apply to women and men, with the exception of the positive correlation between the Preoccupation with Relationships of the ASQ and the Difficulty Communicating Feelings of the TAS-20 that was significant only in the male group. This result seems to suggest the relational nature of the Difficulty Communicating Feelings subscale found in male participants. Our study did not show a gender difference in TAS total score. A similar result was found in a previous Italian study (Pasini, Chiaie, Seripa, & Ciani, 1996) but it must be pointed out that other studies (Parker, Bagby, & Taylor, 1993; Salminen, Saarijarvi, Aarela, Toikka, & Kauhanen, 1999) found that men were alexithymic almost twice as often as women when the study group consisted of older participants from the general population. On the other hand, we found differences between men and women in regard to the different facets of the alexithymia and attachment constructs. Women considered themselves as less able to identify and communicate feelings but less prone to externally oriented thinking and to consider relationships as secondary than men. Finally, several limitations need to be mentioned. The observed relationships in this study were the result of a correlational study, indicating the role of other influences and provoking caution in interpretation. First, from the present study no causal conclusion can be drawn about the association between alexithymia and attachment style. Moreover, it is not clear if insecure attachment contributes to alexithymia or if insecure attachment leads to higher self assessed alexithymia (i.e. a more negative image of one’s meta-emotional abilities) that need not correspond to the person’s actual level of alexithymia, as assessed more objectively. Additionally, this study assessed adult attachment style and alexithymia in university students, the generalization of the findings to younger children, adults or patients is unknown, and the need for longitudinal research to clarify causal models is paramount. Inclusion of observational methods and interview-based assessment of alexithymia would lead to more robust conclusions. Future studies might employ the Adult Attachment Interview to classify attachment styles, as this measure also detects the presence of unresolved trauma (West & Sheldon-Keller, 1994).
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