The relationship between attachment styles and alexithymia: mediating role of defense mechanisms

Exploring attachment security in a sample of Lebanese adolescents: The validation of the Arabic IPPA-R

Despite growing evidence supporting the importance of the quality of attachment during adolescence, no studies have been conducted to date in the Arab world due to an absence of valid and reliable tools to measure this construct in Arabic. The Inventory of Parent and Peer Attachment-Revised (IPPA-R) was devised as a self-report questionnaire in English to assess the quality of adolescent attachment to mother, father, and peers, each scale consisting of 25 items. The current study sets out to determine the psychometric properties of the Arabic IPPA-R and to explore attachment styles in Lebanon in a sample of 765 Lebanese adolescents. Results suggested a modified three-factor structure to reach satisfactory reliability of the Arabic IPPA-R, resulting in a modified questionnaire consisting of 19 items for each of mother (α = .82) and father (α = .85), and 21 items for peers (α = .89). Strict measurement invariance across gender was achieved for the IPPA-R parental forms, while only scalar invariance was achieved for the IPPA-R peers form. Overall, there were significant differences in attachment scores to mother and father, with adolescents scoring higher on attachment to mother, with both scores being significantly lower than attachment to peers. Gender differences were found on the peer scale with girls scoring significantly higher than boys. Results are interpreted from a cultural lens, emphasizing the importance of accounting for cultural, religious, and socio-economic factors in understanding adolescent attachment. This study is the first conducted in the Arab region and provides a road map to understanding gender-roles, parental expectations and adolescent perceived parenting, and their impact on adolescent attachment scores.

Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness

OBJECTIVE

Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED).

METHOD

145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested.

RESULTS

Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology.

DISCUSSION

ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

Mediating role of splitting in relation to attachment styles and shopping addiction

Introduction

Shopping can provide a sense of satisfaction and pleasure; however, if a person's excessive involvement in this behavior starts to negatively impact other aspects of their life, similar to other addictive behaviors like excessive internet use, gaming, and gambling, it may be classified as pathological. Given the lack of agreement regarding the classification of excessive shopping tendencies as a separate mental health condition or addictive behavior, taking a socio-emotional approach to explore the psychological factors that precede this behavior, may offer a better comprehension of it.

Methods

The purpose of this study was to examine the relationship between attachment styles and excessive shopping behavior, as well as to investigate the potential mediating effect of defense mechanisms like splitting on this relationship. Using convenience sampling, a group of 457 stock market employees (116 female, 341 male) between the ages of 24 and 60 were recruited. The researchers utilized a set of validated psychological questionnaires to assess the employees attachment styles, shopping addiction, and splitting tendencies.

Results

The results obtained from both the mediation model and path analysis suggest that attachment styles do not have a direct relationship with shopping addiction. Nonetheless, the study supports the impact of insecure anxious and avoidan attachment styles on splitting. Furthermore, the findings confirm that splitting has a mediating effect on the relationship between attachment styles and splitting.

Discussion

The present study enhanced our comprehension of the subconscious mechanisms underlying shopping tendencies. Specifically, the findings suggest that excessive tendencies towards shopping can be considered a maladaptive response resulting from insecure attachment styles and the unconscious utilization of the splitting defense mechanism.

The Covid-19 pandemic had polarizing effects on trait scores depending on a person's resilience and predispositions: A longitudinal prospective study

While Covid-19 is, first and foremost, a pernicious physical illness, its highly contagious nature has led to significant disruption in social life and psychological stress, occasionally resulting in dire mental health consequences that are still not fully understood. To address this issue, a prospective longitudinal design study was conducted by administering standard self-reporting questionnaires covering the NEO-five factor inventory (NEO-FFI), shyness, alexithymia, autism quotient, anxiety, depression, and sensory processing sensitivity (SPS). A total of 114 participants (of which 71.93% were females) with an average age of 30.29 (standard deviation = 11.04) completed the survey before and a few months after the pandemic. Results revealed the distribution of population scores to become more extreme in either positive or negative trait directions despite the stability of average trait scores across the population. Higher resilience was found to be positively correlated with improved trait scores post-pandemic but corona anxiety score was not correlated with trait score changes. In addition, in the subjects with moderate negative trait scores, agreeableness and autism scores and in subjects with high negative trait scores, openness, SPS and shyness scores were significantly correlated with trait scores changes post-pandemic. These results reveal the nuanced effects of the pandemic on the people's psychological well-being and highlight vulnerabilities for certain groups despite the overall stability of population that needs to be taken into account for mental health policies going forward.

Internet Addiction among Young Adult University Students during the COVID-19 Pandemic: The Role of Peritraumatic Distress, Attachment, and Alexithymia

The literature focused on the effect of the COVID-19 pandemic on young adult university students' mental health shows a significant increase in psychopathological symptoms and Internet Addiction (IA). The key role played by attachment and alexithymia has also been suggested, but no study has explored the possible dynamic relationship between these variables. We recruited a sample of n = 410 young adult university students online. We assessed the attachment to parents and peers (through IPPA), alexithymia (through TAS-20), peritraumatic distress symptoms due to COVID-19 (through CPDI), and IA (through IAT). The results showed that the relationship between the attachment to mothers and IA was partially mediated by alexithymia and by the serial mediation of alexithymia and peritraumatic distress, whereas the influence of the attachment to fathers on IA was fully mediated by peritraumatic distress. The direct effects of the attachment to peers on alexithymia, peritraumatic distress, and IA were all significant, as were the indirect paths via the simple mediation of both alexithymia and peritraumatic distress and the multiple serial mediation of alexithymia and peritraumatic distress. Our findings suggested that the relationship between attachment, alexithymia, and psychopathological risk is dynamic in predicting IA during the pandemic among young adult university students and that the different attachment figures exert a peculiar contribution to these processes.

The effect of attachment style on long-term outcomes in psychogenic nonepileptic seizures: Results from a prospective study

INTRODUCTION

Insecure and fearful attachment styles have been reported in psychogenic nonepileptic seizures (PNES). We have investigated associations between long-term clinical outcome in PNES, parenting and attachment styles and demographic, clinical, and neuropsychiatric factors.

MATERIAL AND METHODS

Patients aged at least 16 years and with documented PNES, according to criteria from the International League Against Epilepsy, were prospectively recruited to this study. They were assessed at baseline to determine clinical characteristics, experience of attachment and perceptions of experienced parenting styles, trauma history, dissociation, and health-related quality of life. At a mean of 70.45 (SD 29.0, range 22-130) months after inclusion, participants were contacted by telephone and asked about their current medical status and psychiatric/psychological interventions.

RESULTS

Of 53 patients included in the study, 51 (96 %) provided follow-up data. Most (84.9 %) patients were female, and the mean age of PNES onset was 25.6 years. At follow-up, 20 patients (39 %) were free of PNES. Those patients that had achieved PNES freedom at follow-up had lower levels of attachment anxiety (p = 0.01) and reported to have experienced their fathers as less controlling (p = 0.02) and their mothers as more caring (p = 0.04) at baseline compared with those patients still suffering from PNES. Seizure freedom at follow-up was predicted by male gender, younger age at PNES onset, and less attachment anxiety.

CONCLUSION

In our cohort from a tertiary epilepsy center the long-term prognosis of PNES is poor. Attachment anxiety is a risk factor for persistent PNES. It may be of therapeutic relevance to assess attachment patterns in patients with PNES.

The Interplay of Attachment Styles and Defense Mechanisms on Eating Disorders Risk: Cross-Sectional Observation in the Community Population

OBJECTIVE

Eating Disorders (Eds) are considered a broad group of pathological conditions characterized by dysregulated eating-related behaviors and habits. Attachment styles and defense mechanisms appear to be linked to the development of EDs-related unhealthy behaviors; however, these factors have been seldom investigated jointly. This study aimed at exploring the shared association between attachment styles, defense mechanisms, and EDs-related behaviors; additionally, we aimed at investigating whether defense mechanisms might be potential mediators of the association between attachment and Eds behaviors.

METHOD

A community-based sample was recruited (88% females, mean age= 22.33 ± 4.81 years) and underwent a comprehensive evaluation protocol assessing attachment styles, defense mechanisms, and risk of eating disorders.

RESULTS

Several shared associations between attachment styles, defense mechanisms, and eating disorders scores were found. Additionally, a maladaptive defense style appeared to be a significant mediator of the association between attachment styles and EDs-related symptoms.

CONCLUSIONS

The integrated evaluation of attachment and defense mechanisms could generate a more comprehensive framework of the psychological antecedents related to Eating Disorders, and it could be a beneficial factor involved in therapies.

Couple's Satisfaction among Lebanese adults: validation of the Toronto Alexithymia Scale and Couple Satisfaction Index-4 scales, association with attachment styles and mediating role of alexithymia

Background

Lebanon is passing through an economic crisis leading to a decreased monthly income within a couple and more couple’s dissatisfaction. Furthermore, many studies postulate that the different types of attachment styles affect the romantic relationship experienced between adults. The main objectives of our study were to (1) validate the Toronto Alexithymia Scale (TAS) and Couple Satisfaction Index-4 (CSI-4) scales, and (2) assess the association between attachment styles and couple satisfaction and evaluate the mediating role of alexithymia in these associations.

Methods

This cross-sectional study involved 445 Lebanese participants (April–May 2021). A confirmatory factor analysis (CFA) was carried out using SPSS AMOS v.24 on the couple satisfaction index and Toronto alexithymia scales’ items. A linear regression was conducted, taking the couple satisfaction index as the dependent variable.

Results

The CFA results of the CSI-4 scale indicated an excellent fit (χ²/df = 3.845/2 = 1.92, TLI = 0.992, RMSEA = 0.046 [95% CI 0.001–0.115] (pclose = 0.436) and CFI = 0.998). The CFA of the TAS indicated a good/acceptable fit (χ²/df = 422.31/132 = 3.2, TLI = 0.89, RMSEA = 0.07 [95% CI 0.063–0.078] (pclose < 0.001) and CFI = 0.91) (items 4 and 8 were removed due to low factor loading (< 0.4)). Being married and higher secure attachment style were significantly associated with more couple satisfaction, whereas older age, higher household crowding index, more alexithymia and mode depression were significantly associated with less couple satisfaction. In addition, alexithymia mediated the association between secure attachment style and couple satisfaction, between preoccupied attachment style and couple satisfaction and between dismissing attachment style and couple satisfaction.

Conclusion

Couple’s satisfaction is positively associated with secure attachment style. In addition, alexithymia plays a mediating role between couple’s satisfaction and attachment styles. Upcoming studies should determine if other mental illnesses play a mediating role between attachment style and couple satisfaction.

Localizing sensory processing sensitivity and its subdomains within its relevant trait space: a data-driven approach

Sensitivity arising from enhanced processing of external and internal stimuli or sensory processing sensitivity (SPS) is known to be present in a sizable portion of the population. Yet a clear localization of SPS and its subdomains with respect to other relevant traits is currently lacking. Here, we used a data-driven approach including hierarchical clustering, t-distributed stochastic neighbor embedding (t-SNE) and graph learning to portrait SPS as measured by Highly Sensitive Person Scale (HSPS) in relation to the Big-Five Inventory (neuroticism, extraversion, openness, agreeableness, and conscientiousness) as well as to shyness, alexithymia, autism quotient, anxiety, and depression (11 total traits) using data from more than 800 participants. Analysis revealed SPS subdomains to be divided between two trait clusters with questions related to aesthetic sensitivity (AES) falling within a cluster of mainly positive traits and neighbored by openness while questions addressing ease of excitation (EOE) and low sensory threshold (LST) to be mostly contained within a cluster of negative traits and neighbored by neuroticism. A similar spread across clusters was seen for questions addressing autism consistent with it being a spectrum disorder, in contrast, alexithymia subdomains were closely fit within the negative cluster. Together, our results support the view of SPS as a distinct yet non-unitary trait and provide insights for further refinements of the current SPS concept and scales.

Late Adolescents' Attachment to Parents and Peers and Psychological Distress Resulting from COVID-19. A Study on the Mediation Role of Alexithymia

The scientific literature has shown the key role played by attachment to parents and peers and difficulties in recognizing, processing, and regulating emotions (i.e., alexithymia) in the (mal-)adaptive psychological response to the COVID-19 pandemic during late adolescence. No study has yet explored the complex interplay between these variables. We recruited a sample of 454 late adolescents (Mage = 22.79, SD = 2.27) and assessed attachment to parents and peers, alexithymia, and peritraumatic distress due to COVID-19 through self-report instruments. Attachment to fathers and peers, but not to mothers, and alexithymia significantly predicted levels of peritraumatic distress. Alexithymia fully and partially mediated the effect of, respectively, attachment to mothers and attachment to peers on peritraumatic distress due to COVID-19. These findings suggested that intervention programs focused on the promotion of peer social relationships, supportive parent-adolescent relationships, and the ability to recognize and discriminate one's own and others' emotions are needed in helping late adolescents to face the current health emergency and preventing short- and long-term psychopathological consequences related to the COVID-19 pandemic.

Associations between early maladaptive schema domains of parents and their adult children: The role of defence styles

Although existing research recognized the associations between early maladaptive schemas (EMSs) of parents and their adult children, the mechanisms that underpin these associations were not fully understood. Therefore, the purpose of the current study was to explore the role of defence styles (DSs) on the associations between two EMS domains (Disconnection/Rejection and Impaired Autonomy) of parents and their adult children. Two hundred and fifteen families (i.e., mother, father, and their adult children) participated in the study. Both parents and their adult children were asked to complete Young Schema Questionnaire-Short Form (YSQ-SF) and Defence Style Questionnaire (DSQ) to assess their EMS domains and DSs. According to the results of the current study, there were significant associations between Disconnection/Rejection and Impaired Autonomy EMS domains of parents and their adult children, and these associations were mediated by only immature DS of parents and their adult children in a serial mediation model. These results contributed to our understanding of the associations between EMS domains of parents and their adult children through immature DSs. Moreover, our findings highlighted the importance of synthesizing the concepts of different theories to enhance our understanding of mental representations in families.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

The mediating role of alexithymia in the association between attachment styles and borderline personality symptomatology

Attachment insecurity and alexithymia are assumed as the probable causes of emotional dysregulation in patients with Borderline Personality Disorder (BPD). The present study was designed and conducted to examine the mediating role of alexithymia in the relationship between attachment styles and Borderline Personality Symptomatology (BPS). In this crosssectional study, 153 patients with BPD were selected using stratified random sampling among outpatients referring to the psychiatric clinics in three major cities of Iran. Also, they were evaluated through the 20-item Toronto Alexithymia Scale (TAS- 20), Attachment Style Questionnaire (ASQ), and BPD Severity Index (BPDSI). On-way ANOVA and then Scheffé post-hoc analysis revealed that the scores of BPS and TAS-20, together with the scores of preoccupied, fearful, and dismissing styles, were higher in the alexithymia group, whereas the scores of secure style were greater in the non-alexithymia group. Furthermore, the results of hierarchical multiple regression analysis showed that alexithymia mediated the association between secure, preoccupied, and fearful styles and BPS based on the model proposed by Baron and Kenny. Hence, modifying the alexithymia need to be a goal of psychotherapy. In this regard, changing the effects of the problematic attachment styles via increasing emotional awareness may be effective in modifying alexithymia and BPS.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis

INTRODUCTION

Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.

METHODS

One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.

RESULTS

Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.

CONCLUSIONS

The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.

Integration Between Cerebral Hemispheres Contributes to Defense Mechanisms

Defense mechanisms are mental functions which facilitate coping when real or imagined events challenge personal wishes, needs, and feelings. Whether defense mechanisms have a specific neural basis is unknown. The present research tested the hypothesis that interhemispheric integration plays a critical role in defense mechanism development, by studying a unique sample of patients born without the corpus callosum (agenesis of the corpus callosum; AgCC). Adults with AgCC (N = 27) and matched healthy volunteers (N = 30) were compared on defense mechanism use across increasing levels of developmental maturity (denial, least; projection, intermediate; identification, most). Narratives generated in response to Thematic Apperception Test images were scored according to the Defense Mechanism Manual. Greater use of denial and less identification was found in persons with AgCC, compared to healthy comparisons. This difference emerged after age 18 when full maturation of defenses among healthy individuals was expected. The findings provide clinically important characterization of social and emotional processing in persons with AgCC. More broadly, the results support the hypothesis that functional integration across the hemispheres is important for the development of defense mechanisms.

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective

Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.

Factors associated with the adults' attachment styles in Lebanon: The role of alexithymia, depression, anxiety, stress, burnout, and emotional intelligence

PURPOSE

To evaluate the association of adults' attachment styles with mental disorders in Lebanon.

DESIGN/METHODS

A cross-sectional observational study enrolled 789 participants between November 2017 and March 2018.

FINDINGS

People with distress (with dismissing- and fearful-dominant relationship styles) and people with instability (preoccupied-dominant relationship style with equal presence of the secured, fearful, and dismissing styles) had higher alcohol use disorder, alexithymia, depression, anxiety, stress, decreased emotional intelligence (emotional awareness, emotional management, and social-emotional awareness), burnout scores and suicidal ideation compared people with wellbeing, with a secure-dominant relationship style.

PRACTICE IMPLICATIONS

It is very important to assess bonding traits in disease prevention centers, caregiver institutions, employment assessments, and then coaching might help those individuals under risk to prevent mental health problems.

A mediational model linking perceptions of security, alexithymia and behavior problems of sexually abused children

BACKGROUND

Perceptions of security toward parents are related with internalized and externalized problems among victims of child sexual abuse (CSA). Alexithymia, which is difficulty in identifying and expressing feelings, is associated with the quality of parent-child relationships (Oskis et al., 2013) and behavior problems in children (Di Trani et al., 2013).

OBJECTIVE

The current study tested the mediational role of alexithymia in the relationship between perceptions of security toward parents and behavior problems among CSA victims.

PARTICIPANTS AND METHOD

Using a short-term multi-informant prospective design, 263 victims of CSA aged 6-12 years completed the Kerns Security Scale (Kerns, Klepac, & Cole, 1996), which evaluates perceived attachment security to mothers and fathers. Parents completed the Child Behavior Checklist (Achenbach & Rescorla, 2001) at Time 1 to provide baseline scores of behavior problems and again four months later. At Time 2, parents also assessed the children's alexithymia using the Children's Alexithymia Measure (Way et al., 2010).

RESULTS

Perceptions of security were both associated with alexithymia, as well as with internalizing and externalizing problems (p < .05). A mediational model showed that perception of security toward fathers outweighed the mother-child relationship in predicting children's alexithymia. Path analysis revealed that the father-child relationship predicted decreased behavioral problems at Time 2 through a lower level of alexithymia. The model explained 46.9% of internalizing problems and 56.1% of externalizing problems (p < .05).

CONCLUSIONS

The findings support the relevance of alexithymia as an intervention target for CSA victims and underscore the importance of the father-child relationship.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders

INTRODUCTION

Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders.

OBJECTIVE

To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP.

METHODS

In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments.

RESULTS

The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up.

CONCLUSION

Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Investigating the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups

Drug addiction as a biological, psychological, and social issue affects all dimensions of one's life. The purpose of this study was to determine the role of attachment styles, dysfunctional attitudes, and spirituality in predicting membership in addicted and non-addicted groups. This was a cross-sectional study conducted on 60 addicted people and 60 non-addicted people. The Adult Attachment Scale of Hazan and Shaver, Allport Religious Orientation Scale, and the 26-item Dysfunctional Attitude Scale (DAS-26) were used to measure the variables. Based on the results, which were analyzed by logistic regression analysis, the variables of attachment style and dysfunctional attitude can significantly predict drug addiction (p < .001). However, avoidant attachment style and spirituality cannot predict readiness for addiction. The results of this study indicate the importance of safe and ambivalent attachment styles and dysfunctional attitudes. Thus, attending to these factors in studies and interventions related to the treatment of substance abuse disorders is essential.

The relationship between defense mechanisms and religious coping using a new two-factor solution for the Defense Style Questionnaire-40

This study examined the factor structure of the Defense Style Questionnaire (DSQ-40) and explored the relationships between defense mechanisms and religious coping in a diverse sample of 380 college students. In contrast with the three-factor model of defenses proposed by the developers of the DSQ-40, principal axis factoring yielded two internally consistent components: adaptive and maladaptive defense styles. Endorsement of adaptive defenses was positively correlated with the use of positive religious coping strategies and negatively correlated with negative religious coping. Maladaptive defenses were associated with the endorsement of negative religious coping strategies. Clinical implications of these findings are discussed and recommendations are made for future use of the DSQ-40.

Exposure to attachment narratives dynamically modulates cortical arousal during the resting state in the listener

BACKGROUND

Affective stimulation entails changes in brain network patterns at rest, but it is unknown whether exogenous emotional stimulation has a prolonged effect on the temporal dynamics of endogenous cortical arousal. We therefore investigated differences in cortical arousal in the listener following stimulation with different attachment-related narratives.

METHODS

Resting-state EEG was recorded from sixteen healthy subjects for ten minutes each with eyes closed: first at baseline and then after passively listening to three affective narratives from strangers about their early childhood experiences (prototypical for insecure-dismissing, insecure-preoccupied, and secure attachment). Using the VIGALL 2.1 algorithm, low or high vigilance stages in consecutive EEG segments were classified, and their dynamic profile was analyzed. Questionnaires assessed the listeners' emotional response to the content of the narrative.

RESULTS

As a general effect of preceding affective stimulation, vigilance following the stimulation was significantly elevated compared to baseline rest, and carryover effects in dynamic vigilance profiles were observed. A difference between narrative conditions was revealed for the insecure-dismissing condition, in which the decrease in duration of high vigilance stages was fastest compared to the other two conditions. The behavioral data supported the observation that especially the insecure narratives induced a tendency in the listener to affectively disengage from the narrative content.

DISCUSSION

This study revealed carryover effects in endogenous cortical arousal evoked by preceding affective stimulation and provides evidence for attachment-specific dynamic alterations of brain states and individual differences in emotional reactivity.

Headache and Alexithymia in Children and Adolescents: What Is the Connection?

Background: Headache is one of the most common complaints in children and adolescents and comorbidity rates are very high and the major associated diseases are depression, anxiety, atopic disorders, sleep, and behavioral disorders. In recent years, it has been highlighted that difficulties regulating emotions such as alexithymia have also been associated with diagnosis of somatization. Methods: We carried out a mini review analyzing the relation between alexithymia and primary headache (e.g., migraine and tension type headache) in children and adolescents by synthesizing the relevant studies in the literature on PubMed, PsycINFO, and Google Scholar. Search terms were "alexithymia" combined with the "primary headache," "migraine," "tension type headache," "children," and "adolescents." Results: All analyzed studies found higher levels of alexithymia in children and adolescents with headache than control groups but there are different opinions about the relationship between headache and alexithymia. For example, some studies suggest that the association between headache and alexithymia in children may be due to an incomplete development of emotive competency or a general immature cognitive development, instead other studies found a correlation between headache symptoms, insecure attachment, and alexithymia. There seems to be also differences between children with migraine compared to those with tension type headache (TTH). Conclusion: There are some studies on adults suffering from headache or migraine and alexithymia, but there is only a moderate amount of research on pediatric age with different opinions and theories about this relationship. Further studies on children and adolescents are necessary to effectively understand this relationship and to help children to reduce headache and improve emotional consciousness.

The Big Five personality dimensions and mental health: The mediating role of alexithymia

The role of personality constructs on mental health has attracted research attention in the last few decades. The Big Five personality traits have been introduced as parsimonious dimensions of non-pathological traits. The five-factor model of personality includes neuroticism, agreeableness, conscientiousness, extraversion, and openness to experience. The present study aimed to examine the relationship between the Big Five dimensions and mental health considering the mediating role of alexithymia as an important emotional-processing construct. A total of 257 participants were recruited from non-clinical settings in the general population. All participants completed the Ten-Item Personality Inventory (TIPI), 20-item Toronto Alexithymia Scale (TAS-20), and General Health Questionnaire-28 (GHQ-28). Structural equation modeling was utilized to examine the hypothesized mediated model. Findings indicated that the Big Five personality dimensions could significantly predict scores of alexithymia. Moreover, alexithymia could predict mental health scores as measured by indices of depression, anxiety, social functioning, and somatic symptoms. The fit indices (GFI=0.94; CFI=0.91; TLI=0.90; RMSEA=0.071; CMIN/df=2.29) indicated that the model fits the data. Therefore, the relationship between the Big Five personality dimensions and mental health is mediated by alexithymia.

Relationship between alexithymia and dependent personality disorder: a dimensional analysis

The present study had two aims and used two different samples. The first aim was to determine if alexithymia and dependent personality disorder (DPD) are distinct or overlapping constructs. The second aim was to determine the specificity and the stability of the relationship between alexithymia and DPD. The first study used exploratory principal components analysis (PCA) in a sample of 477 non-clinical subjects who completed three questionnaires measuring alexithymia (Twenty item Toronto Alexithymia Scale, i.e. TAS-20), dependent personality disorder (Dependent Personality Questionnaire, i.e. DPQ) and depression (Beck Depression Inventory-II, i.e. BDI-II). The second study used a sample of 305 subjects consecutively admitted to an outpatient department of legal medicine. The subjects completed (at admission and 3 months later) the Structured Clinical Interview for DSM-IV, screen questionnaire (SCID-II-SQ), the TAS-20 and the BDI. Multiple regressions were done. For the first study, the PCA yielded a four-factor solution with no overlap of the significant factor loadings for the items from each scale and with the factors corresponding to their respective construct. For the second study, multiple regressions showed that only avoidant personality disorder was an independent predictor of the TAS-20 scores. Alexithymia is a construct that is distinct and separate from DPD and depression. Alexithymia is not a stable feature of DPD while it is a core feature of avoidant personality disorder.