Adult attachment and emotional awareness impairment: a multimethod assessment

"Feeling Invisible": Individuals With Borderline Personality Disorder Underestimate the Transparency of Their Emotions

The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients' social functioning.

Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients

OBJECTIVE

Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.

METHODS

Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.

RESULTS

Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios.

CONCLUSION

Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.

Food allergy and attitudes to close interpersonal relationships: An exploratory study on attachment

BACKGROUND

Food allergy is a common immunologic disease that includes potentially fatal reactions. It impacts considerably on patients' social life including close interpersonal relationships. Attachment theory provides a theoretic framework to evaluate the quality of close interpersonal relationships in chronic disorders. Attachment insecurity, mainly characterized by attachment avoidance, has been found in a variety of health conditions, but still needs to be investigated in food allergy. The study aimed to investigate attachment, as attitude to close interpersonal relationships, among food-allergic young patients, compared to healthy controls.

METHODS

This is a cross-sectional study involving patients suffering from IgE-mediated food allergy sequentially recruited and matched to healthy controls for age and gender. The Attachment Style Questionnaire (ASQ) was used to assess five factors and two attachment dimensions (Anxiety-Avoidance). Associations with anaphylaxis and adrenaline prescription were explored among patients.

RESULTS

174 participants were assessed (female=45%; mean age=17.51; SD=4.26). Food-allergic patients reported significantly higher levels of Discomfort with Closeness (P<.05), Relationships as Secondary (P<.05) and Attachment Avoidance (P<.0001) compared to controls.

CONCLUSIONS

Clinicians should be aware of implications of insecure attachment for health and illness. They should support patients in limiting social impairment finding a balance between safety and psychologic well-being.

Insecure attachment strategies are associated with cognitive alexithymia in patients with severe somatoform disorder

OBJECTIVE

In light of interpersonal difficulties and their relation to alexithymia in patients with somatoform disorder, the primary aim of this study was to explore the association between two insecure attachment strategies (deactivation and hyperactivation strategies), and affective and cognitive alexithymia in a sample of 128 patients with severe somatoform disorder, over and above the levels of negative affectivity and personality pathology.

METHOD

In a cross-sectional study among patients with somatoform disorder, self-report data were obtained using measures for alexithymia (Bermond-Vorst Alexithymia Questionnaire), attachment (Experiences in Close Relationships Questionnaire), personality pathology (Inventory of Personality Organization), and negative affectivity (Dutch Short Form of the MMPI). We used hierarchical regression analyses to test main effects of attachment deactivation and hyperactivation strategies in the prediction of both cognitive and affective alexithymia, while controlling for the levels of negative affectivity and personality pathology.

RESULTS

Only cognitive alexithymia, i.e., the inability to analyze, identify, and verbalize emotions, was associated with personality dysfunction, in particular insecure attachment strategies. Affective alexithymia, i.e., the inability to fantasize and to experience emotions, was associated (negatively) with negative affectivity but not with the personality variables.

CONCLUSIONS

This study, therefore, indicates that both types of alexithymia are relevant for the assessment and treatment of severe somatoform disorder, yet each type may tap into different features of somatoform disorder.

Individual Differences in Work-Related Well-Being: The Role of Attachment Style

Integrating theories of adult attachment and well-being at the workplace, the present study tested the role of attachment style in predicting work-related well-being in terms of job satisfaction and job involvement, over and above dispositional trait measures (emotional traits and work-related traits). A sample of workers took part in a correlational study that explored the relationships among a) adult attachment, b) emotional traits, c) work-related traits, and d) work-related well-being indices. The results showed that both secure and anxious attachment style explained workers’ job involvement, whereas the secure and avoidant attachment styles explained workers’ job satisfaction. The current findings thus confirm and expand the literature's emphasis on studying the variables and processes that underlie people's mental health in the work setting, and have implications for assessing and promoting well-being in the workplace.

What is the emotional core of the multidimensional Machiavellian personality trait?

Machiavellianism is a personality trait characterized by interpersonal manipulation and associated with specific patterns of emotional and social cognition skills. The aim of this study was to investigate its socio-cognitive characteristics by determining its association and predictors on the basis of a multidimensional approach to Machiavellianism. We used Mach IV scale to assess "Machiavellian Intelligence" skill of participants (Christie and Geis, 1970). It includes three subscales that are (1) the use of deceit in interpersonal relationships, (2) a cynical view of human nature and (3) the lack of morality. Associations were found between Machiavellianism and low levels of empathy and affective ToM, and high levels of alexithymia, anhedonia, depression, and anxiety. These associations were observed in varying proportions depending on the three subscales of Machiavellianism. The addition of anhedonia and trait-anxiety to the concepts of empathy and alexithymia made it possible to gain a better understanding of the emotional core of Machiavellianism. These findings are discussed in the light of developmental and adaptive perspectives.