Alexithymia and attachment in eating disorders. (2002)
AuthorsSelway, Susan Lynneshow all
A multi-dimensional construct, alexithymia represents a cluster of characteristics: difficulty distinguishing between feelings and the bodily sensations of emotional arousal, difficulty describing feelings, an externally-oriented cognitive style, constricted imaginal processes and paucity of fantasy. Originally developed to describe features observed in psychosomatic patients, it is now thought that alexithymia makes individuals vulnerable to physical and mental illness, including coronary heart disease, inflammatory bowel disease, anxiety disorders, substance abuse disorders, somatoform disorders, and eating disorders. Alexithymia is thought to reflect dissociation or dysfunction in the emotion regulation system resulting from an arrest in emotion development at the preoperational stage. This study investigated the hypothesis that the origins of alexithymia (i.e. disrupted emotion development) lie in problematic attachment relations. A group of women diagnosed with eating disorders (N = 30) and a comparison group of women of similar age (N = 83) were administered a set of self-report instruments that included the Toronto Alexithymia Scale (TAS-20), Parental Bonding Instrument (PBI), Close Relationships Questionnaire (CRQ), Beck Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI), and the Eating Disorders Inventory (EDI-2). With the exception of the externally oriented thinking subscale of the TAS-20, eating disorders group means were significantly higher than comparison group means for subscales of all measures (p < .05). The eating disorders group was more alexithymic, more severely depressed and anxious, and showed patterns of less secure attachment than the comparison group. Alexithymia was shown to to vary with education. Anxiety, trait anxiety in particular, and depression could account for elevated alexithymia scores in the eating disorders group. In the whole sample, correlations were revealed between the PBI and CRQ suggesting continuity of attachment, and both attachment measures could predict TAS-20 subscales providing support for the hypothesis implicating attachment in the etiology of alexithymia. All measures predicted EDI-2 subscales, with the most diverse relationships revealed for BDI-2 and TAS-20. An unexpected positive relationship was revealed between PBI paternal care and two of the TAS-20 subscales, difficulty describing feelings and externally oriented thinking. A number of possible explanations are discussed.