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 cross sectional 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-hocanalysis 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.
1. Bach, M., de Zwaan, M., Ackard, D., Nutzinger, D.O., & Mitchell, J.E. (1994). Alexithymia: Relationship to personality disorders. Comprehensive Psychiatry, 35(3), 239-243.
2. Baron, R.M., & Kenny, D.A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology, 51(6), 1173.
3. Bartholomew, K., & Horowitz, L.M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of personality and social psychology, 61(2), 226.
4. Bermond, B., Bierman, D.J., Cladder, M.A., Moormann, P.P., & Vorst, H.C. (2010). The cognitive and affective alexithymia dimensions in the regulation of sympathetic responses. International Journal of Psychophysiology, 75(3), 227-233.
5. Besharat, M.A. (2007). Reliability and factorial validity of a Farsi version of the 20-item Toronto Alexithymia Scale with a sample of Iranian students. Psychological reports, 101(1), 209-220.
6. Besharat, M.A., & Khajavi, Z. (2013). The relationship between attachment styles and alexithymia: Mediating role of defense mechanisms. Asian Journal of Psychiatry, 6(6), 571-576.
7. Burmeister, E., & Aitken, L.M. (2012). Sample size: How many is enough?. Australian Critical Care, 25(4), 271-274.
8. Carrère, S., & Bowie, B.H. (2012). Like parent, like child: Parent and child emotion dysregulation. Archives of psychiatric nursing, 26(3), e23-e30.
9. Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the society for research in child development, 59(2-3), 228-249.
10. De Panfilis, C., Ossola, P., Tonna, M., Catania, L., & Marchesi, C. (2015). Finding words for feelings: The relationship between personality disorders and alexithymia. Personality and Individual Differences, 74, 285-291.
11. Deborde, A.S., Miljkovitch, R., Roy, C., Dugré-Le Bigre, C., Pham-Scottez, A., Speranza, M., & Corcos, M. (2012). Alexithymia as a mediator between attachment and the development of borderline personality disorder in adolescence. Journal of Personality Disorders, 26(5), 676-688.
12. Erickson, S.J., & Lowe, J.R. (2008). The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weight. Infant Mental Health Journal, 29(2), 114-132.
13. Firoozabadi, A., Abedi, Z., Aliyari, R., Zolfaghari, B., & Ghanizadeh, A. (2014). Psychometric characteristics of the persian (farsi) version of attachment style questionnaire. Iranian journal of medical sciences, 39(6), 506.
14. First, M.B., Williams, J.B., Benjamin, L.S., & Spitzer, R.L. (2016). User’s Guide for the SCID-5-PD Structured Clinical Interview for DSM-5 Personality Disorders: Also Contains Instructions for the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire. American Psychiatric Assoication Publishing.
15. Fonagy, P., Target, M., & Gergely, G. (2000). Attachment and borderline personality disorder: A theory and some evidence. Psychiatric Clinics, 23(1), 103-122.
16. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of personality and social psychology, 52(3), 511.
17. Khosravi, M., & Kasaeiyan, R. (2019). Attachment Style and Its Relation to the Quality of Life and Readiness to Change Substance Use Behavior: A Causal-Comparative Study. Archives of Pharmacy Practice, 1, 35.
18. Kobak, R.R., Cole, H.E., Ferenz-Gillies, R., Fleming, W.S., & Gamble, W. (1993). Attachment and emotion regulation during mother-teen problem solving: A control theory analysis. Child development, 64(1), 231-245.
19. Láng, A. (2010). Attachment and emotion regulation–clinical implications of a non-clinical sample study. Procedia-Social and Behavioral Sciences, 5, 674-678.
20. Leibowitz, J., Ramos-Marcuse, F., & Arsenio, W.F. (2002). Parent-child emotion communication, attachment, and affective narratives. Attachment & human, 4(1), 55-67.
21. Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364(9432), 453-461.
22. Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of general psychiatry, 50(12), 971-974.
23. Lowe, J. R., MacLean, P. C., Duncan, A. F., Aragón, C., Schrader, R. M., Caprihan, A., & Phillips, J. P. (2012). Association of maternal interaction with emotional regulation in 4-and 9-month infants during the Still Face Paradigm. Infant Behavior and Development, 35(2), 295-302.
24. Lyons-Ruth, K. (2008). Contributions of the mother–infant relationship to dissociative, borderline, and conduct symptoms in young adulthood. Infant Mental Health Journal, 29(3), 203-218.
25. Lyvers, M., Edwards, M., & Thorberg, F. (2017). Alexithymia, attachment and fear of intimacy in young adults. IAFOR Journal of Psychology & the Behavioral Sciences, 3, 1-11.
26. Meins, E., Harris-Waller, J., & Lloyd, A. (2008). Understanding alexithymia: Associations with peer attachment style and mind-mindedness. Personality and Individual Differences, 45(2), 146-152.
27. Mohammadzadeh, A. (2011). Validation of the borderline personality inventory in Iran. International Journal of Behavioral Sciences, 5(3), 269-277.
28. Oskis, A., Clow, A., Hucklebridge, F., Bifulco, A., Jacobs, C., & Loveday, C. (2013). Understanding alexithymia in female adolescents: The role of attachment style. Personality and Individual Differences, 54(1), 97-102.
29. Roque, L., & Veríssimo, M. (2011). Emotional context, maternal behavior and emotion regulation. Infant Behavior and Development, 34(4), 617-626.
30. Salavati, M. (2007). Most schemas and schematherapy efficacy in patients with borderline personality disorder. Clinical Psychology, phD Thesis. Tehran: Tehran Psychiatrist Institute, 189-200.
31. Schore, A.N. (2000). Attachment and the regulation of the right brain. Attachment & human development, 2(1), 23-47.
32. Stasiewicz, P. R., Bradizza, C. M., Gudleski, G. D., Coffey, S. F., Schlauch, R. C., Bailey, S. T., Bole, C.V., & Gulliver, S. B. (2012). The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample. Addictive behaviors, 37(4), 469-476.
33. Taylor, G.J., & Bagby, R.M. (2004). New trends in alexithymia research. Psychotherapy and psychosomatics, 73(2), 68-77.
34. Taylor, G. J., Bagby, R. M., & Parker, J. D. (1999). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press.
35. Taylor, G. J., Bagby, R. M., Kushner, S. C., Benoit, D., & Atkinson, L. (2014). Alexithymia and adult attachment representations: Associations with the five-factor model of personality and perceived relationship adjustment. Comprehensive Psychiatry, 55(5), 1258-1268.
36. Thorberg, F.A., Young, R.M., Sullivan, K.A., Lyvers, M., Connor, J.P., & Feeney, G.F. (2011). Alexithymia, craving and attachment in a heavy drinking population. Addictive behaviors, 36(4), 427-430.
37.Widom, C. S., Czaja, S. J., & Paris, J. (2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of personality disorders, 23(5), 433-446.
38.Wolff, S., Stiglmayr, C., Bretz, H. J., Lammers, C. H., & Auckenthaler, A. (2007). Emotion identification and tension in female patients with borderline personality disorder. British Journal of Clinical Psychology, 46(3), 347-360.