Alexithymia in parents of daughters with eating disorders: Its relationships with psychopathological and personality variables
Introduction
Alexithymia is characterised by: (1) difficulty identifying and describing subjective feelings; (2) difficulty distinguishing between feelings and the bodily sensations of emotional arousal; (3) lack of fantasy; and (4) an externally orientated cognitive style [1]. Several authors suggest that these features might be due to a deficit in the cognitive processing of emotions [2], [3]. Alexithymia is related positively to neuroticism and depression [4], [5], [6], [7], [8], anxiety [9], [10], [11], psychoticism [8] and introversion [6], [7], and negatively to extraversion and sociability [5], [6], [12], [13].
With regard to the question of alexithymia being a personality trait or a state due to distress and depressive mood, some authors have suggested that alexithymia is a trait [14], [15], [16], [17], [18] that could strengthen depression [7], [19]. Corcos et al. [20] suggested that alexithymia is a state associated with depression and serious physical illness [21]. Finally, other authors suggested that alexithymia could be both a state and a trait [4], [22], [23].
Alexithymia has been found in many different pathologies: somatoform disorders, alcoholism, drug addiction, posttraumatic stress, asthma, depression, eating disorders (EDs) and so on [24]. Bruch [25], [26], [27] suggested that the difficulty in distinguishing and describing feelings, as well as in recognizing and responding to emotional states and visceral sensations, constitutes the main deficit in EDs. Later studies have confirmed that alexithymia is present in EDs [10], [20], [22], [23], [28], [29], [30], [31], [32], [33], [34]. Taylor et al. [34] stated that there is a deficit in the cognitive processing of emotions in EDs.
Several authors have related alexithymia to inadequate parenting in childhood [33], [35], [36], [37], [38], [39], [40]. Dahlman [41] found that the mothers of daughters with ED were more alexithymic than the mothers of daughters from the group without pathology. They were less able to distinguish emotions and their families were more conflictive. Onnis and Di Genaro [42], following the description made by Minuchin et al. [43] about “psychosomatogenic families”, outlined that alexithymia, more than an individual problem, is the symptom of a family that avoids conflict and emotional tensions. These authors suggested that the difficulties in expressing emotional experiences verbally are due to the blockade of emotions in these families in order to avoid conflicts and maintain a “myth of harmony”. The somatic symptom would be the language of the whole family. According to the study carried out by Humphrey [44], families of bulimics, on the one hand, were hostile, detached and impulsive, and parents, on the other hand, were not empathic and presented a deficit in parenting. In families of bulimic anorexics, these features were less accused while in restrictive anorexics' parents, they were more positive.
In order to evaluate alexithymia, the most validated and reliable instrument is the Toronto Alexithymia Scale (TAS) developed by Taylor et al. [45], which has suffered several changes up to the 20-item version (TAS-20) [46], [47], [48]. The last version has three factors: (1) difficulty in identifying and distinguishing feelings from physical sensations due to emotional arousal; (2) difficulty in expressing feelings; and (3) externally orientated thinking.
The aim of this study was, on the one hand, to establish whether alexithymia is present in parents of daughters with an ED (anorexia nervosa and bulimia nervosa (BN)), comparing them with one another and with a control group with similar sociodemographic characteristics, and on the other hand, to relate alexithymia to psychopathologic and personality variables.
Section snippets
Subjects
The sample comprised 73 married couples, parents of a woman with an ED who were sent to us by the Association Against Anorexia and Bulimia of Euskadi (ACABE), linked to the Public Health Services. The criteria for selecting the sample were: diagnosis of ED as outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [49], age between 14 and 33 years and a minimum illness duration of 6 months. The exclusion criteria were the following: to be currently
Results
Clinical and sociodemographic characteristics are shown in Table 1.
We compared the three ED groups in the TAS-20 and its factors in fathers and mothers separately, and we found no statistically significant differences.
Discussion
Our results showed a higher rate of alexithymia in mothers of daughters with an ED than in mothers of controls, which confirms Dahlman's [41] findings. The high scores found in the TAS-20 and its factors in parents of ED group suggest that alexithymia is related to these families, like some authors affirmed [42]. The other aspect to be considered is that the externally orientated thinking could be a characteristic of anorexics parent's.
Positive correlations of the TAS-20 with anxiety in fathers
Acknowledgements
This project was supported by a grant from the University of the Basque Country, 1/UPV 00006.231-H-13710/2001.
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