Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T08:37:14.179Z Has data issue: false hasContentIssue false
  • English
  • Français

Early-life adversities and adult attachment in depression and alexithymia

Published online by Cambridge University Press:  15 September 2020

Jani Kajanoja Open the ORCID record for Jani Kajanoja [Opens in a new window] ,
Max Karukivi ,
Noora M. Scheinin ,
Hanna Ahrnberg ,
Linnea Karlsson  and
Hasse Karlsson
Jani Kajanoja*
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland Satakunta Hospital District, Pori, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku
Max Karukivi
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku
Noora M. Scheinin
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku
Hanna Ahrnberg
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku
Linnea Karlsson
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
Hasse Karlsson
Affiliation:
Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland FinnBrain Birth Cohort Study, Population Health Research Centre, University of Turku
*
Author for correspondence: Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland Teutori, FinnBrain/Lemminkäisenkatu 3, 20014, Turun Yliopisto; E-mail: jani.kajanoja@utu.fi
Get access Rights & Permissions [Opens in a new window]

Abstract

Alexithymia is a personality construct characterized by difficulties in identifying and verbalizing feelings, a restricted imagination, and an externally oriented thinking style. As alexithymia shows marked overlap with depression, its independent nature as a personality construct is still being debated. The etiology of alexithymia is unknown, although childhood emotional neglect and attachment formation are thought to play important roles. In the FinnBrain Birth Cohort Study, experiences of early-life adversities (EA) and childhood maltreatment (CM) were studied in a sample of 2,604 men and women. The overlap and differences between depression and alexithymia were investigated by comparing their associations with EA types and adult attachment style. Alexithymia was specifically associated with childhood emotional neglect (odds ratio (OR) 3.8, p < .001), whereas depression was related to several types of EA. In depression co-occurring with alexithymia, there was a higher prevalence of emotional neglect (81.3% vs. 54.4%, p < .001), attachment anxiety (t = 2.38, p = .018), and attachment avoidance (t = 4.03, p < .001). Early-life adversities were markedly different in the alexithymia group compared to those suffering from depression, or healthy controls. Depression with concurrent alexithymia may represent a distinct subtype, specifically associated with childhood experiences of emotional neglect, and increased attachment insecurity compared to non-alexithymic depression.

Type
Regular Articles
Information
Development and Psychopathology , Volume 33 , Issue 4 , October 2021 , pp. 1428 - 1436
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aust, S., Alkan Härtwig, E., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 225–232.CrossRefGoogle Scholar
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto alexithymia scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.CrossRefGoogle ScholarPubMed
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (2020). Twenty-five years with the 20-item Toronto alexithymia scale. Journal of Psychosomatic Research, 131, 109940.CrossRefGoogle ScholarPubMed
Baldwin, J. R., Reuben, A., Newbury, J. B., & Danese, A. (2019). Agreement between prospective and retrospective measures of childhood maltreatment: A systematic review and meta-analysis. JAMA Psychiatry, 76(6), 584–593. doi: 10.1001/jamapsychiatry.2019.0097.CrossRefGoogle ScholarPubMed
Berthoz, S., Consoli, S., Perez-Diaz, F., & Jouvent, R. (1999). Alexithymia and anxiety: compounded relationships? A psychometric study. European Psychiatry. The Journal of the Association of European Psychiatrists, 14, 372–378.CrossRefGoogle Scholar
Brown, S., Fite, P. J., Stone, K., & Bortolato, M. (2016). Accounting for the associations between child maltreatment and internalizing problems: The role of alexithymia. Child Abuse & Neglect, 52, 20–28.CrossRefGoogle ScholarPubMed
Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014). Changes in alexithymia following psychological intervention: a review. Harvard Review of Psychiatry, 22, 162–178.CrossRefGoogle ScholarPubMed
Cassidy, J. (1994). Emotion regulation: influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228–249.CrossRefGoogle ScholarPubMed
Cecil, C. A. M., Viding, E., Fearon, P., Glaser, D., & McCrory, E. J. (2017). Disentangling the mental health impact of childhood abuse and neglect. Child Abuse & Neglect, 63, 106–119.CrossRefGoogle ScholarPubMed
Colman, I., Kingsbury, M., Garad, Y., Zeng, Y., Naicker, K., Patten, S., … Thompson, A. H. (2016). Consistency in adult reporting of adverse childhood experiences. Psychological Medicine, 46, 543–549.CrossRefGoogle ScholarPubMed
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry: The Journal of Mental Science, 150, 782–786. Retrieved 11 January 2019 from.CrossRefGoogle ScholarPubMed
Daniel, S. I. F. (2006). Adult attachment patterns and individual psychotherapy: a review. Clinical Psychology Review, 26, 968–984.CrossRefGoogle ScholarPubMed
Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P., Lenzen, T., Grotegerd, D., … Kugel, H. (2012). Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biological Psychiatry, 71, 286–293.CrossRefGoogle ScholarPubMed
Dorard, G., Bungener, C., Phan, O., Edel, Y., Corcos, M., & Berthoz, S. (2017). Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers. Journal of Psychosomatic Research, 95, 74–80.CrossRefGoogle ScholarPubMed
Ford, E., Clark, C., & Stansfeld, S. A. (2011). The influence of childhood adversity on social relations and mental health at mid-life. Journal of Affective Disorders, 133, 320–327.CrossRefGoogle ScholarPubMed
Fraley, R. C. (2002). Attachment stability from infancy to adulthood: Meta-analysis and dynamic modeling of developmental mechanisms. Personality and Social Psychology Review: An Official Journal of the Society for Personality and Social Psychology, Inc, 6, 123–151.CrossRefGoogle Scholar
Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.CrossRefGoogle ScholarPubMed
Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the Edinburgh postnatal depression scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119, 350–364.CrossRefGoogle ScholarPubMed
Goldberg, D. (2011). The heterogeneity of ‘major depression’. World Psychiatry: Official Journal of the World Psychiatric Association, 10, 226–228.CrossRefGoogle Scholar
Grabe, H. J., Spitzer, C., & Freyberger, H. J. (2004). Alexithymia and personality in relation to dimensions of psychopathology. The American Journal of Psychiatry, 161, 1299–1301.CrossRefGoogle ScholarPubMed
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67, 113–123.CrossRefGoogle ScholarPubMed
Hackman, D. A., & Farah, M. J. (2009). Socioeconomic status and the developing brain. Trends in Cognitive Sciences, 13, 65–73.CrossRefGoogle ScholarPubMed
Heistaro, S. (2008). Methodology report: Health 2000 survey. Helsinki: Hakapaino Oy.Google Scholar
Hiirola, A., Pirkola, S., Karukivi, M., Markkula, N., Bagby, R. M., Joukamaa, M., … Mattila, A. K. (2017). An evaluation of the absolute and relative stability of alexithymia over 11years in a Finnish general population. Journal of Psychosomatic Research, 95, 81–87.CrossRefGoogle Scholar
Honkalampi, K., Hintikka, J., Tanskanen, A., Lehtonen, J., & Viinamäki, H. (2000). Depression is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 48, 99–104.CrossRefGoogle ScholarPubMed
Infurna, M. R., Reichl, C., Parzer, P., Schimmenti, A., Bifulco, A., & Kaess, M. (2016). Associations between depression and specific childhood experiences of abuse and neglect: A meta-analysis. Journal of Affective Disorders, 190, 47–55.CrossRefGoogle ScholarPubMed
Jørgensen, M. M., Zachariae, R., Skytthe, A., & Kyvik, K. (2007). Genetic and environmental factors in alexithymia: a population-based study of 8,785 Danish twin pairs. Psychotherapy and Psychosomatics, 76, 369–375.CrossRefGoogle ScholarPubMed
Kajanoja, J., Scheinin, N. M., Karlsson, L., Karlsson, H., & Karukivi, M. (2017). Illuminating the clinical significance of alexithymia subtypes: A cluster analysis of alexithymic traits and psychiatric symptoms. Journal of Psychosomatic Research, 97, 111–117.CrossRefGoogle ScholarPubMed
Karlsson, L., Tolvanen, M., Scheinin, N. M., Uusitupa, H.-M., Korja, R., Ekholm, E., … FinnBrain Birth Cohort Study Group. (2018). Cohort Profile: The FinnBrain Birth Cohort Study (FinnBrain). International Journal of Epidemiology, 47(1), 15–16j.CrossRefGoogle Scholar
Karukivi, M., & Saarijärvi, S. (2014). Development of alexithymic personality features. World Journal of Psychiatry, 4, 91–102.CrossRefGoogle ScholarPubMed
Kim, H.-Y. (2013). Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38, 52–54.CrossRefGoogle ScholarPubMed
Le, H.-N., Berenbaum, H., & Raghavan, C. (2002). Culture and alexithymia: mean levels, correlates, and the role of parental socialization of emotions. Emotion, 2, 341–360.CrossRefGoogle ScholarPubMed
Le, H. N., Ramos, M. A., & Muñoz, R. F. (2007). The relationship between alexithymia and perinatal depressive symptomatology. Journal of Psychosomatic Research, 62, 215–222.CrossRefGoogle ScholarPubMed
Levant, R. F., Hall, R. J., Williams, C. M., & Hasan, N. T. (2009). Gender differences in alexithymia. Psychology of Men & Masculinity, 10, 190–203.CrossRefGoogle Scholar
Luminet, O., Bagby, R. M., & Taylor, G. J. (2001). An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychotherapy and Psychosomatics, 70, 254–260.CrossRefGoogle ScholarPubMed
Lyvers, M., Mayer, K., Needham, K., & Thorberg, F. A. (2019). Parental bonding, adult attachment, and theory of mind: A developmental model of alexithymia and alcohol-related risk. Journal of Clinical Psychology, 2019, 1–17. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22772.Google Scholar
Mandelli, L., Petrelli, C., & Serretti, A. (2015). The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry: The Journal of the Association of European Psychiatrists, 30, 665–680.CrossRefGoogle ScholarPubMed
Marchesi, C., Brusamonti, E., & Maggini, C. (2000). Are alexithymia, depression, and anxiety distinct constructs in affective disorders? Journal of Psychosomatic Research, 49, 43–49.CrossRefGoogle ScholarPubMed
Marchesi, C., Ossola, P., Tonna, M., & De Panfilis, C. (2014). The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders. Comprehensive Psychiatry, 55, 972–978.CrossRefGoogle ScholarPubMed
Matthey, S., Barnett, B., Kavanagh, D. J., & Howie, P. (2001). Validation of the Edinburgh postnatal depression scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64, 175–184.CrossRefGoogle ScholarPubMed
Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World Psychiatry: Official Journal of the World Psychiatric Association, 11, 11–15.CrossRefGoogle ScholarPubMed
Moutsiana, C., Fearon, P., Murray, L., Cooper, P., Goodyer, I., Johnstone, T., & Halligan, S. (2014). Making an effort to feel positive: insecure attachment in infancy predicts the neural underpinnings of emotion regulation in adulthood. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55, 999–1008.CrossRefGoogle ScholarPubMed
Nemeroff, C. B. (2016). Paradise lost: The neurobiological and clinical consequences of child abuse and neglect. Neuron, 89, 892–909.CrossRefGoogle ScholarPubMed
Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., … Keller, M. B. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the United States of America, 100, 14293–14296.CrossRefGoogle ScholarPubMed
Norman, H., Marzano, L., Coulson, M., & Oskis, A. (2019). Effects of mindfulness-based interventions on alexithymia: a systematic review. Evidence-Based Mental Health, 22, 36–43. Retrieved from https://doi.org/10.1136/ebmental-2018-300029.CrossRefGoogle ScholarPubMed
O'Loughlin, J. I., Cox, D. W., Kahn, J. H., & Wu, A. D. (2018). Attachment avoidance, alexithymia, and gender: Examining their associations with distress disclosure tendencies and event-specific disclosure. Journal of Counseling Psychology, 65, 65–73.CrossRefGoogle ScholarPubMed
Opel, N., Redlich, R., Dohm, K., Zaremba, D., Goltermann, J., Repple, J., … Dannlowski, U. (2019). Mediation of the influence of childhood maltreatment on depression relapse by cortical structure: a 2-year longitudinal observational study. The Lancet. Psychiatry, 6, 318–326.CrossRefGoogle ScholarPubMed
Oukamaa, M, Miettunen, J, Kokkonen, P, Koskinen, M, Julkunen, J, Kauhanen, J, … Järvelin, MR. (2001). Psychometric properties of the Finnish 20-item Toronto Alexithymia Scale. Nordic Journal of Psychiatry, 55, 123–127.CrossRefGoogle Scholar
Ozsahin, A., Uzun, O., Cansever, A., & Gulcat, Z. (2003). The effect of alexithymic features on response to antidepressant medication in patients with major depression. Depression and Anxiety, 18, 62–66.CrossRefGoogle ScholarPubMed
Pasco Fearon, R. M., & Roisman, G. I. (2017). Attachment theory: progress and future directions. Current Opinion in Psychology, 15, 131–136.CrossRefGoogle Scholar
Pechtel, P., & Pizzagalli, D. A. (2011). Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology, 214, 55–70.CrossRefGoogle ScholarPubMed
Rantala, M. J., Luoto, S., Krams, I., & Karlsson, H. (2018). Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions. Brain, Behavior, and Immunity, 69, 603–617.CrossRefGoogle ScholarPubMed
Saarijarvi, S., Salminen, J. K., & Toikka, T. (2006). Temporal stability of alexithymia over a five-year period in outpatients with major depression. Psychotherapy and Psychosomatics, 75, 107–112.CrossRefGoogle Scholar
Salokangas, R. K. R., Schultze-Lutter, F., Patterson, P., von Reventlow, H. G., Heinimaa, M., From, T., … Tuominen, L. (2016). Psychometric properties of the trauma and distress scale, TADS, in an adult community sample in Finland. European Journal of Psychotraumatology, 7, 30062.CrossRefGoogle Scholar
Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy & Psychosomatics, 22, 255–262.CrossRefGoogle ScholarPubMed
Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van IJzendoorn, M. H. (2012). The universality of childhood emotional abuse: A meta-analysis of Worldwide prevalence. Journal of Aggression, Maltreatment & Trauma, 21, 870–890.CrossRefGoogle Scholar
Stoltenborgh, M., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2013a). The neglect of child neglect: a meta-analytic review of the prevalence of neglect. Social Psychiatry and Psychiatric Epidemiology, 48, 345–355.CrossRefGoogle Scholar
Stoltenborgh, M., Bakermans-Kranenburg, M. J., van Ijzendoorn, M. H., & Alink, L. R. A. (2013b). Cultural-geographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence. International Journal of Psychology: Journal International de Psychologie, 48, 81–94.CrossRefGoogle Scholar
Tamminen, T. (1990). Postnatal depression, breastfeeding and mother-infant interaction (Unpublished Doctoral Thesis). Tampere, Finland: University of Tampere.Google Scholar
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, 1258–1268.CrossRefGoogle ScholarPubMed
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (2003). The 20-item Toronto alexithymia scale. IV. Reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55, 277–283.CrossRefGoogle ScholarPubMed
Teicher, M. H., Anderson, C. M., & Polcari, A. (2012). Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum. Proceedings of the National Academy of Sciences of the United States of America, 109, E563–72.CrossRefGoogle ScholarPubMed
Teicher, M. H., & Samson, J. A. (2013). Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. The American Journal of Psychiatry, 170, 1114–1133.CrossRefGoogle ScholarPubMed
Terock, J., Van der Auwera, S., Janowitz, D., Homuth, G., Hannemann, A., Schmidt, C. O., … Grabe, H. J. (2018). Childhood trauma and functional variants of 5-HTTLPR are independently associated with alexithymia in 5,283 subjects from the general population. Psychotherapy and Psychosomatics, 87, 58–61.CrossRefGoogle ScholarPubMed
Thorberg, F. A., Young, R. M., Sullivan, K. A., & Lyvers, M. (2009). Alexithymia and alcohol use disorders: a critical review. Addictive Behaviors, 34, 237–245.CrossRefGoogle ScholarPubMed
Thorberg, F. A., Young, R. M., Sullivan, K. A., & Lyvers, M. (2011). Parental bonding and alexithymia: a meta-analysis. European Psychiatry: The Journal of the Association of European Psychiatrists, 26, 187–193.CrossRefGoogle ScholarPubMed
Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA Psychiatry, 72, 1135–1142.CrossRefGoogle ScholarPubMed
Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachment security in infancy and early adulthood: a twenty-year longitudinal study. Child Development, 71, 684–689.CrossRefGoogle ScholarPubMed