آلکسیتیمیا و مشکلات بین فردی: مطالعه استفاده از زبان طبیعی

The concept of alexithymia refers to difficulties in experiencing, verbalizing and regulating emotions. The relationship between alexithymia and interpersonal style is investigated by means of lexical content analysis. It is hypothesized that alexithymia is related to less frequent and less varied use of communication words and references to others. Alexithymia was measured with the 20-item Toronto Alexithymia Scale and the Toronto Structured Interview for Alexithymia. The Clinical Diagnostic Interview was administered to 50 psychiatric inpatients, transcribed verbatim, and computer-analysed with the Linguistic Inquiry and Word Count-dictionary. Results showed that alexithymia is related to a less complex vocabulary for communication words. Contradictory results for some subscales of the TAS-20 and the TSIA however compromise their construct validity.

The concept of alexithymia was introduced in the 70s (Nemiah and Sifneos, 1970 and Sifneos, 1973) and refers to difficulties in experiencing, verbalizing and regulating emotions. Nowadays alexithymia is defined as consisting of four dimensions: (1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal, (2) difficulty describing feelings to other people, (3) constricted imaginal processes, and (4) a stimulus-bound, externally orientated cognitive style (Taylor, Bagby, & Parker, 1997). These characteristics are understood by Taylor and colleagues to reflect “deficits both in the cognitive-experiential domain of emotion response systems and at the level of interpersonal regulation of emotions” (p. 30). In this context, the authors suggest that alexithymic individuals communicate emotional distress to others poorly and as a result fail to enlist others for help or comfort. Problems with close, affectively invested relationships already became clear in the early clinical observations of alexithymia (Marty and de M’Uzan, 1963 and Nemiah and Sifneos, 1970). With the absence of transference and the slow-moving development of the therapeutic relation, Marty and de M’Uzan (1963) use the term “relation blanche” to characterize the interaction with these patients. Furthermore, this interpersonal style was not limited to the therapeutic relation; in terms of object relations these patients were described as lacking libidinal affect. Moreover, they seemed to be uninterested and unemotional towards significant others (Marty et al., 1963 and McDougall, 1984). More recent research suggests that their relationships are marked by discomfort, avoidance, and a distance taking attitude (Vanheule, Inslegers, Meganck, Ooms, & Desmet, in press). Indeed, an investigation of the association between alexithymia (20-item Toronto Alexithymia Scale, TAS-20; Bagby, Parker, & Taylor, 1994) and interpersonal problems (Inventory of Interpersonal Problems, IIP; Horowitz, Alden, Wiggins, & Pincus, 2000) found that alexithymia is characterized by a cold and socially avoidant interpersonal style (Spitzer et al., 2005 and Vanheule et al., 2007). Research with children and adolescents shows that those with a lower level of emotional competence (a characteristic of alexithymia) display less help-seeking behaviour with respect to family, friends, and professionals (Ciarrochi & Deane, 2001). Adult attachment studies indicate that a dismissing attachment style is related to a higher level of alexithymia (Scheidt et al., 1999), while child attachment studies found that an insecure and disorganized attachment style is associated with a developmental delay in the acquisition of mentalizing language (Lemche, Klann-Delius, Koch, & Joraschky, 2004). To date both clinical observations and theoretical descriptions of alexithymia suggest a link between alexithymia and an interpersonal style that is characterized by a lack of investment in others. However, the studies that provide evidence for this association frequently operationalize both alexithymia and interpersonal styles by means of (self-report) questionnaires. This method can give rise to artificially high correlations due to content overlap and shared method variance (Meyer et al., 2001). In this study, we investigate the link between alexithymia and interpersonal style by means of interview data and lexical content analysis. The rationale behind lexical content analysis is that the lexical choices people make as they speak or write reveal what they have on their mind or are concerned with, irrespective of the intentions they have while communicating (Pennebaker, Mehl, & Niederhoffer, 2003). As we operationalize interpersonal style through language use on social processes, we avoid any correlations with alexithymia being attributable to shared method variance or content overlap. To our knowledge, there is no research on the relation between alexithymia and language use on social processes. However, a pilot study that we carried out prior to this study indicates that the externally oriented thinking (EOT) subscale of the TAS-20 is related to a lower use of social language (Meganck, Vanheule, & Desmet, 2008a). Nowadays, the TAS-20 is the most widely used measure of alexithymia. Nevertheless, while its psychometric properties have been widely investigated and accepted (Meganck et al., 2008b and Taylor et al., 2003), the TAS-20 has been criticized for a number of problems. First, it is not clear whether a person can judge a capacity he or she lacks (Lane et al., 1997 and Waller and Scheidt, 2004), since procedural knowledge and cognitive processes are largely unconscious (Nisbett and Wilson, 1977 and Vanheule, 2008). Second, the TAS-20 is highly susceptible to negative affectivity (Lumley, 2000) and it does not measure the constricted imaginal process dimension of the alexithymia construct. To tackle the problems attributed to TAS-20, its authors have recently introduced the Toronto Structured Interview for Alexithymia (TSIA; Bagby, Taylor, Parker, & Dickens, 2006) as an alternative measure. In this study we use both the TAS-20 and the TSIA to measure alexithymia. We primarily investigate the association between alexithymia and interpersonal style through the analysis of natural speech. We expect that alexithymia is related to a lower use of social words because of the lack of investment in relationships with others and that this will be the case for both frequency and complexity (number of different words) of communication word use and references to others. Next to this, we investigate the convergence between the alexithymia measures.