Attachment and Alexithymia 
by: Francesco Albanian
In the first half of last century, the attempt of psychosomatic medicine to explain the relationship between mental activity and pathological manifestations of the organic type would lead to the so-called theory of conflict, Freud's memory according to which the symptom was the formation of compromise between the primitive sexual instincts and the current psychological defenses of the ego. This type of conflict, causing a constant emotional stimulation, produced the chronic activation of the nervous system, causing inevitable damage to the tissue.
But the evidence that psychoanalytic therapy of patients psychosomatic did not wear the same positive results than that obtained with neurotic patients, who are also "victims" of a psychic conflict, and the impossibility to prove the supposed link between conflict and somatic manifestations, led him to turn its attention to the psychosomatic ability to recognize and express emotions (thrombin and Baldoni, 1999). In this scenario, in 1948, Ruesch identified in the psychosomatic patient what he called infantile personality, characterized by dependency and passivity, and conform to social ideals unattainable, and tendency to action body lack of correlation between expression of verbal / nonverbal and emotional experience.
He noted some difficulty in separating from the mother (ibid.). In the late 50s of last century, and Marty M'Uzan proposed, in addition to the classic descriptions of neurotic and psychotic personality, that of psychosomatic personality, characterized by ipernormalità and adaptation in the environment, and a particular cognitive style called operational thinking, similar to that postulated by Piaget, which is natural as the child's cognitive development, but in adults results in a deficit that will penalize it for an adequate symbolic processing of emotions and channel that the expression emotional at the somatic level. And as previously done by Ruesch, even in this case, particular importance was attached to the object relations between mother and child (ibid.).
The theories of Marty and M'Uzan were confirmed in the early 70s of last century, when Nemiah and Sifneos found in a variety of psychosomatic patients a common feature, and that is difficult to describe their emotions and an amazing poor, just the typical operational thinking. Sifneos Nemiah and coined the specific term for this condition of alexithymia (from the greek "Lack of words for emotions"), not considered a clinical diagnosis, but a stable personality trait that interacts with stressors such as non-specific factor to the development of somatization and illness. In an ideal continuum, which is the difficulty in recognizing, understanding and describing emotional experiences, alexithymia may be placed to the extreme "less serious" with emotional inhibition, as opposed to the more serious conditions and anhedonia anaffettività (ibid.).
present indicators DCPR (Diagnostic Criteria for Psychosomatic Research in use) for the diagnosis of alexithymia include conditions such as inability to properly describe the emotions, the conversation tended to focus on details rather than on emotional experience, lack of a rich fantasy world, content of thought associated with events of the outside world, unawareness of the somatic reactions that accompany emotional states, and occasional extreme emotional behavior, often inappropriati.Inoltre, the specification of DCPR, according to which alexithymia might be encountered in the diagnosis should not be present only during a mood disorder, social phobia or an organic mental disorder, highlights the transnosograficità of this condition.
Finally, in DCPR is the distinction between alexithymia of ubiquitous, and structural level of the individual personality, and situational type, limited to the inhibition of anger and / or assertive behavior. In the latter case, it's still questionable whether we can really talk about alexithymia real or simply a relational model learned early in life to manage more effectively, and less painful, special delicate emotions such as anger so as to secure a higher fitness. The expression of anger in the innate motivational system (SMI) fight / flight, represents the attack, so the comparison the conflict. But what happens when the opponent is a significant figure in the conflict, to be loved? The anger could "destroy" and this would blame, loss, abandonment. Here, then, that the SMI fight / flight is in conflict with another important SMI, the attachment.
Attachment theory (TDA) by John Bowlby (1969/1980) postulates that human beings have an innate predisposition to form attachment relationships with the figures parental primary attachment relationships that have the function of protecting the person attacked, and that these reports exist in an organized manner at the end of the first year of life. The three patterns of attachment identified by Ainsworth et al. (Ainsworth et al., 1978), insecure avoidant (A), secure (B) anxious, insecure resistant (C), and one later identified by Main and Solomon (1986), disoriented / disorganized (D) represent four different ways relationships that characterize many types of the mother / child.
Each pattern has its roots in specific internal working models (MOI) (Bowlby, 1973), mental representations that are intended to convey the perception and interpretation of events by the child, and then the adult, and include a model of self, the other a model and a model of self-with-the-other (Liotti, 2001). usually by the eighth month of life, every child has an attachment well structured and directed towards a specific attachment figure (FDA) preferred. The attachment style that developed from his birth onwards, depends to a large extent on how the parents (or other caregiver) treat it. The boy sure has confidence in the availability and support of the FDA found to be sensitive to signals from the child, or as Winnicott would say good enough.
The avoidant child is characterized by the belief that the request for help will be rejected by the FDA, a figure who constantly rejects his son every time he leans in to search for comfort or protection. The anxious child resistant, however, has no assurance that the FDA is prepared to respond to a request for help, since its mode of response is intermittent. Finally, the child disoriented / disorganized features a dual internal model of the FDA, seen as caring and at the same time frightened / frightening. This dual representation is promoted by a parent threatening, abusive, or two years before or after the birth of the child has suffered a bereavement (Liotta, 1994). The difference that exists in the formation of different MOI as a result of proximity of different responses by the caregiver stresses the importance of early communication exchanges with the child, an exchange whose content is essentially non-verbal and emotional.
According Trevarthen (1998), the emotional transference that exists between mother and child is critical in language development and the quality of the way in which mothers (ideal, I might add) are aimed at children are carefully tuned to promote a dynamic and appropriate emotional support for each stage of language development in children. An infant, in fact, is already able to exchange emotions empathy with another person, provided that this wish present themselves emotionally available to small, in ways they understand. Thus, through the continuous emotional exchange with the FDA, the child learns to talk about their emotions and to classify them. The interconnection between the domain the more purely emotional and cognitive described by Trevarthen is a physiological correlates of alexithymia in the model developed by McLean, according to which in case of difficulty for the recognition of emotions seems to be a lack of integration, a schizofisiologia, including cerebral cortex and limbic system (thrombin and Baldoni, 1999).
We imagine that the transposition in the concept of relational schizofisiologia postulated by McLean, results in a lack of integration between cognitive representation of the FDA and emotional experience it can happen correlato.Questo likely in at least two circumstances: 1. The FDA is not able to communicate emotions, 2. the child is forced to limit the expression of emotions or suppress emotions scomode.Nel first case, FDA is unable to express emotions, the child will propose a working model of herself kind of purely cognitive, limiting the possibility of existence, or at least the importance of an emotional domain. In the second case it is possible that insecure patterns (A, C and D), for the simple adaptive strategies should take special mental going to spoil the natural expression of emotions. For example, an avoidant child, which is systematically rejected by the FDA, it will try first a feeling of sadness.
To remove this painful experience, the alternatives are two: Turn off the system of attachment (which is impossible), or counteract the sadness. A child with anxious-resistant pattern, but with a good chance you autolimiterà expression of anger, which, in his own subjective perspective, it would not lovable in the eyes of the FDA, which may lead to abandonment. Montebarocci et al. (2004) suggest the possibility that alexithymia may constitute not only un'abberrazione personality type hereditary, but can also result as a secondary consequence of a childhood trauma and emerge as a result of defects in the attachment bond.
Several studies have investigated the correlation between alexithymia and attachment styles in adulthood (see eg. Montebarocci et al., 2004, Wearden et al., 2005) and the results that emerge are all in the same direction, showing more or less strong correlations between diagnosis of alexithymia and insecure attachment styles (A, C and D), indicating that attachment style is not is perhaps the primary cause of alexithymia, but at least one risk factor that can attend the non-specific structure of a working model of self-type heavily cognitive.
ALBANESE, F. (2006). Attachment and Alexithymia. Florence: PsicoLAB. Viewed on 01/03/2009 at
http://www.psicolab.net
