Cognitive Alexithymia Mediates the Association Between Avoidant Attachment and Interpersonal Problems in Patients With Somatoform Disorder

ABSTRACT

Patients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.

KEYWORDS:

• Cognitive alexithymia
• insecure attachment
• interpersonal problems
• mentalization
• somatoform disorder

Additional information

Notes on contributors

Jurrijn A. Koelen

Jurrijn A. Koelen is a psychologist and researcher, currently working with the outpatient clinic for mood and anxiety disorders at Dimence, Deventer. His current research interests are attachment and emotional awareness, their manifestation as transdiagnostic risk and resilience factors, and their impact on the process of psychotherapy.

Liesbeth H.M. Eurelings-Bontekoe

Liesbeth H. M. Eurelings-Bontekoe is emeritus professor at Leiden University. She is a clinical psychologist, psychotherapist, and researcher. Her main research interests are the assessment and treatment of personality pathology, and the role of personality attributes as a risk factor for the development of psychopathology.

Stefan Kempke

Stefan Kempke is a postdoctoral researcher at the University of Leuven. His research interests include the role of maladaptive perfectionism in functional somatic disorders, such as chronic fatigue and fibromyalgia. His postdoctoral research focuses on the role of epigenetics in chronic fatigue syndrome, with a special emphasis on DNA methylation of genes involved in the HPA axis.