Relationship of Alexithymia to Adult Attachment Styles and Self-Esteem among College Students

This research investigated the relationship between alexithymia, adult attachment styles and self-esteem. To this end, an available sample of 240 (120 male & 120 female) college students voluntarily completed alexithymia scale (TAS), collins and reeds revised adult attachment scale (RAAS), and Coopersmiths self-esteem questionnaire. The data were analyzed using Pearson correlation coefficient, multiple regression analysis and t-test. The findings indicated negative meaningful correlations between closeness attachment style with difficulty in describing feelings and external –oriented thinking components of alexithymia and with the alexithymia total score. Also, there were


Introduction
Alexithymia is a construct with different aspects and consist of difficulty in identifying feelings, difficulty in describing feelings and external oriented thinking [1].It has been found that there is association between Alexithymia and other disorders like general anxiety disorder [2], social phobia [3], eating disorders [4], substance abuse [5] and tiredness [6].Helmers et al. [7] founded that there is relationship between Alexithymia and unhealthy behaviors like impairment in eating and low active lifestyle.There are different theories in alexithymia field and some factors supposed to be correlated with.Attachment and self-esteem are two of these factors that bear correlation with alexithymia.It is hypothesized that the quality of early child relationship with parents or caregivers, which is similar to attachment style, could strongly affected Alexithymia.Child experiences with those caretakers who do not express their emotions, behave ineffectively with child emotions or do not recognize child's developing emotions, could have serious impact on affect regulation in later stages of childhood [8].
According to attachment theory, attachment system not only plays a central role during childhood but also stays active in other romantic interactions like friendship, marriage and familial relations during lifetime.Also an important part of lifetime would be feeling trust to important people around us.Building on infant attachment study [9], translated Ainsworth's infant attachment patterns into adult patterns in three categories.Secure attachment: secure individuals are able to build Intimate relationships, they tend to have dependence on others to receive support and believe that people interest on them.Describe their attachment figure as warm and have a positive self-view.
Anxious-ambivalent attachment: they have a desire to close relationship, but at the same time they fell anxious.Also, they have a negative view of the self and a positive view of others.Avoidant: avoidants characterized by excessive self-reliance, negative attitude and expectation toward people.When faced with rejection, to protect their positive self-image, they deny their attachment [9].Bernbaum et al. [10] investigated the association between family factors and alexithymia.Their findings indicated that, children who experienced unsecure physical or emotional conditions and they were not allowed expressing their emotions, could not learn to face with their emotions and experiencing emotions make them upset.These problems and the absence of appropriate models for emotional expression may lead them to show ambivalence toward their feelings.Baldaro et al. [11] conducted a study to investigate the association between adult attachment style and alexithymia in 301 students.They found that there are positive correlations between two of attachment measure subscales (anxious & closeness).Instead, dependency was negatively correlated with alexithymia total score.
Self-esteem is an essential and basic factor in development and self-actualization of human being.It is worthiness of self, and involves attitudes about the self.Ref [11] conducted a study to investigate the association between avoidant, alexithymia and self-esteem among 115 young university students (69.9% female & 30.1% male).He reported that there is a positive correlation between avoidant and alexithymia.Also, he founded that alexithymia positively correlated with low self-esteem.Coro et al. [12] studied the relationship between alexithymia and discordance of implicit and explicit self-esteem among 301 university students.They found that alexithymia (difficulty identifying feelings and difficulty describing feelings but not externally oriented thinking) increases the likelihood of discordance between implicit and explicit self-esteem.
Alexithymia importance offers from clinical or theoretical points of view, which is about prevention, control or treatment.So, indication of associated or causal factors, need to be taken into consideration.This study aims to investigate the association between alexithymia, adult attachment style and self-esteem among college students.

Method
This research conducted on a group of 650 undergraduate students in Azad University of arsenjan between 2010 and 2012.Purposive sampling was used to select the participants.The sample, based on morgan table, consist of 240 students, 120 boys and 120 girls, with the age ranged between 20 to 30 years old.About 10 questionnaires were excluded due to not answer all the questions, therefore, 10 questionnaires replaced.Before data gathering students were informed about the goal of the study and how to fill up questionnaires.Ethical considerations like privacy and confidentiality were considered.
Toronto alexithymia scale [13] TAS (20-item version), a 5-point Likert-type scale ranging from Strongly Agree to Strongly Disagree, was used to assess emotional disturbances.TAS consists of 3 subscales: difficulty identifying feelings, difficulty describing feelings and externally oriented thinking.Cronbach's alpha of the total score was .81 and test-retest reliability coefficients over a period of 3 weeks 77.
Revised adult attachment scale [14] was used to measure attachment.The RAAS is an 18-item scale and was used to determine attachment patterns as secure attachment, Anxious-ambivalent or avoidant.The RAAS consists of 3 subscales: Dependency, closeness and anxious.'Anxious' is consistent with anxious-ambivalent attachment.
'Closeness' subscale considered as secure attachment and dependency as avoidant attachment.
Coopersmit self-esteem inventory Ref [15].SEI was used to measure general self-esteem.General self-esteem is a sub-scale of SEI with 25 items and yields a separate score.SEI is adopted by the Iranian population in several previous studies.The data were analyzed using Pearson correlation coefficient, multiple regression analysis and ttest.

Results
To assess the association between Alexithymia, adult attachment styles and self-esteem, the data that have been gathered from 240 students analyzed and is shown in table1 to table 4. As shown in Table 1.There was a significant negative correlation between closeness, one of attachment styles, and difficulty describing feelings, externally oriented thinking and Alexithymia total score.Also, Anxious, one of attachment styles, and difficulty identifying feelings, externally oriented thinking and Alexithymia total score were positively correlated.Pearson correlation was conducted to assess the relationship between Alexithymia and self-esteem and also, the relationship between attachment styles and self-esteem.There was a negative correlation between difficulty identifying feelings, difficulty describing feelings, Alexithymia total score and general self-esteem.Among attachment style sub-scales, Anxious were negatively correlated with self-esteem.But, there was a positive correlation between closeness and self-esteem (Table 2).

Discussion
This study conducted to examine the association of Alexithymia with adult attachment styles and self-esteem.From the results of this study, 'closeness' (one of attachment style subscale) was negatively correlated with 'alexithymia' total score, 'difficulty describing feelings' and 'externally oriented thinking'.But, 'Anxious' (one of attachment style subscale) was positively correlated with 'difficulty identifying feelings', 'externally oriented thinking', and 'alexithymia' total score.Individuals with secure attachment characterized by high self-confidence and social skills, proximity seeking and exploring behaviors that increased experiencing behaviors which promote problem solving strategies.As a result, they develop more positive attitudes toward themselves and will be able to recognize, processing and regulation of emotions and also, could transform affection arousal of experiences to felling and dreams.Those who have secure attachment learn more emotional vocabulary and this would help them to a better understanding of others felling, affection and mental status [16].As a probable result, this may help secure people to describe and express their emotions.These results are consistent with findings by [3,[17][18][19]], but inconsistence with Arciszewski et al. [20] findings.
Another research question was, whether 'alexithymia' aspects associated with self-esteem.From the results of this study, there was a negative correlation between difficulty identifying feelings, difficulty describing feelings, Alexithymia total score and general self-esteem.It is probable that, individuals with high self-esteem are able to identify and express their emotions but, those with low self-esteem face with problem in self-assertivity and emotional expression.These results are consistent with finding [11,[21][22][23][24].
There was a negative correlation between 'Anxious' and self-esteem but, a positive correlation was found between 'closeness' and self-esteem.Individuals with secure attachment have positive internal working models whereas; individuals with Anxious-ambivalent attachment have a negative one.So, they are with a positive abstract selfimage and in comparing with 'Anxious-ambivalent' this helps them to have a high self-esteem.These results are consistent with findings [25,26,27].
Anxious, closeness and self-esteem were strong predictors of Alexithymia.Attachment styles and self-esteem originated from childhood experiences with caregivers and they are effective factors in interpersonal relationships [28].As a possible explanation by Ref [8] finding could be taken into account; Child experiences with caretakers, who do not express their emotions, behave ineffectively with child emotions or do not recognize child's developing emotions formally, could have serious impact on affect regulation in later stages of childhood.These results are consistent with findings [18,22].

Table 2 : Correlation between Alexithymia, attachments styles and self -esteem.
Multiple regression analyzes conducted to assess Predictive power of attachment styles and self-esteem in Alexithymia.F (3.307) was significant at p-value of <0.05.As shown in table 4, Anxious, closeness and self-esteem were the most significant predictors for Alexithymia. **