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Alexithymia in the world of insecure attachment and psychosomatic disorders

Background Alexithymia is a specific disorder of mental functioning with a characteristic deficiency of symbolic thinking, poverty fantasy and impossibility of adequate expression and verbalization of their own emotions and deficiency of empathy. Once the distortions are cleared away, most patients who come to the emergency room tell stories that seem to grow out of the problems they claim to have and the pain they claim to feel. These stories reverberate with emotions congruent to their themes. But occasionally, patients who clearly have problems and are in great emotional pain tell noncongruent stories. They will insist that they have no problems, that life is fine and that they have no idea what is wrong. Their story is that they have no story. These patients seem unable to find the words necessary to describe their feelings. In 1972, Peter Sifneos introduced to psychiatry the term alexithymia, which (derived from the Greek) literally means having no words for emotions (a=lack, lexis=word, thymos=emotions). Alexithymia is not a diagnosis, but a construct useful for characterizing patients who seem not to understand the feelings they obviously experience, patients who seem to lack the words to describe these feelings to others. Identifying this deficit in expressivity is important because doing so gives the clinician a leg up in making a diagnosis and charting a therapeutic course. Many individuals with alexithymia have somatic complaints. Considerable empirical evidence links prolonged states of emotional arousal, and the concomitant physiological arousal, with susceptibility to certain somatic disorders. Clearly, someone who cannot verbally express negative emotions will have trouble discharging and neutralizing these emotions, physiologically as well as psychically. All feelings, whether normal or pathological, are ultimately bodily feelings. Those with alexithymia lack a lived understanding of what they experience emotionally. From the perspective of development, alexithymia implies a glitch in the process that permits the expression of feelings in words that capture the body's involvement in these feelings. Perhaps the child's mother failed to sufficiently encourage a language of feelings (surely excluding her from the pantheon of Winnicott's "good enough" mothers). Alternatively, emotional trauma later in life may compromise the connection between what is felt and what can be grasped about this feeling and can be put into words, particularly if that link were tenuous to begin with. If a patient has no story to tell a clinician, even at a time when emotions are stirred high enough to prompt an ER visit, it seems a good bet that person has no story to tell themselves either. Having no story almost certainly implies an impaired identity: Who we know ourselves to be depends heavily on the story we tell ourselves about who we are. The inability to express emotions verbally implies a deficient interior life. Inevitably, those who cannot match words to feelings will live out that deficit in their contacts with others as well. To have no words for one's inner experience is to live marginally, for oneself and for others. Interpersonal relationship issues Alexithymia creates interpersonal problems because these individuals tend to avoid emotionally close relationships, or if they do form relationships with others they usually position themselves as either dependent, dominant, or impersonal, "such that the relationship remains superficial".Inadequate "differentiation" between self and others by alexithymic individuals has also been observed. Some individuals working for organizations in which control of emotions is the norm might show alexithymic-like behavior but not be alexithymic. However, over time the lack of self-expressions can become routine and they may find it harder to identify with others. MODERN THEORIES OF EMOTION Modern theories of emotion include judgments, desires, physiological changes, feelings, and behavior as possible constituents of emotion. Emotions exert an incredibly powerful force on human behavior. Strong emotions can cause you to take actions you might not normally perform, or avoid situations that you enjoy. Why exactly do we have emotions? What causes us to have these feelings? What Is Emotion? In psychology, emotion is often defined as a complex state of feeling that results in physical and psychological changes that influence thought and behavior. Emotionality is associated with a range of psychological phenomena including temperament, personality, mood, and motivation. According to author David G. Meyers, human emotion involves "physiological arousal, expressive behaviors, and conscious experience." Theories of Emotion The major theories of motivation can be grouped into three main categories: physiological, neurological, and cognitive. Physiological theories suggest that responses within the body are responsible for emotions. Neurological theories propose that activity within the brain leads to emotional responses. Finally, cognitive theories argue that thoughts and other mental activity play an essential role in the formation of emotions. Cognitive Appraisal Theory According to appraisal theories of emotion, thinking must occur first before the experience of emotion. Richard Lazarus was a pioneer in this area of emotion, and this theory is often referred to as the Lazarus theory of emotion. According to this theory, the sequence of events first involves a stimulus, followed by thought, which then leads to the simultaneous experience of a physiological response and the emotion. Facial-Feedback Theory of Emotion The facial-feedback theory of emotions suggests that facial expressions are connected to the experience of emotions. Charles Darwin and William James both noted early on that sometimes physiological responses often had a direct impact on emotion, rather than simply being a consequence of the emotion. Supporters of this theory suggest that emotions are directly tied to changes in facial muscles. Attachment theory is a psychological model that attempts to describe the dynamics of long-term and short-term interpersonal relationships between humans. Attachment is a word used by psychologists to describe the relationship between children and their caretakers. When we watch the behavioral patterns that characterize this relationship, four types of attachment are seen: secure, avoidant, ambivalent, and disorganized. Avoidant and ambivalent attachment are organized forms of insecure attachment, meaning that these children are observed to be insecure in their attachment to the mother, but have modified themselves and their interactions with their mother in an organized way. Children who are disorganized — also an insecure attachment — have not developed an organized way to respond to their caregiver for reasons we will see in a moment. Secure attachment (55-65%) Securely attached adults were raised in a consistent, reliable, and caring way. They learned early that the world is a safe and accessible place and others are viewed as dependable and supportive. They feel able to love and they feel loveable. They are compassionate and responsive to others. They are flexible thinkers and able to explore options and ask for advice. They are accepting of differences and trusting in love. Attachment injuries can occur when needs for comfort, closeness and security are not adequately met. The following attachment styles are influenced by varying degrees of attachment traumas. Insecure attachment and alexithymia- When a Patient Has No Story To Tell: The alexithymia of insecure attachment may cause a stress dysregulation which prompts craving particularly as craving is a consequence of dysregulated stress systems Avoidant attachment (20-30%) Dismissing Style- These individuals have a dismissing state of mind with respect ot attachment. They often have vague and non- specific early childhood memories. They avoid intimacy and close affective involvements. These individuals experienced caregivers as unnurturing, dismissive and critical. Avoidant adults are uncomfortable with closeness and intimacy. They are emotionally distant, uncomfortable expressing needs or asking for help. Often they do not recall much of their childhood experiences. They can be cool, controlled, ambitious and successful. They avoid conflict and tend to be passive-aggressive and sarcastic. They don't want to rely on anyone, fearing dependency or a perception of being weak. Ambivalent attachment (5-15%) Preoccupied Style- These individuals have a preoccupied state of mind with respect to attachment. They have over-detailed stories and continue to reexperience past hurts and rejections in a manner suggesting a lack of resolution. These adutls had parents who alternated between warmth and availability and coldness and rejection for no apparent reason. Ambivalent adults are bossy and controlling and do not like rules and authority. They are impatient, critical and argumentative. They like to "stir the pot" and often sabotage getting what they want. They also can be creative, exciting, adventuresome, and charming. Disorganized attachment (20-40% and up to 80% in situations of abuse). These individuals have a disorganized state of mind with respect to attachment. They do not have an organized approach to relationships. Often these adults exhibit behaviors that suggest a diagnosis of Borderline Personality Disorder. They run very hot and cold and are quite mecurial As children they had histories of abuse, neglect, or severe loss. Their parents were unresponsive, inconsistent, punitive and insensitive. They learned to view others as unavailable, threatening and rejecting. They are afraid of genuine closeness and see themselves as unworthy of love and support. Disorganized adults show many antisocial behaviors such as lack of empathy and remorse. They are selfish, controlling, refuse personal responsibility for their actions, and disregard rules. Their experience of severe attachment trauma makes them much more vulnerable to a variety of emotional, social and moral problems. They are at high risk for alcohol and drug abuse, abusing their own children and other forms of criminality. Psychosomatic Disorders: Mind and body disorders A psychosomatic illness consists of an actual and medically-measurable physical illness that is aggravated by psychological factors. For example, stress has been proven to lead to a dozen health problems including coronary heart disease and a weakened immune system. Sleep disorders also work the same way when they deprive the body of needed rest. What this means is that a psychosomatic illness can be tested and can be documented via medical means. Psychosomatic illnesses are not imaginary and can be verified by a third party. Symptoms that are psychosomatic are not just “all in one’s mind”, illuminating its appropriate definition. It is interesting to point out though that the means of evaluation is limited by medical convention. If there is no evaluative measure that can help corroborate your complaint, then a doctor might be more inclined to write it off as fictitiously psychological. This is not necessarily a problem of expertise but is a consequence of the sociology of health: doctors and patients just have different concepts of ill- health. For patients, being ill is a subjective feeling of discomfort while doctors think in terms of giving a diagnostic label. If the ailment is not in a particular doctor’s repertoire then there is a probability that you need to get a second opinion. Of course, there are instances in which a set of symptoms is entirely subjective, hence the label somatoform disorder. It is a common misconception for people to dub something as psychosomatic when they actually mean that it’s somatoform. Somatoform disorders are a group of mental disorders in which people have subjective feelings of illness that are seemingly untestable by medical means. These disorders are deemed pathological in nature and exhibit symptoms that are not really expected of the average individual. There are five types of somatoform disorders that we should be aware of: (1) conversion disorder ; (2) somatization disorder ; (3) pain disorder ; (4) hypochondriasis ; and (5) body dysmorphic disorder. Keep in mind that the diagnosis of each requires consultation from a professional clinician ; self- diagnosis is not recommended. Conversion disorder happens when you feel that you’ve lost the use of a body part but no medical or physical reason can explain it. Somatization disorder is characterized by a history of medical complaints that have no organic reason. Pain disorder is similar to somatization disorder but is limited only to the subjective feeling of pain. Hypochondriasis is exhibited through a constant worry of physical that leads to frequent seeking of medical attention. Body dysmorphic disorder is an extreme preoccupation with a body part in which a person deems as lacking or defective. DIAGNOSIS AND TREATMENT It is important to emphasize that this disturbance of mental functioning is not classified as a mental disorder in the DSM. Measuring the severity of alexithymia can be done with the help of solving simple questionnaires such as the Toronto Alexithymia Scale (TAS-20) and Bermond-Vorstov questionnaire for alexithymia (BVAQ). Alexithymia can be easily detected by means of detecting the following characteristics: difficulty in identifying feelings and confusion of emotions with physical emotional arousal, difficulty describing feelings to other people, and difficulties in describing the emotions of other people, narrowed imaginative process, namely the low level of fantasy, cognition processes and style of thinking that are externally oriented and have focus on physical symptom. Treatment of alexithymia may be incorporated into the overall treatment of the person's broader condition. During an evaluation, a clinician will most likely talk with the person affected for a period of time and ask them to complete surveys and additional psychological testing. Based upon the results of the person's psychological evaluation, they will have a better idea of how alexithymic symptoms may be associated with one or more forms of mental health conditions. The treatment options for alexithymia are often times very different from typical counseling or talk therapy. For people living with alexithymia, a mental health professional will often concentrate on building a foundation of naming emotions and appreciating a range of feelings. The process will likely include both consideration of the experiences of other people and self- reflection. Even though some people with this emotional comprehension might sound very basic to others, for a person with alexithymia the process of growing their emotional intelligence and capacity may be difficult. Things such as: Group therapy, daily journaling, skill-based therapy, engaging in the creative arts, various relaxation techniques and reading emotional books or stories. Conclusions Insecure attachment is also the basis for alexithymia. The expression of emotion through the body leads to a series of problems and disorders that would later discover the different diagnosis, but the real problem will never be solved. Affective regulation will remain permanently impaired, and will be visible in everyday situations as well as transgenerational transmission. The problem in alexithymia has been posited to be deficient development of the cognitive mature stage, which allows some rudimentary form of emotional experience, such as high arousal of bodily sensations. Deficient emotional development in alexithymia might lead to hypersensitivity to bodily sensations and unhealthy behaviors, which may be a possible link between alexithymia and psychosomatic disorders. Therefore, it is important to prevent, in the form of a close relationship with the child's parents from the first day of life until the psychological separation after adolescence. It should teach a child to listen own body and prevent disease, and thus passed on to children a sense of belonging in relation to parents and their own bodies. Every divert attention from emotion on the body leads to the onset of symptoms and diseases. In order to implement a holistic treatment, medicine should be given the child, not the diagnosis and disease.

Affect ; Alexithymia ; Attachment ; Emotional dysregulation ; Psychosomatic disorders

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