Personality and Individual Differences 36 (2004) 499507

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Adult attachment style and alexithymia

Ornella Montebaroccia,*, Maurizio Codispotib, Bruno Baldaroa, Nicola Rossia
a
Department of Psychology, Viale Berti, Pichat n.5., University of Bologna, 40127 Bologna, Italy
b
Department of General Psychology, via Venezia 8, University of Padova, 35100 Padova, Italy

Received 31 July 2002; received in revised form 1 December 2002; accepted 7 February 2003

Abstract
The focus of the present study was to investigate the relationship between adult attachment behaviour
and alexithymia. Adult attachment behaviour and alexithymic characteristics were assessed using ques-
tionnaire methods. In a single session, 301 University students completed an Italian version of the
Attachment Style Questionnaire (ASQ) and the Italian version of the 20-Item Toronto Alexithymia Scale.
Moderate positive correlations were found among TAS total score and several ASQ subscales such as the
Discomfort with Closeness (0.35), the Relationships as Secondary (0.38) and the Need for Approval (0.41).
On the other hand, TAS total score and the Condence subscale of the ASQ showed a moderate negative
correlation ( 0.45). These results provide interesting cues. Possible hypothetical explanations of this asso-
ciation are discussed. Further longitudinal researches are needed to better investigate the relationship
between the sociocultural environment, deciencies in motherchild relationship and the ease of condence
in intimacy in adulthood.
# 2003 Elsevier Ltd. All rights reserved.
Keywords: Attachment Behaviour; Alexithymia characteristics; Family predictors

1. Introduction

The aim of the present study is to investigate the relationship between adult attachment beha-
viour and alexithymia. Adult attachment is the stable tendency of an individual to make sub-
stantial eorts to seek and maintain proximity to and contact with one or a few specic
individuals, who provide the subjective potential for physical and psychological safety and
security. This stable tendency is regulated by internal working models of attachment, which are
cognitiveaectivemotivational schemata built from the individuals experience in his or her

* Corresponding author. Tel.: +39-051-2091338; fax: +39-051-243086.

E-mail address: omenteba@psibo.unibo.it (O. Montebarocci).

0191-8869/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S0191-8869(03)00110-7
500 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507

interpersonal world. Attachment styles refer to particular internal working models of attach-
ment that determine peoples behavioural responses to real or imagined separation and reunion
from their attachment gures (Berman & Sperling, 1994).
Attachment researchers describe the inuence of early attachment experiences on the evolving
internal representations of the self and others and have begun to investigate how the internal
working model of attachment inuences future relationships as well as aect regulating strate-
gies in adulthood. There is strong suggestive evidence that the attachment style developed in
childhood remains relatively stable across the life span and may even be transmitted between
generations (Goldberg, 1991). Research studies (Bowlby, 1969; Bretherton, 1985; Tennant, 1988)
on attachment styles in infancy and childhood have conrmed that the sensitivity and respon-
siveness of the primary caregiver to the childs emotional states is a major determinant of the way
the child learns to regulate distressing aects and to relate to other people. Children who became
securely attached experienced an optimal and consistent responsiveness expression and learned
that modulated emotional expression has positive outcomes. Decient care-giving results in
insecure patterns of attachment behaviour and impedes the development of eective aect reg-
ulating skills. Studies of adolescents and adults (Hindy & Schwarz, 1994; Rothbard & Shaver,
1994) found that those with secure attachment styles report low levels of negative aect and form
strong relationships with others to whom they turn for support when emotionally distressed.
Individuals with an insecure style of attachment were found to experience less positive aect than
those with secure attachments, and also manifested decits in the ability to self-regulate anxiety,
depression and other negative aects (Parker, 1982).
Alexithymia is a term used most commonly to describe people who have diculties recognizing,
processing and regulating emotions. Several authors (Haviland, Warren, & Riggs, 2000; Taylor,
Bagby, & Parker, 1997) suggest that Alexithymia is a personality trait that places individuals at
great risk for several medical and psychiatric disorders (e.g. substance related, panic, posttrau-
matic stress, somatoform, and eating). A study investigating the relationship between alexithymia
and DSM-III-R psychiatric syndromes and personality disorders found no signicant associ-
ations between alexithymia measured by the Toronto Alexithymia Scale (TAS) and DSM-III-R
diagnoses (Bach, de Zwaan, Ackard, Nutzinger, & Mitchell, 1994), on the other hand nevroti-
cism, anxiety and depression are correlated with TAS scores (Deary, Scott, & Wilson 1997; Tay-
lor et al., 1997).
Of the large number of studies on alexithymia, many have examined the aetiology of alex-
ithymic characteristics. The alexithymia construct is composed of the following salient features:
diculty identifying feelings and distinguishing between feelings and the bodily sensations of
emotional arousal; diculty communicating feelings to other people; constricted imagination
processes, as evidenced by a paucity of fantasies; and a stimulus-bound, externally orientated
cognitive style (Nemiah, Freyberger, & Sifneos, 1976; Taylor, Bagby & Parker, 1991). Several
theorists have posited that alexithymia is caused by events occurring in childhood, such as psy-
chic trauma or disturbances in the motherinfant relationship. Recognition and expression of
emotion have been found to be associated with family environment and history of childhood
maltreatment. Berenbaum and James (1994) examined the family correlates of alexithymia.
Children who grow up in environments in which they feel physically and emotionally unsafe and
insecure, and in which the expression of emotion is discouraged, would not be expected to learn
how to successfully cope with their emotional states, and would consequently be uncomfortable
 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507 501

experiencing emotions. These diculties and the lack of role models for the nonthreatening dis-
play of emotion may lead to discomfort or ambivalence in expressing feelings. Fukunishi and
colleagues (Fukunishi, Sei, Morita, & Rahe, 1999) reported that in a study of college students
with mothers low care, participants expressed alexithymic characteristics, in particular on the
alexithymic construct named diculty communicating feelings. The most important nding of
this study is that poor parental bonding is related to the perceived diculty in articulating feeling.
Clearly, aect development and the development of cognitive skills for regulating aects are
intimately related to the infant and young childs relationships with parents, in particular with
mother.
We suggest that alexithymia not only constitutes an inherent personality aberration but also
constitutes a secondary accompaniment of trauma, and also emerges secondarily as a con-
sequence of attachment and bonding failures. A previous study (Troisi, DArgenio, Peracchio, &
Petti, 2001) found that alexithymia was more pronounced in male participants who had patterns
of insecure attachment in a sample of patients with clinically signicant mood symptoms. The
aim of the current study was to extend this nding by examining the relationship between adult
attachment style and alexithymia in a sample of male and female university students, and to
investigate the role of gender in this relationship.

2. Method

2.1. Participants

Subjects included 301 undergraduate students (148 men and 153 women) who were taking an
introductory psychology course at the University of Bologna. All participants provided informed
consent and received extra credit for participation. Mean age was 22.2 years (S.D.=1.2).

2.2. Measures

Subjects completed the following questionnaires in a single session: the Italian version of the
Attachment Style Questionnaire (ASQ; Feeney, Noller & Hanrahan, 1994) and the Italian version
of the 20-Item Toronto Alexithymia Scale (TAS-20; Bressi et al., 1996).
The ASQ (Feeney et al., 1994) is 40-item self-report scale and yields ve factor scores: one is a
factor representing secure attachment, each of the other four scales represents a particular aspect
of insecure attachment. The ve-factor solution accounted for 43.3% of the total variance, and
yielded the factors of Condence (in self and others) (a sample item is: I feel condent that other
people will be there for me when I need them), Discomfort with Closeness (I nd it dicult to
depend on others), Relationships as Secondary (Achieving things is more important than
building relationships), Need for Approval (Its important to me that others like me) and
Preoccupation with Relationships (I worry a lot about relationships). A previous study
(Feeney et al., 1994) showed that the ASQ demonstrated high levels of internal consistency
(Cronbachs alpha=0.80) and test-retest reliability over a tenweek period (r=0.76).
The TAS-20 Scale has a three-factor structure congruent with the concept of alexithymia.
Factor one measures Diculty Identifying Feelings and distinguishing them from bodily
502 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507

sensations of emotional arousal. A sample item is I am often confused about what emotion
I am feeling. Factor two assesses Diculty Communicating Feelings and has items like I nd
it hard to describe how I feel about people. Factor three determines the extent of Externally
Oriented Thinking with items like I prefer to just let things happen rather than to understand
why they turned out this way. Items 4, 5, 10, 18, and 19 are negatively keyed to help control for
the eects of acquiescence and dissonance and these items were reversed scored. Participants were
assigned a total TAS-20 score and a score for each of the three factors.
Previous studies (Bressi et al., 1996; Taylor et al., 1997) showed that the TAS-20 has good
internal consistency (Cronbachs a=0.81) and testretest reliability over a 3-week interval
(r=0.77).

3. Results

In the total sample we found a 8.3% of the alexithymic subjects (TAS-20 scores561), 9.5% in
males (4.7% of the total sample) and 7.2% in females (3.7% of the total sample).
An ANOVA was performed (gender as between variable) to assess if males and females were
dierent on the ve subscales of the ASQ, the three factors of the TAS-20 and the TAS total
score. We found a gender eect: F(1, 299)=6.34, P<0.001. As shown in Table 1, female partici-
pants scored higher than male participants on the Diculty Identifying Feelings of the TAS-20
(Ps <0.001). On the other hand, male participants scored higher on the Relationships as Second-
ary of the ASQ, on the Diculty Communicating Feelings, and Externally Oriented Thinking of
the TAS-20 (Ps <0.05).
To examine the relationship among scores on the ASQ and the TAS-20, the data obtained were
analysed using Pearson productmoment correlations. Table 2 shows a positive correlation for
Discomfort with Closeness (r=0.35, P<0.01), Relationships as Secondary (r=0.38, P<0.01) and

Table 1
Tests of between-subjects eects (ANOVA) among the ve scales of the Attachment Style Questionnaire (ASQ) and
Alexithymia characteristics (TAS-20)

Males (n=148) Females (n=153) F P

ASQ-F1 33.35 (4.9) 34.14 (4.84) ns ns

ASQ-F2 34.38 (6.02) 33.9 (6.96) ns ns
ASQ-F3 16.87 (5.14) 14.67 (4.36) 16.01 P< 0.001
ASQ-F4 20.64 (4.94) 21.49 (4.86) ns ns
ASQ-F5 27.16 (6.05) 28.30 (5.45) ns ns
TAS-F1 13.89 (5.21) 15.85 (5.34) 10.41 P< 0.001
TAS-F2 13.72 (4.42) 12.72 (4.34) 3.94 P< 0.05
TAS-F3 18.20 (4.26) 16.1 (4.08) 19.11 P< 0.001
TAS-TOT 45.83 (10.03) 44.68 (9.93) ns Ns

Means (and standard deviations) for each scale score in males and females. ASQ-F1, Condence; ASQ-F2, Dis-
comfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need for Approval; ASQ-F5, Preoccupation
with Relationships; TAS-F1, Diculty Identifying Feelings; TAS-F2, Diculty Communicating Feelings; TAS-F3,
Externally Oriented Thinking.
 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507 503

Table 2
Correlations among the ve scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics
(TAS-20) (N=301)

TAS-F1 TAS-F2 TAS-F3 TAS-TOT

ASQ-F1 0.31** 0.37** 0.29** 0.45**

ASQ-F2 0.29** 0.27** 0.18** 0.35**
ASQ-F3 0.18** 0.29** 0.37** 0.38**
ASQ-F4 0.45** 0.31** 0.07 0.41**
ASQ-F5 0.42** 0.19** 0.12** 0.26**

ASQ-F1, Condence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need
for Approval; ASQ-F5, Preoccupation with relationships; TAS-F1, Diculty Identifying Feelings; TAS-F2, Diculty
Communicating Feelings; TAS-F3, Externally Oriented Thinking.
* P< 0.05.
** P< 0.01.

Preoccupation with Relationships (r=0.26, P<0.01) of the ASQ and the TAS-20 total score. In
addition, we found a signicant negative correlation between Condence of the ASQ and the
TAS-20 total score (r= 0.45, P< 0.01).
As shown in Tables 3 and 4 the same correlational patterns apply to both women and men
participants, with the exception of the correlation between the Preoccupation with Relationships
of the ASQ and the Diculty Communicating Feelings of the TAS-20. Namely, in male partici-
pants we found a positive correlations (r=0.34) that was statistically dierent (Fishers Z=2.60;
P<0.01) compared with the correlation found in the female group (r=0.05). All the other con-
trasts between the correlation coecients found in the two groups were not statistically dierent
(Ps >0.05).

4. Discussion

Our ndings seems to be consistent with a previous study (Troisi et al., 2001) which found that
alexithymia was associated with attachment style in male psychiatric patients. The present study
replicated this nding in a sample of male and female university students. In fact, we found
moderate positive correlations among TAS total score and several ASQ subscales such as the
Discomfort with Closeness, the Relationships as Secondary and the Need for Approval. On the
other hand, TAS total score and the Condence subscale of the ASQ showed a moderate negative
correlation. In regard to the dierent facets of the alexithymia construct, while we found moder-
ate correlations among the Diculty Identifying and Communicating Feelings subscales of the
TAS-20 and the ASQ subscales, the Externally Oriented Thinking subscale of the TAS-20 showed
low correlations with the ASQ subscales. This result could be due to the dierent nature of the
TAS-20 factors, namely the Diculty Identifying and Communicating Feelings subscales are
composed of items that ask the participant to evaluate their diculty to identify or communicate
feelings (e.g. I nd it hard to describe how I feel about people), while the Externally Oriented
Thinking subscale is composed of items that ask the participant about their preferences (e.g. I
504 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507

Table 3
Correlations among the ve scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics
(TAS-20) in males (N=148)

TAS-F1 TAS-F2 TAS-F3 TAS-TOT

ASQ-F1 0.35** 0.36** 0.35** 0.49**

ASQ-F2 0.29** 0.28** 0.21** 0.37**
ASQ-F3 0.30** 0.34** 0.29** 0.43**
ASQ-F4 0.44** 0.34** 0.04 0.39**
ASQ-F5 0.46** 0.34** 0.06 0.36**

ASQ-F1, Condence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need
for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Diculty Identifying Feelings; TAS-F2, Diculty
Communicating Feelings; TAS-F3, Externally Oriented Thinking.
** P< 0.01.

Table 4
Correlations among the ve scales of the Attachment Style Questionnaire (ASQ) and alexithymia characteristics
(TAS-20) in females (N=153)

TAS-F1 TAS-F2 TAS-F3 TAS-TOT

ASQ-F1 0.32** 0.37** 0.21* 0.42**

ASQ-F2 0.31** 0.25** 0.14 0.34**
ASQ-F3 0.15 0.21* 0.37** 0.32**
ASQ-F4 0.43** 0.32** 0.16* 0.44**
ASQ-F5 0.37** 0.05 0.14 0.16*

ASQ-F1, Condence; ASQ-F2, Discomfort with Closeness; ASQ-F3, Relationships as Secondary; ASQ-F4, Need
for Approval; ASQ-F5, Preoccupation with Relationships; TAS-F1, Diculty Identifying Feelings; TAS-F2, Diculty
Communicating Feelings; TAS-F3, Externally Oriented Thinking.
* P< 0.05.
** P< 0.01.

prefer to just let things happen rather than to understand why they turned out this way). It is well
established that the perceived diculty in identifying and communicating feelings is associated
with Neuroticism and negative aectivity that are important consequences of an insecure
attachment. On the other hand, it has been suggested that if people who are alexithymic have
diculties in understanding and describing their emotions, they may be unaware of such a decit
and so be unable to report it themselves (Codispoti & Codispoti, 1996), so it would be interesting
to investigate the association between alexithymia and attachment style using interview-rated
instruments to see if the correlation between the two constructs is due to a bias in their oper-
ationalization.
Several studies have indicated that multiple factors, like early developmental deciencies,
sociocultural inuences and neurobiological decits play a role in the aetiology and development
of alexithymia. According to attachment theorists, quality of attachment and aect regulation in
adulthood are closely linked. As a personality trait associated with decits in the cognitive pro-
cessing and regulation of aects, alexithymia has been hypothesized to correlate with insecure
 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507 505

attachment. Normal aect development does not occur when the parents are unable to read the
emotional cues of the infant, and fail to function as external regulators of the infants emotional
states. In addition to a proneness to undierentiated negative aective states, alexithymic indivi-
duals show a limited capacity to experience positive emotions such as joy, happiness and love in
their interpersonal relationships. Lacking knowledge of their own emotional experiences, alex-
ithymic individuals cannot readily imagine themselves in another persons situation and are con-
sequently unempathic and ineective in modulating the emotional states of others, lacking in self
condence (Goleman, 1995; Krystal, 1988). The ndings of this study provide considerable sup-
port for the utility of an attachment theory perspective on the complex interactions between adult
attachment behaviour, the relationship quality and alexithymic characteristics such as cognitive
and aect regulation decit.
Perhaps emotional, behavioural, and problem-solving dysfunction in the family, including
maternal alexithymia, interfere with the primary development of introspection, aect awareness,
and imagination in childhood. In particular, Lumley and co-workers (Lumley, Mader, Gramzow,
& Papineau, 1996) found that externally oriented thinking was related to decient family
behaviour control, and impaired imagination was related to inadequate family problem solving.
Thus, children develop specic alexithymia characteristics as a result of parental dysfunction in
emotional or cognitive domains.
In general, the present study showed that the same correlational patterns apply to women and
men, with the exception of the positive correlation between the Preoccupation with Relationships
of the ASQ and the Diculty Communicating Feelings of the TAS-20 that was signicant only in
the male group. This result seems to suggest the relational nature of the Diculty Communicat-
ing Feelings subscale found in male participants. Our study did not show a gender dierence in
TAS total score. A similar result was found in a previous Italian study (Pasini, Chiaie, Seripa, &
Ciani, 1996) but it must be pointed out that other studies (Parker, Bagby, & Taylor, 1993; Sal-
minen, Saarijarvi, Aarela, Toikka, & Kauhanen, 1999) found that men were alexithymic almost
twice as often as women when the study group consisted of older participants from the general
population. On the other hand, we found dierences between men and women in regard to the
dierent facets of the alexithymia and attachment constructs. Women considered themselves as
less able to identify and communicate feelings but less prone to externally oriented thinking and
to consider relationships as secondary than men.
Finally, several limitations need to be mentioned. The observed relationships in this study were
the result of a correlational study, indicating the role of other inuences and provoking caution in
interpretation. First, from the present study no causal conclusion can be drawn about the asso-
ciation between alexithymia and attachment style. Moreover, it is not clear if insecure attachment
contributes to alexithymia or if insecure attachment leads to higher self assessed alexithymia (i.e.
a more negative image of ones meta-emotional abilities) that need not correspond to the persons
actual level of alexithymia, as assessed more objectively. Additionally, this study assessed adult
attachment style and alexithymia in university students, the generalization of the ndings to
younger children, adults or patients is unknown, and the need for longitudinal research to clarify
causal models is paramount. Inclusion of observational methods and interview-based assessment
of alexithymia would lead to more robust conclusions. Future studies might employ the Adult
Attachment Interview to classify attachment styles, as this measure also detects the presence of
unresolved trauma (West & Sheldon-Keller, 1994).
506 O. Montebarocci et al. / Personality and Individual Dierences 36 (2004) 499507

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