Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

The relationships between problematic

internet use, alexithymia levels and attachment
characteristics in a sample of adolescents in a high
school, Turkey

Nurullah Bolat, Mesut Yavuz, Kayı Eliaçık & Adil Zorlu

To cite this article: Nurullah Bolat, Mesut Yavuz, Kayı Eliaçık & Adil Zorlu (2017): The
relationships between problematic internet use, alexithymia levels and attachment characteristics
in a sample of adolescents in a high school, Turkey, Psychology, Health & Medicine, DOI:
10.1080/13548506.2017.1394474

To link to this article: http://dx.doi.org/10.1080/13548506.2017.1394474

Published online: 25 Oct 2017.

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 Psychology, Health & Medicine, 2017
https://doi.org/10.1080/13548506.2017.1394474

The relationships between problematic internet use,

alexithymia levels and attachment characteristics in a sample
of adolescents in a high school, Turkey
Nurullah Bolata, Mesut Yavuzb,c, Kayı Eliaçıkd and Adil Zorlue
Downloaded by [UNIVERSITY OF ADELAIDE LIBRARIES] at 17:28 31 October 2017

a
Department of Child and Adolescent Psychiatry, Canakkale 18 Mart University, School of Medicine, Canakkale,
Turkey; bDepartment of Psychology, Istanbul Aydin University, Besyol, Istanbul; cChild and Adolescent
Psychiatry, French Lape Hospital, Istanbul, Turkey; dDepartment of Pediatrics, Izmir Tepecik Education and
Research Hospital, Izmir, Turkey; eDepartment of Child and Adolescent Psychiatry, Izmir Tepecik Education and
Research Hospital, Izmir, Turkey

ABSTRACT ARTICLE HISTORY

The aim of this study is to investigate the relationships between Received 14 March 2017
attachment characteristics, alexithymia and problematic internet Accepted 15 October 2017
use (PIU) in adolescents. The study was performed on 444 high KEYWORDS
school students (66% female and 34% male). Internet Addiction Alexithymia; attachment;
Test (IAT), Toronto Alexithymia Scale (TAS-20) and Short Form of problematic internet use;
the Inventory of Parent and Peer Attachment (s-IPPA) scales were adolescent
used. The adolescents who scored ≥50 on IAT were considered as
the PIU group and <50 were considered as control group. There was
a moderate positive relationship between TAS-20 and IAT scores
(r = .441), and a moderate negative relationship between TAS-20 and
s-IPPA scores (r = −.392), and a negative weak relationship between
IAT and s-IPPA scores (r = −.208). S-IPPA scores were significantly lower
in the PIU group compared to the controls (p < .001). TAS-20 scores
of the PIU group were significantly higher compared to the controls
(p  <  .05). Logistic regression analysis indicated that s-IPPA scores
and TAS-20 significantly predict the PIU development (p < .05). The
results indicate that alexithymia increases the risk of PIU and higher
attachment quality is a protective factor for both alexithymia and
PIU. These results suggest that it is important to focus on the insecure
attachment patterns and alexithymic characteristics when studying
adolescents with PIU.

Introduction
Along with increasing rates of psychosocial problems, and mental disorders such as depres-
sion or anxiety disorders (Chen & Lin, 2016; Dalbudak et al., 2013; Dhir, Chen, & Nieminen,
2015) related to excessive internet use, there are questions about the predisposing factors
for problematic internet use (PIU). In adolescence, the prevalence of PIU is reported as
between 4.4% (Durkee et al., 2012), and 20% (Munno et al., 2017). In Turkey, the prevalence
of PIU in adolescents is reported as 20% (Uneri & Tanidir, 2011).

CONTACT  Nurullah Bolat  mesutyavuzdr@gmail.com

© 2017 Informa UK Limited, trading as Taylor & Francis Group
 2   N. BOLAT ET AL.

Alexithymia is a personality trait that includes difficulties in understanding the emotions,

lack of empathy and inadequate emotional response in social interactions (Feldmanhall,
Dalgleish, & Mobbs, 2013). Maladaptive personality types may lead to PIU (Yao, He, Ko,
& Pang, 2014), and addictive behaviors (Casadio et al., 2014). PIU is reported as a disorder
in obsessive compulsive spectrum (OCS) (Goldsmith, Shapira, Phillips, & McElroy, 1998)
and alexithymia is a predisposing factor for OCS disorders (Wu & Wu, 2006) and addictive
disorders (Kandri, Bonotis, Floros, & Zafiropoulou, 2014). The prevalence of alexithymia
in adolescence is reported as about 10% (Karukivi et al., 2010).
Attachment is the emotional bond which develops in association with interaction
between the child, and the parents. Insecure attachment is usually caused by negative
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childhood experiences and/or unfavorable parent–child interactions and is considered as

one of the underlying etiologies of many psychiatric disorders such as depression, anxiety
disorders, addiction and personality disorders (Schimmenti & Bifulco, 2015; Scott et al.,
2013; Thorberg & Lyvers, 2006), alexithymia (Carpenter & Chung, 2011; Scheidt et al., 1999),
and also internet and online gaming addiction (Chang et al., 2015; Kim & Kim, 2015; Li,
Garland, & Howard, 2014). Craparo (2011) reported that there is a significant relationship
between alexithymia, insecure attachment, and internet addiction.
According to the literature, attachment problems are significant risk factors for the devel-
opment of both alexithymia and PIU. However, there is a limited number of study that
investigated the relationships between the attachment characteristics, PIU and alexithymia
collectively. This study aims to focus on these topics.

Method
Study design and participants
Four hundred and forty-four adolescents (293 female, 66%; 151 male, 34%) from a high
school in Izmir, Turkey were included in this cross-sectional study. The high school was
selected according to the approval of the Regional Education Directorate of Izmir. All of the
adolescents gave verbal consent to participate to the study and signed the informed-consent
form. The study was approved by Ethics Committee of Tepecik Education and Research
Hospital.

Measures
Short Form of Inventory of Parent and Peer Attachment (s-IPPA)
Twelve item short version of the s-IPPA was developed by Raja, McGee, and Stanton (1992).
It is a seven point Likert type scale and has three subscales: trust, communication, and
alienation. Higher scores indicate better attachment quality. The Cronbach’s α coefficients
of the Turkish s-IPPA’s maternal and paternal parts were for the .88 and .99, respectively
(Günaydın, Selçuk, Sümer, & Uysal, 2005).

Toronto Alexithymia Scale (TAS-20)

It is a five point Likert type scale and consists of 20 items and three factors: difficulty in
identifying feelings (DIF, factor 1), difficulty in describing feelings (DDF, factor 2), and
externally oriented thinking (EOT, factor 3) (Taylor, Bagby, & Parker, 2003). The Cronbach’s
 PSYCHOLOGY, HEALTH & MEDICINE   3

α coefficients of the Turkish TAS-20 for adolescent population were .78 for the total scale,
.80, .68, .40 for the factor 1, factor 2, and factor 3, respectively (Bolat et al., 2017). Scores
≥50 point out possible alexithymia, and ≥59 point out alexithymia (Güleç & Yenel, 2010).

Internet Addiction Test (IAT)

It is a 5 point Likert type scale which consists of 20 questions and was developed by Young
(1998). Scores ≥70 point out significant problems about internet using and between 50 and
69 mean occasionally or frequent problems in daily life. The Cronbach’s α coefficient of the
Turkish IAT for adolescent population was .91 (Bayraktar, 2001).
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Data analysis
The data were analyzed by SPSS 16 for Windows. Considering the IAT, adolescents scored
≥50 were classified as the ‘PIU’ group; <50 were classified as the ‘control’ group. Levene test
(p > .05), and skewness and kurtosis analysis (within the limits of ±1) indicated that the
data was normally distributed. Categorical variables were compared with chi square test and
numeric variables were compared by independent sample t test. Logistic regression analysis
was performed to determine the risk factors on PIU. Pearson product-moment correlation
test was used in order to assess the relationship between the scale scores of all participants.
The statistical significance level was set at p < .05 for all analysis.

Results
There were no significant differences between two groups in terms of socio-demographic
data including sex, age, monthly income, family structure, marital status and education of
the parents (p > .05). The daily internet use of PIU group was significantly higher compared
to control group (p < .05) (Table 1). The Cronbach α coefficients of the IAT, TAS-20, maternal
s-IPPA and paternal s-IPPA were .90, .80, .84 and .86; respectively.

Table 1. The sociodemographic data of the sample.

Sociodemographic data PIUa group (n = 73) Control group (n = 371) P
Age 16.32 ± .97 16.31 ± .98 .966
Sex Female: (n = 54) Female: (n = 239) .072
Male: (n = 19) Male: (n = 132)
Duration of internet usec 6.19 ± 2.02 3.94 ± 1.92 <.001
Monthly income 2286 ± 1236TLb 2034 ± 1197TLb .134
Family structure Nuclear: (n = 64) Nuclear: (n = 304) .279
Extended: (n = 9) Extended: (n = 67)
Marital status Divorced: (n = 8) Divorced: (n = 43) .386
Married: (n = 65) Married: (n = 328)
Education status of the mothers High school or ↑: 29 High school or ↑: 112 .155
High school ↓: 44 High school ↓: 253
Education status of the fathers High school or ↑: 35 High school or ↑: 161 .256
↓ High school: 38 ↓High school: 197
a
Problematic internet use.
b
Turkish Lira.
c
Hours.
 4   N. BOLAT ET AL.

Considering correlation coefficients, there was a positive moderate relationship between

TAS-20 and IAT (r = .441, p < .05), and a negative moderate relationship between TAS-20
and s-IPPA (r = −.441, p < .05), and a negative weak relationship between IAT and s-IPPA
(r = −.208, p < .05).
Alexithymia scores of the PIU group were significantly higher compared to the controls
(p < .001). Total paternal and maternal attachment scores were significantly lower in the
PIU group compared to the controls (p < .001) (Table 2).
According to logistic regression analysis results, lower attachment levels and higher
alexithymia scores significantly predict PIU development (p < .05) (Table 3).
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Discussion
Individuals with alexithymia have problems in using empathy and understanding the
mental states and emotions of the people. In association with these deficits, their social
skills are poor (Honkalampi, Saarinen, Hintikka, Virtanen, & Viinamäki, 1999) and they
usually feel uncomfortable especially in face to face communication (Kandri et al., 2014).
Communication through technology is a less anxious way of social interaction (Scimeca
et al., 2014). The results of this study support previous reports. By using the internet, when
social interaction becomes uncomfortable, individuals with alexithymia can end the com-
munication and control the social anxiety. In face to face communication, they experience
problems in interpreting the mimics and emotions of other people, and in shaping their
verbal and nonverbal communication attitudes finely. This is a vicious circle because PIU
also limit their socialization and inhibit their learning process of understanding the others’
emotions and cognitions. Additionally, individuals with alexithymia experience higher levels
of emotional dysregulation (Taylor, Bagby, & Parker, 1997), impulse control (De Berardis
et al., 2009), and anger management problems (Berenbaum & Irvin, 1996), and these prob-
lems increase the risk of game (Gaetan, Brejard, & Bonnet, 2016) and internet addiction
(Aricak & Ozbay, 2016). As alexithymia can interfere addiction treatment success (Cleland,
Magura, Foote, Rosenblum, & Kosanke, 2005; Morie, Nich, Hunkele, Potenza, & Carroll,
2015; Thorberg, Young, Sullivan, & Lyvers, 2009), psychotherapeutic interventions about
improving emotional awareness and regulation, impulse control, social skills, and social
anxiety of the individuals with alexithymia may result in better treatment success for PIU.
Adolescent with insecure attachment may experience problems in emotion regulation,
and understanding cognitions and feelings of others and because of these issues, close

Table 2. Statistical comparison of the TAS-20 and s-IPPA scores of the PIUa group and the controls.
  PIUa Adolescents without PIUa T P
TAS-20 total scores 62.06 ± 13.39 51.33 ± 11.01 −7.079 <.001
s-IPPA        
Mother trust 18.34 ± 6.24 21.71 ± 5.45 4.681 <.001
Mother communication 17.74 ± 5.68 19.49 ± 5.62 2.419 .016
Mother alienation 11.97 ± 6.03 9.02 ± 4.98 −4.436 <.001
Mother attachment total scores 56.11 ± 15.39 64.16 ± 13.59 4.498 <.001
Father trust 18.15 ± 6.95 20.43 ± 6.31 2.734 <.001
Father communication 15.74 ± 6.52 17.19 ± 6.29 1.777 .076
Father alienation 13.34 ± 6.37 10.49 ± 6.09 −3.611 <.001
Father attachment total scores 52.50 ± 17.02 59.15 ± 15.82 3.2 <.001
Parents attachment total scores 106.07 ± 27.45 123.53 ± 25.05 5.317 <.001
a
Problematic internet use.
 PSYCHOLOGY, HEALTH & MEDICINE   5

Table 3. Logistic regression analysis results for PIUa.

  Coefficient SEb Wald ORc (95% confidence interval) P
Total TAS-20 scores .079 .014 32.000 1.082 (1.053–1.112) <.001
Total s-IPPA scores −.017 .007 6.794 .982 (.970–.996) .009
Sex −.088 .363 .059 .916 (.450–1.516) .809
Monthly income .000 .000 .733 1.000 (1.000–1.000) .392
Education status of the mothers −.461 .378 1.490 .631 (.301–1.322) .222
Education status of the fathers −.058 .368 .025 .944 (.459–1.941) .875
Marital status .469 .524 .804 1.599 (.573–4.462) .370
a
Problematic internet use.
b
Standard Error.
c
Odds ratio.
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relationships with peers may arouse negative emotions. Additionally, lower self-confidence
levels related to insecure attachment may cause misperceptions about being rejected in social
interactions (Lin, 2015). Adolescents with insecure attachment can start to use internet
excessively to participate social networks in order to avoid negative emotions emerging
from interpersonal relationships (Schimmenti, Passanisi, Gervasi, Manzella, & Famà, 2014).
Social networks can provide a secure environment for socialization and help the adolescents
who are anxious about being socially rejected. Online games may also serve as significant
sources of positive emotions for emotionally fragile adolescents, because those games can
help them to feel powerful and important. Effective parental supervision can prevent the
development of PIU as other types of behavioral problems (Khurana, Bleakley, Jordan, &
Romer, 2015). Contrary, adolescents with insecure attachment style may perceive parental
supervision as an attack against their independence.
The results of this study indicated that higher attachment quality is a protective factor
against the development of alexithymia. This results support the research of Craparo (2011).
Secure attachment is important for children and adolescents in emotion regulation (Spangler
& Zimmermann, 1999) and cognitive and social development (Steele, Steele, & Johansson,
2002), which areas are significantly affected by alexithymia.
This study has some limitations. It is a cross-sectional study that has been conducted in
a non-clinical sample. It was suggested that PIU can disturb the relationship between the
child and parents and influence the attachment security (Şenormancı, Şenormancı, Güçlü,
& Konkan, 2014). This issue should be addressed with a longitudinal study. Additionally,
studying this issue in a clinical population would enable a deeper understanding of the
relationship between PIU and psychiatric comorbidities.
Insecure attachment and alexithymia are associated with emotional problems such as
depressive mood and anxiety, low levels of self-confidence and avoidance in interpersonal
relationships. In conclusion, the authors suggest that adolescents with these types of emo-
tional problems are using the internet to find relief from the negative emotions and unsuc-
cessful social interactions, making them more prone to PIU.

Disclosure statement
No potential conflict of interest was reported by the authors.
 6   N. BOLAT ET AL.

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