Relationship Between Attachment Style in Adulthood, Alexithymia, and Dissociation in Alcohol Use Disorder Inpatients. Mediational Model

Abstract

Background: Attachment theory is a widely used framework for understanding emotion regulation as well as alexithymia, and dissociation and this perspective has also been applied to understand alcohol use disorders. Apart from these theoretical suggestions, there has been scarce empirical research on this subject-matter. Therefore, the objective of the present study was to investigate potential associations between attachment style in adulthood, alexithymia, and dissociation in alcohol use disorder inpatients.Methods: The Revised Adult Attachment Scale (RAAS), the Toronto Alexithymia Scale-20 (TAS-20), the Michigan Alcoholism Screening Test (MAST), and the Curious Experiences Survey (CES) were administered to a sample of 97 alcohol use disorder inpatients recruited from drug and alcohol treatment centers in Warsaw, and 104 persons in control groups, Poland.Results: A comparative analysis between the group of alcohol addicts and non-addicts showed statistically significant differences related to: alexithymia, dissociation, and attachment styles. The analysis of models related to the impact of attachment styles on the level of alcohol addiction with regard to a mediatory role of alexithymia and dissociation showed that all models are well fitted to data and statistically significant: intimacy F(3.197) = 34.41; p < 0.001 and explains 34% (R2 = 0.3438); depend F(3.197) = 36.55; p < 0.001, and explains 36% (R2 = 0.3576); anxiety F(3.197) = 34.71; p < 0.001, and explains 35% (R2 = 0.3458) of the variability of alcohol addiction scores. Mediation analysis found that alexithymia and dissociation enhance the fear of intimacy and rejection in a romantic relationship.Conclusion: These findings support the broad attachment theory suggesting that attachment is associated with and predicts alexithymia and dissociation in the sample of substance use disorder inpatients. Alexithymia and dissociation, by inhibiting the processes of emotions’ identification and verbalization, cause that language does not serve for the purpose of changing self or others, as the communication is distorted. Absent are common meanings and accurate mutual understanding in a relationship.

Dissociative symptomatology mediates the relation between posttraumatic stress disorder severity and alcohol‐related problems

“…These findings are also clinically relevant given that PTSD and alcohol use are highly comorbid and alcohol use among individuals with PTSD has been linked to greater PTSD severity and reduced treatment response (Kilpatrick et al, 2003 ; Pietrzak et al, 2011 ). Moreover, dissociation has also been linked to alcohol use and its related problems (Craparo et al, 2014 ; Evren et al, 2011 ; Zdankiewicz‐Ścigała & Ścigała, 2018 ). Taken together, dissociation plays a unique role in the relation between PTSD severity and alcohol‐related problems making it a critical target for intervention among clinical samples to potentially increase treatment response among individuals with PTSD endorsing alcohol use.…”

“…Notably, dissociation has also been linked to alcohol (Craparo et al, 2014 ; Evren et al, 2011 ; Zdankiewicz‐Ścigała & Ścigała, 2018 ) and/or substance use (Najavits & Walsh, 2012 ; Schäfer et al, 2010 ; Wenzel et al, 1996 ). Prior reports have examined dissociation as a predictor variable with alcohol or substance use and its related problems as outcomes (Craparo et al, 2014 ; Evren et al, 2011 ; Najavits & Walsh, 2012 ; Schäfer et al, 2010 ; Wenzel et al, 1996 ).…”

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

“…While the consideration of different emotions and their role in SUD is of great importance, the absence of these emotions or of their perception has to be considered as well: For example, a recent study (153) found that insecure attachment also seems to be associated with dissociation and alexithymia in individuals with SUD. As they inhibit the identification and verbalization of emotions, dissociation and alexithymia also impair the communication with others and thus the mutual understanding (153).…”

Alexithymia and Self Differentiation: The Role of Fear of Intimacy and Insecure Adult Attachment

“…Several studies have found a link between alexithymic and adult attachment traits (Bekker et al 2007;Berry et al 2007;De Rick and Vanheule 2007;Gong et al 2014;Hexel 2003;Lyvers et al 2017Lyvers et al , 2019Montebarocci et al 2004;Mousavi et al 2016;Taylor et al 2014;Zdankiewicz-Ścigała, Ścigała 2018) indicating that Alexithymia, probably due to its emotional regulation deficits, may solicit forms of insecure adult attachment, characterized by anxiety, fear of rejection and abandonment and difficulties in intimacy in the relationship with the partner. Secure attached adults manage to get in emotional contact with each other, do not fear abandonment and feel the other as a source of security and comfort, while subjects with insecure adult attachment tend to avoid intimacy, to experience anxiety and fear of rejection and abandonment in intimate relationships.…”