Mothers' Alexithymia, Depression and Anxiety Levels and Their Association

International Journal of Psychiatry in Clinical Practice

ISSN: 1365-1501 (Print) 1471-1788 (Online) Journal homepage: http://www.tandfonline.com/loi/ijpc20

Mothers’ alexithymia, depression and anxiety levels and their association with the quality of mother-infant relationship: A preliminary study

Esra Yürümez, Ömer Faruk Akça, Çağatay Uğur, Runa Idil Uslu & Birim Günay Kılıç

To cite this article: Esra Yürümez, Ömer Faruk Akça, Çağatay Uğur, Runa Idil Uslu & Birim Günay Kılıç (2014) Mothers’ alexithymia, depression and anxiety levels and their association with the quality of mother-infant relationship: A preliminary study, International Journal of Psychiatry in Clinical Practice, 18:3, 190-196

To link to this article: http://dx.doi.org/10.3109/13651501.2014.940055

Accepted author version posted online: 04 Jul 2014.

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Download by: [Ankara Universitesi] Date: 02 February 2016, At: 01:41 Int J Psychiatry Clin Pract 2014; 18: 190–196. © 2014 Informa Healthcare ISSN 1365-1501 print/ISSN 1471-1788 online. DOI: 10.3109/13651501.2014.940055

O R I G I N A L A R T I C L E

Mothers ’ alexithymia, depression and anxiety levels informahealthcare.com/ijpcp and their association with the quality of mother- infant relationship: A preliminary study

Esra Y ü r ü mez 1 , Ö m e r F a r u k A k ç a2 , Ç a ğ a t a y U ğ u r3 , R u n a I d i l U s l u3 & Birim Gü nay K ı l ı ç 3

1 Department of Child and Adolescent Psychiatry, Ufuk University Medical School, Ankara, Turkey, 2 Department of Child and Adolescent Psychiatry, Necmettin Erbakan University, Meram Medical School, Konya, Turkey, and 3 Department of Child and Adolescent Psychiatry, Ankara University Medical School, Ankara, Turkey

A b s t r a c t Objective. To evaluate the relationship between mothers and their developmentally normal infants in terms of maternal alexithymia, depression and anxiety, and marital satisfaction. Methods. Fift y children between 18 and 48 months of age, and their mothers, were referred consecutively to the Infant Mental Health Unit of Ankara University School of Medicine, Department of Child and Adolescent Psychiatry. Th e sociodemographic features of the families and the depressive symptoms, anxiety, marital satisfaction and alexithymia levels of the mothers were assessed. Th e relationships between children in normal developmental stages and their mothers were evaluated and rated using a structured clinical procedure. Results. Th ere was a negative correlation between the mothers’ alexithymia scores and the quality of the mother-infant relationship ( p Ͻ 0.05). Mothers with high alexithymia showed higher depression and lower relationship qualities than mothers with low alexithymia, according to the correlation analysis. When depression and anxiety were controlled, high alexithymia levels were predictive of a low, impaired mother-infant relationship. Conclusion. Since alexithymia is a trait-like variable which has a negative correlation with impairment in a mother-infant relationship, it must be investigated in the assessment of mothers ’ interactions with their babies. Key words: Alexithymia , mother-infant interaction , mother-child relationship , mothers ’ depression and anxiety (Received 10 January 2014; accepted 24 April 2014 )

Introduction Alexithymia is a term used to describe people who have Th e mother-infant interaction is one of the most predictive diffi culties recognizing, processing and regulating emotions factors in the development of many psychiatric disorders. Th e (Dereboy 1990), and is a feature that defi nes personality quality of interaction (i.e., sensitive, positive behaviors and rather than a diagnosis (Taylor 1984). It is characterized by

Downloaded by [Ankara Universitesi] at 01:41 02 February 2016 reciprocal attention), which is one of the most acknowledged an inability to describe and identify feelings, the tendency indices of the parent-child relationship, has implications for to utilize an externally focused, analytical cognitive style, subsequent social interactions (Ainsworth et al. 1978) and is and limited fantasy and daydreaming (Tani et al. 2004). In known to be associated with further emotional, cognitive and recent years, alexithymia has been accepted as a personality behavioral outcomes (Valentino et al. 2006). Specifi cally, the trait that leads to greater risks of several medical and psychi- pattern and quality of care regulate the infant’ s brain func- atric disorders. Particularly, it is stated to be a predisposing tion and behavioral expression that determine long-term factor for psychosomatic problems and aff ective disorders emotional regulation. Th e general aspects of the parent-child (Feldman et al. 2002). A positive, strong association between relationship (such as non-stressful play and social communi- alexithymia and depression has been found in both psychi- cation) are suggested to be directly relevant to parent-child atric (Duddu et al. 2003) and non-psychiatric populations attachment styles (Pederson and Moran 1999). Additionally, (Mueller et al. 2003). Other studies have noted the relation- other caregiver-related risk factors such as psychiatric dis- ship between alexithymia and particular psychiatric disor- orders, maltreatment and low socioeconomic status have a ders such as eating disorders, substance use, panic disorder, negative impact on attachment (Carlson et al. 1989). social phobia and conversion disorders (Parker et al. 1993), and personality disorders such as borderline personality disorder (Deborde et al. 2012). More specifi cally, high alexithymia has been found to be associated with high anxiety Correspondence: Esra Yü r ü mez, Department of Child and Adolescent Psychiatry, Ufuk University Medical School, Mevlana Quarter, sensitivity (Devine et al. 1999). However, minimal research number: 86 – 88, Balgat, Ankara, 06520, Turkey. Tel: ϩ 90-506-626-8078. has been focused on the relationship among depression, Fax: ϩ 90-312-204-4088. E-mail: [email protected] anxiety and alexithymia in mothers. DOI: 10.3109/13651501.2014.940055 Alexithymia and mother-infant relationship 191

In addition to psychiatric disorders, a relationship between children, physical and mental illnesses, social support of the attachment style and alexithymia has been indicated in family and other family members, was used. studies on alexithymia (Hexel 2003). More specifi cally, individuals who have an insecure attachment style have higher Toronto Alexithymia Scale . Th e Toronto Alexithymia Scale alexithymia levels, compared to securely attached subjects (TAS) is a validated, self-report questionnaire to measure (Meins et al. 2008). Th erefore, we may conclude that alexi- alexithymia in which participants indicate the extent of their thymia is a trait variable which aff ects attachment style, as agreement or disagreement with statements on a fi ve-point well as particular psychiatric and personality disorders. Likert scale (Bagby et al. 1994). We used the total score and Given that alexithymia is a feature that aff ects understand- scores of three subscales: diffi culty identifying feelings, dif- ing and expressing emotions, we hypothesised that mater- fi culty describing feelings and externally oriented thinking. nal alexithymia levels may aff ect the quality and nature of Th e Turkish version of the TAS-20 has been found to have the mother-infant relationship. Accordingly, mothers with a good internal consistency, and a three-factor structure is alexithymia have a limited capacity to experience positive consistent with the theoretical construct (G ü le ç et al. 2009). emotions such as joy and happiness in their relationships, and they are unempathetic and ineff ective in modulating Beck Depression Inventory . Th e Beck Depression Inventory the emotional states of their children (Goleman 1995). (BDI) was developed to determine the risk of depression Couple confl ict has also been shown to produce a negative in the individual and to measure the severity of depressive emotional climate in the family, which has negative eff ects on symptoms and the change in severity. Its original form was relationships (Cummings and Merrilees 2010). Results sug- developed by Beck (Beck et al. 1988a). Its reliability and gest that mothers with depressive symptoms report lower validity were studied in Turkey by Hisli (1989). Th e cutoff levels of marital satisfaction and higher levels of behavioral score in the Turkish version is 17. problems in their children (Meyers and Landsberger 2002). Individuals interact with one another in a family and aff ect Beck Anxiety Inventory . Th e Beck Anxiety Inventory (BAI) one another through their personal risk factors and the qual- is a Likert-type, self-evaluation scale containing 21 items. ity of their relationships (couple dyad), which can then have A high overall score indicates a high level of anxiety. It was a spillover eff ect on their relationships with others (Coley developed by Beck (Beck et al. 1988b), and its reliability and Hernandez 2006). and validity study in Turkey was carried out by Ulusoy et al. In light of this knowledge, we hypothesized that alexithy- (1998). mia may aff ect the quality of the relationship between mother and child. Th is study ’ s main aim was to explore the alexithy- Marital Satisfaction Scale . Th e Marital Satisfaction Scale mia level of the mother and its association with the quality of (MSS) is a Likert-type, self-report scale containing 13 items the mother-child relationship. Th e study also aimed to evalu- to assess the marital satisfaction of couples. Internal con- ate the impact of the severity of the mother ’ s depression and sistency and test-retest reliability calculations were done by anxiety symptoms and her marital satisfaction on the quality Celik and İ nanc (2009). A factor analysis revealed three fac- of the mother-child relationship. tors: family, sex and self.

Methods Ankara Developmental Screening Inventory . Th e Ankara Developmental Screening Inventory (ADSI) is a 154-item Participants scale based on a parental report used in Turkey for the assess-

Downloaded by [Ankara Universitesi] at 01:41 02 February 2016 The sample comprised 50 young children and their moth- ment and evaluation of social, cognitive and communicative ers who were assessed at an outpatient Infant Mental levels of children between 0 and 6 years of age. Its fi ve sub- Health Unit of a university hospital. Referrals were mainly scales are language-cognitive, fi ne motor, gross motor, social from the Child and Adolescent Psychiatry and Pediatrics interaction skills and self-care abilities (Sava ş ı r et al. 1993). Departments of the same university hospital. Children Th e test-retest reliability values for three age groups (0 – 12 having chronic illnesses, mental and developmental retar- months, 13 – 44 months and 45 – 72 months) were 0.99 – 0.80. dation, autism spectrum disorders and uncorrected visual Its internal consistency was 0.99 – 0.80. and auditory problems were excluded. Of the participants, 43% (n ϭ 22) were girls and 57% (n ϭ 29) were boys. Clinical Problem-Solving Procedure . Th e Clinical Problem- The mean age of the children was 32.4 months (18 – 48 Solving Procedure (CPSP) is a semi-structured observation months), and the mean age of the mothers was 31 (22– 47) procedure designed for children between 24 and 54 months years. The maternal education levels of primary school, of age to assess the caregiver-child interaction and attach- high school and university were 33.3%, 27.5% and 39.2%, ment behaviour (Crowell and Fleischmann 1993). Zeanah respectively. et al. (1997) have extended the procedure for use with children between 12 and 54 months of age. Th e actual procedure Measures involves nine separate episodes of varying lengths of time, designed to elicit behaviours indicative of some domains of Sociodemographic form. A sociodemographic questionnaire the infant-parent relationship. Th ese are free play, cleanup, that comprised queries on the perinatal and developmental playing bubbles, four teaching tasks, separation and reunion history, mother ’ s age, education level, profession, number of episodes, consecutively. 192 E. Yürümez et al. Int J Psychiatry Clin Pract 2014;18:190–196

Diagnostic Classifi cation of Mental Health and Developmental children ’ s respective developmental levels. Th e last two tasks Disorders of Infancy and Early Childhood, revised edition (DC: were diffi cult enough to require each mother’ s assistance to 0– 3R) (Zero to Th ree 2005) . Th e DC:0 – 3R is a classifi cation her child. Aft er this, the mothers left the room as they would system of mental health developmental diffi culties that defi nes at home and stayed outside the door for no longer than 3 mental health disorders in the fi rst four years of life. It was min. Th en the mothers re-entered the playroom, calling their utilised in the present study to assess the interaction between children ’ s names. Th e following behaviours and skills were the child and the caregiver. Its multi-axial construct allows the assessed: each child’ s approach to the tasks (such as being clinician to blend the descriptive, relational, physical, neuro- enthusiastic), each child’ s persistence and self-reliance, as biological, environmental and developmental aspects of the well as each mother’ s supportive presence (such as her atten- infant ’ s presenting problems to achieve a useful formulation tion to and interest in her child), her allowance of her child ’ s for eff ective treatment planning. Axis I is for the primary diag- exploration of the tasks, her correct understanding of her nosis, Axis II is for parent-child relationship disorders, Axis child ’ s behavior, her encouragement of her child ’ s sense of III is for physical, neurological and developmental problems achievement, her capacity to share her child’ s pleasure at the of the child, Axis IV is for psychosocial stressors, and Axis V is task completion (valuing her child’ s experience in his or her for the emotional and social functioning of the child. Th e Par- performance) and the quality of her assistance (skills in help- ent-Infant Relationship Global Assessment Scale (PIR-GAS), ing her child understand the task’ s goal, giving her child the which categorises the severity of the relationship disturbance, opportunity of independent discovery, and giving the nec- is included in the DC:0– 3R and is scored between 90 (well essary assistance and hints in a fl exible way). Th e mother- adapted) and 10 (grossly impaired). In the present study, we infant relationship assessment included the dimensions of used the PIR-GAS scores and correlated them with alexithy- aff ection, negativity, avoidance and controlling behavior. mia, depression, anxiety and marital satisfaction scores to Aft er the administration of the CPSP, the clinical formu- assess the association between the quality of the mother-child lation was recorded with the consensus of a group of profes- relationship and the aforementioned variables. sionals (child psychiatrists and clinical psychologists), based on the DC:0 – 3R. Th e clinicians who observed and coded the Procedure Crowell procedure were blind to the measure scores of the Th e research protocol was approved by the local Ethical mothers. Committee of Ankara University Medical School. Th e procedures of the study were in accordance with the Declara- Statistical analyses tion of Helsinki, as well as local laws and regulations. Th e Statistical analyses were performed using the SPSS for developmental stages of the children were assessed using the Windows (version 15.0) statistical program. Th e variables in ADSI, and the children who showed normal development the present study were examined using descriptive statistics, were included in the study. Th e mothers of the children were Pearson correlation, Mann Whitney U and linear regression invited to complete the TAS, BDI, BAI, MSS and the socio- analyses, and p Ͻ 0.05 was considered as signifi cant. demographic forms. Aft er the procedures were explained to the parents, and consent for videotaping was obtained, Results the mothers and the children were observed in a playroom Th e mothers’ total TAS scores were 23– 73 points (mean 44), with a one-way mirror. Each of the presented episodes was total BDI scores were 0 – 34 (mean 11), total BAI scores were conducted in order, and these episodes were observed by 0 – 39 (mean 10), and MSS scores were 20 – 65 (mean 38). Of trained raters. the mothers’ reported BDI scores, 29% were above the cut-

Downloaded by [Ankara Universitesi] at 01:41 02 February 2016 First, the mother and the child played with toys for 10 off score. Th e PIR-GAS scores were negatively correlated to min. Aft er free play, the mothers had the children cleaned up the total scores and all subscales of the TAS, and these cor- all of the toys for about 5 min. Th en the mothers blew bub- relations were all mild to moderate. Likewise, the PIR-GAS bles for the children to pop for approximately 3 min. Next, scores were all negatively (mild to moderate) correlated to the mothers were instructed to teach the children four pre- the BDI scores. Th e PIR-GAS scores were not correlated to designed tasks, two of which were below and two above the the BAI and MSS scores (Table I). Th e correlation analyses of

Table I. Correlation analyses of PIR-GAS, TAS (and subscales), MSS, BAI and BDI and TAS. TAS DIF DDF EOT BDI BAI MSS DIF 0.82 * * * DDF 0.85 * * * 0.67* * * EOT 0.70 * * * 0.23 0.46 * * BDI 0.44 * * 0.41* * 0.36* * 0.28 * BAI 0.32 * 0.36* 0.11 0.11 0.66 * * * MSS 0.17 0.04 0.12 0.25 0.05 0.08 PIR-GAS Ϫ 0.44 * * Ϫ 0.31 * Ϫ 0.42 * * Ϫ 0.34 * Ϫ 0.32* Ϫ 0.24Ϫ 0.16

PIR-GAS, Parent-Infant Relationship Global Assesment Scale; TAS, Toronto Alexithymia Scale; DIF, Diﬃ culty Identifying Feelings; DDF, Diﬃ culty Describing Feelings; EOT, Externally-Oriented Th inking; BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; MSS, Marital Satisfaction Scale. * Ͻ 0.05, * * Ͻ 0.01, * * * Ͻ 0.001. DOI: 10.3109/13651501.2014.940055 Alexithymia and mother-infant relationship 193

the BDI, BAI and total TAS scores revealed positive and mod- the infant ’ s social readiness (Feldman 2007). Th is synchro- erate to high correlations between each other (Table I). In nous coordination produces the interactive regulation of the addition to the correlation analyses, we divided the mothers biological synchronicity between the mother and her baby, into two groups, according to the total TAS scores. Th e high which is crucial for emotional regulation and attachment alexithymia group was formed by the mothers who scored (Damasio 1998; Schore 2000). Th e formation of a securely higher than the median level of the TAS, and the low alexi- attached relationship contributes to the right brain devel- thymia group was formed by the mothers who scored lower opment, which is important for aff ect regulation (Schore than the median level of the TAS. Each group consisted of 25 2001). Th e right hemisphere, more so than the left one, is subjects, whose members were similar in terms of the ages of deeply connected to the limbic system and the sympathetic the children and the ages and education levels of the moth- and parasympathetic components of the autonomic nervous ers and fathers ( p Ͼ 0.05). Th ese two groups were compared system; therefore, it plays a predominant role in the physi- in terms of the BDI, BAI, MSS and PIR-GAS. Th e results of ological and cognitive components of emotional process- the comparisons revealed that the mothers with high alexi- ing (Spence et al. 1996). Th ese processes may be disrupted thymia had higher BDI scores; however, they had lower PIR- when children undergo adverse social experiences (such as GAS scores than those of the mothers with low alexithymia abuse or neglect in the early phases of life) because of the ( z ϭ Ϫ 2.0 and z ϭ Ϫ 2.1, respectively, two-tailed p Ͻ 0.05). extreme and rapid alterations of the autonomic nervous sys- Aft er obtaining these results, we conducted a linear regres- tem (such as sympathetic hyperarousal and parasympathetic sion analysis to determine the eff ect of alexithymia on the hypoarousal that create chaotic biochemical alterations). PIR-GAS, in case the eff ects of depression and anxiety were Additionally, permanent alterations in opiate, corticosteroid, controlled. According to the linear regression analysis, when corticotropin-releasing factor, dopamine, noradrenaline and the eff ect of both the BDI and the BAI were controlled, the serotonin receptors can be observed, following the stresses TAS was predictive for the PIR-GAS (pϭ 0.01) (Table II). in the early ages (Coplan et al. 1996; Ladd et al. 1996; Lewis et al. 1990; Martin et al. 1991; Rosenblum et al. 1994; van der Discussion Kolk 1987). As a result of the dysregulating eff ect of these Th e present study ’ s fi ndings indicate that the mothers’ alexi- alterations, a toxic neurochemistry arises in the developing thymia and depression levels are related to the quality of their brain (Post et al. 1994). Possibly, the limbic system is one of interactions with their children. However, when the eff ects the most aff ected regions of the brain from these biochemi- of depression and anxiety are controlled in the regression cal alterations. Th e interruption of the development of the anlysis, alexithymia remains to negatively aff ect the quality limbic system leads to an attachment pathology, as well as of interaction. To the best of our knowledge, this is the fi rst inef fi cient coping, organisation and adaptation mechanisms study investigating the relationship between alexithymia and (Schore 2001). Th ere is now agreement that repetitive, sus- the quality of the mother-infant relationship. tained emotional abuse or neglect is at the core of childhood Given the association between the parent-child relation- trauma (O’ Hagan 1995; Schore 2001). Furthermore, child- ship and the children’ s cognitive and emotional development hood neglect in the early phase of life is more detrimental to (Bornstein and Suess 2000), when the mothers and their a child ’ s development than abuse (Schore 2001). young children have problematic relationship patterns, the To create a link between the alexithymia concept and children are apt to show delays in language, mental and social the mother-child interaction, we suggest that because of the development (Akca et al. 2012). Additionally, young chil- inability of a mother with alexithymia to understand and dren who lack satisfying and appropriate interactions with respond to her baby ’ s emotions, her caregiving activity may

Downloaded by [Ankara Universitesi] at 01:41 02 February 2016 their mothers show more aff ect regulation and behavioural not provide a sensitive interaction with her baby’ s emotional problems (Leadbeater et al. 1996). Previous studies suggest requirements. Th is pattern seems to show similarities with that a satisfying and appropriate mother-infant attachment, neglectful caregiving in which appropriate care for both the which is crucial for a child’ s cognitive and emotional devel- physical and emotional requirements of the baby is not pro- opment, is based on a warm, caring, sensitive and responsive vided by the caregiver. Th erefore, we suggest that because interaction between a mother and her infant (Valentino et al. mothers with alexithymia are unable to understand and 2006; DeWolff and van Ijzendoorn 1997; van Ijzendoorn respond correctly to their children’ s feelings, they may fail to and Sagi 1999). Moreover, optimal mothering involves the respond properly to their children ’ s emotions and emotional synchronous coordination between maternal behavior and needs, leading to the hypothesis that alexithymia may be a risk factor that deteriorates the relationship quality between the child and the mother. Th us, their children may be at risk Table II. Linear Regression Analysis of the PIR-GAS. of emotional and developmental problems because of the mothers’ incapability to respond appropriately to their chil- B S.E p Beta dren ’ s emotional needs. Ϫ Ϫ TAS 0.45 0.18 0.01 0.37 As previously stated, alexithymia is described as an inabil- BDI Ϫ 0 . 2 0.29 0.48 Ϫ 0.12 ity to distinguish one ’ s feelings from the accompanying bodily BAI Ϫ 5 . 2 0.21 0.8 Ϫ 0.04 Constant 94 8 Ͻ 0.001 sensations, an inability to communicate feelings to others, and an externally oriented cognitive style refl ecting an absence of PIR-GAS, Parent-Infant Relationship Global Assesment Scale; TAS, Toronto Alexithymia Scale; BDI, Beck Depression Inventory; BAI, Beck Anxiety inner thoughts and fantasies (Taylor et al. 1997). In addition Inventory. to conceptual concerns, recent neuroimaging and clinical 194 E. Yürümez et al. Int J Psychiatry Clin Pract 2014;18:190–196

studies provide further evidence that alexithymic traits are predictive of the low quality of the child-mother interac- linked to various brain regions, including the limbic system; tion, and this relationship is not dependent on the mothers ’ people with alexithymia also have trouble recognising facial depression or anxiety levels. emotions (Aust et al. 2013a; Pedrosa et al. 2008a; Grynberg In conclusion, because of their inability to describe et al. 2012). Several studies investigating the early-life, famil- and express emotions, mothers with alexithymia may have ial and parental features of people with alexithymia indicate problems relating to their children, and this diffi culty may that alexithymia is related to disturbed family functioning, result in impairment in the quality of the mother-child rela- maternal alexithymia, diminished family expressiveness tionship. Several studies suggest that the development of in childhood, feeling emotionally unsafe during childhood alexithymia is based on a social learning model in which and poor maternal care (Kench and Irwin 2000). Th eorists parents who have diffi culties regulating their own emotions speculate that alexithymic features stem from maladaptive, (i.e., high levels of alexithymia) also have more diffi culties early-life experiences, usually associated with poor parent- attending to and interpreting their children ’ s emotions; thus, ing. Trauma, excessive attention given by the caretaker to they are unable to teach their children how to regulate their a child’ s bodily rather than emotional needs, and the care- own emotions (Lumley et al. 1996; Fukunishi et al. 1997; taker ’ s emotional unavailability or inconsistency are posited Kooiman et al. 2002). Our study supports this model and as leading to the disturbed aff ect representation and self- suggests that impairment in the child-mother relationship regulation of alexithymia (Krystal and Krystal 1988; Rickles may be an important contributor to this model. Th erefore, 1986). Th us, the background of alexithymia is stated to be we suggest that if the mother is encouraged to teach her child closely related to aff ective development during early child- to recognise his or her emotions and to learn how to manage hood. Although we could not fi nd any study that investigated them, such an intervention could reduce the transgenera- the relationship between alexithymia and attachment style in tional transmission of alexithymia and may also decrease the early childhood, adult studies suggest that people with alexi- risk of lifetime depression in the child. thymia more frequently have insecure attachment styles than Th ere were some limitations related to our study. First, individuals without alexithymia and report more frequent it was conducted with a relatively small clinical sample. childhood experiences of emotional adversities (Spitzer et al. Th erefore, its results cannot be generalized to the overall 2005; Wearden et al. 2003; Pedrosa et al. 2008b; Troisi et al. population. Replications with larger community samples will 2001). Additionally in a recent study, early emotional neglect improve our knowledge of this subject. Another limitation is is reported to be in association with alexithymia, however, that we did not evaluate the infants ’ attachment styles. Fur- early physical or sexual traumata are not related to alexithy- ther research could involve work with either a more focused mia (Aust et al. 2013b). comparison of target groups or a much larger community To the best of our knowledge, no studies have investigated sample. Additionally, evaluating the attachment styles will the relationship between alexithymia and the quality of the give us an informed opinion on the role of attachment in mother-child interaction. Th erefore, the present study may alexithymic mother-child interactions. contribute to existing knowledge by bridging alexithymia to parent-child relationships. We may conclude that during a Key points child ’ s early years, the family environment is signifi cant in • the development of emotional recognition and expression. In Th e PIR-GAS scores are negatively correlated to the this process, the mother-child interaction may play an impor- total scores and all subscales of the TAS. It is empha- tant role, and our study ’ s fi ndings support this hypothesis. sised that the mothers ’ alexithymia levels aff ect the quality of their interactions with their children. Downloaded by [Ankara Universitesi] at 01:41 02 February 2016 On the other hand, the deterioration in the mother-infant • relationship may be related to other factors. Various studies Th e PIR-GAS scores are all negatively correlated to the suggest that several factors such as communication skills, BDI scores. It is emphasised that the mothers ’ depres- emotional regulation, attachment style and mother-child sion levels aff ect the quality of their interactions with relationship may decline because of a mother’ s depression their children. • (Oztop and Uslu 2007). Moreover, several studies indicate Th e TAS is predictive of the PIR-GAS when the eff ects that alexithymia itself is associated with depression (Celikel of both the BDI and the BAI are controlled. It is sug- et al. 2010; Honkalampi et al. 2000; Saarij ä rvi et al. 2001), gested that alexithymia is a predictive factor for the and a similar result from our study supports this fi nding. quality of the mother-infant relationship, although Although we could not fi nd a relationship between the PIR- depression and anxiety levels are controlled. • GAS and the mothers’ anxiety levels, the same confusion It is suggested that if the mother is encouraged to may come into question. Th erefore, we conducted a linear teach her child to recognise his or her emotions and regression analysis to test the eff ect of the mothers’ alexi- to learn how to manage them, such an intervention thymia on the PIR-GAS, in case the eff ects of the moth- could reduce the transgenerational transmission of ers ’ depression and anxiety levels were controlled. We have alexithymia and may also decrease the risk of lifetime found that alexithymia negatively predicts the PIR-GAS depression in the child. when the mothers’ depression and anxiety levels are controlled. However, anxiety and depression levels are not pre- Acknowledgements dictive when alexithymia scores are controlled. Th is study Th e authors want to thank Necip Coskun for his contribu- contributes to the literature in this respect; alexithymia is tion and editorial support. DOI: 10.3109/13651501.2014.940055 Alexithymia and mother-infant relationship 195

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