Emotion regulation and mental representation of attachment in patients with systemic lupus erythematosus: A study using the adult attachment interview

Department of Psychology, University of Turin, Turin, Italy.
The Journal of nervous and mental disease (Impact Factor: 1.81). 04/2013; 201(4):304-10. DOI: 10.1097/NMD.0b013e318288e215
Source: PubMed

ABSTRACT Mental representations of attachment and emotion regulation influence individual patterns of stress response and vulnerability to illness. The present study investigates the adult attachment states of mind of 40 women with systemic lupus erythematosus (SLE) using the Adult Attachment Interview. We also assessed alexithymia using the Toronto Alexithymia Scale and dissociation using the Dissociative Experiences Scale. The results showed a high prevalence of the unresolved state of mind (13 patients, 32.5%) and the entangled state of mind (10 patients, 25%). The alexithymia score also varied significantly as a function of the mental representation of attachment and was modulated by amnestic dissociation. These findings suggest that adult attachment in patients with SLE influences the presence of alexithymic features. Moreover, these also indicate that dissociative states mediate the perception of painful memories and feelings, thus contributing to the partial avoidance of emotions and the failure to fully experience and recognize them. The clinical implications of these findings are also discussed.

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    • "Using a sample of healthy pregnant women, this study extended previously published studies examining relations between alexithymia and attachment, as well as studies that have investigated the associations of one or other of these constructs with perceived relationship adjustment or the domains of the FFM of personality. Our finding that women classified as insecure on the AAI were more alexithymic than women classified as secure is consistent not only with findings from two previous studies that measured attachment with the AAI [46] [47], but also with multiple studies that assessed attachment styles with self-report questionnaires [38] [39] [40] [41] [42] [43] [44] [45]. In addition, our study is the first to examine relations between alexithymia and coherence of mind, which is rated as a continuous variable and is considered " theoretically and empirically the single best indicator of AAI security " [26]. "
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    ABSTRACT: Several studies have demonstrated associations between alexithymia, adult attachment styles, personality traits, and relationship adjustment. Only two studies, however, have explored associations between alexithymia and attachment representations. As part of a larger investigation of maternal and infant attachment, the current study explored this association in a sample of 97 pregnant women; in addition, measures of alexithymia and domains of the five-factor model (FFM) of personality were compared in predicting attachment security, assessed with the Adult Attachment Interview Coherence of Mind mind scale, and perceived relationship adjustment. Alexithymia negatively predicted coherence of mind; the domains of the FFM did not add significantly to the prediction. The Openness-to-Experience domain predicted relationship adjustment better than alexithymia. Contrary to findings from studies that assessed adult attachment styles, coherence of mind was unrelated to relationship adjustment and the FFM. The results suggest that alexithymia does not uniquely predict relationship adjustment beyond the domains of the FFM.
    Comprehensive psychiatry 03/2014; DOI:10.1016/j.comppsych.2014.03.015 · 2.26 Impact Factor
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    ABSTRACT: This prospective study aims to examine alexithymia, mood states and pain experience in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients. We enrolled 49 patients with SLE or RA. All patients were evaluated through a set of questionnaires: (1) the Toronto Alexithymia Scale-20 (TAS), (2) the Profile of Mood States (POMS) and (3) visual analogue scale (VAS) and Questionario Italiano sul Dolore, self-report measures to assess pain intensity. Alexithymia was more prevalent in RA (44 %) than in SLE (37.5 %). The mean values of VAS were significantly higher in RA than in SLE population (p < 0.05). A linear relation between TAS and VAS values has been found in SLE (R = 0.714, p < 0.0001). The mean values of POMS regarding all negative dimensions of mood were higher in SLE than in RA. There was a linear relationship between TAS and POMS values in SLE patients (R = 0.7, p < 0.001). We found a high prevalence of alexithymia in SLE and RA. The chronic pain is influenced by emotional status as documented by a linear relation between TAS and VAS values in SLE patients. The difficulty in reporting emotional responses in these patients seems to be mediated by negative mood states.
    Clinical Rheumatology 04/2014; 33(10). DOI:10.1007/s10067-014-2593-3 · 1.77 Impact Factor
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    ABSTRACT: Objective The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with rheumatic diseases. The aim of the present study was to describe the educational needs of Dutch patients with systemic lupus erythematosus (SLE) by means of a Dutch version of the ENAT (D-ENAT). Methods The D-ENAT was sent to a random sample of 244 SLE patients registered at the outpatient clinic of a university hospital. D-ENAT consists of 39 items in seven domains. The D-ENAT domain scores range from 0-16 to 0-28 (higher scoring equals higher educational needs) depending of the number of items in the domain. A total D-ENAT score (0-156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and the extent of information need (1-4: nothing-everything) were recorded. Univariate regression analysis was used to examine the D-ENAT's potential determinants. Results The response rate was 122 out of 244 (50%). The mean (% of maximum score) educational needs scores were 56% for D-ENAT total score', 62% for Self-help measures', 60% for Disease process', 58% for Feelings', 56% for Treatments', 50% for Movement', 49% for Support systems' and 46% for Managing pain'. Being female was significantly associated with higher scoring on the D-ENAT total score ( 23.0; 95% CI 5.9, 40.3). Conclusion SLE patients demonstrated substantial educational needs, especially in the domains: Self-help measures', Disease process' and Feelings'. The validity and practical applicability of the D-ENAT to make an inventory of SLE patients' educational needs requires further investigation.
    Lupus 07/2014; 23(13). DOI:10.1177/0961203314544188 · 2.48 Impact Factor