Running head: ATTACHMENT, ALEXITHYMIA AND BPD
Alexithymia as mediator between attachment and development
of borderline personality disorder in adolescence
Anne-S. Deborde1,2,3, Raphaële Miljkovitch1,2, Caroline, Roy4, Corinne
Dugré-Le Bigre1,5,6,
Alexandra Pham-Scottez5,6,7,8, Maurice Corcos1,5,6,9, Mario
Speranza5,6,7,9,10
1 Department of Psychiatry for Adolescents and Young Adults, Institut MutualisteMontsouris, Paris2 CRAC-Laboratoire Paragraphe EA 349, Paris 8 University.3 Psychiatry Department, Cochin Hospital, Paris4 Laval University.5 University René Descartes- Paris V, Faculty of medecine, psychology laboratory6 Inserm U 6697 Paris Sud University8 Clinique des Maladies Mentales et de l’Encéphale, Sainte-Anne hospital, Paris9 UMR-S066910 Versailles Hospital, Child psychiatry department
Author Note:
Anne S. Deborde, Psychiatry department, Institut Mutualiste Montsouris.
Acknowledgments
This research was supported by a grant from the WYETH Foundation for Child and
Adolescent Health & by a grant from the Lilly Foundation. This work was
conducted in a European collaborative research project on borderline personality
disorder (European Research Network on Borderline Personality Disorders EURNET
BPD).
Correspondence concerning this sample paper should be addressed to
Raphaële Miljkovitch,
Université Paris 8, UFR Psychologie Pratiques Cliniques et Sociales, 2 Rue de la
Liberté, 93200 Saint-Denis France. E-mail: [email protected]
Alexithymia as a mediator between attachment and the development
of borderline personality disorder in adolescence
Abstract
Insecure attachment and the inability to identify emotions
have both been put forward as possible explanations for
dysfunction of the emotional system in borderline personality
disorder (BPD). This study aimed to test a model according to
which the influence of attachment on the development of BPD in
adolescence is mediated by alexithymia. Borderline severity was
assessed by means of the SIDP-IV. Attachment and alexithymia were
measured respectively with the RSQ and the TAS-20. Mediation
analyses conducted on 105 participants (54 BPD and 51 matched
controls) suggest that the role of security and negative model of
self (i.e. preoccupied and fearful attachment styles) in the
development of BPD symptoms are mediated by alexithymia.
Keywords: Attachment, alexithymia, borderline personality disorder
Borderline Personality Disorder (BPD) is characterized by intense
and labile emotions, significant conflict in interpersonal
relationships, and extreme behavioral impulsivity, which often
breaks out during adolescence (Roberts, Attkisson & Rosenblatt,
1998). Authors such as Linehan, Heard, & Amstrong (1993),
Corrigan, Davidson, & Heard (2000), and Silk (2000) posit that
borderline patients suffer extreme disturbances in mood
regulation. Linehan (1987) describes this emotional dysregulation
as great sensitivity to emotional stimuli, great emotional
intensity and slow return to emotional baseline (see also Crowell,
Beauchaine & Linehan, 2009 and Kuo & Linehan, 2009). Studies have
indeed evidenced associations between BPD and emotion
dysregulation (e.g. Gratz, Rosenthal, Tull, Lejuez, & Gunderson,
2009), yet data on the developmental pathways leading to this
dysregulation are still lacking.
The inability to identify emotions such as anger, fear, or
shame has been put forward as a possible explanation for emotional
dysregulation (Linehan et al., 1993). This inability relates to
the concept of alexithymia. Alexithymia is a personality construct
characterized by a difficulty in identifying and describing
feelings, a lack of fantasy, and a concrete and externally-
oriented thinking style (Sifneos, 1973, Taylor, Bagby, & Parker,
1997). According to Frijda (1986), identifying emotions usually
serves an adaptive function by providing information about a given
situation, and the different actions that are possible in that
situation. It is assumed that borderline patients often cannot
identify what emotions they feel, and hence what caused the
emotions. This inability may increase distress and trigger a range
of dysfunctional behaviours characteristic of BPD, aimed at
reducing negative affects (eg. suicidal/self-harming behaviours).
The inability to identify feelings has been shown to be an
important component responsible for dysfunction of the emotional
system in BPD (Wolff, Stiglamayr, Bretz, Claas-Hinrich, &
Auckenthaler, 2007). It thus seems reasonable to consider
alexithymia as a risk factor for BPD. Several studies show
associations between alexithymia and BPD scores (Berenbaum, 1996;
Modestin, Furrer & Malti, 2004; see also Bach et al., 1994),
however these samples did not specifically include borderline
patients.
In turn, alexithymia may stem from untoward attachment
experiences. According to Linehan's etiological model for
borderline pathology (Linehan et al., 1993), invalidating
environments where the expression of private emotional experiences
is not tolerated impede the understanding and labelling of
emotions (see also Fonagy, Target, Gergely, Allen & Bateman,
2003). Several studies show negative associations between
alexithymia and attachment security (Hexel, 2003; Meins, 2008;
Montebarocci, Codispoti, Baldaro & Rossi, 2004; Troisi, D’Argenio,
Peracchio. & Petti., 2001; Wearden, Lamberton, Crook & Walsh,
2005). Also, experiences of childhood maltreatment and inadequate
parenting are common among borderline patients (see Widom, Czaja &
Paris, 2009 for a review). According to Fonagy & Bateman (2006),
both insecure attachment and dysfunctional affect regulation
constitute vulnerability factors for the development of BPD. In
the present model, we propose more specifically that alexithymia
mediates the effect of attachment on the development of BPD.
Although many studies show associations between attachment and
alexithymia (Hexel, 2003; Meins, 2008; Montebarocci et al., 2004;
Troisi et al., 2001; Wearden et al., 2005), and between the
inability to identify feelings and BPD symptoms (Berenbaum, 1996;
Modestin et al., 2004; Wolff et al., 2007), none examine the link
between attachment and BPD via alexithymia. In addition, previous
research on attachment, emotional regulation, and BPD has mostly
been conducted on adult samples (see Miller, Muelehnkamp, &
Jacobson, 2008). Research findings on adults cannot be transposed
to adolescents because their emotional consciousness is only
emergent (Lerner & Steinberg, 2004) and because it is a time when
support from parents decreases and autonomous emotion regulation
is just beginning to be expected (Allen & Manning, 2007).
Adolescence is also a key period because the struggle for autonomy
is likely to reactivate unresolved attachment-related issues
(Allen & Miga, 2010) and because it is the time when borderline
symptoms often appear.
The following hypotheses were therefore tested on an
adolescent sample: 1) BPD is associated with attachment; 2) BPD is
associated with alexithymia; 3) Alexithymia mediates the
association between attachment and BPD.
Method
Participants and procedure
To test these hypotheses, one group of borderline patients and
one group of non-clinical adolescents were recruited. The samples
were drawn from a European longitudinal research project (European
Research Network on BPD, EURNET BPD) investigating the diagnostic
stability of BPD from adolescence to young adulthood (13-18
years). The research network involved five academic psychiatric
departments specialized in adolescents and young adults in France,
Belgium, and Switzerland. This study was approved by the French
Ethical Committee (Comité de Protection des Personnes) and data
were collected in an anonymous database, accepted by the French
National Committee for Personal Freedoms (Commission Nationale
Informatique et Libertés).
Borderline participants were recruited in adolescent
psychiatry departments. Patients were considered for inclusion
when they presented at least five of the nine DSM-IV borderline
criteria according to their psychiatrist. Patients with psychotic
disorders were excluded from the study for feasibility reasons.
Among the patients selected, BPD diagnosis was verified after
administration of a semi-structured interview (SIDP-IV) confirming
DSM-IV criteria. Psychiatric comorbidity was explored using a
semi-structured interview assessing DSM-IV criteria (Kiddie-Sads).
The diagnostic interviews were conducted by a team of 5
clinical psychologists and psychiatrists experienced in the
assessment of DSM-IV Axis I and II disorders in adolescents. To
obtain high levels of reliability, the research team participated
in several training sessions, including the commented scoring of
videotaped interviews and a training session conducted by the
developers of the Kiddie-SADS (Boris Birmaher & Mary Kay Gill).
Final research diagnoses were established by the best-estimate
method on the basis of the interviews and any additional relevant
data from the clinical record according to the LEAD standard
(Pilkonis, Heape, Ruddy & Serrao, 1991). The inter-rater
reliability for SIDP-IV was calculated from independent ratings of
ten videotaped interviews. The Kappa coefficient for agreement on
the presence or absence of a BPD was very high (0.84) and the
values for the presence/absence of the other personality disorders
ranged from 0.54 to 1.
Because the number of male participants was too small (N=15),
and because borderline symptomatology varies according to gender
(Johnson et al., 2003), only female participants were included.
All participants, and at least one of their parents for those
under 18 years of age, gave their written informed consent. After
this screening procedure, all patients filled out self-report
questionnaires in their respective psychiatry departments.
Ninety-five female adolescents with a DSM-IV clinical
diagnosis of BPD were referred to the study by their
psychiatrists. The formal diagnosis of BPD according to SIDP-IV
criteria was confirmed for 74 participants. Twenty borderline
patients had incomplete data on the self-report questionnaires and
were excluded from the final sample of the study, which was
composed of 54 outpatients.
Because patients were mostly from the upper-middle classes and
were still studying, an advertisement for the study was placed in
schools and universities to recruit participants for the control
group. The procedure with the non-clinical sample was identical to
that with the borderline sample. Control participants were
screened in order to make sure they did not have BPD (according to
the SIDP-IV) or current or lifetime mental disorders (according to
the Kiddie-SADS). For better contrast, adolescents who had
consulted a psychiatrist or psychologist were also excluded from
the study. Fifty-one control participants matched for
socioeconomic variables were thus included.
There were no significant age differences between the two
groups (mpatients = 16.52; sd = 1.18; mcontrol = 16.35; sd = 1.04; t = -
0.76; NS). Regarding parental employment status, only 3 fathers
(all in the clinical group) and 8 mothers (4 in each group) were
unemployed. Three levels of education were considered: (a) some
secondary education, (b) some post-secondary education, (c) higher
education diploma. Most fathers had higher education diplomas (67%
among controls vs 57% among patients). Mothers from the control
group had more often had post-secondary education (49% vs 27%
among mothers of patients) while mothers of patients were more
likely to have a higher education diploma (41% vs 33% among
controls). Nevertheless, there were no significant differences
between the control and the clinical group concerning parental
education (X2= 5.73, NS for the mother; X2=3.96, NS for the
father).
Measures
The Structured Interview for DSM-IV Personality Disorders
(SIDP-IV, Pfohl, Blum & Zimmerman, 1995) was used to confirm BPD
diagnosis among patients and screen for personality disorders
among all participants. Borderline severity for each of the 9
criteria was coded as absent (0), subliminal (1), present (2) or
massive (3). Borderline severity scores thus varied from 0 to 27.
The SIDP-IV has shown good psychometric properties on adolescent
and young adult samples (Chabrol et al., 2002).
The Kiddie-SADS (Kaufman, Birmaher & Brent, 1996 ; see
Kaufman et al. 1997 for data on psychometric properties) was used
to verify the absence of psychiatric disorders among control
participants and to assess psychiatric comorbidity among patients.
Diagnoses were established according to DSM-IV criteria.
A brief ad hoc self report questionnaire was administered in
order to make sure control participants had never consulted for a
psychiatric disorder, and to obtain socio-demographic data (i.e.
parental employment status and education).
The 20-item Toronto Alexithymia Scale (TAS-20, Bagby, Parker &
Taylor, 1994) is a self-report scale composed of items ranging
from 1 ‘strongly disagree’ to 5 ‘strongly agree’. The 20 items of
the TAS are clustered into three factors corresponding to the
theoretical dimensions of alexithymia: (F1) Difficulty Identifying
Feelings, (F2) Difficulty Describing Feelings, and (F3)
Externally-Oriented Thinking. TAS-20 scores are reliable, and the
three-factor structure is replicable (Bagby, Parker & Taylor,
1994). The TAS-20 is currently the most widely used measure of
alexithymia and considerable work has gone into testing its
reliability and validity (Bagby et al., 1994; Parker, Taylor &
Bagby, 2003; Taylor, Bagby & Parker, 2003).
The Relationship Styles Questionnaire (RSQ, Bartholomew &
Horowitz, 1991) is a self-report instrument with 30 items rated on
a 5-point scale. It is designed to measure a four-category model
of adult attachment: secure, fearful, preoccupied, and dismissing
attachment. The mean rating for each of the four subscales is
computed, generating four continuous variables. Each attachment
style is characterized by a particular underlying model of self
and others (Schafer & Bartholomew, 1994), which can be scored as
two separate continuous variables. Construct validity of the self
and others dimensions has been demonstrated (Bartholomew, 1990),
as well as convergent and discriminant validity (Griffin &
Bartholomew, 1994). In addition, moderate to high test-retest
stability has been established (Schafer et al., 1994).
Statistical Analyses
Descriptive analyses were conducted in order to examine the
main characteristics of both controls and patients. Independent
sample t tests were used to explore differences between the two
groups.
Associations between attachment, alexithymia, and borderline
severity were examined using Pearson correlations. To test the
hypothesis that alexithymia mediates the association between
attachment and borderline severity, the model proposed by Baron
and Kenny (1986) was used. According to this model, mediation can
be established if four conditions are met: (1) the independent
variable (attachment) affects the dependant variable (BPD); (2)
the independent variable affects the mediator (alexithymia); (3)
the mediator affects the dependant variable after the effect of
the independent variable on the dependant variable is taken into
account; and (4) the effect of the independent variable on the
dependant variable is reduced when the effect of the mediator on
the dependant variable is taken into account. The mediation model
is a causal model: the mediator is assumed to cause the outcome
and not vice versa. The total population (54 BPD + 51 non-
clinical) was used to perform these analyses.
Results
Preliminary analyses
The majority of adolescents with BPD met the criteria for at
least one current Axis-I disorder (N=47; 87%). Eating disorders
were the most frequently observed comorbidity (N=24; 44%),
followed by mood disorders (N=21; 39%), substance use disorders
(N=9; 17%), anxiety disorders (N=6; 11%), and disruptive behavior
disorders (N=6; 11%). Borderline adolescents showed high rates of
comorbid Axis-II personality disorders: obsessive-compulsive
(N=21; 39%), avoidant (N=10; 19%), antisocial (N=7; 13%), paranoid
(N=7; 13%), dependant (N=5; 9%), histrionic (N=2; 4%), schizotypal
(N=2; 4%) and narcissistic (N=2; 4%) personality disorders. No
schizoid personality disorder was found, probably because
psychotic patients were excluded from the study.
Table 1 presents the main characteristics for each group
concerning borderline severity and mean scores on the self-report
questionnaires (TAS-20 and RSQ). Borderline severity scores in the
control group ranged from 0 to 9 (m = 2.24; sd = 2.59) whereas
those of patients varied from 10 to 27 (m = 16.61; sd = 1.18). The
alexithymia mean score in the clinical group was 57.75, which is
above the alexithymia cut-off score (56). The alexithymia mean
score in the control group was 49.78.
Main analyses
A series of t tests was conducted to examine differences in
attachment and alexithymia between the two groups (Table 1).
Analyses revealed that, compared to controls, borderline
adolescents had significantly higher alexithymia scores.
Borderline patients were also less secure, more fearful, more
preoccupied and had a more negative model of self. There were no
significant differences for the dismissing style and the model of
others.
Table 2 presents the correlation coefficients among the 6
attachment dimensions, alexithymia, and borderline severity. All
measures were inter-correlated except for dismissing attachment
and model of others, which were not associated with BPD and TAS
scores (see Table 2). The attachment scales associated with the
TAS-20 and with borderline severity (i.e. secure, preoccupied,
fearful, and model of self) were retained for the subsequent
mediation analyses. Table 3 presents the four mediation analyses
linking these attachment dimensions with borderline severity
scores.
A partial mediating effect of alexithymia was found between
secure attachment and borderline severity. Secure attachment
predicted low levels of both borderline severity (9.8%, β = -0.31;
p < .001) (condition 1) and alexithymia (6.2%, β = -0.25; p < .001)
(condition 2). While alexithymia was a significant predictor of
borderline severity (β = 0.40; p < .001) when secure attachment was
taken into account (Condition 3), secure attachment was less
related to borderline severity (β = -0.21; p < .05) when
alexithymia was taken into account (Condition 4).
A complete mediating effect of alexithymia was found between
fearful attachment and borderline severity. Fearful attachment
significantly predicted both borderline severity (5.4%, β = 0.23; p
< .05) (condition 1) and alexithymia (5.1%, β = 0.23; p < .05)
(condition 2). But fearful attachment no longer explained
borderline severity once alexithymia was taken into account,
whereas alexithymia did (β = 0.43; p < .001) (conditions 3 & 4).
No mediating effect of alexithymia was found between
preoccupied attachment and borderline severity.
Another partial mediating effect of alexithymia was also found
between model of self and borderline severity. Model of self
predicted both borderline severity (9.1%, β = -0.30; p < .005)
(condition 1) and alexithymia (3.8%, β = -0.20; p < .05) (condition
2) but model of self was less related to borderline severity (β = -
0.22; p < .05) when alexithymia was taken into account (Condition
4).
To summarize, the protective effect of secure attachment and
model of self for borderline severity was only partially explained
by low levels of alexithymia. The association between preoccupied
attachment and borderline severity was not mediated by
alexithymia. Conversely, the predictive power of fearful
attachment with regard to borderline severity is explained by
alexithymia (i.e. complete mediation).
Discussion
In accordance with previous findings on adults (Webb &
McMurran, 2008), these results show that borderline adolescents
are more alexithymic than their matched controls. As expected,
patients were also significantly more insecure than non-clinical
participants. As in previous research (Westen, Nakash, Thomas, &
Bradley, 2006; Lyons-Ruth, 2008), secure attachment was negatively
associated with borderline severity.
Mediation analyses suggest that secure attachment is a
protective factor in the development of BPD. This is consistent
with Bowlby's (1969/1982) view that secure attachment is central
to personality development. Results further suggest that this
protective effect is partly due to the ability to identify and
express emotions. Bowlby proposed that a secure base is necessary
for the exploration of internal states. This exploration allows
better identification of emotions, which in turn promotes mature
and efficient affect regulation (see also Gergely & Watson, 1996).
Conversely, because insecure attachment is associated with lack of
sensitive caregiving (see de Wolff & van IJzendoorn, 1997), the
findings also corroborate Linehan’s model (Linehan et al., 1993).
According to this model, the development of BPD occurs within an
invalidating environment in which emotional displays are
considered unwarranted, thus compromising the understanding and
labelling of emotions. The person thus fails to learn how to solve
the problems contributing to these emotional reactions, giving
rise to more extreme emotional, behavioral, and cognitive
dysregulation (see also Fonagy, Target, Gergely, Allen & Bateman,
2003).
Among the insecure attachment dimensions considered,
preoccupied and fearful attachment were associated with BPD.
Preoccupied and fearful attachments both imply a negative model of
self. Further analyses showed that a part of the effect of the
negative model of self on borderline severity is direct, whereas
another part is mediated by alexithymia. The RSQ (Bartholomew et
al., 1991) was developed according to Bowlby’s (1969/1982) concept
of internal working model (IWM). Depending on the quality of care,
people develop IWMs of self as more or less lovable and of others
as more or less reliable and loving. Batholomew (1990) proposed
that the negative model of self (i.e. fearful and preoccupied
styles) relates to anxiety (whereas the negative model of others
relates to avoidance). Anxiety refers to high vigilance concerning
caregiver availability, frequent verbal or physical contact with
him/her, intense distress during separation, anger and resistance
at the caregiver’s return (Hazan & Shaver, 1987). Our findings
concerning the negative model of self offer a better understanding
of many BPD symptoms, such as anxiety and anger. Borderline
adolescents’ attachment styles can account for the constant
worrying about caregiver availability and the anger this leads to,
as well as intense and labile affects and relationships. Also,
people with a negative model of self behave in accordance with
caregivers’ expectations rather than with their true self. Proper
identification of feelings is thus compromised, rendering them
more vulnerable to borderline symptoms. This fits nicely with the
theory developed by Fonagy et al (2003), according to which an
"alien self" (Fonagy, Target & Gergely, 2000) —arising from
insensitive caregiving— added to limited reflective capacities,
constitutes the roots of BPD.
Although preoccupied and fearful attachment styles were both
predictive of borderline severity, alexithymia only mediated the
link between fearful attachment and borderline severity. What
differentiates fearful attachment from preoccupied attachment is
the model of others, negative for the first and positive for the
latter. People with a negative model of others expect rejection
from others when seeking comfort and reassurance. Avoidance of
closeness to minimize disappointment logically limits the sharing
of emotions. This is also consistent with Linehan's etiological
model of BPD (Linehan et al., 1993).
The current study has certain limitations that must be
considered. First, because control participants were selected as
having no psychiatric disorder, representativeness of this sample
is questionable. This procedure was nevertheless preferred so as
to obtain greater contrast between the clinical and non-clinical
groups and identify borderline specificity more clearly. In future
studies, comparisons with other disorders would also enable
understanding of the psychopathological pathways specific to
borderline adolescents.
Although the present borderline sample is quite large
compared to those of most studies on adolescents, only female
participants were included, thus limiting the generalizability of
our results. Future research examining the links between
attachment, alexithymia, and BPD is still needed to understand the
development of BPD among male adolescents. This seems particularly
useful given that borderline symptomatology varies significantly
according to gender (Johnson et al., 2003).
Thirdly, reservations can be made regarding the assessments.
Concerning alexithymia, even if the TAS-20 is the most widely-used
questionnaire, there is a growing consensus that the way in which
people represent and regulate emotions is, in part, implicit and
not accessible to self-knowledge (e.g. Westen & Blagov, 2007). In
this respect, self-reports, which call for explicit self-
knowledge, probably miss the crucial component of the way in which
people actually process affective states. The use of a more
objective measure (e.g. Observer Alexithymia Scale, Haviland,
Warren & Riggs, 2000) could provide a more reliable assessment of
affect regulation.
Attachment was also measured using only a brief self-report.
Thus, participants’ responses reflected subjective evaluations of
self rather than actual attachment strategies. Nevertheless,
subjective representations may be relevant in understanding the
processes at work in psychopathology. It should also be noted that
it is avoidance —rather than anxiety— that is likely to lead to
biased self-reports (Cassidy, 1994). In the present study,
borderline patients proved to have preoccupied and fearful (i.e.
anxious) rather than avoidant attachment styles.
In other studies, disorganized attachment has been identified
as a vulnerability factor for the development of BPD (Fonagy et
al., 2006, Lyons-Ruth, 2008). A task for future research would be
to examine mediation between attachment, alexithymia and BPD
including a measure of disorganization (eg. unresolved loss or
trauma, hostile/helpless state of mind).
Conclusion
In short, this study provides support for an etiopathogenic model
according to which part of the association between attachment and
borderline severity is mediated by alexithymia. This process
already seems to be at work during adolescence. Because in this
period of life emotional consciousness is only emergent, the
ability to reflect upon emotions could be expected to be limited.
Yet the present study suggests that inter-individual differences
with respect to the ability to identify and express emotions are
already determining factors for borderline symptomatology.
Therefore, therapies aiming to increase emotional consciousness
(eg., Dialectical Behavior Therapy, Linehan, 1987; Transference
Focused Psychotherapy, Yeomans, Clarkin & Kernberg, 2002;
Mentalization-Based Treatment, Bateman & Fonagy, 2006), which have
been developed for adults, could also reasonably be considered for
treatment of borderline adolescents.
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Table 1Characteristics of study participants: borderline severity, alexithymia, and attachment
styles
CONTROLSMean ± SD [Range]
PATIENTSMean ± SD [Range]
t
BPD 2.24±2.59 [0-9] 16.61±4.44 [10-27] -20.1****
TAS-20 49.78 ±9,28 [30-68]
57.75 ±11.24 [28-81]
-4.09****
RSQ Secure 3.33 ±0,41 [2.40-4,20]
3.00 ±0.51 [1,80-4,00]
4,33****
Fearful 2.63 ±0,79 [1.25-4,75]
3.02 ±0.89 [1,25- -4.49*
Dismissing 2.66 ±0,64 [1,40-3,80]
2.68 ±0,87 [1-5] -0,12
Preoccupied 3.13 ±0,71 [1-4,75]
3.46 ±0,79 [1,75- -2.26*
Model ofself
1.47 ±0,50 [1-2] 1.25 ±0,44 [1-2] 2.41*
Model ofother
1.81 ±0,39 [1-2] 1,71 ±0,46 [1-2] 1.25
Note. NS Non Significant; * p < .05; ** p < .01; *** p < .005; **** p< .001
Table 2Correlation coefficients between borderline severity, alexithymia, and attachment styles
BPD TAS-20
RSQ
Fearful
Dismissing Secure Preoccup
ied
Model ofself
Modelofother
BPD 1 .46*** .23* -.27 -.31**** .36**** -.30**
* -.76
TAS-20 .46*** 1 .23* -.01 -.25* .22* -.20* -.06Note. NS Non Significant; * p < .05; ** p < .01; *** p < .005; **** p
< .001
Table 3Regression analyses testing the mediating role of alexithymia in the relationship betweenattachment style and borderline severity
Predictedvariables
Variables in equation R2 total β
BPD Secure Style 9.8% -.31****
Alexithymia Secure Style 6.2% -.25**BPD Secure Style &
Alexithymia25.0%
Secure StyleAlexithymia
-.21*.40***
*BPD Preoccupied Style 12.7% .36***
*Alexithymia Preoccupied Style 4.9% .22*
BPD Preoccupied Style &Alexithymia
27.6%
Preoccupied StyleAlexithymia
.27***
.40****
BPD Fearful Style 5.4% .23*Alexithymia Fearful Style 5.1% .23*
BPD Fearful Style &Alexithymia
22.6%
Fearful StyleAlexithymia
.14NS
.43****
BPD Model of self 9.1% -.30***
Alexithymia Model of self 3.8% -.20*BPD Model of self &
Alexithymia25.0%
Model of self -.22*Alexithymia .41***
Note. NS Non Significant; * p < .05; ** p < .01; *** p < .005; ****p < .001
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