Accelerat ing t he world's research.

Alexithymia: Relationship With Ego

Defense and Coping Styles
R. Michael Bagby, Graeme Taylor

Related papers Download a PDF Pack of t he best relat ed papers 

Comparison of Early Maladapt ive Schemas and Defense St yles in Ast hmat ic, Alexit hymic and…
Zohreh Khosravi

Clinical correlat es of alexit hymia among pat ient s wit h personalit y disorder
Ant hony Joyce

Relat ions bet ween anxiet y sensit ivit y and dimensions of alexit hymia in a young adult sample
Heat her Devine, Margo Wat t
 Alexithymia: Relationship With Ego Defense and Coping Styles
James D.A.Parker, Graeme J. Taylor, and R. Michael Bagby

There is controversy in the literature as to whether Situations (CISS).lnsample1,the TAS-20and its three
alexithymia reflects a deficit in the cognitive process. factors were associatedmost strongly with an imma-
ing of emotions or a defensivecoping style. Previous ture defense style, weakly with a neurotic defen.e
studies with clinical populations reported a strong style, and negatively with a mature defensestyle. In
association between alexithymia and a maladaptive sample 2, alexithymic students scored significantly
(Immaturel ego defensestyle. The present study was higherthan nonalexithymicstudents on the immature
designed to examine this relationship in nonclinical and neurotic defensefactors of the DSQ and signifi-
populations. and also to explore the relationships cantly lower on the mature defensefactor. Alexithy-
between alexithymia and three general styles for mic students also scored significantly higher on the
coping with stressful situations. Sample 1. 287 non. emotion-oriented coping scale and the distraction
clinical adults. completed the Twenty-Item Toronto component of the avoidance-orientedcoping scale of
Alexithymia Scale (TAS.201and the Defense Style the CISSand significantly lower on the task-oriented
Questionnaire (DSQI. Sample 2. 83 undergraduate coping scale.The results fail to support the view that
students who had been categorized previously into alexithymiais an adaptivedefenseor coping style.
alexithymic and nonalexithymic subgroups. com. Copyrightc 1998by W.B.SaundersCompany
pleted the DSQand the CopingInventoryfor Stressful

F ORMULATED BY Nemiah and Sifneosl,: dur- sion. displacement. reaction formation. and exter-
ing the early 1970s.the alexithymia construct nalization. However. it should be noted that recent
encompasses the following salient features: (1) studies have yielded considerable empirical sup-
difficulty identifying and describing feelings. (2) port for the validity of the alexithymia constructi.16
difficulty distinguishing between feelings and the and also have shown that alexithymic individuals
bodily sensations of emotional arousal. (3) con- are prone to high levels of negative emotion and
stricted imaginal processes as evidenced by a somatic distress.4.17 which would not be expected if
paucity of fantasies. and (4) an externally oriented alexithymia is an effective coping response.
cognitive style, It has been hypothesized that these Given that ego defenses are conceptualized as
characteristics reflect deficits in the mental represen- psychological mechanisms for managing distress-
tation of emotions and in the ability to regulate ing or overwhelming affects. it is logical that
emotions through cognitive processes,-'-SConsis- researcherswould attempt to explore the relation-
tent ~'ith this view is empirical evidence that ship between alexithymia and ego defense styles.
alexithymic individuals have difficulty distinguish- Over the past two decades. considerable progress
ing betweendifferentaffectivestates.6
showaJ:} has been made in the empirical study of ego
impaired ability to recognize both verbal and defenses.Influenced by psychodynamic theory and
nonverbal emotional stimuli: and show greater by findings from some longitudinal studies suggest-
Stroop interference than nonalexithymic individu- ing an association between ego defenses and the
als in color-naming arousal words,s severity of psychopathology. researchers adopted
However. some groups have expressedthe view the view that ego defenses can be organized
that alexithymia is better conceptualized as a hierarchically in relationship to their overall adap-
coping style to defend against affective distress tiveness.18.mGiven that each person usually de-
associated with specific stressful situations such as
trauma. recent abstinence from alcohol depen-
dency. and chronic medical illness.9.11Bonanno FromtheDeportmelltof PJ',\'t"holog,\',
TFrlltUlli\'ersii)',
Pt'ter.
and Singer.12for example. suggestthat alexithymia borough.Oll,ario: Departmelltof Ps.\'chiatry,,~Oll/ltSinai
may be similar to or an as t of the re ressive- Hospital,Torol!lO:Department of PJ',\'chiat,:,',
Uni"t'nii)' of
, , , pec , p,. TOrolltO,Torollto: and Section on Pt'rsonalii)' and PJ',\'chopathol-
defensIve copIng style. In ~'hlch there IS lIttle ogy,Clarkt'Institutt'ofPs,\'chiatry,
Toronto,Ontario,CanaJa.
tendency to experience emotional distress despite Supporrt'd in parr by a grantfrom theSocialScit'nct's
and
increased autonomic nervous system arousal. Humallities
Rt'.ft'arrh Councilof CanadaIJ,D.A.P.).
Knapp!3.1"and HoganlS completely reject the con- Add"ss"print "questst~ Grot'me~,Taylor: M',D"Deporr-
ceptof alexithymiaandclaimthatthecharacteris- mellt of P.r.vch~try,Moll/lt SIMI HospItal,600 Unl"t'nll:\' A\'e,
, . , ,Toronto, Olltano, M5G I X5, Canada.
tICS compnsmg the construct can be explaIned Cop,vright
C 1998byWB.Saulldt'rs
Company
solely by ego defenses. particularly denial. repres. OOJO-440X/98/J901.(XK)5SOJ,00tfJ

Comprehensive Psychi.,ry; Vol, 39, No, 2 (March/April), 1998: pp 91-98 91

..
 92 PARKER.TAYLOR. AND BAGBY

ploys severaldefensesandis therebycharacterized relationships between alexithymia and ego defense

by a defensive style. individual defenseswere styles. Wise et al,~6administered the original 26-
grouped into categoriesinitially on the basis of item version of the self-report Toronto Alexithymia
their conceptualrelationships.Vaillant.~.11
for ex- Scale (TAS)~7and a revised 88-item version of the
ample. proposeda theoreticalhierarchyof four DSQ23 to a group of mildly depressedpsychiatric
categoriesfrom least to most adapti\e: psychotic. outpatients. Alexithymia was found to be associ-
immature.neurotic.and mature;the so-calledbor- ated positively with the maladaptive (immature)
derline-level defenseswere not included in this defense style and negatively with the adaptive
categorization.Other researchersgroupedthe psy- (mature) defense style. and was unrelated to the
chotic defenseswith the immature-leveldefenses self-sacrificing neurotic and image-distorting de-
andaddedan image-distortingcategor)'of defenses fense styles,
that includesborderlineand narcissisticdefenses. Similar findings were reported by Schaffer.~8
Empiricalsupportfor this hierarchicalarrangement who administered the TAS and the revised 88-item
was provided by se\'ernlstudiesin which mature DSQ to a group of adult psychiatric outpatients
defensescorrelated positively and immaturede- receiving individual psychotherapy on a once.
fensescorrelatednegativelywith measures of suc- weekly basis, Alexithymia was again associated
cessfuladult life adjustmentand/orglobal mental positively with the maladaptive defense style and
health.The image-distortingdefenseswerenextto negatively with the adaptive defense style. and was
the immature defensesin the overall negative unrelated to the self-sacrificing neurotic defense
associationwith mental health. and within the style: however. a weak but statistically significant
categor)' of neurotic defenses.there were some relationship \\'as found between alexithymia and
positive and some negative but much weaker the use of image-distorting defenses.
associations. 19,10
In addition to identifying predominant ego de-
Whereas Vaillant's:1 method of investigating fense styles \\ith the DSQ. researchers have also
defenses''''as based on ratings of protocols of identified individuals who use a repressive-defen-
detailed clinical inteT\iews. several researchers sive coping style by the combination of high scores
subsequently developed self-repon instruments to on the Marlo\\'e-Crowne Social Desirability Scale
assess defense mechanisms and used statistical and low scores on the Taylor Manifest Anxiety
methods, specificaJly factor analysis, to determine Scale,29Two recent studies examining the relation-
whether defenses cluster into defensive styles. ship bet"'een alexithymia and the repressive-
Although it is impossible for individuals to evalu- defensive coping style in nonclinical adult samples
ate their own unconscious defense mechanisms have shown that these are distinct constructs. with
directly, self-repon scales yield information about repressors scoring low on both the TAS and the
an individual's perception of his or her habitual revised Twenty-Item TAS (TAS-20),Jo.JI Myers31
ways of deaJing with conflict or stressthat may be established that the low alexithymia scores of
considered conscious or behavioral derivatives of repressors are due to the combination of high
defenses. Bond et al.,==.=.1 for example, developed defensiveness and low trait anxiety. and not to one
the self-repon Defense Style Questionnaire (DSQ). of these characteristics alone.
which has been found to agree ~'ith Vaillant's Whereasego defensestyles. including the repres-
intervie~'-based measures of defense style.1.5On sive-defensive coping style. involve largely uncon-
the basis of the factor structure of the questionnaire. scious processes for managing affects.1O.19.J2 re-
the DSQ ranks defense styles on a continuum from searchers now also identify conscious strategies
a maladaptive pattern (involving immature de- used by individuals to cope with stressful or
fensessuch as regression.acting-out. passiveaggres- upsetting external situations,33 Some researchers
sion. and projection). through image-distorting de- focus on situation-specific coping behaviors: others
fenses (including primitive idealization. splitting. emphasize more general coping styles that are
and devaluation) and a self-sacrificing neurotic characteristic of particular individuals and are used
style (consisting of pseudoaltruism and reaction across different types of stressful situations, The
formation). to an adaptive or mature style (consist- three general coping styles usually identified in the
ing of humor. suppression,and sublimation).U.2.1 literature are problem-focused or task-oriented cop-
In a prelimiliar)" investigation exploring the ing. emotion-oriented
coping, and avoidance-
I
ALEXITHYMIA AND DEFENSE AND COPINGSTYLES 93

oriented coping.33.34 Task-oriented coping involves consistent with central facets of the aIexithymia
active attempts to deal with stress either behavior- construct. namely a paucity of fantasy and diffi-
ally or cognitively: emotion-oriented coping strate- culty in expressing feelings to others.:'.!
gies include telling oneself that the situation is not As part of the previously described study exam-
really happening. developing aches and pains. and ining the relationship between alexithymia and ego
becoming angry; avoidance-oriented coping in- defense styles. Schaffer~8developed the self-report
cludes distraction activities such as watching televi- Affect Regulation Scale (ARS) to assessstrategjes
sion or going out for a snack or a meal. and social used by people to cope with distressing emotional
diversion strategies such as socializing with others. states that might be evoked by a variety of situa-
Whereas the task-oriented style of coping can be tions. In her sample of adult psychiatric outpatients.
effective in modulating the impact of stressful life alexithymia was associatedwith maladaptive styles
events on mental and physical health. an emotion- of affect regulation. such as binging on food or
oriented style of coping with stressful events has developing a headache. and negatively with adap-
been found to be associated with negative a."pects tive behaviors. such as thinking about and trying to
of health such as anxiety. depression. and the understand distressing feelings or talking to a
development of "functional" somatic symptoms.-14 caring person. Further researchis neededto evalu-
rndeed. some investigators35 view the emotion- ate the validity of the ARS and to explore its
oriented strategies as maladaptive emotional re- relationship with validated measuresof the three
sponsesto stress rather than coping strategies. The general coping styles.
effectiveness of avoidance behaviors in coping Based on the investigations to date. the alexi-
with stress is equivocal. Research has shown that thymia construct appears to be associated with an
socializing with others (the social diversion compo- immature ego defense style and with maladaptive
nent of avoidance-oriented coping) lessens the ways of coping with stress. However. because the
impact of stressful events. but trying to avoid stress studies by Wise et al.26 and Schaffer~8were con-
by engaging in distracting activities is often associ- ducted with samples of psychiatric outpatients. the
ated with psychological and somatic symptoms and results might be influenced by psychiatric symptom-
is potentially a maladaptive coping strategy.34 atology and cannot be generalized to nonclinical
There are only two repons of studies in which populations.
the relationships between alexithymia and coping The aims of the present study were to extend the
styles were examined empirically. Vingerhoets et previous investigations of alexithymia and ego
al.36 used the self-repon Amsterdam Alexithymia defense styles to nonclinical populations. and to
Scale (AAS) to measure alexithymia. and assessed examine the empirical relationships between alexi-
coping styles with the Ways of Coping Checklist thymia and the three general coping styles.
(WCC). In contrast to the original WCC..17subjects METHOD
in this study were instructed to indicate how they
respond to stressful situations in general. rather Subjects
than a panicular stressful situation. The WCC was The study was conducted "ith two -eparate samples. Sample
I consisted of ~87 adults (139 men and 1~8 women) recruited
scored for seven coping styles that were based on
from 3ffi{)ng friends ;uId relatives of unde~raduate university
previous factor analysis of the scale (one problem- students. The mean age of the men "3.\ 32.71 := 11.13 years
focused factor and six emotion-focused factors). In (mean:: SD): the mean age of the ,,'omen was 33.02 = 10.28
a nonclinical sample of female adults. the AAS years.
correlated positively with a coping style described Sample 2 consisted of 83 undergraduate university students
(38 men and ~5 women, drawn from a larger group of 390
as distancing (e.g.. "1 went on as if nothing had
students who had completed the TAS-20 as pan of another
happened") and negatively with three coping styles _tudy. The 83 students ,,'ere selected for the present study on the
described as ( I) expression of emotion and seeking basis of their TAS-20 scores being in either the a1exithymic or
social suppon. (2) daydreams and fantasies. and (3) nonalexithymic range as defined by empirically derived cutoff
planning and rational actions (e.g.. "I made a plan scores.~'sThiny-seven of the selected students (15 men ;uId 22
women, were categorized as alexithymic (TAS-20 scores ~ 61).
of action and follo~.ed it). Although the AAS has
and 46 students (23 men and 23 women) were categorized as
not been fully validated and attempts to cross- nonalexithymic (TAS-20 scores ~ 51). The mean age of the
validate the factor structure of the WCC have met student subjects was 2~.93 = 8.1 years for men and 20.35 :=
with mixed results?3 some of these findings are 1.72 years for women.
 ,.

94 PARKER.TAYLOR. AND BAGBY

Subjects In bcMII samples Wtfe told lhatthe aim 0( IIIe sIudy DSQ are displayed in Table I. The global TAS- 20
was 10 investigate aspects of penonaJity and emotIon; they all score and scores on the three factors all correlate
volUnlee~ to panicipate in the study. The ~ubJ«ts in ~pIe I
positively and strongly with the immature defense
Wtfe assessed for aiexilhymla and ego defense styles. Subjects
in sample 2 were as~e~sed for copiRi styles ;md e8° defense factor of the DSQ. positively but more weakly with
styles. the neurotic defense factor. and negatively with the
mature defense factor. The only nonsignificant
Measures correlation was between the neurotic defense factor
Alexithymia was as~sed by the self-report TAS-20. a of the DSQ and the externally oriented thinking
revised and improved vmion of the Mginal 1ft-item TAS.11~ factor of the TAS-20.
The scale has three factors that as~s three salient componenu To determine whether the relationship between
of the mullifaceled alexilhymia conSInlCI: difficulty identifying aJexithymia and immature defenses mjght accrue
feelings, difficulty communic8lin, feelings 10 odIen. ~ exter-
nally oriented thinkin,. In ~bon 10 demonSlratin, stability
only from the well-known association between
and replicabilily of it~ three-fa..'tor structure, the TAS-10 has aJexithymja and somatization. TAS-20 total scores
,hown internal consisten.:y. food test.retest reliability. and were correlated ,,'ith somatization d~fensesthaI are
conve~m. discnminanL iInd COltCUrTenI \alidil~..lI'" Consis- assessedby tWo irems on the DSQ, The correlation
lent with the definition of the ale,'lthymi3 .:un"truct. the TAS-20 was .20 (P < ,0 I). which is considerably lower
also correlates negatively "ilth a mea,ure uf fanta~y and other
than the correlarion betWeenthe TAS-20 rO(aJscore
imaginala..-livity.l":
Ego defense styles were a.,~~ by the 88-item re\ised and the full cluster of immature defenses,
DSQ.:J Tu render this que'tlonnalre more ..'onsistem with the For sample 2. Table 2 displays a comparison of
draft ,Iossary of defen~ Je~eloped fur lhe DSM-III-R. An- the aJexithymic and nonaJexithymjc subjects on the
drews et al," modified lhe \Conn! of the DSQ to 71 Items three factors of the DSQ and the three scalesof the
relating to 10 defenses .plus 10 lie and ~I31 dcsir:lbility items I
IhaIload on three fact~ labeled mature, neurotic. and imma-
CISS. Alexithymic subjects scored significantly
ture: this three-fact~ ~I is rDfXe "cable than Bond's four- higher than nonalexithymjc subjects on the imma-
factOI' solution used to score the DSQ In the ~lUdies by Wise el ture and neurotic defense factors of the DSQ. and
al.:. iInd Sch:lffer,:. The dcfenses of repres~ion and Intelle.:tual- significantly lower on the mature defense factor.
iZaiion aft excltxled from thiS mOOitiedsconnl me~ because
On the CISS. aJexithymic subjects scored signifi-
~sion, by definition, .:annoc be measured directly and no
cantly higher than nonalexithymic subjects on
consensu~ could be reached regarding appropn31e items for
.1S~sin, Imellectualiz3lion,.II' The mature factor Includes the emorion-orienred coping and avoidance-ori~nred
defenses of wblimallon. humor. 3nd w~~jon: the IIeUro(IC coping and significanrly lower on task-oriented
factOI' includes !he dcfenses of undoin" re:ICtion fonn31ion, and coping. However. on rhe subscales of avoidance-
idealization: iInd the immature f3CtOl'includes the defenses of
oriented coping. aJexithymic subjectsscoredsignifi-
Jenial. proje..'tion. ;)Cling llUl, oIUtlstic fanwy, spllnin" and
cantly higher than nonalexirhymic subjecrs on
~atizallon.
Copinl styles were asses~edby the Coping In\'enlory for distracrion. bur rhe two groups did not differ
Srressful Situations (CISSI, 01..s-llem self-report me.1Surethai significanrly on social diversion.
;IS~se~ three general .:opn, 'itYles: 13"k-orientN .:opinl,
cmOlion-l.>riented.:opinl. and ..\oidance-onenl~d .:opnl,.l1 The DISCUSSION
three-fa..-IOI'sbUCture of the CISS is slable and rcplicablc. and
The resulrsof this study ".ith nonclinical adulr
exh f~l~ scale has demon.-u;aledinlemal rell3bilily. ~-mesI
reliability. and con~lrucl and concurrent \3IidiIY,.I: Separate and university studenr samples are consistent with
factor analyses of the 3voidance copin, itcms have yielded those of previous studies e~amining the relarion-
SUA'Of' f~ two compooenlS of 3voidance-orienled coping-
dislra.'tioo and s«ial divenlOll,.I:
.
T8bIe 1. Corr8l8tlons of the TI.I-20 and F8ctor Ice'" WIth

Data Analysis
For sample I. PeanOll product-moment cOfTelations were DSO
die DSQIN

TAS.aoF1
2871
,-
F2 n
computed between the TAS-~ and its three f&l:tors and the three
Maturede'-- -.2It -.15- -.111 -.2It
factors of w DSQ. For sample 2. I teS1Swere used to compare
Neurollc de'-- .m .2ft .17t .11
aJc~ithymic aIKt nonaJexithymic InNps on !he thrft f~ of
Immlturedefen.. .55t ,53t .41t .381
the DSQ and w three scales of the CISS.
NOTt. FICtOtSara defined .. follows: F1. difficulty identify-
RESULTS ing feeling.; F2. difficulty communicating feelings to others;
F3. ext8m811yoriented thinking.
For sample .I. correlationsbetweenthe TAS-20 'p< .01.
and its three factors and the three factors of the tP< .01.
AlEXITHYMIA AND DEFENSE AND COPING STYlES 95

and negatively with the broader personality dimen-

sion of openness to experience.17FutUtt studies
need to distinguish bet~'een a capacity for creative
In - 371 In." 1811 P
imaginaJ and fantasy activity. which clinicians
~ report is deficient in alexithymic individuaJs. and a
~d8f8.- U8 =10.74 ~17 =10.202.72 .1X8
~ ~ 79.~ =14.. 87.. =15.81 3.43 .001
capacity for crude fantasy elaborations of affect as
Immature observed in the sexuaJ perversions and addictive
dele.- -.42 : 44.34 1"- = 8.E <.001 use of pornography with which alexithymia is
CISS sometimes associated."
T_~ 58.81~ 12.00 82.8 = 8.. 2.. .010
The findings of a significant positive association
Emotion-oriented 57.71:: 12.43 ~.OO:: 8.70 7.21 .001
A\IoidInceo between alexithymia and a neurotic defense style in
~ 50.37:: 12..» 43..:: 11.732.» .021 the nonclinical adult population and higher scores
~ 24.1' %8.73 11.18%8.M ~ <.001 on the neurotic defense factor in alexithymic stu-
Soci8Idiversion 17" %8.28 18.71= 6.15 0.28 .79 dents versus nonaJexithymic students might sug-
gest that alexithymic individuals cannot be distin-
ship between alexi[hymia and ego defensestyles in guished from psychoneurotic individuals. However.
clinical populations. Aleximymia. as measuredby the magnitude of the correlation was low. and
the TAS-20. was associatedpositively with me use alexithymia was unrelated to self-sacrificing neu-
of immature defenses and negatively wim the use rotic defenses in the previous studies with clinicaJ
of mature defenses. In addition. ~tudents catego- populations.~'~ Moreover. according to Perry.19
rized as aleximymic on [he basis of previously most individuaJs use some neurotic defense mecha-
established TAS-20 cutoff scores scored signifi- nisms regardless of what other defenses they aJso
cantly higher on the immature defensefactor of me use. and the placement of neurotic defenses in the
DSQ and significantly lo~er on the mature defense middle ground of adaptiveness~.ithin the hierarchi-
factor than students categorized as nonalexithymic. caJarrangement of defensesdoes not allow them to
Although the findings from previous studies wim differentiate individuals well in terms of overall
clinical samples leave open the possibility that the mentaJheaJth.
association between alexithymia and an immature The finding that alexi thymic students use less
defense style might be influenced by psychiatric task-oriented coping strategies than nonaJexithy-
symptoma[ology.~6~3[he replication of the findings mic students is consistent with the finding by
in a large nonclinicaJ population renders this un- Vingerhoets et aJ.J6of a negative association be-
likely. tween alexithymia and problem-focused coping as
Given that an impoverished fantasy life is pan of measuredby the WCC. Alexithymic individuals are
the definition of the aJexithymia construct. one prone to use action-oriented behaviors such as
might ~'onder about [he association between aJexi- binging on food or abusing alcohol. seemingly in
[hymia and autistic fantasy- ~.hich is included an attempt to regulate distressingemotionaJstates}.":
among £heimmature defenses.Only one item of [he however. these are either compulsive or impulsive
DSQ assessesautistic fantasy (--I work more things behaviors rather than rationally planned activities.
out in my daydreams than in my real life/: the and may be considered examples of avoidance-
correlation between [his item and the TAS-20 total oriented coping. Examples of task-oriented coping
score in sample I was positive :md significant but behaviors assessedby the CISS include thinking
of low magnitude (r = .16. P < .0 I). This associa- about how one has solved similar problems. anaJyz-
tion is not inconsistent ~'ith the alexithymia con- ing the problem before reacting. and considering
stnJct. as the defense of autistic fantasy is defined several different solutions to the problem. The
as the use of daydreaming as a substitute for human negative association between aJexithymia and task-
relationships or problem-solving.~o rather than oriented coping suggestsa lower capacity of alex-
imaginal activity mat enhances relationships or ithymic individuals to reflect upon stressful situa-
finds creative solutions to problems. As noted tions and to use cognitive strategies to modulate
earlier. the TAS-20 has been found to correlate their emOtional states. This finding is consistent
negatively with a more reliable measureof fantasy with other researchthat has found a strong negative
and imaginal activityl': it also correlates strongly association between alexithymia and the tendency
 . PARKER.TAYlOR.AND -=av

to engage in and enjoy effortful and analytical DSQ. Bond et 31.:1 found that the mala~tive
I.:ognitive endeavors as measured by the Need for defense style con-elated strongly and neg:nvely
Cognition Scale.~"17 with independent measures of ego devel~nt
The findings that alexithymic students used and ego functioning. whereas the image-dis~g
significantly more distraction and emotion-oriented and self-sacrificing neurotic styles correlated ~-
coping strategiesthan nonalexithymic studentsalso what negatively and the adaptive style co~d
indicate that alexithymic individuals tend not to use positively. Although the present study and $be
cognitive skills to process and regulate emotions studies by Wise et al.16and Schaffer:s did ~ use
evoked by stressful situations. Examplesof emotion- any measures of ego development. the cons8nt
oriented coping behaviors assessedby the CISS finding that alexithymia is associatedmost stJn8J!1y
include becoming preoccupied with bodily aches with defenses that least protect an individua] from
and pains, blaming oneself for not knowing what to distressing affects lends some support fCY the
do. and worrying about what one should do.~1~2 ego-deficit model of alexithymia.
Examples of distraction activities assessedby the There is also theoretical and empirical su)p)rt
distraction component of the avoidance-oriented for relating the ability to represent and reg*e
coping dimension of the CISS include watching emotions cognitively to ego development. Pi~ .1.1
television. buying oneself something, and going for example. proposed that emotional develo~t
out for a snack or meal, The correlations obtained follows a parallel and complementary course I) the
in our study are consistent with Schaffer's:s find- stageshe outlined for cognitive development. lane
ings that alexithymic individuals tend to develop and Schwanz) later integrated Piaget's theory with
somatic symptoms or engage in oral behaviors to the ideas about symbolization and language devel-
cope ,,"ith emotional distress, opment formulated by Werner and Kaplan.~ ~;Jd
The finding that alexithymic and nonalexithymic thereby conceptualized a cognitive-develop~.lal
students did not differ on the social diversion model in ~'hich the experience and organizatioo of
component of avoidance-oriented coping contrasts emotions progress from sensorimotor refle."(iveand
with the finding by Vingerhoets et al.}6 of a sensorimotor enactive stages to a preoperaOOnal
negati\"e relationship between alexithymia and a level. at ~'hich early forms of mental representation
coping style assessed by the WCC that involves (preconcepts) begin. to increasingly abstract and
seeking social suppon as well as emotional expres- complex levels of organization associaled with
sion. However. there is evidence of both highly concrete and formal operations. Frosch.l5similarly
dependent and avoidant styles of interpersonal makes an important distinction bern'een emOOons
relating among alexithymic individuals. Schaffer.:s lhat are organized at a preconceptual level li,e.,
for example. found that alexithymia is associated early in or prior to the preoperational stageI and
most strongly with a compulsive care-seeking style emotions lhat are organized on a more abstract.
of insecure attachment. and secondarily with a logical, and reality-oriented level li.e.. in the con-
compulsive self-reliant attachment style. crete or formal operational stages).At the precon-
Despite the consistent findings across clinical cepfUal level of organization. emotions are experi-
and nonclinical samples of a strong association enced as sensations. perceptions, or impulses to
between alexithymia and an immature defense action. and there is an associatedinability to move
style, one cannot conclude that alexithymia itself is freely into the world of creative imagination and
merely a defensive process. as Knappl).I", and fantasy: at the concrete and formal operarional
Hogan'S have proposed. Rather. given its defining levels of organization. emotions are experiencedas
features, one must view alexithymia as a more subjective feeling states that can be differentiated
complex construct and ask what are the de\eloprnen- from one another and verbally communicated to
tal and psychic structural elements that prevent an other people.-'According to these theoretical mod-
alexithymic individual from using more mature els, serious arrests in the sequential process of
defensesand adaptive coping strategies to manage emOtional development maintain a perceptually
distressing affects. To this end, we are helped by bound affectomotor existence and an alexithymic
empirical evidence that the hierarchically arranged cognitive style. Empirical support for these mooels
ego defense styles are related to a person's ego is provided by the findings that a measure of the
development. Using the original version of the levels of emotion organization-The Levels of

#
ALEXITHYMIA AND DEFENSE AND COPING STYLES .,
Emotion AwarenessScale(LEAS ~orrelates posi- emotion-oriented coping styles of alexithymic indi-
tively with a measureof ego development and with viduals suggest a preconceptual level of emotion
a cognitive-developmental measure of mental rep- organization. wruch helps to explain the tendency
resentation-16and negatively with the TAS-20.7 of these individuals to develop dysphoric and
Although the relationship between ego defense "functional somatic symptoms,~11 as well as their
styles and levels of emotion organization has yet to proneness to compulsive affect-regulating behav-
be investigated empirically. patients with border- iors such as binge-eating and psychoactive sub-
line personality disorder. who typically show a stance abuse.~.~q.soSecond. whereas interpretation
predominance of immature defenses (especially of ego defensesand drive-related conflicts is gener-
splitting and projection). score significantly lower ally helpful for psychoneurotic individuals who use
than non-borderline control subjects on the LEAS.-I7 a predominance of neurotic defenses. alexithymic
It thus seems that an immature defense style is patients require understanding and managementof
associated with a failure to achieve particular levels their immature defenses. as well as greater atten-
of cognitive and emotional development. tion to object relations and the development of
The results of this study have certain clinical cognitive strategies. to enhance their emotion-
implications. First. the maladaptive defense and regulating capacity.

REFERENCES
I. Nemiah JC. Sifneos PE. Affect and fanlasy in patients with Health.Chicago.IL: L'niv~ity of Chicago Press.1m:435-
psychosomatic disorders. In: Hill OW led I: Modem Trends in 470.
Psychosomatic Medicine. Vol. 2. London. l'K: Bunerworth. 13. Knapp PH. Core p.-ocessesin the ofJanization of emo-

1970:26-34. tions. JAm Psychoanal Assoc 1981:9:415-434.

2. Nemiah JC. Freyberger H. Sifneos PE. Alexithymia: a 14. Knapp PH. Emotions and bodily changes: a reassess-
view of the ~ychosomatic process. In: Hill OW CedI: Modem mentln: Temoshok L. Van Dyke C. Zegans LS (eds): Emotions
Trends in Psychosomatic ~'edicine. Vol. 3. London. l'K: in Health and Illness: TheO(etical and Research Foundations.
New York. NY: Grune& Stranon. 1983:15-27.
Butterworth. 1976:430-439.
15. Hogan CC. Psychosomatics. Psychoanaly~is. and Inftam-
3. Lane RD. Schwanz GE. Levels of emotional awareness: a
matory Disease of the Colon. Madison. CT: International
cognitive-developrnenlal theory and its application to psychopa-
Universities Press. 1995.
thology.AmJPsychiatry 1987:144:133-143.
16. Taylor GJ. Bagby R.\t. Ryan DP. Parker JDA. Validation
4. Taylor GJ. Bagby R.\4. Parker JDA. Disorders of Affect
of the alexithymia constnxt: a measurement-based aPl"1>aCh.
Regulation: Alexithymia in Medical and Psychiatric Illness.
Can J Psychiatry 19'X>:35:290-297.
Cambridge. UK: Cambridge University ~s. 1997.
17. Bagby RM. Taylor GJ. Parker IDA. The Twenty-Item
5. Sifneos PE. Affect deficit and alexithymia. Ne~. Trends
Toronto Alexithymia Scale-II. Convergent discriminant. and
ExpClinPsychiatr).1994:10:193-195. concurrent validity. J Psychosom Res 1994:38:33~.
6. Bagby R.M. Parker JDA. Taylor GJ. Acklin W. Alexi-
18. Cooper SH. The empirical $tudy of defensive processes:
thymia and the at-ility to distinguish different emotional states.
il review. In: BaITOn JW. E:lgle MN. Wolilzky DL <eds):
Poster presentation at the Annual Meellng of the American Interfoce of Psychoanalysis and Psychology. Washington. DC:
Psycho~omatic Soci(ty. March 4-6. 1993. Charleston. SC.
American Psychological A,;sociation. 1992:327-346.
7. Lane RD. Sechrest L Reidel R. Weldon V. Kaszniak A. 19. Perry JC. Detenses and their effects. In: Miller NE.
Schwanz GE. Impaired verbal and nonveroil! emotion recogm- Luborsky L. Barber jP. Docherty JP (eds,: Psychodynamic
tion in alexithymia. Psychosom Med 1994:58:203-210. Treatment Research. .'Iew York. NY: Basic Books. 1993:27~
8. ParkerJ. Taylor G. BagbyM. Alexithymiaand the 306.
processing of emotional stimuli. New Trends E.,p Clin Psychia- 20. Vaillant GE. The struggle for empirical assess_nt of
try 1993:9:9-14. defenses. In: Vaillant GE (edl: Ego Mechanisms of Defense.
9. Ahrens S. Deffner G. Empirical study of alexithymia: Washin~on. DC: American Psychiatric Press. 1992:89-103.
methodology and results. Am J Psychother 1986:40:430-447. 21. Vaillant GE. Theoretical hierarchy of adaptive ego mecha-
10. Freyberger H. Supportive psychotherapeutic technique~ nisms. Arch Gen Psychiatry 1971:24: 107-118.
in prinulry and secondary alexithymia. Psychother ~ychosom 22. Bond M. Gardiner ST. Christian J. Sigal JJ. An empirical
1977:28:337-342. examination of defense mechanisms. Arch Gen Psychiatry
II. Haviland MG. MacMulTaY JP. Cummings MA. The 1983:40:333-338.
relationship between alexithymia and depressive symptoms in a 23. Bond M. Defense Style Questionnaire. In: Vaill8lt GE
sample of newly abstinent alcoholic inpatients. ~ychother ledl: Empirical Studi~ of Ego Mechanisms of Defense. Wash-
Psychosom 1988:49:37-~. in~on. DC: American Psychiatric Press. 1986:146-152.
12. Bonanno GA. Singer JL. Repressive personality style: 24. Bond M. An empirical study of defensive ~tyles; the
theoretical and methodological implications for health and Defense Style Questionnaire. In: Vaillant GE (ed): Ego Mecha-
pathology. In: Singer JL fed): Repression and Dissociation: nisms of Defense. Washington. DC: American Psychiatric Press.
Implications for Persooality Theory. Psychopathology and 1992:127-158.
 . PARKER.TAVlo... AND BAGBY

25. Vaillant GE. Vaillant CO. A .;ross-validation of two 38. Bagby R.\t. ParkerIDA. Taylor GJ. 'nae Twenry-llem
methods of inveslJ,ating deten~. In: Vaillant GE fed..: Eco ToronlO Alexllh~mia Scale-l. Item ~Iection and cross.
Medlanisn\S of' Defense. ~'ashin"on. DC ,\mencan Psychill- validalionof !hef~or SInlC~. J PsycbosomRes 1994:38:23-
ric Press. 199~: I S9-170. 32.
26. Wise TN. Mann LS. Eps~in S. Ego Ikfense styles and 39. AndrewsG. PollockC. Sle~'1nG. 'naedeterminarioaof
alexithymia: a discriminanl ,'alidution ~tudy PsychOlherPsycho- defenseslyre by queslionnaJre.
Arch Gen Psychiauy 1989:46:
sam 1991:56:141.14S. 4SS-460.
~7. TayltW"GJ. Ryan 0, Bagby R.\f: To.ard thelX'o'e~ 40. A.-ews G. Sinp M. Bond M. 'nae Defense SIyIe
of a new self-~ alexlthymia scale. Psychother Psy~ QueSIiom8ire. J Nen Mem Cis 1993:181:246-261.
1985:44:191-199. 41. Endler NS. Parker IDA. Coping Inventory for Stressful
~8. S<:haffer CEo The role of adult an.1chmentIn the experi- Silualions (CISSI: Manual. Toronlo. OnlariO. Canada: Multi-
ence and regulation of affect (dissenutionl. Ne" Haven. CT: Health Systems. 1990.
Vale University. 1993.
42. Endler NS. Parker IDA. AssesSnlenl of mullidimensional
29. WeinberJer OA. The cmSInICt validity of the repressive-
.:oping: wk. e~. and avoidllK:e stralegies. Psychol Assess
defensive copinl sl)'le. In: Sinser Jl led!: ReJXeSSlonand
1994:6:50-60.
Dissociation: Defense Mechanisms and Personality Styles.
43. Piagell. Intelligence and Affectivity: 'naeir Relalionship
Chicago.ll: l'niversity of Chica,n Press. 1990:337-386.
During Child Developmem. Translaled and ediled by Brown
30. Newlon TL Conuada RJ. Ak~ith~1nia and repression:
TA. ~ CE. PaIoAho. CA: AMual Reviews. 1981.
cOfl(ra§ling emOtion-focused copin, "1~ln. P'~c~ Med
.14. Werner H. ~ B. S~-mbolFormation: An 0rJanismic:-
1994:56:~S7~2.
DevelopmetMal APIXOaI:h 10 Language and Ihe Expression of
31. Myers LB. Ale~ith~mia and reprt:ssjon: lhe role of
Thought. Ne~ York. ~Y: Wiley. 1963.
defensiveness and trait anxiel~'. Pers Individ Differ 1995: J9:~89-
4S. Frosch A. The preconcepual or,aniulion of emotion. 1
-492.
Am PsYch~aI Assoc: I99S:43:423..a47.
32. Kin, lA. Emmons RA. Woodley S. The .lnICture of
inhibition. J Res Pm 1992:26:8S-102. 46. lane RD. Quinlan DM. Schwanz GE. Walker PA. Uillin
33. Parter JOA, Erx1ler ;'IS Coping arxI defen.e: a histtW"icai SB. The levels of EftI(Mjon A.areness Scale. A .:ognilive-
overview. In: Zeidner M. Endler ~S ledsl: Handbook of Coping: developmental measure of emotion. 1 Pen Assess I990:S5:124-
Theory. Research. Applicaltons. ,~ew York. :-.'V: ~"iley. 1996:3- 134.
23. 47. uvine D. Muziali E. Hocxt 1. EmCMjon processing in
~. Higgins IE. ~ler ~S. Coptng.life ~s. ~ psycho- borderline penonaJity disordm.l ~erv Menl Cis 1997: 185:24().
lOIicai and somaticdi~s. Eur J Pm 1995:9:2S-,.~70. 146.
35. JensenMP. Turner JA. RomanoJM. KiJIOlyP Copin, 48. Taylor Gl. Parker JDA. Bagby RM. Acklin MW. Alexi.
with chronic pain: a critical revie'" of the literature. Pain thymia and ~mlltic complaints in psychialric oulpalienls. 1
1991:47:249-283. Psychosom Res 1992;36:417-'24.
36. Viogerlloels Ad JJM. Van HeI.-k Gl. Grim R. Bermond B. 49. Schmick AJM. liwany A. Trea.~ure1. A controlled study
Alexilhymia: a further expltW"ation of its nomologICal ~twork. "f alexilhymia in tarin, disorders. COrrI{K Ps~chl~ 1993:34:
Psychother Psychosom 1995:64:3~.~2. 54-S8.
37. Folkman S. Lazarus RS. An anal~sisof coping in a SO. Ta~lor Gl. Parker IDA. Ba,by R.\t. A preliminary
middk-aged communitysample.J Ht:althSO(8ehav 1980:21: :n\'esligation of alexilhymia in men wilh psychoacti\'e sub-
219-239. ,tatlCedepel.te1lCe.
Am 1 Psychiatry1990:147:1228-1130.