A STUDY OF ALEXITHYMIA IN RELATION TO

PERCEIVED SOCIAL SUPPORT AND MENTAL HEALTH

OF INSTITUTIONALIZED AND NON-

INSTITUTIONALIZED ADOLESCENTS

SUMMARY ofMajor Research Project Report

Submitted to The University Grants Commission

New Delhi2014-15

Submitted by: Supervisor: Dr. Roshan Lal Dr. Rajesh Kumar Co-investigator Principal InvestigatorAssistant Professor Assistant Professor Department of Psychology Department of Psychology,Panjab University P.G. Govt. College, Sector 46, Chandigarh Chandigarh

UNIVERSITY GRANTS COMMISSIONNEW DELHI

Adolescence is a transitional stage of human development that involves biological

(i.e. pubertal), social, and psychological changes in preparation for adulthood. This stage of

development is marked by a socialization process whereby youth are actively engaged in

social interactions with various individuals, authority figures, groups, and networks of the

family, community, peer group, the school and other predominant institutions.

Separation from parents will have an adverse effect on the overall development of the

child. However, the influence of separation will vary with the nature and the context of

separation, the type of foster care available, opportunities for developing one's potentials, the

intellectual, social, perceptual and emotional stimulation available, the type of encouragement

available etc. The present study is the outcome of the detailed study of the literature.

The word “deprivation” is etiologically derived from the verb “to deprive” which

means to dispossess or strip (a person or an object), and it implies a “felt loss”. It literally

refers to dispossession or loss of privileges, opportunities, material goods and the like.

Deprivation is considered as a multi-dimensional and quantifiable variable operating over

long periods. The term encompasses a broad range of human conditions that are below par.

A deprived child is one who suffers from a continuing inadequacy of material,

affectional, educational or social provisions and is subject to detrimental environmental

stresses, of any kind, which are likely to interfere with his growth and development and thus

prevent him from achieving inherent potentials. The reference is to certain deficiencies in the

environment, which are not only there, but are also experienced as such by the individual.

Deprivation can be considered as a prolonged process relative to a defined social setting and

represents a broad spectrum of the environmental and organismic variables which constitute

the basic source of experiences to the living organism. The extent of the growth of various

psychological functions, especially problem solving, cognitive, needs, defenses and

personality ones, would be correlated with the kind of experiential background the individual

comes with.

Children reared in institution/orphanages are often exposed to an environment

unfavorable to emotional maturation, and are deprived of close continuing and warm

emotional contact with a loving mother and a father figure. The child reared in an institution

lacks the personal stimulation and the opportunity for the development of affection and trust

that are important for successful relations with others. It has been reported that such children

often feel rejected, and show a greater frequency of problem behaviors characterized by lack

of impulse control, anxiety, aggression, cognitive limitations and affective impoverishment.

Specifically, they are more restless, hyper-active, limited in concentration, may have temper

tantrums, and are crude destructive. They are more likely to show impairment of speech and

cognitive abilities that lead to academic difficulties.

Children who are living with their parents have more feelings of security, and source

of affection and acceptance, regardless of what they do. They are also fortunate to have good

models, proper guidance in learning skills needed for adjustment, and stimulation of their

abilities to achieve success. Children who are living away from home lack the immediate

presence of loving parents to appraise their success. They are always under tension to secure

the proper kind of attention from those who are looking after them.

In the present study, parental deprivation has been treated as an important concept

having far reaching implications.

The concept of alexithymia was coined by psychiatrist Peter Sifneos to describe the

lack of emotional skills in psychosomatic patients (Sifneos, 1973). Alexithymia signifies a

personality construct typically represented by reduced ability to identify and verbalize

feelings, a less vivid imagination, and an externally oriented, concrete way of thinking.

Literally, alexithymia stands for ‘no words for feelings’ and is a neologism based on three

Greek words: a = ‘lack’, lexis = ‘word’ and thumous = ‘emotion or mood’.

Alexithymia refers to difficulties in identifying and describing feelings, and to an

externally oriented, unimaginative way of thinking. The term was first coined in a

psychosomatic clinical setting (Sifneos, 1973) as patients with illness which were thought to

have psychosomatic etiology seemed to demonstrate a paucity of inner feelings. Later, the

interest in alexithymia moved beyond the psychosomatic clinics. Accumulating empirical

evidence suggests associations between alexithymia and several physical diseases and mental

health disorders (Lumley et al., 2007; Taylor & Bagby, 2004; Taylor, 2000).

Alexithymia has been defined as a deficit in cognitive processing and regulation of

emotions, characterized by difficulties in describing and differentiating emotions and a cognitive

style focused on external events instead of inner experience. Alexithymia is considered an

important risk factor for somatization. Supposedly, emotions of highly alexithymic individuals

are not well represented mentally, with an ensuing tendency to focus on somatic sensations that

accompany emotional arousal and to misinterpret these as signs of illness.

Social network members, such as family, friends and community members, can

provide social support in the form of positive interaction and appraisal that guard against a

negative self image and feelings of worthlessness. Social support from others can also help

individuals to redirect the negative impact from stressors by helping to evaluate the situation

as one that is not beyond the individual’s control and help provide positive solutions to the

problem.

Social support matters for mental health. The mediator effect model of social

interaction posits that “the impact of a stressor is mediated by social interactions with others;

these positive and negative social interactions, in turn, either increase or decrease one’s

vulnerability to psychological distress. (Lincoln et al., 2003).

Social support is a term that does not have a widely agreed-upon definition in the

adolescent health and development literature. Social support is generally defined as a range

of interpersonal relationships or connections that have an impact on the individual’s

functioning, and generally includes social support provided by individual and social

institutions.

Social support may improve coping through different forms of helping behavior, such

as emotional, informational, practical, and appraisal, in adulthood but also in childhood and

adolescence. In addition, support will be protective and will improve well-being through the

psychological effects of the mere presence of others preventing understanding, and of being

sure of receiving help when needed. Social support will not only foster self-esteem and self-

assurance, but also feelings of security and control over oneself and the environment (Heller,

Swindle, & Dusenbury, 1986).

The preamble of the World Health Organization’s charter defined health as a state of

complete physical, mental, social, emotional, and spiritual well-being, not merely the

absence of disease or infirmity. Thus, health is a broader concept including physical, social,

and mental health. Mental health has been reported as an important factor influencing

individual’s various behaviors, activities, happiness, and performance.

Operational definition of mental health is defined as “a person’s ability to make

positive self-evaluation, to perceive the reality, to integrate the personality, autonomy, group

oriented attitudes and environmental mastery” (Jagdish & Srivastava, 1998).

Somatization is the expression of emotional discomfort and psychosocial stress in the

physical language of bodily symptoms (Barskey amd Klerman, 1983). Lipowsky (1988)

defines it as “the manifestation of psychological difficulty or distress through somatic

symptoms, a tendency to experience and communicate somatic distress and symptoms

unaccounted for by pathological findings, to attribute them to physical illness and to seek

medical help. It encompasses a wide spectrum of symptoms referred to various organs”.

The presence of physical symptoms that suggest general medical conditions are

present, but they are not fully explained by general medical conditions, by the direct effects

of a substance, or by another mental disorder. Yet symptoms cause clinically significant

distress or impairment in social, occupational, or other areas of functioning (DSM-IV, APA,

1984).

The term ‘somatization’ was first used by Steckel (1943) who defined it as “a bodily

disorder that arises as the expression of a deep-rooted neurosis, especially of a disease of the

conscious”. He regarded it as identical to Freud’s concept of conversion.

Somatoform disorders are disorders in which patients have physical symptoms (e.g.

pain. Light-headedness, diarrhoea) that suggest a general condition, but are not fully

explained by any general medical condition. These symptoms are not under the patient’s

voluntary control.

Based on the above observations and empirical data, the present study makes an attempt

to examine and compare the perceived social support, general mental health, psychosomatic

complaints and perceived health status of institutionalized and non-institutionalized deprived

adolescents.

OBJECTIVESThe following objectives are framed for the present research work:

1. To study the alexithymia among institutionalized and non-institutionalized

adolescents.

2. To study the general mental health of high and low alexithymics.

3. To study the perceived social support to these alexithymics.

4. To find out interrelationships amongst all the variables of the study.

METHODOLOGYHypothesis:

The hypotheses for the study are as follows:

1. There would be significant relationship between alexithymia and institutionalized

deprived adolescents.

2. It is hypothesized that alexithymia is positively related to institutionalization

along with mental health, depression, anxiety, stress of deprived adolescents.

3. The highly alexithymic would perceived the social support lesser as compared to

low alexithymia.

4. Highly alexithymic would possess poor mental health as compared to low

alexithymic.

5. The perceived social support would be significantly and positively related with

mental health of institutionalized adolescents irrespective of alexithymia.

DESIGN:

With the help of 2x2 matrix, total sample of 1600 adolescents was classified into 4

groups of 400 each: high alexithymic; low alexithymic, institutionalized group; and

non-institutionalized group.

Inst

itutio

nalis

atio

n

Alexithymia

High

alexithymia

Low Alexithymia

Institutionalize

d

400 400

Non-

Institutionalised

400 400

Sample:As per the objective of current study, 800 institutionalized and 800 non-

institutionalized adolescents were selected by adopting stratified random sampling method

from physically deprived areas of Punjab, Haryana, Chandigarh, Rajasthan and Western U.P.

Institutionalized adolescents were those adolescents who were living in either govt. owned or

privately being run institutions, where biological parents were not available to them. To

match the suitable comparative sample, non-institutional adolescents were selected from

deprived areas of corresponding states. Deprivation was taken care of in terms of

socioeconomic status, literacy and physical environment. The sample was selected in the age

range of 17-19 years. Several demographic variables like material status, employment status,

area of residence, education were controlled and exclusion criteria was set to be any

diagnosed illness.

Two stage sampling was done for the present study. In the first stage, after making

the list of available and approved children homes and schools in states, various institutes

were visited which were selected randomly by using the fish-bowl sample technique. Further

the children were selected with the help of incidental purposive technique of sampling.

Before administration of tools, children were enquired about their demographic information

and consent was taken.

Tools:Toronto Alexithymia Scale (TAS): Alexithymia was assessed using Twenty item Toronto

Alexithymia Scale rated on 5-point Likert Scale of agreement ranging from 1 (Strongly

Disagree) to 5 (Strongly Agree), with a higher scores indicating more alexithymia. This is

self-report scale consist of 3 factors: Factor-1 (Fl) difficulty identifying feelings, Factor-2 (F

2) difficulty describing feelings, and Factor-3 (F3) externally-oriented thinking. These three

factors represent essential inter-correlated traits that are theoretically congruent with the

alexithymia construct. The TAS-20 eliminates the theoretical overlap of the three factors and

the cross-loading of items that was a liability in earlier versions, and demonstrates good internal

consistency and test-retest reliability. TAS scores can be used dimensionally (scores range

20-100) and categorically, indicating 'yes' or 'no' alexithymia (score > 60 & < 60, respectively).

General Health Questionnaire (GHQ): The mental health was assessed using 28-item General

Health Questionnaire (Goldberg, 1978) which assessed mental health on the dimensions of

anxiety, depression, somatic symptoms and social dysfunction. Low score on this questionnaire

indicate poor health.

Somatic Health Complaints Checklist (SHCC): The Psychosomatic health was assessed by the

Somatic Health Complaints Checklist (Singh & Srivastava, 1998) consisting of 28 items rated on

5-point scale of frequency. Higher the scores, greater the symptoms.

Social Support Questionnaire (SSQ): Social Support Questionnaire (Sarason, Levine Basham

& Sarason, 1983) of 27 items will be used. It has been factor analytically derived from a large

body of items intended to measure the functions of social network. The two basic elements

studied by this scale are: (i) Number of available others to whom individual believe they

can turn to in times of need (SSQN). (ii) The degree of  satisfaction they anticipate from

support they see as available on a 6-point rating scale (SSQS). The correlation of items with the

total score for SSQN ranged from 0.51 to 0.79. The correlation of items with the total score of

SSQS ranged from 0.48 to 0.72. The test-retest correlation for number and satisfaction were 0.90

and 0.83 respectively. For the present study of scores obtained in terms of both:

(i) the number of score (N) as well as

(ii) the satisfaction score (S).

STATISTICAL ANALYSIS

In order to derive the conclusion for proposed hypotheses from the obtained results of

data collected, 2x2 ANOVA was applied to examine the causal-effectual relationship

among the variables, where 1st order i.e. main effect and 2nd order effect i.e.

interactional effect of each demographic variable. Bivariate correlation matrix was

calculated for inter variable relationship, suggestive of indicating the magnitude and

direction of relationship possessed by among variables. In some cases where

interactional effect appeared to be significant, t-ratio was also calculated to examine

the groups caused by interaction of alexithymia with institutionalization.

RESULTS & DISCUSSION

The results have been meaningfully presented under the following headings:

1) Correlation matrix, depicting strength and the direction of relationship among various

variables with each other

2) Independent versus interaction effect of independent variables i.e. Alexithymia and

Institutionalization on dependent variables i.e. Mental Health (consisting physical;

autonomic; cognitive; and depression – all separately as well as in total), Somatic

Health (as measured by SHC) and Perceived Social Support, as revealed by 2X2

ANOVA

3) Graphical representations of comparison between the means of all dependent

variables (GHQ-A, GHQ-B, GHQ-C, GHQ-D, SSQ-N, SSQ-S, and SHC) among the

categorized groups on the basis of independent variables, i.e., High Alexithymia

versus Low Alexithymia and Institutionalized versus Non-Institutionalized groups.

Main Findings

Institutionalization has significant effect on perceived social support providers whereas,

have non-significant effect.

There is significant effect of institutionalization and interaction of alexithymia with

institutionalization on satisfaction out of the perceived social support providers.

Alexithymia, institutionalization and interaction of both have no significant effect on

physical health as an index of general health.

There is significant effect of alexithymia and institutionalization separately on autonomic

health of an individual, however, strangely but non-significant effect of interaction of both.

There is highly significant effect of alexithymia and comparatively less significant effect

of interaction of alexithymia with institutionalization, however, at the same time non-

significant effect of institutionalization on cognitive health among adolescents as such.

Alexithymia and Institutionalization have highly significant effect on the depression as a

domain of mental health, whereas, surprisingly non-significant effect of interaction of both

independent variables on dependent variable. This could be a matter of concern for the

future researchers.

There is highly significant effect of alexithymia only on total scores of GHQ, revealing

one’s general health, whereas less significant of institutionalization as a single factor,

however, non-significant effect of interaction of both the variables.

Alexithymia and institutionalization have highly significant effect on somatic health

(complaints) among adolescents, whereas, the interaction of both is non-significant. This

also requires replication and validation in near future.

In the present study alexithymia and institutionalization were treated as independent

variables affecting the overall mental health and somatic health as dependent variables

separately as well as in relation with the effect of social support.

In this study, we argued that social support might serve as a protective factor in the

development or occurrence of physical problems, somatic problems, mental illnesses and can

be beneficial in minimizing the effect of alexithymia on physical as well as mental health or

can help in preventing the occurrence of alexithymia among institutionalized and non-

institutionalized adolescents.

The current cross-sectional comparative study primarily aimed at investigating the role of

alexithymia in relation to social support on mental health among institutionalized and non-

institutionalized adolescents. It was hypothesized that institutionalized adolescents would

score higher on alexithymia with less number of social support providers perceived and less

satisfaction with the social support perceived than non-institutionalized adolescents.

The present investigation can be concluded by stating that besides the fulfillment of aimed

objectives for the study, three out of five formulated hypotheses were accepted and two were

rejected. The accepted hypotheses are: H1; H2 & H4 as institutionalized adolescents were

found to be higher on alexithymia than non-institutionalized adolescents (H1); Alexithymia

irrespective of institutionalization was found to be significantly potential causing poor mental

health or mental health problems among adolescents (H2) and high alexithymics and

institutionalized adolescents were found to be scoring low on SSQN i.e. number of perceived

social support providers (H4). Whereas H3 & H5 were found to be not acceptable as

alexithymia in combination with institutionalization was not found to be significantly

potential for causing mental health problems (H3) as interactional effect of alexithymia and

institutionalization was found to be not at all significant at traditional level; at the same time

H5 i.e. social support satisfaction would play a preventive role among high alexithymic

adolescents to protect from mental health problem, was also not found to be supported by the

results as though high level of satisfaction was observed among them but at the same time

they were found to be high on mental health problems than low-alexithymic adolescents.

Apart from the objective fulfillment and hypotheses testing alexithymia was found to be

emerged as a predictor correlate of depression marked with loneliness tendency, negative

cognition, anxiety, mental health problem and somatic health problems among the

institutionalized adolescents with low social support.