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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 119-124

Examining the relationship between attachment, somatization, and expressing emotions


Department of Clinical Psychology, Institute of Social Sciences, Üsküdar University, Istanbul, Turkey

Date of Submission19-Apr-2021
Date of Decision08-Jul-2021
Date of Acceptance16-Jul-2021
Date of Web Publication13-Aug-2021

Correspondence Address:
Gökben Hizli Sayar
Üsküdar University- Altunizade-Üsküdar, İstanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnbs.jnbs_19_21

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  Abstract 


Aim: The baby's special relationship with his caregiver affects his future psychological and physical health. The disruption of the mother-baby bonding can lead to mental difficulties and even psychopathologies in that period and afterward. This study aimed to reveal the relationships between attachment, expressing emotion, and somatization. Materials and Methods: A total of 175 volunteer university students, 142 females, 33 males, were included in the study. In the study, data were collected via self-report forms, namely, sociodemographic form, the Parental Bonding Instrument, the Somatization Scale, and the Emotional Expression Questionnaire. Results: A low level of negative correlation was found between expressing emotions and attachment to the mother. A weak but statistically significant negative relationship was found between somatization and attachment to mother and father. A weakly significant negative correlation was found between somatization and Overprotection-Father scores. While the somatization scores of the participants increased, the perceived protective, controlling, nonsupporting attitudes of the father also increased significantly. Conclusion: Further research needs to be focused on the theoretical and clinical implications of these results. The precise nature of these possible relationships is yet to be interpreted.

Keywords: Attachment, emotional expression, somatization


How to cite this article:
Yesil H, Özdogan B, Ünübol H, Sayar GH. Examining the relationship between attachment, somatization, and expressing emotions. J Neurobehav Sci 2021;8:119-24

How to cite this URL:
Yesil H, Özdogan B, Ünübol H, Sayar GH. Examining the relationship between attachment, somatization, and expressing emotions. J Neurobehav Sci [serial online] 2021 [cited 2021 Oct 17];8:119-24. Available from: http://www.jnbsjournal.com/text.asp?2021/8/2/119/323804




  Introduction Top


Scientists who try to understand human behavior have been focusing on attachment for many years. Attachment theory explores the impact of early experiences with caregivers on subsequent interpersonal behaviors and perceptions.[1] According to the attachment theory, a baby's special relationship with his caregiver affects his future psychological and physical health. Forming and sustaining social ties that are safe and satisfying seems to be a fundamental human desire. Deprivation of this need, particularly in early childhood, can affect how people function in relations in their adult life and can contribute to building adult insecure attachment patterns.[2] The disruption of mother-infant bonding can lead to mental challenges and even psychopathologies both in that period and after.[3] Hence, it is essential to understand this relationship with the caregiver. The attachment theory is a practical conceptual framework for understanding the development of somatization in adults.[4]

Somatization is described as a tendency to encounter and communicate somatic distress and symptoms unaccounted for by pathological findings, attribute them to physical illness, and seek medical help.[5] Expressing emotion, on the other hand, is verbal or nonverbal behaviors that can be seen from the outside after the emotions are experienced. They may be actions that follow an emotion such as shedding, crying, laughing.[6] Studies have revealed a relationship between attachment and somatization. Other studies have shown that there is a relationship between expressing emotions and psychological and physiological well-being.

On the other hand, emotional processing has an essential place in attachment theory. All sorts of attachment are formed by the pattern of parent-child interaction. In communicating with caregivers, the infant internalizes specific cognitive and emotional responses named the internal working model. The attachment type has a critical role in processing emotional situations and acquiring emotional responses.[7]

Although recent research reported that secure attachment could be considered as a protective factor against deficits in emotional processing and somatization of negative emotions,[8] relatively few studies focused on relationships between somatization and attachment. This study aims to reveal the relationships between attachment, expressing emotion, and somatization.


  Materials and Methods Top


Methods

The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee (61351342/2019-10).

In this correlational study, 175 volunteers (142 females and 33 males) students were reached at Üsküdar University. The sampling selection method is sampling according to the group present. The age range of the participants forming the sample was calculated as 22–52 years (mean = 27.15). The education level of the participants varies from undergraduate to doctorate with a mean of 13.4 years.

Materials

Sociodemographic form

To determine the sociodemographic characteristics of the participants and to investigate the factors affecting other scales, they are asked about their age, gender, education, marital status, income level, current chronic illness, whether there is a psychiatric illness in himself or his family, and a medical illness. It is a form consisting of 11 questions, including the medical history.

The parental bonding instrument

The Parental Bonding Instrument (PBI) was developed by Parker, Tupling, and Brown in 1979.[9] Kapçı and Küçüker conducted the Turkish validity and reliability study in 2006. This scale evaluates not attachment styles, but positive or negative attachment to parents.[10] The scale consists of 25 items. Twelve of these items are in the sub-dimension of interest, and 13 of them are in the care-control/overprotection sub-dimensions. The person is asked to respond to the items considering the first 16 years of his life. For each item, there are the options “It was totally like this,” “It was partially like this,” “Not quite like this,” “It was not like this at all” and the person is expected to choose one of them. Scoring is between 0 and 3 for each statement, while the person can get the minimum “0” and the maximum “36” points from the interest dimension, the minimum “0” and the maximum “39” points for the care-control/overprotection dimension.

Somatization scale

The validity and reliability study of the Somatization Scale (SS) was carried out by Dülgerler in 2000.[11] Each expression on the scale has a choice of “true” or “false.” A total score is obtained by adding up the scores from correct and incorrect answers. The scores obtained from the scale range between “0 and 33.” If the scores get closer to 33, it indicates somatization disorder.

Emotional Expression Questionaire

Emotional Expression Questionaire (EEQ) was developed by King and Emmons in 1990 and adapted to Turkish by Kuzucu.[12] The scale determines at what level “positive,” “negative” and “closeness” feelings are expressed in interpersonal relationships and individually, verbally, or nonverbally. It has 15 Likert items. The total score is obtained by adding the score from each item on the scale. A high score means a high expression of emotion.[13]

Statistical analysis

SPSS v. 20.0 package program (software package SPSS® version 20.0, IBM Inc., Chicago, IL, USA) was used to evaluate the data. t-test and one-way ANOVA test were used in the analysis of normally distributed data. Pearson's correlation analysis was used to examine the relationship between variables. P < 0.05 was accepted as a statistical significance level.


  Results Top


175 subjects (n = 175) participated in the study. Women had a rate of 81.1% (n = 142) and men had a rate of 18.9% (n = 33). The average age of the participants was 27.15. Of the participants, 81.5% (n = 141) are single and 18.5% (n = 32) are married. While 15.6% (n = 27) of the participants stated that they applied to the psychiatry department before, 84.4% (n = 146) stated that they did not have such an application. Those with a history of psychiatric illness in their families constituted 22% (n = 38) of the participants.

The average score the participants got from the Parental Attachment Scale (PAS)-Mother scales is 44.74; the average of the scores they got from the PAS-Father scales is 44.86. The average of the scores the participants got from the EEQ is 73.35. The average of the scores the participants got from the SS is 7.69. Examination of the relationship between the participants' PBI, EEQ, and SS scores is given in [Table 1].
Table 1: Examination of the relationship between the participant's parental bonding instrument, emotional expression questionaire, and Somatization Scale scores (Pearson correlation test results)

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When the PBI, EEQ, and SS scores of the participants were compared according to their gender, PBI and EEQ scores did not show a statistically significant difference between women and men (P > 0.05). SS scores were statistically significantly higher in women (8.22 ± 4.50) compared to men (5.28 ± 3.37) with a significance level of P < 0.001.

When the PBI, EEQ, and SS scores of the participants were compared according to their marital status, the overprotection-Mother scores were found to be statistically significantly higher in married (15.51 ± 3.35) compared to single (13.24 ± 4.96, P < 0.05). Overprotection-Father scores were found to be statistically significantly higher in married (16.06 ± 4.11) than singles (14.08 ± 4.79, P < 0.05). EEQ scores were found to be statistically significantly higher in married (76.73 ± 7.89) compared to single (72.61 ± 9.38, P < 0.05). SS scores did not show a statistically significant difference between married and single individuals (P > 0.05).

Care Control-Father scores were found to be statistically significantly higher in those with high-income levels (30.94 ± 6.11) compared to those with medium (30.50 ± 5.51) and low income (25.82 ± 6.68, P < 0.05). EEQ scores do not differ statistically significantly according to income level (P > 0.05). SS scores were also not statistically significantly different according to income level (P > 0.05).

When the PBI, EEQ, and SS scores of the participants were compared according to having or not having a child, the Care Control-Mother scores were found to be statistically significantly higher (P < 0.05) in those without a child (31.32 ± 5.27) compared to those with a child (28.65 ± 5.12). Overprotection-Mother scores were found to be significantly higher in those with a child (15.61 ± 3.76) compared to those without a child (13.35 ± 4.89, P < 0.05). Overprotection-Father scores were found to be significantly higher in those with children (16.47 ± 3.89) compared to those without children (14.23 ± 4.78) (P < 0.05). EEQ scores do not show a statistically significant difference according to whether they have children (P > 0.05). SS scores were also not statistically significantly different between those with and without children (P > 0.05).

PBI-Father total scores were higher in those with a low somatization level when compared to a high somatization level and a moderate somatization level (P < 0.05). Care-Control Father total scores were higher in those with a low somatization level when compared to a high somatization level and a moderate somatization level (P < 0.05). Overprotection Father's total scores were higher in those with a low somatization level when compared to a high somatization level and a moderate somatization level (P < 0.05). The statistical effect of variables on somatization is given in [Table 2].
Table 2: Statistical effect of variables on somatization

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In the model, the participant's age, gender, marital status, education level, whether or not they have children, medical illness history, family history of psychiatric illness, PBI Mother and PBI Father total scores, and total score of Emotion Expressing Scale were tested. It was found that being a woman increased the presence of somatization with a coefficient of 1.446 (P < 0.05, 95% confidence interval: 1.223–14.753).


  Discussion Top


In this study, the associations between attachment, somatization, and expressing emotions were aimed to be examined. As a result of the study, it was determined that there was no statistically significant relationship between expressing emotions and somatization. This research supported the hypothesis that there is a relationship between attachment and somatization and attachment with expressing emotion. Besides, the gender factor was found to be the influencing variable in somatization.

The results of this study revealed that somatization differs according to gender. Somatization Scale scores were found to be statistically significantly higher in women compared to men. The literature supports our research results. It has been found that somatization disorder is seen 5–20 times more in women than men.[14],[15] Studies show that the prevalence in women ranges between 0.2% and 20%, somatization is lower than 0.2% in men.[16] Somatization is more common in women over the age of 40 than in younger ages.[17] Other studies have shown that bodily complaints are expressed more by women. It has also been stated that physical disorders not based on an organic cause are more common in women.[18] First-degree female relatives of women diagnosed with somatization disorder may also have an increased risk for somatization disorder.[15]

In this study, a slightly significant negative correlation was noticed between mother attachment and somatization. Although it is a mild relationship, the degree of somatization decreases as the levels of individuals to find their mothers meet their psychological and physical needs increase. Furthermore as the father's positive evaluation increases, the somatization scores of the participants decreased. The literature also presents results compatible with this study. Stuart and Noyes found in their study that the attachment of patients experiencing somatization was anxious, and this attachment arises from their childhood experiences with their caregivers.[19] A study on people who took part in the war found that people who had traumatic experiences in their childhood had more depression, anxiety, and somatization symptoms, whereas the group with fewer stress symptoms than those with a secure attachment style.[20] According to the present study results, a low level of significant negative correlation was found between the participants' expressing their emotions and their attachment to the mother. In other words, as individuals' expressions of emotions increase, their positive evaluation of their mothers and finding their mothers as relevant decreases. A longitudinal study found that securely attached individuals had more emotional experiences with their partners during adulthood and expressed less negative emotions.[21] Another study points to a mild-to-strong relationship between mother's interest in childhood and alexithymia, the difficulty in recognizing and expressing emotions. A slight correlation was found between parental overprotection and alexithymia and between parental overprotection and difficulty expressing emotions.[22] In our study, no relationship was found between attachment to father and expressing emotion. Contrary to our findings, a study found a positive relationship between alexithymia scores and childhood maternal neglect and paternal indifference.[23]

Another hypothesis of the present study was that there is a relationship between somatization and expressing emotions. Research findings revealed that there was no relationship between EEQ and SS scores. Research findings from the literature on the subject do not seem compatible with this study. It has been thought that chronic pain and depression may be related to difficulties in communication with others, disruption in processing intense emotions, and immune system problems.[24] A study conducted on oncologists found a positive correlation between participants' levels of burnout and their negative attitude in expressing emotions.[25] There found to be a negative correlation between the prevalence of eating disorders, different somatic disorders, and substance addiction, and the levels of perception and expression of emotion.[26] A recent study provides strong support for the assumption that attachment avoidance and attachment anxiety distinctively predict health outcomes, and emotion dysregulation can be one of the mechanisms explaining attachment–health relationships.[27]

This research has some limitations. The most important limitation of this study is its cross-sectional character. This type of research certainly cannot be an ideal way to establish causality between different variables. Furthermore, the data in this study are based on self-report measures. Due to the use of questionnaires that can only check for symptoms, not whether these symptoms are medically explained or not, it is, however, not possible to conclude somatization adequately defined.


  Conclusion Top


In this study, the possible relationships between attachment, somatization, and expressing emotion were investigated. A low level of negative correlation was found between expressing emotions and attachment to the mother. A weak but statistically significant negative relationship was found between somatization and attachment to mother and father. A weakly significant negative correlation was found between somatization and overprotection-father scores. While the somatization scores of the participants increased, the perceived protective, controlling, nonsupporting attitudes of the father also increased significantly.

Further research needs to be focused on the theoretical and clinical implications of these results. The precise nature of these possible relationships is yet to be interpreted.

Patient informed consent

Informed consent was obtained.

Ethics committee approval

The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee (61351342/2019-10).

Financial support and sponsorship

No funding was received.

Conflicts of interest

There are no conflicts of interest to declare.

Author contribution subject and rate

Hatice Yeşil (50%): Design the research, data collection, and analyses and wrote the whole manuscript

Büşra Özdoğan (15%): Contributed with on research design and analyses

Hüseyin Ünübol (10%): Supervised the article write-up

Gökben Hızlı Sayar (25%): Supervised the research, contributed with comments on research design and manuscript.



 
  References Top

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    Tables

  [Table 1], [Table 2]



 

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