|Year : 2022 | Volume
| Issue : 3 | Page : 170-179
Role of Early Maladaptive Schemas and Alexithymia in the Relationship Between Perceived Parenting Styles in Moroccan Psychoactive Substance Users
Khadija Karjouh1, Fatima-Zahra Azzaoui1, Samira Boulbaroud2, Wafae Idrissi Samlali1, Ahmed Ahami1
1 Laboratory of Biology and Health, Department of Biology, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
2 Polydisciplinary Faculty, Beni Mellal, Morocco
|Date of Submission||18-Apr-2022|
|Date of Decision||24-May-2022|
|Date of Acceptance||06-Jun-2022|
|Date of Web Publication||3-Oct-2022|
Laboratory of Biology and Health, Department of Biology, Faculty of Science, Ibn Tofail University, University Campus, P.O. Box 190, Kenitra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: Many studies have reported that inadequate parental styles can contribute to alexithymic symptoms through maladaptive dysfunctional cognitive styles. Aims: To investigate the relationship of dysfunctional schemas and recalled parenting attitudes with alexithymia and other symptomatology, as well as to evaluate the effect of early maladaptive schema (EMS) and alexithymia such as moderators and mediators in the relationship between the perceived parenting styles (PS) among patients with substance use disorders (SUDs). Methods: The study sample consists of 451 Psychoactive Substance (PAS) users, aged between 13 and 67 years of age. The data collection took place in the addictology center of Rabat, Morocco. The Young Schema Questionnaire-Short Form, the Young Parenting Inventory, the 20-item Toronto Alexithymia Scale (TAS-20), the State-Trait Anxiety Inventory, the Columbia-Suicide Severity Rating Scale, and the Rosenberg Self-Esteem Scale were used. Descriptive statistics tests and hierarchical multiple regression were executed. Results: First, the sample was classified into two groups as “alexithymic” (n = 330) and “nonalexithymic” (n = 121) according to the scores obtained from TAS. The analysis showed that the alexithymic group perceived both their attitudes of mother and father negatively, possess more severe EMSs, and women face more difficulties in the emotion regulation, experienced greater EMS than the men group, and the association between parenting and alexithymia was moderated by EMS. On the contrary, the results supported meditational models in which PS are associated with the cognitive schemas, and these, in turn, are related to alexithymia. Conclusions: Correlations between childhood experiences and alexithymia in adulthood are mediated by dysfunctional schemas.
Keywords: Alexithymia, early maladaptive schemas, morocco, perceived parenting styles, substance use disorders
|How to cite this article:|
Karjouh K, Azzaoui FZ, Boulbaroud S, Samlali WI, Ahami A. Role of Early Maladaptive Schemas and Alexithymia in the Relationship Between Perceived Parenting Styles in Moroccan Psychoactive Substance Users. Int J Nutr Pharmacol Neurol Dis 2022;12:170-9
|How to cite this URL:|
Karjouh K, Azzaoui FZ, Boulbaroud S, Samlali WI, Ahami A. Role of Early Maladaptive Schemas and Alexithymia in the Relationship Between Perceived Parenting Styles in Moroccan Psychoactive Substance Users. Int J Nutr Pharmacol Neurol Dis [serial online] 2022 [cited 2022 Nov 29];12:170-9. Available from: https://www.ijnpnd.com/text.asp?2022/12/3/170/357212
Key Messages: The implication of emotional dysregulation in the etiology, clinical evolution, and treatment of addiction, needs the systematic detection of alexithymia, as well as the incorporation of psychotherapeutic approach to improve the emotional abilities of drug-dependent patients.
| Introduction|| |
Substance use disorder (SUD) continues to be a global problem of significant proportions in society, affecting not only individuals’ health and well-being but also society’s economic development and environmental sustainability. In Morocco, the most recent studies of drug abuse prevalence have indicated a serious and growing problem (5.8%). Zarrouq et al. have investigated the associated factors of psychoactive substance use in Morocco and revealed that male gender, secondary school level, smoking tobacco, living with family members who use tobacco, and feeling insecure within family environment were the risk factors predicting drug use within middle and high school students.
Moreover, the biological, environmental (unhealthy parenting practices), and social factors were the main causes of personality disorders in children, including substance dependence.
Young et al. defined a schema subset of enduring and pervasive psychological factors labeled schemas as early maladaptive schema (EMS) which is a broad, pervasive theme or a pattern comprising memories, emotions, cognitions, and bodily sensations regarding oneself and one’s relationships with others developed during childhood or adolescence, and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.
Consequently, Young et al. paid more attention to the importance of focusing on EMS, or other aspects of personality in psychological disorders, in particular in substance dependence.
EMS may operate as etiological risk factors by causing affective disturbance, prompting individuals to reduce negative affect through the use of substances. For other individuals, their substance misuse may be influenced by alternative risk profiles, mediated by their specific repertoire of biological, psychological, social, and cultural vulnerabilities.
Therefore, toxic experiences in childhood may contribute to psychopathological development in offspring during their lifespan.
In this regard, several factors associated with this perceived parenting styles (PS)/behaviors which influenced the occurrence of psychological symptoms have been investigated as well. EMSs are among the most widely investigated factors contributing to the development of personality disorders, since they are related to the early enduring experiences with parents.
The association between maltreatment during childhood, EMS, and the presence of different symptomatology has been demonstrated by investigating the relationship between EMS and psychopathological symptoms, suicide, and recently alexithymia.
Numerous studies have identified a relationship between perceived parenting and the development of depression symptoms and anxiety disorders. It is well known through the results of these studies that overcontrolling, critical and punitive, and uninterested/depriving parent perceptions play significant role, especially in the development of depression and anxiety.
Moreover, the studies found investigated psychopathologies other than EMS and perceptions of PS, such as depressive disorders, anxiety disorders, eating disorders, personality disorders, and only one survey has also investigated the condition of SUD, which is a neuropsychiatric disorder characterized by a craving for, the development of tolerance to, and difficulties in controlling the use of a particular substance or a set of substances, as well as withdrawal syndromes upon abrupt cessation of substance use. Apart from the aforementioned, it is often associated with other psychiatric conditions such as, major depressive disorder, or anxiety disorder.
Addictive disorders are also associated with various psychological disorders such as sleep disorders, suicidal behavior, and depressive disorders. In this line of thinking, it can be inferred that PS seems to be significantly related to variables of consumption history and drug dependence, anxiety, and depression.
In many studies conducted with different populations, significant relation was found between maladaptive PS and/or both EMS domains and depressive symptoms, such as authoritarian parenting and EMS; Emotional Deprivation (ED) and excessive parental control; maternal pessimism, paternal overprotection, and emotional alienation; low parental care and overprotection; emotional neglect and low-income alcoholic parents; and maternal rejection. Additionally, another study showed significant association between low parental responsivity levels, major depression symptoms, and high levels of psychological control. In particular, depressive symptoms were significantly associated with the structure of schemas characterized by strongly interconnected negative information and weakly dispersed positive information.
Consistent with these, other authors have also found that dysfunctional poor parenting is related to the development of pathological personality disorder symptomatology., Through this symptomatology, dysfunctional perceived parenting styles were related to mediating role of EMS.,,,
As far as we are concerned, we are more interested in the relationship between EMS and the PS among psychoactive substance users. Since, until now, only one study has examined the interrelationships between EMS and parenting origins in substance abusers.
Jalali et al. have investigated the psychological symptoms and assessed the possible repercussions of parental functioning in opioid-dependent males in comparison to opioid nondependents, noting that opioid-dependent males reported a higher number of adverse parenting experiences and a more negative view of self and others, compared to the control groups. With regard to EMS and their domains, the two groups differed significantly. Approximately, all EMS were related to their parenting origins which, in turn, were related to their corresponding schemas.
In parallel, the results also showed that the clinical group was more likely to develop psychiatric symptoms and described their mothers lower on the emotion deprivation, less affective, and higher on the abandonment during their childhood, when compared with controls. All parenting origins were significantly different between the two sample groups, except for Mistrust/Abuse (MA), Defectiveness/Shame (DS), Dependence/Incompetence, and Failure in mother parenting origins. In turn, father parenting origins, the exception was the origins of Failure, DS, and Self-Sacrifice schema.
Several studies have concluded that different domains of EMSs play a mediator role on the relationship between different PS and different symptomatology.
Therefore, it is concluded in the literature, poor PS may contribute to the association with psychological manifestations in offspring through its effects on children’s beliefs about themselves, their future, or ways of interpreting life experiences, especially, depression and EMS have a mediating effect on this relationship. Particularly, children reared in a controlling environment, and especially those with no warmth and care, may develop ways of thinking that increase their vulnerability to develop psychological symptoms in the short term, as well as over the course of development into adulthood. Consequently, it can be hypothesized that unhealthy core beliefs develop the necessary cognitive level to understand the links between poor perceived parental styles in childhood and subsequent psychological symptoms.
Moreover, certain personality characteristics, low confidence, using maladaptive beliefs, and perceiving lower levels of emotional regulation increase the likelihood of psychological problems.
Unfortunately, not many researches were found in this area. There are limited studies investigating the mediating role of EMSs on parenting practices and other psychological symptoms, such as depression, anxiety, alexithymia, suicide, and low self-esteem in substance abusers, along with the effects of perceived PS and EMS on the psychological symptoms. Despite the relevance of the topic, a recent meta-analysis revealed this scarcity of published research in this area.
In this respect, the aim of the study is to examine the interrelationship between PS and the emergence of study measures in adulthood among addicted patients and the role of dysfunctional schemas as mediators or moderators.
| Subjects and Methods|| |
The study was conducted in addictology center in Rabat, Morocco, during 1 year, between March 13, 2017 and March 30, 2018.
The participants consisted of 451 patients, 62 (13.7%) women and 389 (86.3%) men, who were received at the center for the first time.
The recruitment of patients is based on the following criteria:
- patients aged >13 years,
- the patients not having undergone any treatment recently, and
- individuals were included if they met criteria for a current drug use other than nicotine.
Interviews with the subjects computed in the study sample were done after accepting the patient at the center.
All the patients were assessed by using a semistructured, sociodemographic information form. This form included questions on age, sex, marital/professional, and academic status.
The following questionnaires were subsequently administered to the patients:
- The 20-item Toronto Alexithymia Scale
- The 20-item Toronto Alexithymia Scale (TAS-20; α = 0.816) was applied to investigate the level of alexithymia. The TAS-20 is a self-report scale made of 20 items that must be rated from one (strongly disagree) to five (strongly agree).
- The State-Trait Anxiety Inventory
- The State-Trait Anxiety Inventory (STAI-Y; α = 0.83) is a self-report measure that quantifies anxiety. This particular instrument is used to simplify the separation between state anxiety and trait anxiety, feelings of anxiety, and depression. STAI-A evaluates state of anxiety while STAI-B measures trait anxiety.
- The 21-item Beck Depression Inventory
- Beck Depression Inventory (α = 0.866) is a self-report scale developed by Beck et al.in order to assess the level and severity of the cognitive, affective, and somatic symptoms of depressive disorders.
- The Columbia-Suicide Severity Rating Scale
- The Columbia-Suicide Severity Rating Scale is a semistructured interview which was developed to fill a void, where there was no unique assess that included systematic measure of both suicidal ideation (passive and active suicidal ideation) and behavior (i.e., actual attempts, interrupted attempts, aborted attempts, preparatory acts or behavior, and self-injurious behavior), to quantify the severity of suicidal ideation, the intensity of ideation, suicidal behavior, and lethality of suicide attempts.
- I have received training in the administration of this scale, which is required to use this questionnaire.
- The Rosenberg Self-Esteem Scale
- The Rosenberg Self-Esteem Scale (α = 0.721) consists of 10 items assessing the level of global self-esteem. In this scale five items are presented in positive form and five items in negative form. Responses were rated on a five-point Likert scale ranging from one (strongly disagree) to five (strongly agree).
- Young Parenting Inventory
- The Young Parenting Inventory (YPI; α = 0.90) is a 72-item, self-report measure of perceived parenting experiences during childhood. This measure is designed to assess the parental origin separately than the EMSs identified by Young et al.
- Young Schema Questionnaire-Short Form or Early Maladaptive Schema Questionnaire
- The Early Maladaptive Schema Questionnaire is made by Young et al., in order to measure EMSs. Patients assess themselves regarding that which schemas describe their situation, based on a six-point Likert scale. Young Schema Questionnaire-Short Form (α = 0.902) is a self-report tool for evaluating schemas. It consists of 75 items tending to assess 15 core beliefs in five main schematic domains of the EMS.
Descriptive statistics tests and hierarchical multiple regression were executed for the purpose of analyzing data. Firstly, for the aim of making normality of the data, Kolmogorov–Smirnov test was performed. Linearity test was also utilized for the assessment of the linear correlation. The results of both tests revealed normality and linear correlation.
Data were expressed as mean ± standard deviation for quantitative variables and percentage for qualitative variables. We also used the independent samples test for comparison between two independent groups. Significance was seen at a P-value < 0.05.
| Results|| |
There were a total of 451 participants in this study, 62 women (13.7%) and 389 men (86.3%). The average age was 26.76 years (±10.51; minimum 13 years and maximum 67 years).
[Table 1] and [Table 2] shows the mean scores of each schema in both alexithymic and nonalexithymic groups.
|Table 1 Mean scores and standard deviations of participants’ demographic information (n = 451)|
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|Table 2 Relationships between early maladaptive schemas (EMSs) in sample with and without alexithymia among male and female|
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The means for all EMSs in the alexithymic group are higher than the nonalexithymic group and also in the schema domain categories. The women alexithymic group experienced greater EMS than the men alexithymic group.
A series of t tests were then conducted to explore the relationship between YPI-F [Table 3] and YPI-M [Table 4] means and their alexithymic diagnosis.
|Table 3 Relationships between perceived fathers’ parenting style scores and alexithymia|
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|Table 4 Relationships between perceived mothers’ parenting style scores and alexithymia|
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We found that average parental style scores differed significantly between alexithymic and nonalexithymic groups in all subscales of the YPI-F (except Punishment, P = 0.849). The alexithymic group experienced greater maladaptive parental attitude from father than the nonalexithymic group, with the exception of Entitlement/Grandiosity (EG).
[Table 4] shows that alexithymic patients consistently showed more unhealthy scores toward mothers than nonalexithymic did [except Abandonment/Instability, Vulnerability to Harm or Illness (VHI), DS, Self-Sacrifice, and EG], and that this difference was significant for all subscales, except Dependence/Incompetence (P = 0.870), Negativity/Pessimism (P = 0.675), and Punishment core beliefs (P = 0.741).
Means for all YPI-M subscales among women in the alexithymic group are higher than those observed among men (except for EG).
The correlation, Cronbach alphas mean, and standard deviations of variables are presented in [Table 5]. All scales had >0.70 alpha reliability coefficients (except for schema domain 4 and 5, α = 0.529, and α = 0.678, respectively).
|Table 5 Correlation between psychopathological symptoms, mother and father’s parenting style, schema domains, and early maladaptive schemas scales and Cronbach alpha mean ± standard deviations of our patient sample|
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Correlations were significant at P < 0.01 and P < 0.05 level.
The correlations indicated that almost in all psychopathological symptoms, PS, schema domains, and EMS scales, there were significant correlations between parenting schemas.
To test the hypothesis stating that the relationship between PS and alexithymic symptoms were mediated by EMS, multiple regression analyses were conducted, which are demonstrated in [Table 6] and [Table 7]. In order to investigate the mediator role of EMS between perceived PS and alexithymic symptoms, hierarchical regression analyses were performed.
|Table 6 Hierarchical and multiple regression analyses examining the mediating role of EMS between parenting style-father (PS-F) and alexithymia among addicts|
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|Table 7 Hierarchical and multiple regression analyses examining the mediating role of EMS between parenting style-mother (PS-M) and alexithymia among addicts|
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| Discussion|| |
The present study was conducted to investigate the potential role of core beliefs and schemas in the relationship between recalled parenting in childhood and alexithymia in the adulthood among Moroccan psychoactive substance users. This study aimed to investigate the effect of EMS on the relationship of childhood maltreatment and toxic experiences through parenting attitudes with alexithymia and other symptomatologies.
The present study exhibited the correlations of EMS and PS with psychological symptoms and alexithymia. Similarly, a study, in a clinical sample, found that parenting overprotection was significantly associated with vulnerability to alexithymia in adulthood and especially with Difficulty Identifying Feelings (DIF).
The results also showed that perceived PS was linked with psychological symptoms among patients, that is, apart from cultural influences on PS, any inadequacy in parenting leads to high risk for offspring’s psychological problems later in adulthood. OOther evidence has examined alexithymia in relation to depression; these studies have proposed that for anxiety and suicidal ideation, depression may be the pathway that links dependence with alexithymia. This finding is in agreement with studies in clinical samples.
Similar to the previous researches, the present study demonstrated that exposure to a lack of perceived low parenting is associated with increased risk of alexithymia and symptomatology in adulthood. These results pointed out the relationship of PS and EMS with alexithymia among psychoactive substance users. The outcomes obtained in this part are consistent with, theory. They hypothesized that maladaptive schemas are generally developed from unmet or frustrated developmental and emotional needs early in life − due to negative PS − which once activated, negatively distort the cognitive patterns, leading an increased risk of psychopathological symptoms.
The result of this part is consistent to some extent with investigations stating that when the child experiences inadequacy of a good thing in the early environment, the frustration of needs occurs and the schemas such as Failure, Insufficient Self-Control (ISC), ED, VHI, MA, Enmeshment/Undeveloped Self (US), and DS are seen. A recent study also indicating that cognitive styles mediated the link between the parental representation and alexithymia. Since, family is the first environment in which children can practice their emotion regulation skills, parents play an important role in the formation and development of an individual’s ability to regulate emotions. Family interactions include positive and negative emotions, and the emotion regulation ability is important for successful management of family relationships, especially when facing with a challenge.
In alexithymia, mind has a defective capacity to build emotional–mental representations. Therefore, researchers have identified emotion regulation and processing defectiveness as an important issue in alexithymia.
In accordance with the above, we demonstrated that perceived low parental during childhood years may be experienced as a lack of emotional sensitivity to childhood needs, which may cause a significant relationship between alexithymia in offspring during adulthood, because early attachment theory proposes that the parental styles with a significant caregiver during childhood is essential for the development of internal working models for communication, regulation of emotions, and interpersonal functioning.
Our finding also fits well with view on the combination of low attitudes toward father and mother can probably decrease the likelihood of emotion regulation, such as alexithymia.
These findings indicate that paternal attachment may still be important, at least in clinical samples.
In this study, it was found that the risk group for alexithymia perceived more negative parenting from both mother and father than nonalexithymic group. In childhood, low PS during childhood years are connected with higher risk for alexithymia and symptomatology in offspring during adulthood. When the parents have negative parental attitudes such as overprotectiveness, authoritativeness, punishment, etc., it is suggested that addictive patterns develop as a way of controlling the environment. It is stated that in the families where PS was perceived as neglectful, indulgent, or authoritarian (nonauthoritative), children were significantly associated with drug use, because children need an option to take risks, make mistakes, and live in accordance with their actions. Similarly, according to a study in a clinical sample measuring PS, Pedrosa et al. confirmed that those adults who suffer paternal abuse and indifference in their childhood are at higher risk to develop alexithymia (DIF) and symptomatology. As a result, it is thought that they resort to inappropriate addictive activities to block the negative emotions created by negative parenting experience.
Another finding in the study is that the risk group for alexithymic disorder has a higher score in the entire EMS.
It has been found that the addicted group with higher mean of EMS has more difficulties in understanding and accepting their feelings, controlling their impulses, setting purposes, and developing strategies, as compared to group with lower mean in this study. A similar study conducted by Ghabadizade et al. revealed that addicted patients have more difficulties in emotion regulation in many aspects as compared to normal sample. It is thought that addicted patients primarily have problems related to awareness of emotion that they experienced. However, Yam and Perez-Garcia found that the lack of inner awareness of emotion is associated with only addictive behavior.
As a matter of fact, studies investigating the relationship between EMS and alexithymia in substance addicts showed that the individuals with alexithymia have more intense schema beliefs than normal sample.,
It is believed that drug use or needing more of the drug helps individuals escape the emotional distress caused by the act of schemas.
The mediate and moderate roles of EMS were examined too. The results showed that dysfunctional schemas failed to moderate the correlation between PS and alexithymia. It indicated that the mediation role of EMS had a mediated role in the association of PS with alexithymia. EMS mediated the effects of unhealthy paternal style on alexithymia among addicts.
Therefore, our findings show that the combination of low difficulty identifying feelings and low difficulty describing feelings can probably decrease the likelihood of EMS and attitudes toward father and mother. Substance abusers develop EMS at later stages of lifespan and, once activated, negatively distort the cognitive patterns, leading to alexithymia. In the same manner, the EMS mediated between maladaptive parenting and alexithymia among adult offspring. Such beliefs are usually the consequence of poor parenting or other traumatic experiences.
The analysis of the data also revealed that EMS mediated the effects of perceived paternal style on alexithymia scores in patients. According to schema approach, the results can be explained by considering the father’s authority and prominent role in his family; he has a prerogative to behave in his own way. As it was mentioned, unhealthy paternal style leads to the insecure feeling that the father might unpredictably abandon the family. Hence, these unhealthy schemas originate from the father’s PS in family. In the maternal attitude, nowadays, mothers have the greatest responsibility to fulfill the primary emotional needs of children. If a mother is unstable or unreliable in meeting the child’s basic needs, unhealthy schemas might be formed.
As it was mentioned, in families, the father has important role in Failure, ISC, ED, VHI, MA, US, and DS. These states contribute to form malfunctioning schemas in children. Furthermore, the results support significant differences between parental styles as a result of family environments and cultural distinctions in maternal and paternal behaviors. It could be concluded that parenting rearing are each crucial in the mental health of a child.
The results are compatible with the study indicating culture influences parental practice in child rearing.
Results showed that among the first block variables, the negative perceived PS was significant. At the second step, the significant effect of the negative perceived PS disappeared when the schemas were entered. At the third step, PS and EMS entered the model. As a result of the analysis, it was seen that Failure, ISC, ED, VHI, MA, US, DS, and PS explained the alexithymia among addicted patients meaningfully. These last schemas were found as significant contributors in explaining alexithymia among addicted patients in this study, were often associated and have often been associated with alexithymia among addicted patients in the literature. Pedrosa et al. argued that drug and alcohol abusers described their parental bonding as “affectionless control” which is the most frequent style and they can never be satisfied so they believe they should sacrifice their own needs. It is also known family were more likely than those who were satisfied with their family, to be addicted and reported more impaired schemas related, for instance, to Self-Control, Social Isolation, and VHI. In a study investigating the relationship between schemas and the addiction potential at the item level, it was found that becoming addicted to substances was predicted by higher score on the EMSs.
All 15 EMSs are thought to be discriminating variables in terms of alexithymic addicts, with the exception of ED, VHI, and Emotional Inhibition. At the same time, as it was found in this study, the difficulties in emotion regulation have been revealed many times as a significant predictor of addiction. At this point, it can be said that the results are consistent with the literature.
With regard to mother, the negative perceived PS had a direct effect on the alexithymic patients but this effect disappeared when EMS were controlled, that is, these variables had full mediating effect. These maternal attitudes explained the disturbances of the addictive behavior through EMS and difficulties in emotion regulation. In the literature, there is no study investigating the role of EMS and emotion regulation difficulties as mediator in the relationship between negative perceived parenting in SUD. However, there are studies assessing the mediator role of these variables separately on the relationship between attachment/styles of parents in the SUD. Liese et al. found that incompatible emotion regulation was partially mediating the link between insecure attachments with parents in SUD which stem in part from adaptive changes in the brain as it seeks to regain homeostasis.
The findings of McGinn et al., in which the role of cognitions in mediating the link between negative parenting and psychopathology were evaluated in the clinical sample, are consistent with the results of the present study. At the same time, it was mentioned that these individuals develop a belief that their emotional needs could never be met and for this reason they should never show their feelings.
| Conclusion|| |
In conclusion, the variables differentiated between risk and nonrisk group of alexithymic disorder should be taken into consideration in the treatment of SUD. In this context, it is important to focus on whether the patient’s inappropriate addictive attitude does not originate from a retaliatory attitude toward the parent or an attitude toward meeting the expectations of the parent. These can be the source of the patient’s resistance to remediation, especially in the treatment models where the parents are involved. Although it is no longer possible to change the already experienced parenting behaviors, it is thought to be very useful to study areas such as EMS and emotion regulation difficulties that help to sustain their effects. Consequently, screening of alexithymia, EMS, parenting attitudes, and psychological symptoms may help to plan psychological treatment interventions for addicted patients. This study can also provide more evidences supporting the relationship between EMS and attitudes toward parents and alexithymia.
We thank all the personnel as well as the patients of the addictology center in Rabat.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]