The relation between Impulsivity and Alexithymia in a group of subjects with Nicotine Addiction Dr. D. Montanaro*, Dr. C. Medici** *Health Psychologist, psychoterapist, **Doctor specializing in psychiatry
Introduction The diagnosis of “Nicotine Addiction” was included in the classification of addiction syndromes some time ago, along with “Internet Addiction Disorder” or “Gambling Addiction”. This choice was taken as a result of increasing attention towards the so called ‘New Addictions’, characterized by the presence of an intense compulsive and repetitive search of an object, or self- stimulating behavior, whose absence is intolerable. Research about the mechanisms underlying ‘New Addiction’ results in posing new questions about neuropsychological factors and psychic dimensions at the base of it¹. The following study conducted on a small group of nicotine addicted people in a public anti-smoking center, is aimed to focalize some psychological characteristics of the participants, according to the hypothesis that the compulsive behavior of a heavy smoker (a subject with a severe addiction) complies with “sensation seeking” that originates from loss of interpersonal, intrapsychic and physical sensitivity², as it seems to be in other forms of addiction. Recent studies highlight the difficulty that addicted people have to recognize correctly stimuli coming from the body and in interpersonal relationships³. This difficulty can result in an insufficient awareness of experienced feelings, and in a scarce possibility to individualize their source. The emotional experience could be incomprehensible and barely intense, followed by negative, vague and non-specific emotions, dysphoric experience and a feeling of inefficacy⁴¯⁵. Impulsive actions in addiction would therefore represent an attempt to recover from an internal confusion related to psychophysical incomprehensible experiences, whilst providing a sensory stimulation that serves as a temporary autoregulator of unpleasant emotional states⁶. The objective of our research is to analyze the correlation between Alexithimia and Impulsivity in this sample of nicotine addicted, and if Alexithymia (defined according to literature, as a difficulty in representing mentally one’s emotions due to a lack of integration between their physiological and cognitive elements) plays the role of a mediator in the documented relation between Impulsivity and Nicotine Addiction, worsening a tendency to impulsive acting out in addicted subjects. Alexithymia may be characterized by an operative thought, lacking in imaginative capacity, oneiric activity and fantasy that are necessary, according to M. Fagioli’s “Human Birth Theory”⁷, to fulfill the representative-symbolic thinking activity that consent to mentally elaborate human psychophysical sensations. According to Fagioli’s theory, the human identity originates at birth, when the absolute new stimulation of the retina by light provokes the activation of the cortex and, simultaneously the formation of a nonconscious mental activity conceptualized as “Capability to Imagine”⁸. This preverbal human thinking activity consents to consider the existence of a thought constituted by images. The Capability to Imagine is a component of what Fagioli named “Disappearance Fantasy”⁷ that is a reaction of defense towards the overwhelming physical stimulation arriving from the non-human environment, considering the impossibility of the newborn to deal with, and with which the external material world is rendered non-existent in its mind, to search selectively for a human environment that allows its needs to survive. The biological and contemporary psychic reaction of the newborn to light that renders itself indifferent to non-human environment permits to form simultaneously, through the activation of the somatosensory cortex, the formation of mental contents constituted by “a memory of the sensation had” through the cutaneous contact between foetus and amniotic liquid. This memory of a merely biological experience of homeostatic sensations form a first indefinite “image” of itself together with an “image” of a human environment that can respond assuring the possibility to develop. This reaction constitutes the libidic basis of the proper human tendency to seek another human being to recreate that psychophysical sensation of well-being through the relationship. The child, from the first moment of life, is actively engaged in the exchange with the human environment through a form of thought by images which allows to use the sensory data to form mental non-conscious images, which progressively build an increasingly precise map of themselves and the other. A responsive relationship with caregivers sensitive not only to physiological needs of the infant but also to their psychic requirements of development can guarantee the possibility to understand their internal physical and mental states and to be confident with their cognitive interpretation to comprehend themselves and human relationships. However, if the human environment is not sufficiently responsive the infant may gradually lose the capability to recognize internal experiences. Emotive reactions becomes less comprehensible and the possibility to integrate new experiences in the inner Self becomes more difficult. A repeated disappointment in the research of a correspondence in human relationships can evoke in the infant a reaction that Fagioli called “Annulment Pulsion”⁷ directed to cancel in their mind a human reality felt as non responsive. This repeated reaction can induce an ‘impairment’ of the memory of the sensation had realized at birth⁹: the infant can lose progressively their interrelational and intrapsychic sensitivity until the lost of physical sensitivity, together with the possibility to develop and define a knowledge of their self and human relationships. Many studies on the impact of emotional deprivation and childhood trauma highlight that it produces self-regulatory behaviors used as a defense from non-responsive mothers. For example the auto-stimulating behavior of body parts to regulate negative internal states avoiding human contacts and relationships, may represent an emerging compulsive and exclusive relationship with the object of addiction. In adulthood such behavioral modalities can appear when intolerable emotions are impossible for the person to mentalize. Thus, a childhood affected by non-responsive relationships may cause a difficulty to integrate sensorial and emotional experiences with their cognitive appropriate interpretations and produce an impoverishment of imaginative thought. A non-responsive human environment jeopardizes in children the evolution of an efficient elaboration of emotional experiences, and provokes states of tension/agitations and a sense of permanent fragility, creating the psychic conditions for impulsive acting out. Method This study was conducted on a group of 30 help-seekers admitted to a public anti-smoking centre and diagnosed with nicotine addiction. A test battery composed by Fagerstorm, TAS-20 and BIS-11 were administered at admission to fulfill the assessment. The analysis of the data obtained is aimed at evaluating a correlation between impulsivity and alexithymia, calculated with Pearson Correlation Index on “Heavy Smokers” (Fagerstorm score: >9) and on “Not Heavy Smokers” (Fagerstorm score: <9). Moreover, the purpose of the evaluation is to analyze the role of mediation (Indirect Relation) of Alexithymia in the well-known relationship between Impulsivity and Nicotine Addiction studying a linear and multiple regression. We controlled this hypothesis with the t-test. Results A strong significant correlation (r=0,71) was found between Alexithymia and Impulsivity in the group of Heavy Smokers and a moderate correlation (r=0,47) was found in the group of Not Heavy Smokers (TAB 1). The major correlation appears between Alexithymia and the subscale “Lack of reflection and behavior planning” of Impulsivity, rather than “Motor impulsivity” and “Attention impulsivity”. These data seem to underline a close relation between a difficulty of exploring and understanding emotional experiences and acting out. The obtained results point out the mediating role that Alexithymia plays in the “Apparent Relation” between Impulsivity and Addiction (Fig. 1).
TAB 1
Heavy Smokers
Fig. 1
Not Heavy Smokers
mediation
Pearson Correlation Index (Alexithimia-Impulsivity)
0.71
0.47 apparent linkage
Conclusions Results obtained seem to corroborate that a difficulty to mentalize exposes the possibility of acting out and sensation seeking, aimed at overcoming a deficiency in the capability to feel and elaborate emotional experiences, preserving one’s integrity. The tendency towards an impulsive gesture may therefore be triggered by a deficiency in psychophysical sensitivity that alters the process of mentalization and drives to seek sensorial stimuli outside of interpersonal relationships³. Sources
Aknowledgments Thanks to Dr. Matteo Tortoli for data analysis. Thanks to Emanuela Atzori and Julian Bowden-Smith for the English translation
Correspondence: dorimontanaro@gmail.com; caterinamedici89@gmail.com Copyright © 2018
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Journal of psychiatry and psychoterapy based on Human Birth Theory