臺灣博碩士論文加值系統

背景：述情障礙（alexithymia）的人較缺乏同理能力，而此障礙在精神疾病的發生率較高。過去不同的研究分別發現雙親教養、人格特質和述情障礙間的關係，然而此三者的路徑關係仍不明。因此本研究的目的為探討述情障礙是否為精神健康和適應障礙的預測因子，以及述情障礙與雙親教養風格和人格特質的路徑關係。此外，若述情障礙為適應障礙的促發因素，它是否為有效和具經濟效益的精神健康篩檢工具。
方法：本研究募集一百五十八位被診斷為適應障礙的義務役和一百五十五位控制組的年輕男性軍人。所有參與者均填答雙親教養態度量表、艾氏人格問卷、台灣版多倫多述情量表(TAS-20)以及華人健康問卷。
結果：適應障礙組的平均年齡為21.46（標準差=2.35），控制組為22.94（標準差=2.26）。邏輯回歸顯示年紀輕、高神經質人格特質、較差的心理健康狀況和無法區分內在情緒的述情特質，有較高的傾向會發展為適應障礙。結構方程式的路徑關係顯示雙親教養影響人格特質，人格特質影響述情特質，以及述情特質影響精神健康路徑的人比較可能發展為適應障礙。排除精神健康的中介因素，述情障礙能夠預測適應障礙。TAS-20的三個因素當中，無法區分內在情緒對適應障礙有直接的影響，而上述的因素能夠解釋本樣本59%的變異量。接受者操作特徵發現使用無法區分內在情緒篩檢適應障礙最佳的切分點為21/22，得到敏感性0.84、特異性0.87、陽性預測值0.87以及陰性預測值0.84。
討論：此研究發現雙親教養、人格特質、述情特質、精神健康和適應障礙間的路徑關係。進一步的，述情障礙中無法區分內在情緒分測驗可用為適應障礙的篩檢指標。由於述情障礙以及其他精神疾病間有高相關，特別在缺乏同理能力的疾病，因此未來研究應繼續探討無法區分內在情緒是否可類化到與同理能力相關的疾病和精神疾病篩檢的應用上。

Background: Alexithymics are relatively lacking in the ability to empathize; this condition is also highly prevalent in psychiatric disorders. Previous studies have separately found the relationship between parental bonding, personality characteristics and alexithymia; however, the pathway relationship among the three is uncertain. Therefore, this study aimed to investigate both whether alexithymia is a predictor for mental health and adjustment disorder, and its pathway relationships with parental rearing style and personality characteristics. In addition, if alexithymia is a precipitating factor for adjustment disorder, whether it can be used as an efficient and cost-effective screening instrument for mental health.
Methods: One-hundred and fifty-eight young male compulsory military soldiers diagnosed with adjustment disorder and another 155 young normal male soldier controls were recruited. All participants had to fill out the Parental Bonding Inventory, Eysenck Personality Questionnaire, 20-item Toronto Alexithymia Scale (TAS-20), and Chinese Health Questionnaire.
Results: The mean age of the case group was 21.46 (standard deviation, SD=2.35), and the control group, 22.94 (SD=2.26). Structural equation modeling showed that those with the pathway relationships of parental bonding influencing personality characteristics, personality characteristics affecting alexithymic traits, and alexithymic traits affecting mental health were more likely to develop adjustment disorder. Without the mediating factor of mental health, alexithymia was predictive of adjustment disorder. Of the three factors in the TAS-20, DIF had a direct effect on adjustment disorder, and the above-mentioned factors accounted for a 59% variance within this sample. Receiver operating characteristic found the optimal cutoff point for screening of adjustment disorder using DIF was 21/22, resulting in a sensitivity of 0.84, specificity of 0.87, positive predictive value of 0.87, and negative predictive value of 0.84.
Discussions: This study found the pathway relationship between parental bonding, personality characteristics, alexithymia, mental health and adjustment disorder. In addition, the DIF sub-scale of alexithymia can be used as a screening index for adjustment disorder. With the high degree of association between alexithymia and other psychiatric disorders, especially in those relatively lacking in the ability to empathize, future studies should investigate whether DIF can be generalizable to the screening of other empathy-related and psychiatric disorders.

Table of Contents
Acknowledgement II
English Abstract III
Chinese Abstract VI
Table of Contents VIII
List of Tables and Figures XI
Abbreviations XIII
Chapter 1 Introduction and Overview 1
1.1. Introduction 1
1.2. Importance of Topic 3
1.3. Purpose of Research 5
Chapter 2 Literature Review 6
2.1. The Neurobiological Causes of Alexithymia 6
2.2. The Psychosocial Causes of Alexithymia 9
2.3. Alexithymia and Adjustment Disorder 12
2.4. The Relationship among Alexithymia, Adjustment Disorder, Attachment and Personality Characteristics 14
Chapter 3 Research Methodology 16
3.1. Research Structure 16
3.2. Research Hypothesis 19
3.3. Participants 26
3.4. Materials 28
3.5. Statistical Analysis 32
Chapter 4 Results 35
4.1. Descriptive Analysis 35
4.2. Logistic Regression 41
4.4. Four-step Regression 43
4.3. Structural Equation Model 47
4.4. Receiver Operating Characteristic 55
Chapter 5 Discussion 58
5.1. The Pathway Relationship among Parental Bonding, Personality Characteristics, Alexithymic Traits, Mental Health and Adjustment Disorder 58
5.2. The Effect of Alexithymia on Adjustment Disorder 60
5.3. TAS-20 and its Implication 62
5.4. Limitations 64
Chapter 6 Conclusion 66
6.1. Conclusion 66
6.2. Clinical Implication 68
6.3. Suggestions 69
References 70
Appendix 80
Appendix I. Demographic Information 80
Appendix II. Parental Bonding Instrument (PBI) 82
Appendix III. Eysenck Personality Questionnaire (EPQ) 83
Appendix IV. Toronto Alexithymia Scale (TAS-20) 84
Appendix V. Chinese Health Questionnaire (CHQ) 85
Appendix VI. Instituational Review Board Approval 87

Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y., & Uchitomi, Y. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. American Journal of Clinical Oncology, 22, 1957-1965.
Akimoto, M., Fukunishi, I., Baba, T., Matsumori, M., & Iwai, M. (2002). Alexithymia and sociocultural factors in a Japanese sample: a study with the Rorschach. Psychological Reports, 90, 205-211.
American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4 ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text revision). Washington, DC: American Psychiatric Association.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
Bermond, B., Vorst, H. C. M., Vingerhoets, A. J. J. M., & Gerritsen, W. (1999). The Amsterdam Alexithymia Scale: its psychometric values and correlations with other personality traits. Psychotherapy Psychosomatics, 68, 241-251.
Borod, J. C., Cicero, B. A., Obler, L. K., Welkowitz, J., Erhan, H. M., Santschi, C., et al. (1998). Right hemisphere emotional perception: evidence across multiple channels. Neuropsychology, 12, 446-458.
Cedro, A., Kokoszka, A., Popiel, A., & Narkiewicz-Jodko, W. (2001). Alexithymia in schizophrenia: an exploratory study. Psychological Reports, 89, 95-98.
Cheng, T. A., & Williams, P. (1986). The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychological Medicine, 16, 415–422.
Cheng, T. A., Wu, J. T., Chong, M. Y., & Williams, P. (1999). Internal consistency and factor structure of the Chinese Health Questionnaire. Acta Psychiatrica Scandinavica, 82, 304–308.
De Gucht, V., Fontaine, J., & Fischler, B. (2004). Temporal stability and differential relationships with neuroticism and extraversion of the three subscales of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples. Journal of Psychosomatic Research, 57, 25-33.
De Panfilis, C., Rabbaglio, P., Rossi, C., Zita, G., & Maggini, C. (2003). Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology, 36, 239-246.
Decety, J., & Jackson, P. L. (2004). The functional architecture of human empathy. Behavioral and Cognitive Neuroscience Reviews, 3, 71-100.
Denham, S. A., & Burton, R. (1996). A social-emotional intervention for at-risk 4-year-olds. Journal of School Psychology, 34, 225-245.
Dion, K. L. (1996). Ethnolinguistic correlates of alexithymia: toward a cultural perspective. Journal of Psychosomatic Research, 41, 531-539.
Egan, J. P. (1975). Signal Detection Theory and ROC Analysis. New York: Academic Press.
Eysenck, H. J., & Eysenck, S. B. G. (1975). Manual for the Eysenck Personality Questionnaire. London: Hodder and Stoughton.
Fitzgenral, M., & Bellgrove, M. A. (2006). Letter to the editor: the overlap between alexithymia and Asperger''s syndrome. Journal of Autism and Developmental Disorders, 36, 573-576.
Fukunishi, I., & Paris, W. (2001). Intergenerational association of alexithymic characteristics for college students and their mothers. Psychological Reports, 89, 77-84.
Fukunishi, I., Sei, H., Morita, Y., & Rahe, R. H. (1999). Sympathetic activity in alexithymics with mother''s low care. Journal of Psychosomatic Research, 46, 579-589.
Galderisi, S., Mancuso, F., Mucci, A., Garramone, S., Zamboli, R., & Maj, M. (2008). Alexithymia and cognitive dysfunction in patients with panic disorder. Psychotherapy and Psychosomatics, 77, 182-188.
Gillberg, C. (2007). Non-autism childhood empathy disorder. New York: Cambridge University Press.
Goldberg, D., & Williams, P. (1972). A User''s Guide to the General Health Questionnaire. Windsor, UK: NFER-Nelson.
Grabe, H. J., Frommer, J., Ankerhold, A., Ulrich, C., Groger, R., Franke, G. H., et al. (2008). Alexithymia and outcome in psychotherapy. Psychotherapy and Psychosomatics, 77, 189-194.
Grunkemeier, G. L., & Jin, R. (2001). Receiver operating characteristic curve analysis of clinical risk models. The Annals of Thoracic Surgery, 72, 323-326.
Heiberg, A., & Heiberg, A. (1976). Alexithymia- an inherited trait: a study of twins. Psychotherapy and Psychosomatics, 28, 221-225.
Heiberg, A., & Heiberg, A. (1978). A possible genetic contribution to the alexithymia trait. Psychotherapy and Psychosomatics, 30, 205-210.
Hill, E. L., & Berthoz, S. (2006). Response to “letter to the editor: the overlap between alexithymia and Asperger’s syndrome”, Fitzgerald and Bellgrove, Journal of Autism and Developmental Disorders. Journal of Autism and Developmental Disorders, 36, 1143-1145.
Honkalampi, K., Hintikka, J., Saarinen, P., Lehtonen, J., & Viinamaki, H. (2000). Is alexithymia a permanent feature in depressed patients? Psychotherapy and Psychosomatics, 69, 303-308.
Joukamaa, M., Luutonen, S., von Reventlow, H., Patterson, P., Karlsson, H., & Salokangas, R. K. R. (2008). Alexithymia and childhood abuse among patients attending primary and psychiatric care: results of the PADEP study. Psychosomatics, 49, 317-325.
Kooiman, C. G., van Rees Vellinga, S., Spinhoven, P., Draijer, N., Trijsburg, R. W., & Rooijmans, H. G. (2004). Childhood adversities as risk factors for alexithymia and other aspects of affect dystregulation in adulthood. Psychotherapy and Psychosomatics, 73, 107-116.
Krystal, H. (1988). Integration and self-healing: affect-trauma-alexithymia. Hillsdale, NJ: Analytical Press.
Lane, R. D., Reimann, E. M., Axelrod, B., Lang-Sheng , Y., Holmes, A., & Schwartz, G. E. (1998). Neurological correlates of levels of emotional awareness: evidence of an interaction between emotion and attention in the anterior cingulated cortex. Journal of Cognitive Neuroscience, 10, 525-535.
Lemche, E., Klann-Delius, G., Koch, R., & Joraschky, P. (2004). Mentalizing language development in a longitudinal attachment sample: implications for alexithymia. Psychotherapy and Psychosomatics, 73, 366-374.
Lin, Y. C., & Chan, C. H. (2003). A factor analysis of the Taiwan version of the Toronto Alexithymia Scale-20. Taiwanese Journal of Psychiatry, 17, 276-282.
Lin, Y. C., & Chan, C. H. (2006). Alexithymia in non-psychiatric outpatients of a general hospital. Taiwanese Journal of Psychiatry, 20, 272-278.
Lirio, R. B., Donderiz, I. C., & Perez Abalo, M. C. (1992). Maximum likelihood estimation of signal detection model parameters for the assessment of two-stage diagnostic strategies. International Journal of Bio-Medical Computing, 31, 117-126.
Lu, L. (1994). University transition: Major and minor life stressors, personality characteristics and mental health. Psychological Medicine, 24, 81-87.
Lu, L., & Chen, C. S. (1996). Correlates of coping behaviours: Internal and external resources. Counseling Psychology Quarterly, 9, 297-307.
Lumley, M. A., Mader, C., Gramzow, J., & Papineau, K. (1996). Family factors related to alexithymia characteristics. Psychosomatic Medicine, 58, 211-216.
Lung, F. W., Lee, F. Y., & Shu, B. C. (2002). The relationship between life adjustment and parental bonding in military personnel with adjustment disorder in Taiwan. Military Medicine, 167, 678-682.
Lung, F. W., Lee, F. Y., & Shu, B. C. (2006). The premorbid personality in military students with adjustment disorder. Military Psychology, 18, 77-88.
Lung, F. W., & Shu, B. C. (2007). Father-son attachment and sexual partner orientation in Taiwan. Comprehensive Psychiatry, 48, 20-26.
Lutz, C. (1988). Unnatural emotions: everyday sentiments on a Micronesian atoll and their challenge to eastern theory. Chicago: University of Chicago Press.
Mandal, M. K., Borod, J. C., Asthana, H. S., Mohanty, A., Mohanty, S., & Koff, E. (1999). Effects of lesion variables and emotion type on the perception of facial emotion. Journal of Nervous Mental Disorders, 187, 603-609.
Marchessi, C., Bertoni, S., Cantoni, A., & Maggini, C. (2008). Is alexithymia a personality trait increasing the risk of depression? A prospective study evaluating alexithymia before, during and after a depressive episode. Psychological Medicine, 38, 1717-1722.
Mari, J. J., & Williams, P. (1985). A comparison of the validity of two psychiatric screening questionnaires (CHQ-12 and SRQ-12) in Brazil, using relative operating characteristics (ROC) analysis. Psychological Medicine, 15, 651-659.
Markus, H. R., & Kitayama, S. (1991). Culture and the self: implications for cognition, emotion and motivation. Psychological Review, 98, 224-253.
Modestin, J., Lotscher, K., & Erni, T. (2002). Dissociative experiences and their correlates in young non-patients. Psychology and Psychotherapy, 75, 53-64.
Moriguchi, Y., Decety, J., Ohnishi, T., Maeda, M., Mori, T., Nemoto, K., et al. (2007). Empathy and judging other''s pain: an fMRI study of alexithymia. Cerebral Cortex, 17, 2223-2234.
Moriguchi, Y., Ohnishi, T., Lane, R., Maeda, M., Mori, T., Nemoto, K., et al. (2006). Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia. Neuroimage, 32, 1472-1482.
Murphy, J. M., Berwick, D. M., Weinstein, M. C., Borus, J. F., Budman, S. H., & Klerman, G. (1987). Performance of screening and diagnostic tests. Archives of General Psychiatry, 44, 550-555.
Nishimura, H., Komaki, G., Igarashi, T., Moriguchi, Y., Kajiwara, S., & Akasaka, T. (2009). Validity issues in the assessment of alexithymia related to the developmental stages of emotional cognition and language. BioPsychoSocial Medicine, 3, 12.
Parker, G., Tupling, H., & Brown, L. B. (1979). A parental bonding instrument. British Journal of Medical Psychology, 52, 1-10.
Parker, J. D. A., Taylor, G. J., & Babgy, R. M. (1989). The alexithymia construct: relationship with sociodemographic variables and intelligence. Comprehensive Psychiatry, 30, 323-441.
Richter, J., Moller, B., Spitzer, C., Letzel, S., Bartols, S., Barnow, S., et al. (2006). Transcallosal inhibition in patients with and without alexithymia. Neuropsychobiology, 53, 101-107.
Romei, V., De Gennaro, L., Fratello, F., Curcio, G., Ferrara, M., Pascual-Leone, A., et al. (2008). Interhemispheric transfer deficit in alexithymia: a transcraniel magnetic stimulation study. Psychotherapy and Psychosomatics, 77, 175-181.
Runeson, B. S., Beskow, J., & Waern, M. (1996). The suicidal process in suicides among young people. Acta psychiatrica Scandinavica, 93, 35-42.
Ryder, A. G., Yang, J., Yao, X. Z., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300-313.
Saarijarvi, S., Salminen, J. K., & Toikka, T. (2006). Temporal stability of alexithymia over a five-year period in outpatients with major depression. Psychotherapy and Psychosomatics, 75, 107-112.
Schaefer, E. S. (1965). A configurational analysis of children''s reports of parent behavior. Journal of Counseling Psychology, 29, 552-557.
Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 201-269.
Shu, B. C., Chang, Y. Y., Lee, F. Y., Tzeng, D. S., Lin, H. Y., & Lung, F. W. (2007). Parental attachment, premorbid personality, and mental health in young males with hyperventilation syndrome. Psychiatry Research, 153, 163-170.
Shu, B. C., Lo, W. J., & Lung, F. W. (1999). The reliability and validity of a Chinese version of the Parental Bonding Instrument. The Journal of Nursing Research, 7, 479-489.
Spalletta, G., Pasini, A., Costa, A., De Angelis, D., Ramundo, N., Paolucci, S., et al. (2001). Alexithymic features in stroke: effects of laterality and gender. Psychosomatic Medicine, 63, 944-950.
Spence, S., Shapiro, D., & Zaidel, E. (1996). The role of the right hemisphere in the physiological and cognitive components of emotional processing. Psychophysiology, 33, 112-122.
Stifneos, P. E. (1973). The prevalence of alexithymic characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255-262.
Strain, J. J., & Diefenbacher, A. (2008). The adjustment disorders: the conundrums of the diagnoses. Comprehensive Psychiatry, 49, 121-130.
Swets, J. A. (1964). Signal Detection and Recognition by Human Observers. New York: John Wiley & Sons.
Swets, J. A. (1979). ROC analysis applied to the evaluation of medical imaging techniques. Investigative Radiology, 14, 365-377.
Szklo, M., & Nieto, F. J. (2004). Epidemiology beyond the basics. Sudbury, MA: Jones and Bartlett Publishers.
Tabibnia, G., & Zaidel, E. (2005). Alexithymia, interhemispheric transfer, and right hemispheric specialization: a critical review. Psychotherapy and Psychosomatics, 74, 81-92.
Tani, P., Lindberg, N., Joukamaa, M., Nieminen-von Wendt, T., von Wednt, L., Appelberg, B., et al. (2004). Asperger syndrome, alexithymia and perception of sleep. Neuropsychobiology, 141, 725-732.
Taylor, G. J. (1984). Alexithymia: concept, measurement, and implications for treatment. The American Journal of Psychiatry, 141, 725-732.
Taylor, G. J. (1994). The alexithymia construct: conceptualization, validation and relationship with basic dimensions of personality. New Trends Experimental and Clinical Psychiatry, 10, 61-74.
Taylor, G. J. (2000). Recent developments in alexithymia theory and research. Canadian Journal of Psychiatry, 45, 134-142.
Taylor, G. J., & Bagby, R. M. (2004). New trends in alexithymia research. Psychotherapy and Psychosomatics, 73, 68-77.
Taylor, G. J., Parker, J. D. A., & Bagby, R. M. (1990). A preliminary investigation of alexithymia in men with psychoactive substance dependence. The American Journal of Psychiatry, 147, 1228-1230.
Valera, E. M., & Berenbaum, H. (2001). A twin study of alexithymia. Psychotherapy and Psychosomatics, 70, 239-246.
Yang, S. C., Du, A. L., Wang, X. Y., & Li, H. F. (2008). A study on correlation between adult personality and alexithymia. Chinese Journal of Clinical Psychology, 16, 425-426.