Mediating role of self-esteem in the relationship between parental disapproval of the child and alexithymic personality

Abstract

BACKGROUND

Alexithymia is defined as difficulties in identifying, expressing, and understanding emotions. An unapproving environment during childhood is defined as the child not receiving emotional approval from their parents, being punished, or having their emotions devalued. The formation of self-esteem is shaped by the influence of parental behavior during childhood. The communication that the child establishes with their parents contributes to their increased self-esteem and sense of importance. The absence of this may play a role in developmental psychopathology.

AIM

To examine the mediating role of self-esteem in the relationship between a disapproving environment in childhood and alexithymia.

METHODS

The research in the relational screening model was conducted with 404 participants. Demographic Information Form, Disapproving Environment Scale in Childhood, Toronto Alexithymia Scale, and Rosenberg Self-Esteem Scale were used as data collection tools. Hayes’ bootstrapping technique was used in the analysis of the data obtained from the research.

RESULTS

As a result of the analyses, parental disapproval positively predicted the level of alexithymia (r_mother = 0.51, r_father = 0.52, P < 0.05) and negatively predicted self-esteem (r_mother = -0.75, r_father = -0.67, P < 0.05). Additionally, self-esteem negatively predicted alexithymia (r = -0.58, P < 0.05). It was observed that self-esteem had a partial mediating effect on the relationship between parental disapproval and alexithymia. Family types were analyzed separately as chaotic, approving, perfect, and typical. Of these, the chaotic family type positively predicted alexithymia (r = 0.33, P < 0.05) and negatively predicted self-esteem (r = -0.60, P < 0.05). The approving family type negatively predicted alexithymia (r = -0.43, P < 0.05) and positively predicted self-esteem (r = 0.61, P < 0.05). The perfect family type negatively predicted alexithymia (r = -0.27, P < 0.05) and positively predicted self-esteem (r = -0.45, P < 0.05).

CONCLUSION

The type of family in which the child grows up in and parental disapproval during childhood affected the child’s self-esteem and caused alexithymic personality traits.

Key Words: Psychopathology; Childhood trauma; Disapproving environment in childhood; Family type; Alexithymia

Core Tip: This study showed that the type of family in which a child grows up and parental disapproval in childhood affected the child’s self-esteem and led to alexithymic personality traits. The child’s self-esteem partially mediated the relationship between parental disapproval and alexithymia. Family type was also important for alexithymia. A chaotic family type had a positive effect on alexithymia and a negative effect on the self-esteem variable, whereas the approving and perfect family types had a negative effect on alexithymia and a positive effect on self-esteem and protected the child in terms of alexithymic personality traits.

INTRODUCTION

Alexithymia is defined as difficulties in defining, expressing, and understanding emotions[1]. Alexithymia, which manifests itself with difficulties in emotional functions and social relationships, is a personality trait rather than a disease[2] or an emotional dysfunction[3-5]. Neurobiological and environmental factors are responsible for the etiology of alexithymia[6]. Neurobiologically, there is evidence of disorder in the communication between the hemispheres in the brain provided by the corpus callosum[7], a dysfunction in the right hemisphere[8], and a disruption in the emotional representation system in the cortex localized to the insular cortex and anterior cingulate[4]. In psychopathology, depression and anxiety[9,10], self-harming behaviors[11], stress[12], and post-traumatic stress disorder[13] are associated with alexithymia. The disruption in affective development that continues in early childhood[14], dysfunctional cognitive distortions in cognitive schemas[15], and the emotional inconsistency of the primary caregiver in childhood is thought to be important in the emotional development of the child due to emotional limitation, failure to gain emotional self, and decreased self-regulation and emotional arousal capacity of the individual due to inconsistent emotional exchange with the caregiver[16].

In the etiology of alexithymia, there is evidence that sociodemographic determinants such as age, sex, or socioeconomic status are associated with alexithymia. Alexithymia may show increasing symptoms with age[17]. The process of emotional development continues throughout life, and some people may have difficulty in fully developing their emotional skills. This may contribute to the increase in alexithymia symptoms as age progresses[18]. Studies examining the relationship between alexithymia and sex show that the prevalence rates of alexithymia are higher in males[19-21]. However, findings from studies on sex differences among adolescents are mixed. Some studies have not found sex differences among young age groups[22], but other studies have shown that girls have more alexithymic characteristics than boys[23].

There are different research results regarding the relationship between alexithymia and parental education level. In addition to studies revealing that there is no relationship between parental education level and alexithymia[24], there are also studies reporting that alexithymia decreases as parental education level increases[25,26]. Although the contribution of parental education level to the development of alexithymia is controversial, alexithymia is basically associated with impaired emotional development during childhood. The impact of environmental factors such as negative experiences in childhood and an unapproving environment may form the basis of alexithymia[27].

The ‘disapproving environment’ in childhood is defined as the child’s inability to receive emotional approval from parents and punishment or devaluation of emotions[28]. This situation affects the child in three ways. First, the child cannot learn the approval of their own emotions, which affects the child’s emotional expression skills. At the same time, the child who cannot get approval from their environment experiences contradictions in understanding and regulating their emotions, and it becomes difficult for him/her to make sense of their own wishes. Finally, these situations may lead to restlessness and maladaptive behaviors over a long period of time and may lead to alexithymic personality traits in the future[29,30]. Although, the literature on the relationship between a disapproving environment in childhood and alexithymia has not yet reached sufficient saturation.

Thorberg et al[31] conducted a meta-analysis on parental attachment and alexithymia. In that study, the relationships between alexithymia and maternal care, maternal overprotection, paternal care, and paternal overprotection were examined. As a result of the study, it was observed that maternal care had a negative relationship especially with the difficulty in identifying and expressing emotions[31]. However, maternal overprotection had a positive relationship with alexithymia and difficulty in identifying emotions. Therefore, inadequate maternal care and overprotection affected the emotional components of alexithymia more. Father care was also negatively related to alexithymia. Like maternal overprotection, paternal overprotection was also linked to alexithymia and difficulty identifying emotions. However, the relationship between paternal overprotection and alexithymia was not as strong as maternal overprotection.

However, not all children who are not approved by their environment show alexithymic characteristics. Genetic factors, early childhood traumas, stress, neurological factors, and cultural, social, and psychological factors are effective in the development of alexithymia[32]. Self-esteem may also be an important determinant among psychological factors. It is thought that when alexithymic individuals cannot cope with emotional difficulties, their self-esteem may decrease. Self-esteem is related to thoughts and feelings about oneself. While high self-esteem can trigger the individual to achieve positive results, low self-esteem can trigger negative results[33]. Individuals with high self-esteem may be more optimistic, decisive, and effective in coping with stress. In addition, while high self-esteem can reduce psychological problems, low self-esteem can cause incompatibility with the individual’s social environment and psychological problems[34,35].

The formation of self-esteem is shaped by the influence of parental behaviors during childhood. The communication between the child and their parents contributes to the increase in self-esteem and feeling important[36]. Self-esteem becomes more stable and more difficult to change as the child grows up and steps into adulthood[37-39]. Research has shown that the family environment in early childhood was an important factor for self-development[40]. It has a long-term permanent effect and can still be observed in adulthood[40]. Positive behaviors that the child sees from their environment support him/her to develop a healthy and integrated self-esteem[41] and approval and disapproval behaviors that the individual sees from their environment in childhood affect the formation of self-esteem. The relationship between a disapproving environment in childhood and self-esteem is positive[42]. Exposure to a disapproving environment may cause the child to question their abilities. If these situations are frequently experienced, even children with high self-esteem may begin to doubt themselves, and this may lead to a decrease in self-esteem by succumbing to an environment of disapproval[43].

In the light of the above information, the main purpose of this study was to examine how the mediating role of self-esteem functions in the relationship between a disapproving environment in childhood and alexithymia. In addition to the main question of the study, the sub-problems included: (1) Does self-esteem play a mediating role in the relationship between disapproving environment and alexithymia in childhood; (2) Does self-esteem play a mediating role in the relationship between chaotic family life and alexithymia; (3) Does self-esteem play a mediating role in the relationship between approving family life and alexithymia; (4) Does self-esteem play a mediating role in the relationship between perfect family life and alexithymia; and (5) Does self-esteem play a mediating role in the relationship between typical family life and alexithymia?

MATERIALS AND METHODS

Research model

Before starting the research, an application was made to the Marmara University Social Sciences Research Ethics Committee in Türkiye. Permission was received from the ethics committee dated April 7, 2023, number 2023-51 and protocol number 2023/30. Then, the sample size of the study was determined according to the recommendations of Krejcie and Morgan[44]. It was recommended that the number of samples be 384 and above in order to obtain generalizable results in large populations. Therefore, in this study, it was aimed to apply the survey form to at least 384 people, and survey responses were collected from 425 individuals.

To identify extreme values in the data set, z values were calculated, and data outside the (-3, 3) range were removed. As a result of this process, the number of participants remained at 404 (200 females, 204 males). The sample of the research was created by selecting the convenient sampling method from 404 participants over the age of 18. The convenience sampling method involves choosing locations that researchers can easily access and carry out data collection in a practical manner. This approach aims to minimize problems that may arise during the sampling process[45].

The model of the research was mediation. Mediation models examine the relationship between dependent and independent variables through a third hypothetical variable, the mediator variable, and explain partial or full mediation situations. These models do not examine the relationship between the dependent and independent variables directly but the relationship of the independent variable with the mediator variable and the mediator variable with the dependent variable. In other words, this model aims to reveal subtle effects in the relationship between the dependent and independent variables[46]. Visualization of the mediation model, representing the main purpose of the research, is presented in Figure 1.

Figure 1 Proposed model for the mediating effect of self-esteem.

Statistical analysis

Hayes’ bootstrapping technique was used to determine whether self-esteem had a mediating role in the relationship between a disapproving environment in childhood and alexithymic personality traits, which was the main question of the study. The significance of the mediation effects (direct and indirect effects between dependent and independent variables) of the tested models was determined using the SPSS 20.00 program (IBM Corp., Armonk, NY, United States). Hayes’ macro, called “Simple Mediation Model 4”, was used for these analyses[47]. The macro was downloaded from https://processmacro.org/index.html. The Bootstrap method[48] is a widely used method to test the significance of indirect effects. This method uses the confidence interval (CI) coefficients of the distributions as well as the P value to evaluate whether the mediation effects are statistically significant. According to the bootstrap result, whether the indirect mediation effect of the variables are statistically significant is evaluated by checking whether the point estimate of the mediator variable includes zero within the 95%CI[49].

The bootstrapping method, defined by Preacher and Hayes[48], is a calculation method that aims to estimate indirect effects. This method calculates indirect effects by repeatedly extracting samples from the data set. A few prescribed sample sizes are 1000, but it is generally recommended to use 5000 samples[48,50]. For this reason, the mediation effects of the models tested within the scope of the research were examined over 5000 bootstrapping samples to see if they were statistically significant and evaluated at a 95%CI.

To determine the mediating effect of self-esteem on the relationship between a disapproving environment in childhood and alexithymia, the PROCESS add-on developed by Hayes and Rockwood[51] was loaded into the SPSS program, and calculations were made using the bootstrapping technique with a repeated sample count of 5000. Analyses were carried out within the 95%CI, and Hayes’ model number 4 was used as the mediation model.

Data collection tools

Data were collected with a survey form created in the Google Forms application. This questionnaire included the Demographic Information Form, Disapproving Environment Scale in Childhood (DESC), Toronto Alexithymia Scale (TAS), and the Rosenberg Self-Esteem Scale (RSES).

Sociodemographic information form

The form contained questions aimed at obtaining information about the participants’ sex, mother’s education level, and father’s education level. These questions include variables that were found to be associated with a disapproving environment in childhood as a result of the literature review, and other variables were excluded from the research.

DESC

DESC was developed by Mountford et al[52] to measure the degree to which individuals were approved by their parents in their childhood. The Turkish adaptation of the scale was made by Alpay et al[42]. The scale consists of two parts. The first part, which contains 14 items designed on a 5-point Likert type (1: Never; 5: Always), includes statements about whether individuals were approved or disapproved by their mothers and fathers in their childhood. These statements are answered separately for mother and father. The lowest score from the scale is 14 and the highest score is 70. A high score indicates a highly disapproving environment in childhood. Items 5, 8, 12, and 14 are reverse coded in this section. In the second part of the scale, there are four different items belonging to four family types (chaotic, approving, perfect, typical), and participants are asked to evaluate on a scale between 1 and 5 to what extent the behaviors stated in these items reflect their own families. As a result of the reliability analysis conducted in the study of adapting the scale to Turkish, it was determined that the Cronbach’s alpha reliability coefficient obtained for the mother’s form was 0.84, and the Cronbach’s alpha reliability coefficient obtained for the father’s form was 0.87[42]. As a result of the reliability analysis conducted for the data obtained from this study, it was found that the Cronbach’s alpha reliability coefficient was 0.94 for the mother’s form and 0.87 for the father’s form.

TAS

TAS was developed by Taylor et al[53] to measure characteristics such as individuals’ difficulty in understanding and expressing emotions. The first form of the scale consists of 26 items and is applied on a 5-point Likert scale (1: Never, 5: Always). Later, after some criticism, the scale was updated to 20 items by Taylor et al[53] and has been used in that form since. The Turkish adaptation of the scale was made by Güleç and Yenel[54]. The scale consists of three subscales: Difficulty recognizing emotions; difficulty expressing emotions; and extroverted thinking. A high score from the scale indicates high alexithymic personality traits. As a result of the reliability analysis of the Turkish adaptation of the scale, the Cronbach’s alpha reliability coefficient was determined as 0.80 for the difficulty in recognizing emotion dimension, 0.57 for the difficulty in expressing emotion dimension, 0.63 for the extroverted thinking dimension, and 0.86 for the entire scale[54].

As a result of the reliability analysis conducted for the data obtained from this study, the Cronbach’s alpha reliability coefficient was found to be 0.81 for the difficulty in recognizing emotion dimension, 0.59 for the difficulty in expressing emotion dimension, 0.79 for the extroverted thinking dimension, and 0.91 for the entire scale.

RSES

RSES is a scale developed by Rosenberg[33] and is a 4-point Likert (1: Very false, 4: Very true) self-report scale containing 10 items to evaluate self-esteem. The scale was adapted into Turkish by Çuhadaroğlu; the Cronbach’s alpha reliability coefficient was 0.85[55]. As a result of the reliability analysis conducted for the data obtained from this study, the Cronbach’s alpha reliability coefficient was 0.94.

RESULTS

Descriptive statistics of the participants are presented in Table 1. In total, 49.50% (n = 200) of the participants were female and 50.50% (n = 204) were male. The education level of the mothers of the individuals included in the research was determined as 14.60% (n = 59) primary school, 32.18% (n = 130) middle school, 36.14% (n = 146) high school, and 17.08% (n = 69) university. The education level of the participants’ fathers was determined as 4.70% (n = 19) primary school, 30.20% (n = 122) middle school, 44.55% (n = 180) high school, and 20.55% (n = 83) university.

Table 1 Descriptive statistics of participants.

Characteristics	Frequency, n	Percentage
Sex
Female	200	49.50
Male	204	50.50
Mother’s education level
Primary school	59	14.60
Middle school	130	32.18
High school	146	36.14
University	69	17.08
Father’s education level
Primary school	19	4.70
Middle school	122	30.20
High school	180	44.55
University	83	20.55

Descriptive statistics regarding the participants’ scale scores are presented in Table 2. It was determined that the participants received 43.34 ± 14.23 points from the mother form of the DESC and 42.50 ± 10.61 points from the father form. Among the family subtypes, it was determined that they received 2.68 ± 1.25 points from the chaotic family type, 2.69 ± 0.93 points from the approving family type, 2.43 ± 1.00 points from the perfect family type, and 2.74 ± 0.76 points from the typical family type. Participants received 19.04 ± 6.28 points from the difficulty in recognizing emotion dimension of TAS, 15.30 ± 4.26 points from the difficulty in expressing emotion dimension of TAS, and 23.92 ± 7.30 points from the extroverted thinking dimension of TAS. It was determined that they received 55.40 ± 16.04 points from the entire scale of TAS. Finally, it was determined that the minimum score that the individuals included in the study received from the RSES was 10 and the maximum score was 37. They received 21.19 ± 8.51 points from the entire scale.

Table 2 Descriptive statistics of participants’ scores obtained from the Disapproving Environment Scale in Childhood, Toronto Alexithymia Scale, and Rosenberg Self-Esteem Scale.

Variables	n	Minimum	Maximum	Mean	SD
DESC
Mother form	404	15.00	68.00	43.34	14.23
Father form	404	28.00	67.00	42.50	10.61
Chaotic family	404	1.00	5.00	2.68	1.25
Approving family	404	1.00	5.00	2.69	0.93
Perfect family	404	1.00	5.00	2.43	1.00
Typical family	404	1.00	5.00	2.74	0.76
TAS
Alexithymia	404	21.00	96.00	55.40	16.04
Difficulty recognizing emotions	404	7.00	34.00	19.04	6.28
Difficulty expressing emotions	404	5.00	24.00	15.30	4.26
Extroverted thinking	404	9.00	42.00	23.92	7.30
RSES
Self-esteem	404	10.00	37.00	21.19	8.51

DESC: Disapproving Environment Scale in Childhood; RSES: Rosenberg Self-Esteem Scale; SD: Standard deviation; TAS: Toronto Alexithymia Scale.

The model in which maternal disapproval in childhood was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2A. The coefficients in this model are the coefficients obtained when the relationships between the variables are examined separately. After determining that there was a significant relationship between all variables in the model, all variables were included in the model together to determine whether self-esteem had a mediating effect. Findings regarding testing of the model in which maternal disapproval in childhood (predictor), alexithymia (predicted), and self-esteem (mediator) are presented in Table 3. Maternal disapproval in childhood (predictor variable) significantly predicted alexithymia (predicted variable) (β = 0.51, t = 11.99; P < 0.05). At the same time, childhood maternal disapproval (predictor variable) also significantly predicted self-esteem (mediator variable) (β = -0.75, t = 22.65; P < 0.05). Self-esteem, which was the mediator variable, also significantly predicted alexithymia, which was the predicted variable (β = -0.58, t = 14.41; P < 0.05). In addition, when self-esteem was included in the relationship between maternal disapproval and alexithymia in childhood, it was observed that the effect of maternal disapproval in childhood on alexithymia decreased but was still significant (β = 0.17, t = 2.86; P < 0.05). In line with the findings, it can be stated that self-esteem has a partial mediating effect between maternal disapproval and alexithymia in childhood. Considering the significance of the indirect effect of self-esteem, the partial mediator, variable effect was found to be statistically significant (β = 0.35, boot SE = 0.02, 95%CI: 0.30-0.41). Finally, the final model was found to be significant [F(2403) = 109.77; P < 0.05, R² = 0.35], and it explained 35% of the total variance.

Figure 2 Model in which self-esteem mediated the relationship. A: Model in which self-esteem mediated the relationship between maternal disapproval in childhood and alexithymia; B: Model in which self-esteem mediated the relationship between paternal disapproval in childhood and alexithymia; C: Model in which self-esteem mediated the relationship between chaotic family life and alexithymia; D: Model in which self-esteem mediated the relationship between approving family life and alexithymia; E: Model in which self-esteem mediated the relationship between perfect family life and alexithymia; F: Model in which self-esteem mediated the relationship between typical family life and alexithymia.

Table 3 Maternal disapproval in childhood (predictor), alexithymia (predicted), and self-esteem (mediator) model.

P value test	Predictors	Predicted variable	β	t	P value
Model	Maternal disapproval in childhood	Alexithymia	0.51	11.99	0.000
Model	Maternal disapproval in childhood	Alexithymia	0.17	2.86	0.004
	Self-esteem		-0.45	-7.49	0.000
Hayes’ bootstrap	β = 0.35, boot SE = 0.02, 95%CI: 0.30-0.41, R2 = 0.35

CI: Confidence interval.

The model in which paternal disapproval in childhood was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2B. The coefficients in this model were obtained when the relationships between the variables are examined separately. After determining that there was a significant relationship between all variables in the model, they were included to determine whether self-esteem had a mediating effect. The findings are presented in Table 4. Paternal disapproval in childhood (predictor variable) significantly predicted alexithymia (predicted variable) (β = 0.52, t = 12.34; P < 0.05). At the same time, paternal disapproval in childhood also significantly predicted self-esteem (mediator variable) (β = -0.67, t = -18.09; P < 0.05). Self-esteem also significantly predicted alexithymia (β = -0.58, t = -14.41; P < 0.05). In addition, when self-esteem was included in the relationship between paternal disapproval and alexithymia in childhood, it was observed that the effect of paternal disapproval in childhood on alexithymia decreased but was still significant (β = 0.24, t = 4.54; P < 0.05). In line with the findings, it can be stated that self-esteem had a partial mediating effect between paternal disapproval and alexithymia in childhood. Considering the significance of the indirect effect of self-esteem, the partial mediator variable effect was found to be statistically significant (β = 0.21, boot SE = 0.02, 95%CI: 0.17-0.25). Finally, the final model was found to be significant [F(2403) = 119.16; P < 0.05, R² = 0.37], and it explained 37% of the total variance.

Table 4 Paternal disapproval in childhood (predictor), alexithymia (predicted), and self-esteem (mediator) model.

P value test	Predictors	Predicted variable	β	t	P value
Model	Paternal disapproval in childhood	Alexithymia	0.52	12.34	0.000
Model	Paternal disapproval in childhood	Alexithymia	0.24	4.54	0.004
	Self-esteem		-0.42	-7.91	0.000
Hayes’ bootstrap	β = 0.21, boot SE = 0.02, 95%CI: 0.17-0.25, R2 = 0.37

CI: Confidence interval.

The model in which chaotic family life was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2C. The coefficients in this model were obtained when the relationships between the variables were examined separately. After determining that there was a significant relationship between all variables in the model, they were included to determine whether self-esteem had a mediating effect. The findings are presented in Table 5. Chaotic family life (predictor variable) significantly predicted alexithymia (predicted variable) (β = 0.33, t = 6.92; P < 0.05). At the same time, chaotic family life also significantly predicted self-esteem, which was the mediator variable (β = -0.60, t = -15.18; P < 0.05). Self-esteem also significantly predicted alexithymia (β = -0.58, t = -14.41; P < 0.05). In addition, when self-esteem in the relationship between chaotic family life and alexithymia was included, the effect of chaotic family life on alexithymia was found to be insignificant (β = -0.04, t = -0.80; P > 0.05). In line with the findings, it can be stated that self-esteem had a full mediating effect between chaotic family life and alexithymia. Considering the significance of the indirect effect of self-esteem, the full mediator variable effect was found to be statistically significant (β = 0.03, boot SE = 0.01, 95%CI: 0.02-0.03). Finally, the final model was found to be significant [F(2403) = 104.04; P < 0.05, R² = 0.34], and it explained 34% of the total variance.

Table 5 Chaotic family life (predictor), alexithymia (predicted), and self-esteem (mediator) model.

P value test	Predictors	Predicted variable	β	t	P value
Model	Chaotic family life	Alexithymia	0.33	6.92	0.000
Model	Chaotic family life	Alexithymia	-0.04	-0.80	0.421
	Self-esteem		-0.61	-11.97	0.000
Hayes’ bootstrap	β = 0.03, boot SE = 0.01, 95%CI: 0.02-0.03, R2 = 0.34

CI: Confidence interval.

The model in which an approving family life was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2D. The coefficients in this model were obtained when the relationships between the variables were examined separately. After determining that there was a significant relationship between all variables in the model, they were included to determine whether self-esteem had a mediating effect. An approving family life (predictor variable) significantly predicted alexithymia (predicted variable) (β = -0.43, t = -9.76; P < 0.05) (Table 6). At the same time, an approving family life also significantly predicted self-esteem (β = 0.61, t = 15.58; P < 0.05). Self-esteem significantly predicted alexithymia (β = -0.58, t = -14.41; P < 0.05). In addition, when self-esteem was included in the relationship between approving family life and alexithymia, it was observed that the effect of approving family life on alexithymia decreased but was still significant (β = -0.17, t = -4.01; P < 0.05). In line with the findings, it can be stated that self-esteem may have had a partial mediating effect between approving family life and alexithymia. Considering the significance of the indirect effect of the partial mediator variable, it was found to be statistically significant (β = -0.01, boot SE = 0.00, 95%CI: -0.01 to -0.02). Finally, the final model was found to be significant [F(2403) = 115.75; P < 0.05, R² = 0.37], and it explained 37% of the total variance.

Table 6 Approving family life (predictor), alexithymia (predicted), and self-esteem (mediator) model.

P value test	Predictors	Predicted variable	β	t	P value
Model	Approving family life	Alexithymia	-0.43	6.92	0.000
Model	Approving family life	Alexithymia	-0.17	-4.01	0.000
	Self-esteem		-0.53	-12.74	0.000
Hayes’ bootstrap	β = -0.01, boot SE = 0.00, 95%CI: -0.01 to -0.02, R2 = 0.37

CI: Confidence interval.

The model in which a perfect family life was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2E. The coefficients in this model were obtained when the relationships between the variables were examined separately. After determining that there was a significant relationship between all variables in the model, they were included to determine whether self-esteem had a mediating effect. Findings regarding the testing of the model in which perfect family life was predictor, alexithymia was predicted, and self-esteem was mediator are presented in Table 7. Perfect family life significantly predicted alexithymia (β = -0.27, t = -5.52; P < 0.05). At the same time, perfect family life significantly predicted self-esteem (β = 0.45, t = -10.06; P < 0.05). Self-esteem also significantly predicted alexithymia (β = -0.58, t = -14.41; P < 0.05). In addition, when self-esteem was included in the relationship between perfect family life and alexithymia, the effect of perfect family life on alexithymia was found to be insignificant (β = -0.01, t = -0.11; P > 0.05). In line with the findings, it can be stated that self-esteem had a full mediating effect between perfect family life and alexithymia. Considering the significance of the indirect effect of self-esteem, the full mediator variable effect was found to be statistically significant (β = -0.02, boot SE = 0.00, 95%CI: -0.02 to -0.01). Finally, the final model was found to be significant [F(2403) = 103.56; P < 0.05, R² = 0.34], and it explained 34% of the total variance.

Table 7 Perfect family life (predictor), alexithymia (predicted), and self-esteem (mediator) model.

P value test	Predictors	Predicted variable	β	t	P value
Model	Perfect family life	Alexithymia	-0.27	-5.52	0.000
Model	Perfect family life	Alexithymia	-0.01	-0.11	0.000
	Self-esteem		-0.58	-12.81	0.000
Hayes’ bootstrap	β = -0.02, boot SE = 0.00, 95%CI: -0.02 to -0.01, R2 = 0.34

CI: Confidence interval.

The model in which typical family life was the predictor, alexithymia was predicted, and self-esteem was the mediator is presented in Figure 2F. The coefficients in this model were obtained when the relationships between the variables were examined separately. As seen in Figure 2F, typical family life did not significantly predict alexithymia (β = 0.04, t = 0.79; P > 0.05). Typical family life significantly predicted self-esteem (β = -0.22, t = -4.56; P < 0.05). Self-esteem also significantly predicted alexithymia (β = -0.58, t = -14.41; P < 0.05). As a result, one of the assumptions of mediation was not fulfilled because typical family life was the predictor variable and did not significantly predict alexithymia. Therefore, the mediation effect was not examined.

DISCUSSION

This study showed that the type of family the child grows up in and parental disapproval in childhood affected the child’s self-esteem and caused alexithymic personality traits. Self-esteem had a partial mediating effect in the relationship between parental disapproval and alexithymia.

The first finding of the study was that parental disapproval significantly predicted alexithymia positively and self-esteem negatively. Parental disapproval increased, self-esteem decreased, and alexithymia increased. In addition, self-esteem was found to significantly negatively predict alexithymia. Accordingly, self-esteem increased and alexithymia decreased. Finally, it was found that self-esteem had a partial mediating effect on the relationship between parental disapproval and alexithymia.

It was considered that there could be four main reasons for the partial mediating effect of self-esteem on the relationship between parental disapproval and alexithymia. The first of these is internal beliefs and negative evaluation. Parental disapproval can make children feel worthless or inadequate. This negative evaluation affects the child’s internal beliefs and evaluations of the self. Negative attitudes of parents damage the child’s self-esteem and negatively affect their ability to express themselves and recognize and express emotional experiences[56]. This may lead to alexithymia.

The second reason is relational dynamics. Parental disapproval affects the child’s relationship with their parents. When the child does not receive the love, acceptance, and approval the child expects from their parents, the child may experience a feeling of relational emptiness or inadequacy. This may contribute to the development of alexithymia by affecting the child’s self-esteem[57].

The third reason is emotional regulation. Parental disapproval can affect a child’s emotional regulation skills. Children whose emotional regulation ability is weakened have difficulty managing their emotional experiences. Their ability to express themselves and regulate their emotional experiences becomes limited. Children may feel inadequate or uncontrollable when they cannot regulate their emotional experiences[58]. These emotional difficulties can contribute to lowered self-esteem and the development of alexithymia.

The fourth reason is role models. Children consider their parents as role models. Parental disapproval negatively affects children’s self-evaluation and self-esteem. Parents’ critical or disapproving behaviors can lead the child to evaluate himself/herself in a similar way[59]. This can contribute to low self-esteem and indirectly to alexithymia. These factors may explain the partial mediating effect of self-esteem in the relationship between parental disapproval and alexithymia.

The second result of the study was that a chaotic family life significantly predicted alexithymia positively and self-esteem negatively. Accordingly, growing up in a family environment with a chaotic family type had a lowering effect on self-esteem and increasing alexithymic personality traits. In addition, self-esteem was found to significantly negatively predict alexithymia. Accordingly, self-esteem increases and alexithymia decreases. Finally, it was determined that self-esteem had a full mediating role in the relationship between a chaotic family life and alexithymia. Chaotic family life can cause self-esteem to drop, and this low self-esteem can contribute to symptoms of alexithymia.

Conflicts, stress, and uncertainty occur constantly in chaotic family life. This situation may prevent children from meeting their emotional needs and ensuring emotional security. When parents are constantly busy or emotionally unavailable, it can cause children to feel rejected or unimportant. In this case, children’s self-esteem may decrease[60]. Individuals with low self-esteem may have difficulty expressing their emotional experiences. Their ability to identify, express, and regulate their own emotions may weaken[61]. Symptoms of alexithymia may manifest as suppression of emotional experiences or difficulty identifying them. In this context, chaotic family life may mediate the emergence of alexithymia symptoms by lowering children’s self-esteem.

The third finding of the study was that an approving family life significantly predicted alexithymia negatively and self-esteem positively. Accordingly, growing up in an approving family type had the effect of increasing self-esteem and reducing alexithymic personality traits. In addition, self-esteem was found to negatively predict alexithymia significantly. Accordingly, self-esteem increases and alexithymia decreases. Finally, it was determined that self-esteem had a partial mediating role in the relationship between approving family life and alexithymia.

Several reasons can be considered in the mediating effect of self-esteem in the relationship between approving family life and alexithymia. The first is emotional support and acceptance. Approving families are sensitive to emotional needs and accepting of children’s emotional needs. Parents care about their children’s emotional experiences and empathize with them. This emotional support and acceptance increases children’s self-esteem[62]. Children who feel lovable and valued may be more capable of coping with emotional difficulties and may contribute to reduced symptoms of alexithymia.

The second reason is the development of intrinsic values and self-efficacy. Approving families support children’s intrinsic values and self-efficacy. Parents appreciate and trust children’s achievements. This enables children to trust themselves and contributes to the development of self-esteem[63]. Individuals with strong self-esteem can reduce alexithymia symptoms by improving their ability to better understand and express their emotional world.

The third reason is supportive relationships. Approving families build healthy, supportive relationships with children. Parents spend time and effort to meet children’s emotional needs and ensure a secure attachment. These solid relationships support children to develop emotional regulation skills and express their emotions better. Children who receive good relational support may have a healthier emotional balance, which helps reduce alexithymia symptoms[64].

Another finding of the study was that perfect family life significantly predicted alexithymia negatively and self-esteem variable positively. Accordingly, growing up in a perfect family type had the effect of increasing self-esteem and reducing alexithymic personality traits. In addition, it was determined that self-esteem significantly predicted alexithymia in a negative direction. Accordingly, self-esteem increases and alexithymia decreases. Finally, it was determined that self-esteem had a full mediating role in the relationship between perfect family life and alexithymia.

Parents in a perfect family life type care about children’s emotional needs and provide emotional support like the approving family life type. Parents provide their children with an environment of love, acceptance, and trust. This secure attachment and emotional support strengthen children’s self-belief and self-esteem[65]. Children with high self-esteem tend to be more emotionally stable and may be more effective at reducing symptoms of alexithymia. These factors included in the perfect family life contribute to the reduction of alexithymia symptoms by increasing children’s self-esteem. Individuals with high self-esteem develop their skills in better understanding, expressing and managing their emotional experiences. This can create a healthy emotional balance that supports the reduction of alexithymia symptoms.

CONCLUSION

Parental disapproval of the child affects alexithymia positively and self-esteem variable negatively. There is a partial mediating effect of self-esteem in the relationship between parental disapproval and alexithymia. The type of family is also important for alexithymia. It was concluded that a chaotic family life affected alexithymia positively and self-esteem variable negatively, and self-esteem had a full mediating effect on the relationship between chaotic family life and alexithymia. It was concluded that approving family life and perfect family life significantly predicted alexithymia negatively and self-esteem variable positively. Self-esteem had a partial mediating effect in the relationship between approving family life and alexithymia, and a full mediating effect in the perfect family life and alexithymia. A typical family life negatively predicted self-esteem but did not significantly predict alexithymia.

ACKNOWLEDGEMENTS

We would like to thank all the participants for being part of the research despite the time they were in.