1. Introduction
Alexithymia is a personality trait characterized by an inability to identify and describe the emotions experienced by oneself (Taylor & Bagby, 2004). Alexithymia is also identified by extroverted thinking and poor imaginative processes (Keefer et al., 2019). One of the ways to control stress, especially in the case of negative emotions, is to reveal and express the emotions caused by stress. If the emotions are not exposed and the person fails to express their negative emotions verbally, psychological problems are aggravated, and consequently, the person suffers from physiological arousal. This state of arousal will remain active and is not suppressed due to problems in differentiating, describing, and regulating emotions. In this case, the person becomes prone to many psychological and physical disorders (Chen et al., 2011; Taylor, et al., 1999). On the contrary, people who can recognize their feelings and express their emotional states can effectively cope with problems in their lives and are more successful in adapting to various environmental and other conditions. These people will have better mental health (Bagby et al., 2009).
The ability to recognize emotions makes it easier for people to face life challenges and, as a result, they enjoy greater mental health. Emotionally empowered people recognize their feelings, understand their implications, and communicate their emotional states to others more effectively. These individuals are more successful in coping with negative experiences than those who cannot perceive and express emotional states and also show better adaptation to the environment and others (Taylor, et al., 2014). The better people can exchange their emotions, the better they can build a relationship, and this leads to more psychological and physiological well-being in them. However, the capacity of individuals to create emotional relationships is not the same (Hesse & Mikkelson, 2018). Kench and Irwin (2000) showed that the family environment and the family emotional atmosphere are also influential in the etiology of alexithymia. Moreover, factors associated with childhood family environment, such as the family’s level of cohesion, expressiveness, conflict, disengagement, sociability, enmeshment, organization, and parenting style are involved in the formation of alexithymia (Kench & Irwin, 2000).
The most effective factor in predicting the behaviors of people in adulthood is the family and the emotional atmosphere formed in the family environment. Accordingly, some studies reported the family emotional atmosphere as an important factor in shaping the emotions of family members (Raikes & Thompson, 2006). Some theorists believe that because the family environment is the place where children learn how to express their emotions, the characteristics of the family can be associated with alexithymia. When people grow up in safe families and are supported in expressing emotions, they learn how to experience and recognize emotions (Costa, et al., 2019).
The family emotional atmosphere refers to the parent’s relationship with the children and how to satisfy the emotional needs of the child. Thus, the family must be a safe and calm environment for children to learn how to deal with social issues and problems and be able to solve them (Raikes & Thompson, 2006). How parents interact with each other and their children has also an impact on the formation of the family’s emotional atmosphere and can be effective in emotional and behavioral feedback at certain times (Johnson, 2019). In addition to the emotional atmosphere of the family, the attachment relationship that is formed between children and their caregivers during childhood determines the pattern of their interaction with the important people in their lives in adulthood (Johnson, 2019; Holmes, 2014). Attachment researchers have acknowledged the impact of early emerging experiences of self and others, and have examined how attachment styles affect future relationships and emotion regulation strategies in adulthood (Dewitte et al., 2010; Shahbazi et al., 2020). These visualizations influence people’s perceptions of themselves and others about whether they deserve to be cared for and whether others can be trusted to provide care (Holmes, 2014). Knapp et al. revealed that the relationships between family-of-origin experiences and the quality of interactions are profoundly associated with communication skills in couples. When couples have experienced secure attachment behaviors, like acceptance and warmth, they have more responsive and healthy interactions than couples with weaker relationships with their parents (Knapp et al., 2015). Mancinelli et al. (2021) examined the relationship between reactive and proactive aggression attachment styles and alexithymia in adolescents. The results showed a difference between attachment styles in adolescents and the type of aggression with alexithymia. Research on the relationship between attachment styles and alexithymia has shown that alexithymia-related traits are more prevalent in insecure attachment styles (Montebarocci et al., 2004). These difficulties and the absence of effective role models for emotional expression may lead to anxiety and ambivalence in emotional expression, and insecure attachment can lead to the failure in learning how to feel and, thus, pave the way for alexithymia (Karukivi et al., 2011). Alexithymia has negative effects on psychological and emotional well-being and is a risk factor for people suffering from emotional distress, psychological problems, and physical illness. The victims of domestic violence had higher alexithymia, more depressive symptoms, insecure attachment styles, and could not cope with stress compared to controls (Craparo et al., 2014). Alexithymia is also associated with anxious and avoidant attachment styles (Pellerone et al., 2017). 
Based on what was discussed, alexithymia is associated with the attachment styles of parents and adults, impaired social functions, and abnormality in relationships, it can make people susceptible to physical and mental disorders and plays a key role in reducing the ability to manage stress and emotional regulation. Therefore, it is necessary to pay more attention to the importance of social and family experiences in the emotional development of people, as well as the role of attachment styles and the emotional atmosphere of the family in the lives of married people. Accordingly, the present study was conducted to investigate the role of family emotional atmosphere and attachment styles in predicting the alexithymia of married people. 
2. Materials and Methods
It was a predictive correlational study. The research population consisted of all married men and women living in District 2 of Tehran Municipality in 2021 who visited counseling centers in the same district for their marital communication problems. The subjects were selected using stratified proportional sampling. First, among 12 available private counseling and psychotherapy centers, five centers were selected by simple random sampling. Then, 400 subjects who had been referred to these clinics and had marital communication problems were selected through convenient sampling based on inclusion criteria. The inclusion criteria were Wiliness to participate in the study, being married, not having a self-reported serious medical and psychiatric condition that required taking medication, having at least a diploma, and being married for at least five years. Finally, 400 people were selected by the Cochran formula and the questionnaires were completed by them. The questionnaires were distributed among the participants and completed by them from April 18 to July 4, 2021. After a careful review of the questionnaire, four uncompleted questionnaires were omitted, and finally, the data from 394 questionnaires were analyzed. 
Instruments 
The following questionnaires were used to collect the data: 
Toronto Alexithymia Scale (TAS-20)
This scale was developed by Taylor et al. (1986) and was revised by Bagby, et al. (1994). This scale measures deficits in understanding, processing, or describing emotions. This 20-item instrument has three subscales: difficulty identifying feelings (DIF: seven items; 1,3,6,7, 9, 13, and 14), difficulty describing feelings (DDF: five items; 2, 4, 11, 12, and 17), and externally oriented thinking (EOT: eight items; 5, 8, 10, 15, 16,18,19, and 20). The items are scored on a 5-point Likert scale, ranging from strongly disagree to strongly agree. The psychometric properties of the scale have been validated  (Taylor, et al. 2000; Bagby et al. 1994). The TAS-20 uses cutoff scoring as: ≤51=non-alexithymia, 52 to 60=possible alexithymia, and ≥61=alexithymia. The Cronbach’s alpha value for the Persian version of the scale was calculated to be 85%, confirming the good internal consistency of the scale (Shahgholian, et al., 2007). The reliability of the scale was measured as 0.79 using Cronbach’s alpha in this study. 
Family Emotional Climate Questionnaire
This questionnaire was created by Mahmmoud Nodargah Fard (1994) as a master’s thesis in the field of counseling to measure the family emotional atmosphere using 35 five-choice items (1=never to 5=always). The total score ranges from 35 to 175 and higher scores indicate more emotional involvement and a more unfavorable atmosphere in the family. Nodargah Fard reported the reliability coefficient of the questionnaire using the split-half method equal to 0.94 (Zandipayam, Davoudi, & Mehrabizade Honarmand, 2019). Its reliability was re-evaluated in this study using Cronbach’s alpha of 0.88.
The Adult Attachment Scale (AAS)
This scale is a self-measurement of relationship-formation skills (Collins & Read 1990). The scale including 18 items is scored on a 5-point Likert-type scale (1=not at all characteristic of me, 5=very characteristic of me) and consists of three sub-scales, including “Secure” (S), “anxious/ambivalent (AX)” and “avoidant (AV)” attachment styles. It takes 10 minutes to complete the AAS either individually or in groups. Each item is scored from 0 to 4 for options 1 to 5. Items 1, 6*, 8*, 12, 13, and 17* measure secure attachment, and items 5*, 2, 16*, 14, 7, and 18* assess avoidant attachment style. Finally, items 3, 4, 9, 10, 11, and 15 measure ambivalent-anxiety attachment style. Items 1 to 5 are the items to be scored reversely (the items marked with*) are scored as 4, 3, 2, 1, and 0, respectively. The total score of each subscale is measured as the sum of the scores of the 6 items (Shirzadi, et al., 2021). Collins and Read (1990) reported Cronbach’s alpha coefficients of the subscales from 0.52-0.75. Test-retest correlations of the subscales for a 2-month period were 0.52- 0.71. In this study, the reliability of the questionnaire was recalculated through Cronbach’s alpha and the corresponding value was 0.83. The collected data were analyzed using the correlation coefficient test and multiple regression analysis by SPSS software, version 22.
3. Results 
The mean age of the subjects was 41.08±4.02 years. Other characteristics of the subjects are shown in Table 1.



Table 2 shows the descriptive indices of the research variables. Because the skewness and kurtosis values for all variables range from -2 to +2, it can be concluded that the distribution of data related to the research variables does not show any obvious deviation from the univariate normality.



As shown in Table 3, the secure and avoidant attachment style was negatively correlated with alexithymia (P<0.01). Moreover, the anxious/ambivalent attachment style was positively correlated with alexithymia (P<0.01). The family’s emotional atmosphere was negatively correlated with alexithymia (P<0.01).



As shown in Table 4, the R2 value was 0.466, indicating that 46.6% of the variances in alexithymia can be explained by the family’s emotional atmosphere and attachment styles. In addition, the F was 86.04, which is significant at the 99% confidence level. Thus, it can be concluded that the family emotional atmosphere and attachment styles were significantly correlated with alexithymia. Accordingly, the research hypothesis was confirmed. Furthermore, the t indicates the family emotional atmosphere (P<0.01), avoidant (P<0.05), secure (P<0.01), and anxious/ambivalent (P<0.01) had significant correlations with alexithymia. 



The beta values also showed that the family emotional atmosphere and the secure and avoidant attachment were negatively correlated and the anxious/ambivalent attachment style was positively and significantly correlated with alexithymia
4. Discussion 
We found that the family’s emotional atmosphere and attachment styles can predict alexithymia in married people. The findings also indicated that the family emotional atmosphere was inversely associated with alexithymia as a personality trait. This means that people living in a more unfavorable emotional family atmosphere, experience higher levels of alexithymia and vice versa. El Frenn (2022) showed that couples with a higher secure attachment style and less alexithymia are more likely to have higher marital satisfaction. Marital satisfaction is directly related to secure attachment style and alexithymia plays an important mediating role (El Frenn et al., 2022). Moreover, Taylor et al. showed that individuals with higher alexithymia have less coherence of mind (Taylor, & Bagby, 2004). 
Lyvers et al. showed that alexithymia, fear of intimacy, and secure attachment can predict couples’ marital satisfaction. They also concluded that married individuals with low satisfaction with their marital relationship were more likely to have more alexithymia and that fear of intimacy, insecure attachment, and negative mood could predict alexithymia (Lyvers et al., 2022a).
Moreover, Lyvers et al. (2022b) examined alexithymia, attachment security, and negative mood and concluded that insecure attachment and negative mood were significantly associated with alexithymia and alexithymia could predict emotional self-regulation (Lyvers et al., 2022b). Di Trani et al. examined the relationship between alexithymia, romantic attachment in couples, and the clinical course of myocardial infarction and concluded that alexithymia and avoidant attachment can negatively affect the course of the disease (Di Trani et al., 2020). Scigala et al. also showed that alexithymia predict self-differentiation while fear of intimacy and adult attachment may act as mediators of alexithymia (Scigala et al., 2021). 
Attachment style is important for understanding how individuals perceive and control their relationships and social behaviors. To better understand attachment styles, it is important to examine alexithymia. Anxious/ambivalent attachment style in individuals is positively associated with difficulty identifying and describing emotions and regulating negative emotions. Alexithymia is a mediating and influential variable in regulating people’s emotions. Thus, when examining alexithymia, attention should be paid to the type of attachment of individuals (Ferraro & Taylor, 2021). Alexithymia is associated with decreased emotional awareness and increased aggression. Parents with authoritarian parenting styles contribute to developing alexithymia in their children. The results of a study on the relationship between alexithymia, parenting styles, and the incidence of aggression in adults showed a positive relationship between the authoritarian parenting style and alexithymia, between alexithymia and aggression, and between the authoritarian parenting style and aggression. The researchers concluded that a high level of alexithymia is associated with increased aggression in adulthood due to an authoritarian parenting style of parents, especially the father (Janik McErlean &Lim, 2020). Alexandru found that alexithymia is directly related to an anxious/ambivalent attachment style and conflicting interpersonal relationships (Alexandru, 2022).
This study was conducted only on married men and women referring to counseling centers in District 2 of Tehran Municipality. In addition, the limitations of self-reporting should be considered when applying the findings. It is recommended that future studies investigate the role of emotion regulation and aggression as psychological constructs and their relationship with alexithymia. 
5. Conclusion
The findings of this study indicated that the family emotional atmosphere and attachment styles in married people can predict their alexithymia. Paying attention to this psychological construct is important not only because it makes people fail to express their emotions, but because it also affects their marital and other interpersonal relationships.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Islamic Azad University, Tehran North Branch (IR.IAU.TNB.REC.1400.070). The subjects were assured of their anonymity and the confidentiality of their information. Before starting the study, written informed consent was obtained from all the subjects.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest. 
Acknowledgments
This article is an excerpt from the data of a PhD dissertation of the first author from the Islamic Azad University, Tehran North Branch. The authors would like to appreciate managers and staff of Counseling centers in District 2 of Tehran Municipality and all those participating in the study.


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