Examining a model of anxiety in autistic adults

ABSTRACT

Anxiety disorders commonly occur in autism. Existing studies implicate intolerance of uncertainty, alexithymia, sensory processing differences and emotion regulation difficulties as influencing factors of anxiety in autism. To date, a few studies have considered the combination of these factors within the same sample. This study used structural equation modelling to test the prediction that intolerance of uncertainty and emotion regulation constitute more direct causes of anxiety in autism that mediate the influences of sensory processing difference and alexithymia as more sequential contributing factors. Autistic (n = 86) and non-autistic adults (n = 100) completed a battery of self-report questionnaires. Only when applied to each group separately, the broad predictions of the model were confirmed for the autistic group following data-driven additions of paths between sensory processing difference and anxiety and alexithymia implying that sensory processing difference contribute indirectly as well as directly to individual differences in anxiety. For the non-autistic group, model fit could only be achieved after removing autism-related traits and sensory processing differences as predictors of anxiety. These results suggest that aetiology and expression of anxiety in autism partially overlap with what is observed in the general population except that sensory processing differences appear to play a relatively unique role in the context of autism.

Alexithymia modulates emotion concept activation during facial expression processing

Alexithymia is characterized by difficulties in emotional information processing. However, the underlying reasons for emotional processing deficits in alexithymia are not fully understood. The present study aimed to investigate the mechanism underlying emotional deficits in alexithymia. Using the Toronto Alexithymia Scale-20, we recruited college students with high alexithymia (n = 24) or low alexithymia (n = 24) in this study. Participants judged the emotional consistency of facial expressions and contextual sentences while recording their event-related potentials. Behaviorally, the high alexithymia group showed longer response times versus the low alexithymia group in processing facial expressions. The event-related potential results showed that the high alexithymia group had more negative-going N400 amplitudes compared with the low alexithymia group in the incongruent condition. More negative N400 amplitudes are also associated with slower responses to facial expressions. Furthermore, machine learning analyses based on N400 amplitudes could distinguish the high alexithymia group from the low alexithymia group in the incongruent condition. Overall, these findings suggest worse facial emotion perception for the high alexithymia group, potentially due to difficulty in spontaneously activating emotion concepts. Our findings have important implications for the affective science and clinical intervention of alexithymia-related affective disorders.

The relationship between dissociation and panic symptoms in adolescence and the exploration of potential mediators

Background

Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear.

Methods

In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13-18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart.

Results

Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators.

Conclusions

Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship.

The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem

Background & Aim

Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents.

Methods

A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects.

Results

The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect.

Conclusion

These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.

Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations

Purpose

Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder.

Patients and Methods

From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia.

Results

The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients.

Conclusion

In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.

Basolateral Amygdala Functional Connectivity in Alexithymia: Linking Interoceptive Sensibility and Cognitive Empathy

Emotions rely on bodily states, and perceiving the emotions of others depends on awareness of one's own emotional state. However, the intercorrelations among interoception, alexithymia, and empathy are not well understood, and the neural mechanisms behind this connection are also largely unknown. To address these issues, 297 college students participated in this study, completing measures of interoceptive sensibility (IS), empathy and alexithymia and undergoing resting-state fMRI scans. The functional connectivity of the amygdala was analysed to identify the neural substrates of alexithymia, and mediation analyses were conducted to examine the mediation effect of alexithymia and alexithymia-specific amygdala functional connectivity on the relationship between IS and empathy. The results showed that higher levels of IS were associated with increased cognitive empathy through weakened alexithymia. Functional connectivity analysis indicated that right basolateral amygdala (BLA)-left precuneus connectivity was negatively related to alexithymia, while right BLA-left precentral gyrus connectivity was positively related to alexithymia. Furthermore, right BLA-left precuneus connectivity was found to mediate the impact of interoception on cognitive empathy. In conclusion, this study provides valuable insights into the relationships among IS, alexithymia, and empathy. The right BLA-left precuneus connectivity may serve as a shared neural substrate between interoception and cognitive empathy.

Addressing psychosomatic symptom distress with mindfulness-based cognitive therapy in somatic symptom disorder: mediating effects of self-compassion and alexithymia

Objective

This study explored the association between self-compassion, alexithymia, and psychosomatic symptom distress in a clinical sample of somatic symptom disorder (SSD) patients participating in a mindfulness-based cognitive therapy (MBCT) program.

Methods

One hundred sixteen SSD patients who had participated in an MBCT program and completed ≥4 intervention sessions were included in a retrospective study (76.7% women, mean age = 40.0, SD = 9.5). Psychometric measures of psychosomatic symptom distress [Brief Symptom Inventory-18 Global Severity Index (BSI-GSI)], self-compassion [Self-Compassion Scale (SCS)], and alexithymia [Toronto Alexithymia Scale (TAS)] were collected upon admission to the MBCT program and at 6-month follow-up following treatment inclusion.

Results

Serial mediation analysis (MBCT→ΔSCS→ΔTAS→ΔBSI-GSI) suggested that changes in both self-compassion and alexithymia had significant indirect effects on improvement in psychosomatic distress [ΔSCS β = -1.810, 95% bootstrap CI (-2.488, -1.160); ΔTAS β = -1.615, bootstrap 95% CI (-2.413, -0.896); ΔSCS→ΔTAS β = -0.621, bootstrap CI (-1.032, -0.315)]. Furthermore, a post-hoc analysis with a reverse sequence (MBCT→ΔTAS→ΔSCS→ΔBSI-GSI) revealed that reduction in alexithymia improved psychosomatic distress and that an increase in self-compassion was a subsequent outcome of alleviation of alexithymia [ΔTAS β = -2.235, bootstrap 95% CI (-3.305, -1.270); ΔSCS β = 0.013, 95% bootstrap CI (-0.600, 0.682); ΔTAS→ΔSCS β = -1.823, bootstrap CI (-2.770, -1.047)].

Conclusion

Both alleviation of alexithymia and improvement in self-compassion play a mediating role in the reduction of psychosomatic distress in SSD patients following an MBCT program. Improvement in self-compassion might be a subsequent outcome of MBCT-related alleviation of alexithymia.

Alexithymia and depression may predict treatment failure in patients undergoing Gamma Knife radiosurgery for trigeminal neuralgia: the potential contribution of colored pain drawings

OBJECTIVE

Gamma Knife radiosurgery (GKRS) effectively achieves high rates of pain control in trigeminal neuralgia (TN); however, psychological factors can also impact how individuals perceive pain and respond to treatment. The authors aimed to measure the effects of alexithymia and depression on GKRS outcomes, as well as the potential role of colored pain drawings (CPDs) in identifying patients who require additional psychological support.

METHODS

Seventy-three medically intractable, typical patients with TN were included. Participants completed a visual analog scale (VAS), the Toronto Alexithymia Scale (TAS-20), and the Turkish version of the Beck Depression Inventory-II (BDI-II). Participants used colored pens to draw their pain patterns on standardized face charts and CPDs were categorized as expected or unexpected. Based on the Barrow Neurological Institute pain scale, patients were categorized as responders or nonresponders.

RESULTS

Most patients (63%) were female, and the median age was 60 (range 27-88) years. Of 73 patients, 56 (76.7%) were responders and 17 (23.3%) were nonresponders. Forty-nine patients (67.1%) had expected CPDs, whereas 24 (32.9%) had unexpected CPDs. Responder and nonresponder groups had similar ages, genders, education, comorbidities, and initial VAS scores. Both groups preferred the colors red and black to describe intense pain (79.2% vs 67.3%, p = 0.411). Significantly better pain relief was observed in patients with expected CPDs than in those with unexpected CPDs (87.8% vs 54.2%, p = 0.003). The unexpected CPD group had significantly more alexithymia (58.3% vs 32.7%, p = 0.045). The mean BDI-II score of the cohort was 26 (range 15-37) and was significantly higher in the unexpected group (28.3 vs 24.8, p = 0.028). Unexpected CPD (OR 12.540) and higher TAS-20 score (OR 3.22) increased treatment failure risk.

CONCLUSIONS

The outcomes of TN treatment can be influenced by psychological factors, and patients with TN with higher total TAS-20 and BDI-II scores, along with unexpected CPDs, had an increased likelihood of treatment failure. CPDs can be accessed quickly and may allow the physician to screen out most patients with unfavorable psychometrics and proceed with the necessary treatment with appropriate psychological support.

A multifaceted approach to assessment of mentalization: the mentalization profile in patients with eating disorders

Purpose: The existing literature, however sparse, suggests an association between eating disorders (ED) and mentalization ability. The aim of this study was to investigate the mentalization profile (MP) in patients with ED. It was hypothesized that patients with ED would have a lower degree of mentalization ability compared to healthy controls (HC).Materials and methods: The study is based on a cross-sectional survey on a sample of patients diagnosed with ED compared to a HC group.Results and conclusion: A total of 88 participants, distributed between patients with ED (N = 30) and HC (N = 58) were included.Results: The study results show statistically significant differences between patients with ED and HC. Thus, patients with an ED scored significantly higher on Reflective Functioning Questionnaire (uncertainty about mental states) (RFQ-U) (mean difference: 0.31, p = 0.048) and Toronto Alexithymia Scale (TAS-20) (mean difference: 0.44, p = 0.019) compared to the HC. Furthermore, the results indicated that patients with Bulimia Nervosa (BN) may have a lower ability to mentalize about oneself as well as a generally lower ability to mentalize across different dimensions of the mentalization profile as the BN group scored significantly higher on RFQ-U (mean difference: 0.71, p = 0.023) and TAS-20 (mean difference: 0.89, p = 0.006) compared to the Anorexia Nervosa (AN) group. Further research should be conducted to gain knowledge on the mentalization ability in patients with an ED.

Alexithymia, Suicidal Ideation, and Self-Esteem As Psychological Factors Affecting Chronic Kidney Disease Patients Under Haemodialysis: A Contextual Review

Chronic kidney disease is a universal topic gravitating towards various aspects of widespread illness, impacting the overall well-being of human beings. Patients with longstanding renal complaints under dialysis encounter challenges correlated with physical, intuitive, and socio-economic conditions to a greater extent in their daily existence. These portions may include changes in the appearance of a person, restricted physique movements, curbed diet, duration of surgical protocols, travelling time during the period of prevention, financial load, role reversal in the family followed by ruining their livelihood, deprived social rank, difficulty in relational, cordial relationships, and so on. Excluding these details, the sick may be profoundly influenced by sorrow, health anxiety, despair, itching, the impoverished essence of vitality, dysfunction in sexual intimacy, impaired cognition, disturbances in disposition, sleeping fluctuations, frequent panic attacks, delirium, brain-afflicted degeneration disabilities, etcetera. Our analysis focuses on exploring a few unidentified intrinsic factors that distinguish these views over combined elements due to the existing disorder.

Role of Alexithymia in the Association Between Childhood Abuse and Risk Perception for Sexual Victimization in College Women

Sexual victimization is prevalent among college women with a history of childhood abuse (CA), which some research suggests is linked to impaired risk perception for sexual victimization or difficulties identifying and responding to unwanted sexual advances. Alexithymia is one construct yet to be examined in the association between CA and risk perception for sexual victimization. The purpose of this study was to elucidate the associations between CA, alexithymia, and risk perception for sexual victimization in a sample of college women with a history of CA. Participants included 294 undergraduate women with a history of childhood emotional, physical, and/or sexual abuse (Mage = 20.6, 80.6% White). An a priori path analysis was conducted to examine whether alexithymia indirectly explains the association between CA and risk perception for sexual victimization (i.e., comprising two related constructs, including threat detection and behavioral response to threat). Supplementary analyses were conducted post hoc to examine potential differences across CA subtypes (emotional, physical, and sexual). Alexithymia indirectly explained the relationship between CA and threat detection, and behavioral response to threat. However, indirect effects were negative, suggesting that undergraduate women with more severe CA and alexithymia identify sexual assault threat cues and intentions to "leave" a hypothetical sexual assault scenario sooner rather than later. The same pattern of results was observed for emotional and physical (but not sexual) CA when examining their indirect effects on threat detection, and for emotional CA when examining behavioral response to threat. Findings contribute to the literature on sexual victimization by clarifying the role of alexithymia in risk perception for sexual victimization. Results also highlight the potential utility of increasing emotional literacy among college women with a history of CA (and especially emotional abuse) to facilitate adaptive responding to unwanted sexual advances.

Bodily confusion: Lower differentiation of emotional and physiological states in student alcohol users

BACKGROUND

Alexithymia, difficulty in recognising and naming emotions, is common among people who use alcohol. There is also emerging evidence that people with alexithymia are unable to distinguish emotions from non-emotional physiological states. The project aimed to test if alcohol use is related to the way student drinkers experience emotions and physiological states in the body.

METHODS

We employed a novel method to study bodily sensations related to emotions and physiological states in the context of alcohol use: the emBODY tool, which allowed participants to mark areas of the body in which they experience various emotions and physiological states.

RESULTS

Students who showed a hazardous pattern of alcohol use (alcohol use disorders identification test [AUDIT] score ≥ 7, N = 91), overall, presented higher alexithymia levels and coloured larger areas for emotions and physiological states (showed less specificity) than those who show low-risk alcohol consumption (AUDIT ≤ 4, N = 90). Moreover, statistical classifiers distinguished feeling-specific maps less accurately for hazardous drinkers than low-risk drinkers [F(1,1998) = 441.16; p < 0.001], confirming that higher alcohol use is related to higher confusion of emotional and non-emotional bodily feelings.

CONCLUSIONS

Plausibly, this increased bodily confusion drives alcohol consumption: alcohol may serve as a means of dealing with undifferentiated changes in psychophysiological arousal accompanying emotional states.

Relationships Between Prenatal Cocaine Exposure, Cannabis-Use Onset and Emotional and Related Characteristics in Young/Emerging Adults

Background: Exposure to substances in utero may have significant early-life consequences. Less is known about the effects in emerging adulthood, particularly regarding patterns of substance use and related characteristics.Objectives: In this study, we recruited emerging adults, followed since birth, who had been prenatally exposed, or not, to cocaine. Individuals reported on their cannabis, alcohol, and tobacco use, and measures of impulsivity, anhedonia, emotional regulation, and mental health were obtained. Comparisons were made between emerging adults with prenatal cocaine exposure and those without. Correlations were performed between psychological measures and substance use, and regression analyses were conducted to determine potential pathways by which such measures may relate to prenatal exposure or substance use.Results: Individuals with prenatal cocaine exposure (vs. those without) used cannabis at younger ages, reported greater cannabis-use severity, and demonstrated higher impulsivity, state anxiety, and alexithymia. Earlier age of onset of cannabis use was associated with higher impulsivity, state anxiety, alexithymia, and social and physical anhedonia. Cannabis-use age-of-onset mediated the relationship between prenatal cocaine-exposure status and state anxiety and between prenatal cocaine-exposure status and cannabis-use severity in emerging adulthood but not relationships between prenatal cocaine-exposure status and impulsivity or alexithymia in emerging adulthood. Findings suggest that adults with prenatal cocaine exposure may use cannabis at younger ages, which may relate to increased anxiety and more severe use.Conclusions: These findings suggest both mechanisms and possible intervention targets to improve mental health in emerging adults with prenatal cocaine exposure.

Isolating unique variance in mental health outcomes attributable to personality variables and childhood emotional abuse

Introduction

University students are at high risk for anxiety and depression. Our main objective was to tease apart variance in symptom severity that was uniquely attributable to four associated variables that are frequently confounded: exposure to childhood emotional abuse, alexithymia, sensory processing sensitivity (SPS), and anxiety sensitivity (AS).

Methods

University students (N = 410) completed an online survey designed to measure our four key study variables along with several other potentially relevant variables including sex, physical activity levels, and perceived COVID-19 impacts.

Results

Over half of the participants reported moderate to extremely severe symptoms of anxiety and depression. Females reported stronger signs of SPS and AS and were more likely than males to have increased their moderate/vigorous exercise since the pandemic began. After controlling for the other variables, the best predictors of perceived COVID-19 impacts were SPS, childhood emotional abuse, and current levels of physical activity. Whereas all three personality variables and childhood emotional abuse emerged as significant predictors of both depression and anxiety, neither COVID-19 impacts nor physical activity levels accounted for unique variance in either model. Unexpectedly, male sex emerged as an additional risk factor for depression, raising the possibility that males experience unique stressors and societal pressures that increase their risk of depression.

Discussion

These findings help to clarify the links between childhood emotional abuse, personality traits implicated in emotional awareness and self-regulation, and mental health. They may have important implications for the development and implementation of individualized treatments for common mental disorders.

Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study

Type 1 diabetes mellitus (T1DM) represents a complex pathology affecting a large number of people. Research suggests that psychological factors influence coping with T1DM. This study aimed to investigate the presence and role of psychopathology, alexithymia and uncertainty in people affected by T1DM. The sample consisted of 137 patients (88 females, 49 males) affected by T1DM aged from 11 to 19 years old (Mean: 13.87; SD: 2.40). The diagnostic protocol consisted of a sociodemographic questionnaire, Self-administration Psychiatric Scales for Children and Adolescents (SAFA), Toronto Alexithymia Scale-20 (TAS-20) and Intolerance to Uncertainty Scale-12 (IUS-12). Descriptive, differential, correlational and regression analyses were performed in order to examine the relationships between these variables. The results suggested the sample had high levels of psychopathological indexes, alexithymia and intolerance of uncertainty. Also, there were significant differences between TAS-20 and IUS-12 distributions with respect to psychopathology. Correlations and multivariate linear regressions indicated age, gender and education significantly predicted alexithymia and intolerance of uncertainty. This data suggest the presence of elevated psychopathology, alexithymia and uncertainty in people with diabetes.

The Effect of Alexithymia, Attention, and Pain Characteristics on Mentalizing Abilities Among Adults With Chronic Pain

Introduction: Impaired mentalizing abilities are found among persons with chronic pain, yet it is still unknown why. The current study focuses on mentalizing abilities and how these could be affected by different pain factors, alexithymia traits, and other aspects of psychological functioning (depression, anxiety, attention) in persons experiencing chronic pain.Methods: 71 participants (80.3% female; mean age 56.1 (SD = 13.1)) with subjectively reported chronic pain conditions participated in the study. Mentalizing abilities were assessed using an objective assessment of the Frith-Happé animations test. Alexithymia was measured using Toronto Alexithymia Scale. Subjectively reported data on various pain characteristics and other related psychological factors (depression, anxiety, attention) were collected. Bivariate linear regression analyses were used to identify variables that had statistically significant relationships with Frith-Happé test scores as dependent variables, which were then used to build multivariate models.Results: Mentalization task scores had no significant associations with alexithymia. However, in bivariate models, greater Frith-Happé animations categorisation score was associated with higher attention task scores (βs = .332, p = .005), higher education (βs = .317, p = .007), and lower level of depressiveness (βs = -.234, p = .049). Greater animations feelings scores were associated with less severe pain intensity (βs = -.322, p = .006), younger age (βs = -.399, p = .001), and better attention (βs = .383, p = .001). In multivariate analysis models predicting both animations categorisation and feelings scores, attention was found to be the only statistically significant factor (respectively, βs = .257, p = .029 and βs = .264, p = .035).Conclusions: No significant correlations were found between mentalizing abilities and alexithymic features in persons with chronic pain. Disruptions of attention was the most significant factor leading to lower mentalizing abilities in persons with chronic pain.

Alexithymia in the Narratization of Romantic Relationships: The Mediating Role of Fear of Intimacy

PURPOSE

The purpose of the study was to verify the hypothesis concerning the relationship between alexithymia and selected indicators used to describe emotional events, specifically romantic relationships. Alexithymia, due to significant distortions in cognitive processing of emotional content, is demonstrated by poor recognition of emotions in oneself and others and, as a result, by deficits in empathy, avoidance of social relationships, and deficits in the ability to mentalize. Differences in narrations were tested by alexithymia levels (high vs. low) and the relation between specific narration features and individual alexithymia factors, i.e., difficulties in identifying emotions, difficulties in verbalising emotions, and externally oriented thinking.

METHOD

A total of 356 people who had been in a romantic relationship for at least six months participated in the study. The TAS-20 was applied to measure alexithymia, and the FIS questionnaire was used to investigate anxiety in close relationships. Participants were asked to freely describe the romantic relationship they were in at that moment. The Linguistic Inquiry Word Count (LIWCLIWC2015 v1.6-unlimited duration academic licence) software was used for content analysis. The study was conducted online.

RESULTS

On the basis of the analyses conducted, high levels of alexithymia were found to be significantly associated with a lower total number of words used in narrative, a lower number relating to positive emotions, a lower number relating to causation and insight, and a higher number relating to negative emotions. Various results were obtained for individual dimensions of alexithymia in relation to the LIWC categories and the mediating role of fear of intimacy. For the difficulty identifying feelings (DIF), a significant mediating effect was observed only for words associated with negative emotions, whereas for the difficulty describing feelings (DDF), significant mediating effects were found for words relating to negative emotions and causality. In the case of externally oriented thinking (EOT), significant mediating effects were obtained for all analysed categories from LIWC.

Attachment Anxiety and Nomophobia: A Moderated Parallel Mediation Model

Nomophobia is the state of being anxious or disturbed when feeling disconnected from the digital world and can have a significant impact on individuals' health and well-being. Drawing upon attachment theory and the previous literature on nomophobia, this study aims to understand how attachment anxiety influences nomophobia and whether this relationship differs between males and females. In the Human Penguin Project (HPP) (N = 1221; 12 countries; participants aged ≥20 years), the Experiences in Close Relationships Questionnaire-Revised (ECR-R), the Toronto Alexithymia Scale (TAS-20), the Perceived Stress Scale (PSS), and the Nomophobia Questionnaire (NMP-Q) were used to assess attachment anxiety, alexithymia, perceived stress, and nomophobia, respectively. The results demonstrated that (1) there were significant positive correlations between attachment anxiety, nomophobia, alexithymia, and perceived stress. Additionally, (2) there was a direct and significant effect of attachment anxiety on nomophobia, and alexithymia and perceived stress partially mediated this relationship. Finally, (3) gender significantly moderated the relationship between attachment anxiety and nomophobia. Specifically, the predicted effect was significant in both males and females, but the direct effect of attachment anxiety and nomophobia was stronger in males.

Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period

Introduction

It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.

Methods

We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.

Results

Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.

Discussion/Conclusion

Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

Role of history of traumatic life experiences in current psychosomatic manifestations

OBJECTIVES

Although the relationship between traumatic experiences (TEs) and psychosomatic manifestations (pain, somatization, somatosensory amplification [SSA], and alexithymia) has been widely described, very few studies have investigated how these variables correlate with each other and with a history of TEs. The aim of this study was to investigate whether and how current psychosomatic manifestations are correlated with major and minor adult- and childhood TEs.

METHODS

One hundred and forty-six patients (91 with pain) from the Pisa Gift Institute for Integrative Medicine Psychosomatics Lab., Italy, were assessed for pain, history of TEs (divided into major and minor based on whether or not they meet the DSM-5 Criterion A for post-traumatic stress disorder), alexithymia, somatization, and SSA.

RESULTS

TEs were positively correlated with age, the sensorial dimension and intensity of pain, somatization, psychopathology index, SSA, and alexithymia. Using the somatization score (controlled for age) as a covariate, the previous correlations between psychosomatic dimensions and TEs lost their statistical significance: SSA (total TEs: from r = 0.30, p = 0.000 to r = -0.04, p = 0.652); alexithymia (total TEs: from r = 0.28, p = 0.001 to r = 0.04, p = 0.663); sensorial dimension of pain (total TEs: from r = 0.30, p = 0.015 to r = 0.12, p = 0.373); and pain intensity (total TEs: from r = 0.38, p = 0.004 to r = -0.15, p = 0.317). Interestingly, the tendency to report more intense pain was mainly predicted by minor TEs in childhood (β = 0.28; p = 0.030).

CONCLUSIONS

The number of lifetime TEs is positively correlated with the sensorial dimension and intensity of pain but not its affective and cognitive dimensions. However, the former relationship depends on the presence of somatization. The intensity of pain is associated with minor rather than major TEs, especially when they occur in childhood.

[Alexithymia and self-harm in people with borderline personality disorder]

OBJECTIVE

To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD.

MATERIAL AND METHODS

We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID-II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data.

RESULTS

The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% (p=0.001). The prevalence of self-aggression was 70.3% (n=38) in patients with BPD, and 12% (n=6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% (n=45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend (p=0.051).

CONCLUSION

Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.

Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness

OBJECTIVE

Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED).

METHOD

145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested.

RESULTS

Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology.

DISCUSSION

ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms

A comprehensive investigation of psychological features in chronic patients is very important for tailoring effective treatments. In this study we tested anxiety, depression, health related quality of life (HR-QoL), alexithymia, coping styles, and defense mechanisms, in eighty-four patients with Crohn disease (CD) and ulcerative colitis (UC). Participants reported low to moderate HRQoL and anxiety, apart from alexithymia. Women experienced lower QoL and higher levels of anxiety and depressive symptoms. Coping and defense strategies were related to distress symptoms and QoL. Positive attitude and principalization, showed negative associations with depression, anxiety and alexithymia and were also found to be associated with mental health. CD patients used significantly more turning against objects (p=0.02) and projections (p=0.01) and UC patients used more reversal (p=0.04). Elderly women showed higher anxiety symptoms and lower perceived QoL. Multiple regression analysis revealed anxiety and depression were independently associated with QoL. Significant differences emerged in defense styles among CD and UC. CD participants used more maladaptive coping and defense styles which were related to mental distress, depression and anxiety, together with higher level of alexithymia. Findings suggest that psychological aspects play a key role in mental health in patients suffering from inflammatory bowel diseases. A multi-integrated clinical strategy including psychotherapeutic interventions should be considered in treating CD and UC.

Identifying and regulating emotions after acquired brain injury: the role of interoceptive sensibility

Introduction

Interoceptive deficits are associated with difficulties in identifying and regulating emotions. However, research on interoception after acquired brain injury (ABI) is scarce, and its relationship with emotional difficulties in this population is unknown. This study aimed to (1) examine differences in self-reported alexithymia, performance-based emotional awareness, emotion regulation, depression, and interoceptive sensibility between ABI and control individuals; and (2) analyze the role of adaptive interoceptive dimensions in these emotional processes after ABI.

Methods

Forty-three individuals with ABI and 42 matched control individuals completed the Multidimensional Assessment of Interoceptive Awareness-2, the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Difficulties in Emotion Regulation Scale, and the Hospital Anxiety and Depression Scale.

Results

Compared to the control group, individuals with ABI showed reduced tendency to ignore unpleasant sensations increased severity of depressive symptoms, as well as tendencies to have greater difficulties in emotion regulation and lower emotional awareness. Additionally, interoceptive dimensions such as trusting, as well as not-distracting from and not-worrying about bodily sensations, played a relevant role in explaining lower alexithymia and difficulties in emotion regulation. Moreover, lower alexithymia and emotion dysregulation were related to less depressive symptoms. These relationships were invariant across ABI and control individuals.

Discussion

Although individuals with ABI may have different levels of emotional abilities compared to non-ABI individuals, the relationship patterns between interoceptive and emotional processes appear to be similar between the two groups. This study suggests the potential benefit of addressing both interoceptive and emotional difficulties in treatments targeting such prevalent sequelae of ABI as depressive symptoms.