Trauma, early life stress, and mindfulness in adulthood

This article is a review that was inspired by recent studies investigating the effects of childhood trauma or early life stress (ELS) and mindfulness in adulthood. One recent study found that some forms of abuse and neglect led to higher scores in several subscales of a self-report measure of mindfulness. The authors concluded that some forms of ELS can help cultivate certain aspects of mindfulness in adulthood. However, and in contrast to this recent finding, much of the extant literature investigating ELS and trauma are linked to emotional dysregulation, alexithymia, and a host of psychopathologies in adulthood which makes the results of this study surprising. Central to the mindfulness literature is cultivating an open, non-reactive, or non-judgment awareness of inner experiences which are important for emotional regulation. In this paper, I review some of the effects of trauma or ELS on critical neural circuits linked to mindfulness, interoception, attachment, and alexithymia which I hope may clarify some of the conflicting findings from this study and throughout the literature and provide additional context and a framework that may inform research investigating these two constructs going forward.

The association between childhood trauma and emotion recognition is reduced or eliminated when controlling for alexithymia and psychopathy traits

Emotion recognition shows large inter-individual variability, and is substantially affected by childhood trauma as well as modality, emotion portrayed, and intensity. While research suggests childhood trauma influences emotion recognition, it is unclear whether this effect is consistent when controlling for interrelated individual differences. Further, the universality of the effects has not been explored, most studies have not examined differing modalities or intensities. This study examined childhood trauma's association with accuracy, when controlling for alexithymia and psychopathy traits, and if this varied across modality, emotion portrayed, and intensity. An adult sample (N = 122) completed childhood trauma, alexithymia, and psychopathy questionnaires and three emotion tasks: faces, voices, audio-visual. When investigating childhood trauma alone, there was a significant association with poorer accuracy when exploring modality, emotion portrayed, and intensity. When controlling for alexithymia and psychopathy, childhood trauma remained significant when exploring emotion portrayed, however, it was no longer significant when exploring modality and intensity. In fact, alexithymia was significant when exploring intensity. The effect sizes overall were small. Our findings suggest the importance of controlling for interrelated individual differences. Future research should explore more sensitive measures of emotion recognition, such as intensity ratings and sensitivity to intensity, to see if these follow accuracy findings.

Alexithymia and aspects of dreaming: Differential associations of alexithymia facets with dream variables

Research on aspects of dreaming associated with alexithymia has yielded mixed results. The present study recruited a young adult online sample of 577 participants who completed validated indices of alexithymia, emotion suppression, negative moods, and eight aspects of dreaming, with a focus on evaluating a counterintuitive previous finding that alexithymia and two of its core facets were associated with greater self-reported typical emotional intensity of dreams. Total alexithymia and facet scores showed differential relationships to aspects of dreaming including dream recall frequency, emotionality, meaningfulness, nightmare frequency, nightmare distress, usefulness of dreams in problem-solving and creativity, and learning about oneself through dreams. Planned hierarchical regression controlling for demographics, alcohol use, and dream recall frequency indicated that the difficulties identifying feelings (DIF) facet of alexithymia was a significant positive predictor of dream emotionality, whereas the externally oriented thinking (EOT) facet was a significant negative predictor. Stress, but not emotion suppression, mediated the positive relationship between DIF and dream emotionality. The likely role of dream emotionality in higher ratings of nightmare distress, dream meaningfulness, and learning about oneself through dreams among those with higher DIF scores is noted, along with other findings and the strengths and limitations of the study.

Connected minds in disconnected bodies: Exploring the role of interoceptive sensibility and alexithymia in problematic use of the internet

INTRODUCTION

The ever-increasing prominence of the internet and digital technology in our society requires a deeper examination of how these developments alter perception of our bodies and emotions. One such consequence is the emergence of Problematic Use of the Internet (PUI) - an array of compulsive or addictive behaviors mediated by the web that detrimentally affect an individual's functioning. This suggests that some people may be shifting their consciousness from the physical realm to the digital world. The objective of this study was to investigate how shortcomings in interoception (the sensibility to bodily signals) and alexithymia (an inability to identify and express emotions) might contribute to PUI.

METHODS

The Internet Addiction Test (IAT), the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Assessment of Interoceptive Awareness (MAIA) were used to assess a sample of 1076 adolescents and young adults aged between 16 and 26 years via an online survey. Data analysis was based on t-test, correlations and multivariate regression.

RESULTS

26.8% (n = 288) of participants met the criteria for moderate PUI. Individuals with PUI displayed higher levels of alexithymia (p < 0.001) and diminished abilities in certain aspects of interoceptive sensibility, including placing trust in their own bodily signals (p = 0.006), not responding excessively to uncomfortable sensations with worry (p < 0.001), and not denying them (p = 0.006). Multivariate modelling revealed associations between PUI and the following factors: having a boyfriend/girlfriend (aOR = 5.70), substance use (aOR = 1.78), difficulty in identifying feelings (aOR = 1.09), externally oriented thinking (aOR = 1.05), low disposition in perceiving body sensations (aOR = 0.25), tendency to become distracted (aOR = 0.82) or excessively worried (aOR = 0.11) in the face of pain. Furthermore, the analysis indicated how these aspects of body perception may be interrelated, either enhancing or reducing the risk of PUI when examined individually, collectively, or in combination.

CONCLUSIONS

This study underlines the potential connection between difficulties in the mind-body interaction and the development of PUI. It suggests a bidirectional relationship between excessive digital device use and distorted bodily interoceptive processes in PUI, reinforcing the notion that individuals struggling with emotion identification and expression may be more prone to excessive internet usage. To further comprehend the relevance of these constructs in PUI, it is necessary to conduct more targeted investigations and longitudinal studies.

Alexithymia and facial emotion recognition in patients with functional neurological disorder

OBJECTIVES

Patients with functional neurological disorder (FND) are known to have difficulties recognizing and processing emotions. Problems recognizing internal emotional states (alexithymia) are common in FND, but little is known about recognizing emotions expressed by other people. This study investigates whether patients with FND have higher levels of alexithymia and reduced facial emotion recognition compared to healthy controls.

METHODS

Patients with FND (n = 31, mean age=42.7 [SD=14.8] years, 54.8% women) were compared to healthy controls (n = 33, mean age=45.1 [SD=16.2] years, 63.6% women). The Bermond-Vorst Alexithymia Questionnaire (BVAQ) was used for the assessment of alexithymia and the Ekman 60 Faces Test (EFT) for facial emotion recognition.

RESULTS

Patients with FND had higher levels of alexithymia than healthy controls (BVAQ=71.8 [SD=19.8] versus 59.3 [SD=20.3], p = .02, Cohen's d=0.62). Facial emotion recognition did not significantly differ between FND patients and controls (EFT total score FND: 46.1 [SD=5.9], Controls: 47.5 [SD=5.5], p = .34, Cohen's d=0.24). Only recognition of surprise differed between patients and controls (FND: 8.4 [SD=1.8], Controls: 9.2 [SD=1.0), p = .03, Cohen's d= 0.56). Higher levels of alexithymia were associated with poorer facial emotion recognition, but this relationship was not statistically significant (FND: β= -0.20, p = .28; Controls: β=-0.03; p = .87).

CONCLUSIONS

The current data confirm prior observations that patients with FND have higher alexithymia levels than controls without FND. Difficulties recognizing emotions among patients with FND primarily involves recognition of internal emotional states rather than recognition of facially expressed emotions by others. These findings require replication in a larger and more divers sample.

Screening for affective dysregulation in school-aged children: relationship with comprehensive measures of affective dysregulation and related mental disorders

Affective dysregulation (AD) is characterized by irritability, severe temper outbursts, anger, and unpredictable mood swings, and is typically classified as a transdiagnostic entity. A reliable and valid measure is needed to adequately identify children at risk of AD. This study sought to validate a parent-rated screening questionnaire, which is part of the comprehensive Diagnostic Tool for Affective Dysregulation in Children (DADYS-Screen), by analyzing relationships with comprehensive measures of AD and related mental disorders in a community sample of children with and without AD. The sample comprised 1114 children aged 8-12 years and their parents. We used clinical, parent, and child ratings for our analyses. Across all raters, the DADYS-Screen showed large correlations with comprehensive measures of AD. As expected, correlations were stronger for measures of externalizing symptoms than for measures of internalizing symptoms. Moreover, we found negative associations with emotion regulation strategies and health-related quality of life. In receiver operating characteristic (ROC) analyses, the DADYS-Screen adequately identified children with AD and provided an optimal cut-off. We conclude that the DADYS-Screen appears to be a reliable and valid measure to identify school-aged children at risk of AD.

Interoceptive beliefs moderate the link between physiological and emotional arousal during an acute stressor

Growing work suggests that interoception, that is, representations of one's internal bodily changes, plays a role in shaping emotional experiences. Past studies primarily examine how behavioral accuracy in detecting interoceptive signals (interoceptive ability) relates to emotional states, with less work examining self-reported interoceptive facets such as the characterizations of one's interoceptive abilities (interoceptive sensibility) or evaluative beliefs about the value versus danger of interoceptive signals (interoceptive beliefs). However, existing studies rarely examine physiological reactivity, behavioral, and self-reported dimensions of interoception together in the same sample. As such, it remains unclear whether and how much individual differences in interoceptive facets uniquely and in interaction with physiological reactivity may matter for emotional experience. Herein, 250 healthy young adults completed a heartbeat detection task assessing interoceptive ability and questionnaire measures of interoceptive sensibility and beliefs during an initial laboratory visit. At a follow-up session, 227 participants returned to undergo an acute psychosocial stressor. Measures of physiological arousal such as preejection period (PEP) and heart rate variability were acquired throughout the stressor with self-reported emotions acquired immediately after. Linear regressions revealed that greater sympathetic nervous system reactivity (i.e., PEP), poorer interoceptive ability (i.e., accuracy), and less positive interoceptive beliefs were related to more intense high arousal emotions during the stressor. Importantly, across models, interoceptive beliefs was the only interoceptive facet to moderate the concordance between physiological and emotional arousal. Implications for psychological theories of emotion, stress, and interoception are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotion differentiation among individuals in a randomized clinical trial for alcohol use disorder: Within- and between-person associations with affect, craving, and alcohol use in daily life

Emotion differentiation refers to cognitively distinguishing among discrete, same-valenced emotions. Negative emotion differentiation (NED) is a transdiagnostic indicator of emotional functioning. The role of positive emotion differentiation (PED) in clinical disorders, including alcohol use disorder (AUD), is less understood. Further, despite consensus that emotions are highly variable, little is known about within-person fluctuations in NED/PED. The current study leveraged 84 consecutive daily smartphone surveys from participants (N = 181) in a clinical trial of cognitive behavioral therapy for AUD to investigate whether between-person differences in overall NED/PED, or within-person variability in daily NED/PED, were associated with affect intensity, craving, drinking, and heavy drinking in daily life. Subsequent analyses explored whether associations were moderated by baseline alexithymia. At the between-persons level, greater average PED, but not NED, was associated with lower heavy drinking odds. At the within-persons level, higher-than-usual PED was associated with lower negative affect and odds of any drinking. Individuals with baseline alexithymia had stronger negative within-person associations between daily NED and both any and heavy drinking. PED is a skill linked to less alcohol use between- and within-persons irrespective of baseline alexithymia, whereas greater daily NED appears especially important for reduced alcohol use among individuals with co-morbid AUD and alexithymia.

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.

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.

Emotion dysregulation in older people: validity and reliability of an 8-item version of the Difficulties in Emotion Regulation Scale

OBJECTIVES

The abbreviated 16-item version of the Difficulties with Emotion Regulation Scale (DERS-16) is widely used to assess individuals' perceived challenges in regulating their emotions, a central aspect of psychological symptoms commonly experienced in old age. However, its psychometric properties have yet to be tested in this population. Furthermore, a shorter version of the DERS-16 could further minimize the assessment burden on older individuals. Thus, we aimed to test the DERS-16's psychometric performance and determine if any items were redundant to develop a psychometrically sound shorter version.

METHODS

We enrolled 302 Portuguese older adults (Mage = 75.22; SD = 8.99 years) in a cross-sectional study.

RESULTS

Exploratory factor analyses indicated a one-factor structure and a four-factor solution with eight items (69.3%-81.9% of the variance observed). The four-factor-8-item solution presented an interpretable structure and demonstrated good reliability values (> 0.70) and construct validity with the Twenty-Item Toronto Alexithymia Scale, Eight-Item Geriatric Depression Scale, and Geriatric Anxiety Inventory (r = 0.66, 0.40, 0.52; p < 0.001).

CONCLUSION

The robust psychometric properties of DERS-8 make it a valuable tool for clinical and longitudinal studies, facilitating targeted interventions in older adults and allowing for precise emotion dysregulation screening.

Gender difference in association between clinical symptoms and alexithymia in chronic schizophrenia: A large sample study based on Chinese Han population

BACKGROUND

Alexithymia, a prevalent social cognitive impairment in schizophrenia, remains insufficiently studied. Though some studies propose a link between alexithymia and clinical symptoms of schizophrenia, this connection lacks consistent confirmation. Additionally, there is limited research on gender difference in alexithymia among schizophrenia patients. To fill this gap, our study aimed to conduct a large-sample survey of Chinese Han patients with chronic schizophrenia to explore whether there are gender differences between clinical symptoms and alexithymia.

METHODS

We obtained sociodemographic characteristics of 987 schizophrenia patients, measured their clinical symptoms using the Positive and Negative Syndrome Scale (PANSS), and assessed their self-reported alexithymia using the Toronto Alexithymia Scale (TAS-20).

RESULTS

In patients with chronic schizophrenia, the prevalence of alexithymia did not differ between genders (male: 35.51 % vs. female: 26.91 %, P = 0.018). Correlation and linear regression analyses revealed that PANSS scores and TAS-20 scores were widely correlated in both male and female patients. In particular, multiple linear regression analysis showed that the TAS total score was positively correlated with negative symptoms and cognitive symptoms in male patients, while it was positively correlated with negative symptoms and depressive symptoms in female patients.

CONCLUSION

Our study suggests that the prevalence of alexithymia in patients with chronic schizophrenia does not differ between genders. Negative symptoms are related to the TAS-20 total score in both male and female patients, while cognitive symptoms are only related to the TAS-20 total score in male patients, and depressive symptoms are only related to the TAS-20 total score in female patients.

Attachment and comorbid anxiety in ADHD

Anxiety comorbidity is quite common in children with attention-deficit hyperactivity disorder (ADHD). What is known about the relationship between anxiety, attachment and emotion regulation in such children is still limited. We aimed to investigate the associations between attachment, emotion regulation and comorbid anxiety in children with ADHD. 100 children with ADHD and 100 children without any diagnosis aged 8-13 years were included. After the participants were clinically evaluated, Turgay ADHD Scale, Emotion Regulation Checklist, Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) and Kerns' Security Scale were completed. According to the RCADS-CV scores, ADHD/ANX(+), ADHD/ANX(-), and control groups were formed. The emotional lability/negativity levels were higher in the ADHD groups compared to the non-ADHD controls. Paternal and maternal attachment security levels were lower in the ADHD/ANX(+) group compared to the controls. The regression analysis indicated that higher hyperactivity/impulsivity symptom levels and lower maternal attachment quality were associated with higher anxiety in children with ADHD. These results suggest that focusing on attachment quality and emotion regulation problems may be significant in management of core symptoms and comorbid anxiety problems in children with ADHD.

The Prevalence of Behavioural Symptoms and Psychiatric Disorders in Hadza Children

The worldwide pooled prevalence of psychiatric disorders in children is 13.4%. Studying the prevalence of childhood psychiatric disorders across radically different economic systems and social structures could indicate universal factors leading to their development. The prevalence of childhood psychiatric disorders in a mixed-subsistence foraging society has not been studied. The Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment were used to compare the prevalence of behavioural symptoms and psychiatric disorders in Hadza children aged 5-16 years (n = 113) to a nationally representative sample from England (n = 18,029) using a cross-sectional study design. Emotional problems, conduct problems and hyperactivity were lower in the Hadza children. Prosocial behaviour and peer problems were higher in Hadza children. 3.6% of Hadza children met the criteria for a psychiatric disorder compared to 11.8% of English children. All psychiatric disorders in Hadza children were co-morbid with autism spectrum disorder. No child from the Hadza group met the criteria for an emotional, behaviour or eating disorder. Further work should study the factors which lead to the different prevalence of psychiatric disorders in Hadza children.

Linking Blood Pressure-Associated Emotional Dampening to Trait Empathy

Gradual and sustained increases in resting blood pressure are accompanied by gradual and sustained reductions in the capacity to consciously experience several affective and somatosensory processes. Burgeoning theory suggests that this phenomenon, termed cardiovascular emotional dampening, contributes to heart disease risk by interfering with our ability to effectively respond to environmental demands. Interpersonal relationships are contexts in which this risk cascade likely occurs, but prior researchers have paid little attention to how emotional dampening might influence these relationships. As empathy is a construct used to describe facets of emotion-linked responding that facilitate interpersonal relationships, if emotional dampening influences interpersonal relationships, then we might expect resting blood pressure to covary with measures of empathy as it does with other previously studied aspects of affective responding. We recruited 175 healthy undergraduate college student participants (120 Women; M age = 19.17, SD age = 2.08) to complete a counterbalanced procedure in which we measured resting blood pressure and related it to participants' responses on the Toronto Alexithymia Scale, the Questionnaire of Cognitive and Affective Empathy, and a demographic survey. Bivariate comparisons revealed a significant inverse relationship between average resting systolic blood pressure (SBP) and cognitive empathy, as well as a significant inverse relationship between SBP and affective empathy. Multiple regression analyses revealed that SBP remained a significant predictor of cognitive empathy, but not affective empathy, after controlling for related covariates (i.e., sex, age, and alexithymia). SBP predicted cognitive empathy such that higher SBP was associated with lower cognitive empathy. Thus, people with higher resting blood pressures might experience increased interpersonal distress because of a reduced capacity for empathetic accuracy and perspective-taking. We discuss the implications and future directions of these findings.

The relationship between alexithymia, emotion regulation, and sleep problems in school-aged children: A multicentric study

OBJECTIVES

Alexithymia, mood dysregulation, and sleep quality have complicated effects on children's development. The current study aimed to investigate the relationship between alexithymia, emotion regulation, psychiatric problems, and sleep problems among Egyptian school-aged children.

METHODS

A total of 564 Egyptian children, aged 6 to 14, were divided into two groups based on their total Children's Sleep Habits Questionnaire abbreviated score: group 1 (N = 300) with sleep problems and group 2 (N = 264) with non-sleep problems. Their parents completed the Strengths and Difficulties Questionnaire (SDQ) and subjectively assessed the children's emotions using the Children's Alexithymia Measure (CAM) and the Clinical Evaluation of Emotional Regulation-9 (CEER-9).

RESULTS

Males were more proportional in the sleep problems group than others. The sleep problem group was significantly younger and had a longer daily sleep duration than the non-sleep problem group. Alexithymia and emotion dysregulation had the highest mean in the sleep problem group. Furthermore, alexithymia, emotion dysregulation, emotion difficulty, conduct, and prosocial problems were the most significant contributing factors and risk factors for sleep problems in children.

CONCLUSION

Sleep problems in children were associated with younger male children with lengthy daily sleep duration and emotional, behavioural, and prosocial difficulties. Furthermore, alexithymia and emotion dysregulation are significant contributors and risk factors for sleep problems in school-aged children.

Fluency generating emotion words correlates with verbal measures but not emotion regulation, alexithymia, or depressive symptoms

How do you feel? To answer this question, one must first think of potential emotion words before choosing the best fit. However, we have little insight into how the ability to rapidly bring to mind emotion words-emotion fluency-relates to emotion functioning or general verbal abilities. In this study, we measured emotion fluency by counting how many emotion words participants could generate in 60 s. Participants (N = 151 in 2011-2012) also completed a behavioral measure of verbal fluency (i.e., how many words starting with "P" or "J" participants could produce in 60 s), a cognitive reappraisal emotion regulation task, and emotion functioning questionnaires. In preregistered analyses, we found that participants produced more negative emotion words than positive words and more positive words than neutral words in the emotion fluency task. As hypothesized, emotion fluency was positively related to verbal fluency, but contrary to hypotheses, emotion fluency was not related to self-reported or task-based emotion functioning (e.g., alexithymia, depression, and emotion regulation ability). As such, in community samples, emotion fluency may reflect general cognitive abilities rather than processes crucial to emotional well-being. While emotion fluency as measured here does not track indices of well-being, future research is needed to investigate potential contexts in which verbal fluency for emotion words may be key to emotion regulation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Recognition of facial expressions in autism: Effects of face masks and alexithymia

It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia-a trait associated with difficulties interpreting interoceptive and emotional states-not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism.

Childhood maltreatment, alexithymia and eating disorder psychopathology: A mediation model

BACKGROUND

The relationship between childhood maltreatment and eating disorder psychopathology has been under-investigated.

OBJECTIVE

The purpose of this study was to investigate the role of alexithymia in mediating the relationship between childhood maltreatment experiences and eating disorder (ED) symptoms.

PARTICIPANTS AND SETTING

One-hundred-forty-three women with anorexia nervosa, 110 women with bulimia nervosa and 108 healthy women filled in the Eating Disorder Inventory-2, the Childhood Trauma Questionnaire and the Toronto Alexithymia Scale-20 (TAS-20).

METHODS

A mediator path model including childhood trauma types as predictors, the subscales of the TAS-20 as mediators and ED specific symptoms as dependent variables was conducted in individuals with EDs and in healthy women.

RESULTS

In women with EDs emotional abuse was directly associated with body dissatisfaction and was associated to drive to thinness, bulimia and body dissatisfaction through the mediation of difficulties to identify emotions. In healthy women, physical neglect was directly associated to drive to thinness and bulimia, but no significant mediation effect through alexithymia emerged.

CONCLUSION

Impaired emotion recognition mediates the association between childhood emotional abuse and ED symptoms. Individuals with early emotional abuse may experience ED symptoms to manage confused emotional perceptions. Improving emotional understanding and acceptance may be a treatment target in early maltreated individuals with EDs.

Online Assessment of Social Cognition in a Population of Gamers and Gamblers: Results of the eSMILE Study

The purpose of the eSMILE study was to explore social cognition (SC) in the two behavioural addictions (BAs) included in international classifications: gaming disorder and gambling disorder. In these disorders, cognitive functioning is involved in the development and maintenance of addiction. Nevertheless, SC have received less attention than other cognitive functions. The eSMILE study was conducted online and included 105 participants (gamers and gamblers). This study included: the Penn emotion recognition task, the Condensed and Revised Multifaced Empathy Test, the Interpersonal Reactivity Index, the Chicken Game, social metacognition questions, and the Toronto Alexithymia Scale. We analysed the relationships among SC measures, addiction levels, and behaviour frequency. For gamers, we showed that the higher their level of addiction was, the lower their self-confidence following the identification of basic emotions, although the more frequently they played, the better their performance on this task. Additionally, we found lower performance on the identification of more complex emotions by gamblers, which seems to be the result of their levels of addiction rather than the frequency of their gambling behaviour. This study contributes to our understanding of the cognitive processes underlying BAs. Additionally, working on SC abilities may be an additional management mode for BAs that could be added to existing treatments.

The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model

AIM

The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents.

METHODS

This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data.

RESULTS

Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization.

CONCLUSIONS

This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia.

PRACTICE IMPLICATIONS

Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.

Bidirectional relationship between insular grey matter volume and alexithymia: Evidence from a longitudinal study

BACKGROUND

The insula is considered to be involved in emotional cognitive processes, and may be structurally altered in people with alexithymia. However, it remains unclear how the relationship between the insula and alexithymia changes over time. This study aimed to investigate whether alexithymia has longitudinal relationship with the insular structure.

METHODS

Having processed structural MRI data via FreeSurfer, the insula was divided into five sub-regions, and the Toronto Alexithymia Scale was administered to assess alexithymia in the general population. Subsequently, we established the latent change score models between insular sub-regions and the alexithymia (N = 252).

RESULTS

The TAS-20 mean value of the sample at Time 1 was not significantly different by sex (t = -0.993, df = 250, p = 0.321), while the TAS-20 mean value at Time 2 was slightly different by sex (t = 2.025, df = 250, p = 0.044). Most insular grey matter volumes at Time 1 and Time 2 were significantly associated with TAS-20 at Time 2. The baseline alexithymia and insular grey matter volume positively predicted the other's rate of change between Time 1 and Time 2 in a bidirectional way.

LIMITATIONS

This study had a limited number of measurement time points, potential bias due to smaller sample sizes and gender imbalance, as well as the potential for inaccuracy in the self-report measure of alexithymia.

CONCLUSIONS

Time-lagged alexithymia changes and insular grey matter volume changes occur in coupled manner over time, which might improve our understanding of the neurological underpinnings of alexithymia, and shed light on clinical and psychological treatment for alexithymia.

Interoceptive and Affective Alterations in Body Integrity Dysphoria: An Online Self-Reporting Study

INTRODUCTION

Body integrity dysphoria (BID) is a rare condition in which individuals experience a long-lasting desire to achieve a specific physical disability. In this study, we tested the hypothesis of interoceptive and affective abnormalities in BID, in line with the evidence of structural and functional alteration of the interoceptive-affective neural system in these individuals.

METHOD

Our study involved 68 participants with BID (mean age: 35.6, SD: 16.4). Among these participants, 47 expressed a desire for amputation, 14 desired paralysis, 3 sought sensory deprivation, and 3 desired a combination of these forms. For comparisons, we recruited a control group of 79 participants (mean age: 35.2, SD: 15.8). We administered assessment measures to investigate alexithymia level (TAS-20), disgust sensitivity (DS-R), interoceptive awareness (MAIA-2), and (affective and cognitive) empathy (QCAE). We also administered the Short Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) to identify psychiatric comorbidities. Subgroups with low O-LIFE scores (BID = 31; controls = 43) and subgroups with high O-LIFE scores (BID = 37; controls = 36) were derived through a median-split procedure.

RESULTS

Within the BID low O-LIFE group, we found reduced interoceptive sensibility, reduced disgust sensitivity, and increased difficulty in identifying feelings, which refers to a dimension of the alexithymia trait. Within the BID high O-LIFE group, we observed a reduced disgust sensitivity and interoceptive sensibility, accompanied by a diminished score in cognitive empathy.

CONCLUSION

Our study suggests that BID can be associated with altered interoceptive and affective processing.

Association of illness perception and alexithymia with fatigue in hemodialysis recipients: a single-center, cross-sectional study

Fatigue in hemodialysis recipients interferes with daily activities and renal rehabilitation, and its underlying causes and treatment remain unclear. Psychological factors, like illness perceptions and alexithymia, cause fatigue in other diseases; however, their contribution to hemodialysis-related fatigue is unknown. This cross-sectional study included 53 hemodialysis recipients. To assess participants' fatigue, we used a self-administered patient-reported outcome questionnaire whose items have shown correlation with those of established scales, such as the Profile of Mood States and Visual Analogue Scales. The associations among the scores of the revised Illness Perceptions Questionnaire (IPQ-R), Toronto Alexithymia Scale (TAS-20), and Hospital Anxiety and Depression Scale and fatigue were analyzed using bivariable and multivariable analyses. Patients with fatigue had significantly higher median scores for the IPQ-R subscales "Identity" and "Negative emotional representation about illness" than those without fatigue, suggesting the association of specific illness perception with fatigue. Median scores for the TAS-20 subscale "Difficulty identifying feelings" were also significantly higher among fatigued patients, suggesting the association of alexithymia with fatigue. Depression was not associated with fatigue. Multivariable logistic regression revealed the association of a high "Identity" score with the risk of fatigue (adjusted odds ratio, 1.32; 95% confidence interval, 1.00-1.73; P = 0.04), while there were no significant association between a high "Difficulty identifying feelings" score and the risk of fatigue (adjusted odds ratio, 1.09; 95% confidence interval, 0.95-1.24). Specific illness perception and alexithymia were slightly associated with hemodialysis-related fatigue. Cognitive-behavioral therapy for these conditions could reduce fatigue and promote renal rehabilitation.