Loss-Chasing, Alexithymia, and Impulsivity in a Gambling Task: Alexithymia as a Precursor to Loss-Chasing Behavior When Gambling

Objective: To examine the relationship between loss-chasing, the propensity to continue gambling to recover from losses, alexithymia, a personality trait associated poor emotional processing and impulsivity, the tendency to act quickly without reflection or consideration of the consequences.

Method: Two experiments are reported (E1: N = 60, Males, 11; Age, 21.6 years. E2: N = 49, Males, 22; Age, 21.1 years). In experiment 1, two groups (low alexithymia, high alexithymia) completed the Cambridge Gambling Task (CGT). Loss-chasing behavior was investigated. In experiment 2, both alexithymia (low, high) and impulsivity (low, high) were examined also using the CGT. A further change was the order of bet proportion from ascending to descending.

Results: Experiment 1 shows loss-chasing behavior in participants high in alexithymia but not those low in alexithymia (ηp2=0.09). Experiment 2 shows loss-chasing behavior in participants both low and high in alexithymia but it was greater for participants high in alexithymia (ηp2 = 0.09). The effect of impulsivity was not statistically significant (ηp2 = 0.01). Loss-chasing behavior was correlated with the emotional facets of alexithymia but not the cognitive facet.

Conclusions: Alexithymia is a precursor to loss-chasing when gambling and loss-chasing reflects the cognitive and emotional aspects of gambling. Specifically, the tendency to loss-chase depends on the need to recoup previous losses and failure to process the emotional consequences of those losses.

Neural representation of emotion regulation goals

The use of top-down cognitive control mechanisms to regulate emotional responses as circumstances change is critical for mental and physical health. Several theoretical models of emotion regulation have been postulated; it remains unclear, however, in which brain regions emotion regulation goals (e.g., the downregulation of fear) are represented. Here, we examined the neural mechanisms of regulating emotion using fMRI and identified brain regions representing reappraisal goals. Using a multimethodological analysis approach, combining standard activation-based and pattern-information analyses, we identified a distributed network of lateral frontal, temporal, and parietal regions implicated in reappraisal and within it, a core system that represents reappraisal goals in an abstract, stimulus-independent fashion. Within this core system, the neural pattern-separability in a subset of regions including the left inferior frontal gyrus, middle temporal gyrus, and inferior parietal lobe was related to the success in emotion regulation. Those brain regions might link the prefrontal control regions with the subcortical affective regions. Given the strong association of this subsystem with inner speech functions and semantic memory, we conclude that those cognitive mechanisms may be used for orchestrating emotion regulation. Hum Brain Mapp 37:600-620, 2016. © 2015 Wiley Periodicals, Inc.

Metabolic mapping reveals sex-dependent involvement of default mode and salience network in alexithymia

Alexithymia, a personality construct marked by difficulties in processing one's emotions, has been linked to the altered activity in the anterior cingulate cortex (ACC). Although longitudinal studies reported sex differences in alexithymia, what mediates them is not known. To investigate sex-specific associations of alexithymia and neuronal markers, we mapped metabolites in four brain regions involved differentially in emotion processing using a point-resolved spectroscopy MRS sequence in 3 Tesla. Both sexes showed negative correlations between alexithymia and N-acetylaspartate (NAA) in pregenual ACC (pgACC). Women showed a robust negative correlation of the joint measure of glutamate and glutamine (Glx) to NAA in posterior cingulate cortex (PCC), whereas men showed a weak positive association of Glx to NAA in dorsal ACC (dACC). Our results suggest that lowered neuronal integrity in pgACC, a region of the default mode network (DMN), might primarily account for the general difficulties in emotional processing in alexithymia. Association of alexithymia in women extends to another region in the DMN-PCC, while in men a region in the salience network (SN) was involved. These observations could be representative of sex specific regulation strategies that include diminished internal evaluation of feelings in women and cognitive emotion suppression in men.

When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders

INTRODUCTION

In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients' families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters' evaluations of maternal alexithymia.

METHODS

45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of "ED" mothers (n = 20) and "non-ED" ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia.

RESULTS

Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs.

DISCUSSION

Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Abnormalities in Automatic Processing of Illness-Related Stimuli in Self-Rated Alexithymia

Aim

To investigate abnormalities in automatic information processing related to self- and observer-rated alexithymia, especially with regard to somatization, controlling for confounding variables such as depression and affect.

Sample

89 healthy subjects (60% female), aged 19–71 years (M = 32.1). 58 subjects were additionally rated by an observer.

Measures

Alexithymia (self-rating: TAS-20, observer rating: OAS); automatic information processing (priming task including verbal [illness-related, negative, positive, neutral] and facial [negative, positive, neutral] stimuli); somatoform symptoms (SOMS-7T); confounders: depression (BDI), affect (PANAS).

Results

Higher self-reported alexithymia scores were associated with lower reaction times for negative (r = .19, p < .10) and positive (r = .26, p < .05) verbal primes when the target was illness-related. Self-reported alexithymia was correlated with number (r = .42, p < .01) and intensity of current somatoform symptoms (r = .36, p < .01), but unrelated to observer-rated alexithymia (r = .11, p = .42).

Discussion

Results indicate a faster allocation of attentional resources away from task-irrelevant information towards illness-related stimuli in alexithymia. Considering the close relationship between alexithymia and somatization, these findings are compatible with the theoretical view that alexithymics focus strongly on bodily sensations of emotional arousal. A single observer rating (OAS) does not seem to be an adequate alexithymia-measure in community samples.

Relationship between alexithymia and dependent personality disorder: a dimensional analysis

The present study had two aims and used two different samples. The first aim was to determine if alexithymia and dependent personality disorder (DPD) are distinct or overlapping constructs. The second aim was to determine the specificity and the stability of the relationship between alexithymia and DPD. The first study used exploratory principal components analysis (PCA) in a sample of 477 non-clinical subjects who completed three questionnaires measuring alexithymia (Twenty item Toronto Alexithymia Scale, i.e. TAS-20), dependent personality disorder (Dependent Personality Questionnaire, i.e. DPQ) and depression (Beck Depression Inventory-II, i.e. BDI-II). The second study used a sample of 305 subjects consecutively admitted to an outpatient department of legal medicine. The subjects completed (at admission and 3 months later) the Structured Clinical Interview for DSM-IV, screen questionnaire (SCID-II-SQ), the TAS-20 and the BDI. Multiple regressions were done. For the first study, the PCA yielded a four-factor solution with no overlap of the significant factor loadings for the items from each scale and with the factors corresponding to their respective construct. For the second study, multiple regressions showed that only avoidant personality disorder was an independent predictor of the TAS-20 scores. Alexithymia is a construct that is distinct and separate from DPD and depression. Alexithymia is not a stable feature of DPD while it is a core feature of avoidant personality disorder.

Factorial structure of the 20-item Toronto Alexithymia Scale in a large sample of somatoform patients

Although a strong association between alexithymia and somatization has been postulated in numerous studies, no systematic study has investigated the psychometric properties of the 20-item Toronto Alexithymia Scale (TAS-20) in a sample of patients with somatoform disorder yet. The purpose of this study was to ensure a valid assessment by the German version of the TAS-20 in somatoform samples. We investigated whether the original three-factor model proposed by Bagby et al. (1994a), which is widely used in clinical research and practice, is replicable in a large sample of somatoform patients (n=806). Using confirmatory factor analysis (CFA) the goodness-of-fit of the originally proposed factor structure was compared to three factor models generated with exploratory factor analysis (EFA) and other factorial solutions derived from the literature. Our results demonstrate that the original three-factor model is not replicable in somatoform patients. Instead, the four-factor model by Franz et al. (2001b) described the data best. However, none of the models met all criteria of confirmatory factor analysis. Our results indicate that the three-factor model is not robust in the German version of the TAS-20. At this state of research we recommend to use the TAS-20 sum-score as a measure of alexithymia in somatoform patients in clinical practice.

Alexithymia in patients with conversion disorder

BACKGROUND AND AIMS

In the recent years, it has been observed that alexithymia is not specified for the psychosomatic disorders. It is known that alexithymia is observed frequently in various psychiatric disorders especially in the somatoform disorders. The aim of this study is to evaluate alexithymia in the patients with the conversion disorder.

METHODS

The study was performed in the Psychiatry Outpatients Clinics of the Izmir Atatürk Training and Research Hospital and Erenköy Psychiatry Education and Research Hospital. A total of 93 cases-47 outpatients who were diagnosed with conversion disorder according to the DSM-IV criteria and 46 age, gender and educational level matched healthy controls-were included in the study. All the cases were assessed by a Structured Clinical Interview for DSM-IV and were evaluated with a questionnaire (which included demographics and clinical data), the Toronto Alexithymia Scale and the Somatosensory Amplification Scale.

RESULTS

When the two groups were compared, the Toronto Alexithymia Scale scores (except "externally oriented thinking" subscale) and the Somatosensory Amplification Scale score of the conversion disorder group were statistically significantly higher than the control group. The number of the alexithymic cases of the patient group was significantly higher than the control group's.

CONCLUSIONS

The level of alexithymia in conversion disorder patients, without any other psychiatric disorder, is higher than that of the healthy controls. During the evaluation of the psychological state of patients with conversion disorder, it could be useful to keep in mind the probability of them having alexithymia to determine the type of suitable therapy.

Toronto alexithymia scale for patients with eating disorder: [corrected] performance using the non-parametric item response theory

BACKGROUND

The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patient's condition.

SUBJECTS AND METHODS

We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale.

RESULTS

We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.

Are mood and anxiety disorders and alexithymia associated with endometriosis? A preliminary study

Objective. The aim of this preliminary study was to determine whether psychiatric disorders, psychopathological symptoms, and alexithymia are associated with endometriosis in an Italian population. Study Design. A preliminary study comprising 37 Italian patients with surgically confirmed endometriosis and 43 controls, without clinical and ultrasound signs of endometriosis, was carried out. Both patients and controls were evaluated for the presence/absence of psychiatric disorders, psychopathological symptoms, alexithymia, and pain symptoms (nonmenstrual pelvic pain, dysmenorrhea, and dyspareunia). Results. Statistically significant differences were found between cases and controls for prevalence of mood and anxiety disorders, malfunctioning on obsessive-compulsive subscale (P < 0.01) and depression subscale (P < 0.05) of the Symptom Checklist-90-Revisited (SCL-90-R), and higher alexithymia levels (P < 0.01). Patients with endometriosis-associated pain showed greater prevalence of psychiatric disorders compared to pain-free patients but that difference was not significant. Significant correlation was found between malfunctioning in some SCL-90-R dimensions and pelvic pain, dysmenorrhea, and dyspareunia scores at the visual analog score (VAS). Conclusion. Some psychopathological aspects, such as psychoemotional distress and alexithymia, are more frequent in women with endometriosis and might amplify pain symptoms in these patients.

Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to reduce the incidence of posttraumatic stress after acute myocardial infarction through trauma-focused psychological counseling: study protocol for a randomized controlled trial

BACKGROUND

Posttraumatic Stress Disorder (PTSD) may occur in patients after exposure to a life-threatening illness. About one out of six patients develop clinically relevant levels of PTSD symptoms after acute myocardial infarction (MI). Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events. The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI.

METHODS/DESIGN

The study is a single-center, randomized controlled psychological trial with two active intervention arms. The sample consists of 426 patients aged 18 years or older who are at 'high risk' to develop clinically relevant posttraumatic stress symptoms. 'High risk' patients are identified with three single-item questions with a numeric rating scale (0 to 10) asking about 'pain during MI', 'fear of dying until admission' and/or 'worrying and feeling helpless when being told about having MI'. Exclusion criteria are emergency heart surgery, severe comorbidities, current severe depression, disorientation, cognitive impairment and suicidal ideation. Patients will be randomly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions (that is, the verum intervention) or the general role of psychosocial stress in coronary heart disease (that is, the control intervention). The session will take place in the coronary care unit within 48 hours, by the bedside, after patients have reached stable circulatory conditions. Each patient will additionally receive an illustrated information booklet as study material. Sociodemographic factors, psychosocial and medical data, and cardiometabolic risk factors will be assessed during hospitalization. The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up, which is hypothesized to be at least 20% lower in the verum group than in the control group using the t-test. Secondary outcomes are posttraumatic stress levels at 12-month follow-up, and psychosocial functioning and cardiometabolic risk factors at both follow-up assessments.

DISCUSSION

If the verum intervention proves to be effective, the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01781247.

The Profile of Emotional Competence (PEC): development and validation of a self-reported measure that fits dimensions of emotional competence theory

Emotional Competence (EC), which refers to individual differences in the identification, understanding, expression, regulation and use of one’s own emotions and those of others, has been found to be an important predictor of individuals’ adaptation to their environment. Higher EC is associated with greater happiness, better mental and physical health, more satisfying social and marital relationships and greater occupational success. While it is well-known that EC (as a whole) predicts a number of important outcomes, it is unclear so far which specific competency(ies) participate(s) in a given outcome. This is because no measure of EC distinctly measures each of the five core emotional competences, separately for one’s own and others’ emotions. This lack of information is problematic both theoretically (we do not understand the processes at stake) and practically (we cannot develop customized interventions). This paper aims to address this issue. We developed and validated in four steps a complete (albeit short: 50 items) self-reported measure of EC: the Profile of Emotional Competence. Analyses performed on a representative sample of 5676 subjects revealed promising psychometric properties. The internal consistency of scales and subscales alike was satisfying, factorial structure was as expected, and concurrent/discriminant validity was good.

A Behavioral Genetic Analysis of Alexithymia and the Dark Triad Traits of Personality

The present study is the first to assess phenotypic correlations between alexithymia and the Dark Triad traits of personality in a community sample, as well as the common genetic and environmental factors underlying these correlations. Participants were 232 North American adult twin pairs who completed the Narcissistic Personality Inventory, the Self-Report Psychopathy Scale, the MACH-IV, and the Toronto Alexithymia Scale. Results revealed that alexithymia correlates significantly and positively with psychopathy and Machiavellianism, and negatively with narcissism. Subsequent bivariate behavioral genetic analysis demonstrated that these phenotypic correlations were primarily attributable to common genetic and common non-shared environmental factors. The implication of these findings regarding the maladaptive functions of alexithymia within the antisocial realm of behavior and the need for replication are discussed.

Anxiety in close relationships is higher and self-esteem lower in patients with irritable bowel syndrome compared to patients with inflammatory bowel disease

BACKGROUND

Previous research has suggested an interaction between personality factors and inflammatory bowel disease (IBD) as well as irritable bowel syndrome (IBS). We therefore aimed to elucidate differences in psychological and coping functioning between patients with IBD and IBS, and to assess the relationship of disease activity with these functions.

METHODS

Seventy-four patients with IBD (mean age 43±17 years, range 18-82 years) and 81 patients with IBS (mean age 37±12 years, range 21-66 years) completed the questionnaires; Rosenberg Self-Esteem Scale, Toronto Alexithymia, Experiences in Close Relationships, and Sense of Coherence. Disease activity was evaluated either by the Harvey-Bradshaw index, the Simple Clinical Colitis Activity Index, or the Visual Analogue Scale for Irritable Bowel Syndrome.

RESULTS

The study revealed that patients with IBS had higher degree of anxiety in close relationships than patients with IBD (p=0.003), and lower self-esteem (p=0.001). No other statistical differences between the whole groups IBS and IBD or between subgroups were seen.

CONCLUSIONS

The fact that patients with IBS seem to have higher levels of anxiety in relationships and lower self-esteem could influence the way the patient deal with the disease and how the communication with health care professionals works out. A higher awareness of the importance of past negative life events should be taken into consideration. Whether the disease or the personal traits are the primary event should be addressed in future research.

Alexithymia and eating disorders: a critical review of the literature

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

Alexithymia, negative emotions, and sexual behavior in heterosexual university students from Italy

Alexithymia is a construct which denotes thought characterized by pragmatic content, an inability to recognize and verbally express emotion, a difficulty in distinguishing between feelings and bodily sensations, and a limitation in fantasy life. Research has revealed a role for alexithymia in different kinds of sexual dysfunctions; it was also associated with reduced frequency of penile-vaginal intercourse but not with sexual behaviors-like masturbation-which do not include an emotional interaction in normal individuals. The aim of this research was to further investigate the association between alexithymia scores and sexual behavior in a sample of normal individuals, taking into account the role of gender differences and the possible effect of negative emotions (depression, anxiety, and anger). Participants were 300 university students (142 men and 158 women); sexual behavior was measured by the Sex and the Average Woman (or Man) Scale while alexithymia was measured with the Toronto Alexithymia Scale. The findings of the study showed that higher alexithymia scores were associated with lower levels of sexual satisfaction and higher levels of sexual detachment for females, and with sexual shyness and sexual nervousness for both genders. Results also suggested that the correlations between alexithymia scores and sexual behavior are partially influenced by the effect of negative emotions. Overall, it seems that the same detachment which denotes the alexithymic interpersonal style also characterizes sexual behavior.

Emotional conflict in a model modulates nociceptive processing in an onlooker: a laser-evoked potentials study

Observing models displaying facial expressions of pain elicits neural activity in onlookers' neural structures involved in first-hand experience of pain and in monitoring conflicting information. We investigated whether the purported conflict between the pain and its emotional expression in a model modulates cortical responses elicited by nociceptive laser stimuli in an onlooker. Seeing happy facial expressions, incongruent with the perceptual status attributed to the model, determined a significant reduction in the laser-evoked N2 potential. One of the main sources of this response is the anterior cingulate cortex, an area involved in pain perception, empathy for pain and conflict detection. A pre-activation of the anterior cingulate cortex due to the detection of the emotional conflict may, therefore, be responsible for the reduction of nociceptive-related response in the same brain area. Thus, top-down variables, like the appraisal of the others' emotional status, modulate onlookers' nociceptive-related neural activity.

Does alexithymia explain variation in cue-elicited craving reported by methamphetamine-dependent individuals?

Drug craving is an important motivational phenomenon among addicted individuals, and successful management of craving is essential to both the initiation and maintenance of abstinence. Although craving in response to drug cues is common in drug-dependent individuals, it is not universal. At the present time, it is not known why approximately 20-30% of all addicted persons fail to report appreciable craving in laboratory-based cue reactivity studies. This study examined the possibility that alexithymia, a personality attribute characterized by a difficulty identifying and describing emotions, may contribute to the impoverished cue-elicited craving experienced by some addicts. Specifically, we tested the hypothesis that alexithymia, as measured by the Toronto Alexithymia Scale (TAS), would be inversely related to the magnitude of cue-elicited craving obtained in a cue reactivity protocol. Forty methamphetamine-dependent individuals completed the TAS and provided craving ratings for methamphetamine after presentation of methamphetamine-associated cues. Thirteen participants (32%) reported no methamphetamine cue-elicited craving. Contrary to expectation, TAS factor 1 (a measure of difficulty identifying feelings) scores were positively associated with cue-elicited craving. Thus, the results suggest that increasing difficulty-identifying feelings may be associated with higher cue-elicited craving. Clinical implications for this finding are discussed.

Training in Emotion Regulation as a Treatment for Binge Eating: A Preliminary Study

Binge eating within Binge Eating Disorder (BED) may represent ineffective management of, and inappropriate escape from, strong, dysphoric emotions, but treatments have been slow to incorporate an emotion regulation focus. Eleven women meeting criteria for BED participated in 11 sessions (2 hours per week) of a psychoeducational group program providing training in emotion recognition and management, problem-solving, assertion training, relaxation and stress management. Outcome was evaluated using a multiple-baseline design replicated across groups. Binges were self-monitored daily, and self-report questionnaires assessed wellbeing and emotion regulation at pretreatment, posttreatment and follow-up. Cognitive changes from pre to posttreatment were evaluated by Articulated Thoughts in Simulated Situations. The program was effective in reducing binge eating, alexithymia, stress and depression, and it improved coping and positive cognitions. No participant met criteria for BED at follow-up. The findings provide support for the inclusion of training in emotion recognition and regulation in treatments for BED and for affect regulation models of binge eating.

Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample

BACKGROUND

Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use.

METHODS

This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M=27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT).

RESULTS

TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT).

CONCLUSIONS

The findings suggest that alexithymia is related to deficiencies in frontal lobe functioning that may reflect a heritable predisposition to alcohol problems.

Betrayal trauma: associations with psychological and physical symptoms in young adults

Betrayal trauma, or trauma perpetrated by someone with whom a victim is close, is strongly associated with a range of negative psychological and physical health outcomes. However, few studies have examined associations between different forms of trauma and emotional and physical symptoms. The present study compared betrayal trauma to other forms of trauma as predictors of young adults' psychological and physical symptoms, and explored potential mediators. A total of 185 university undergraduate students completed the Brief Betrayal Trauma Survey, the Trauma Symptom Checklist, the Toronto Alexithymia Scale, and the Pennebaker Inventory of Limbic Languidness. For each set of symptoms, simultaneous multiple regressions assessed the relative contributions of low versus high betrayal trauma to psychological and physical health reports. Structural equation models examined traumatic stress symptoms and alexithymia as mediators of the relationship between betrayal trauma and physical health symptoms. A total of 151 participants (82%) reported exposure to at least 1 of 11 forms of trauma queried (M = 2.08, SD = 1.94); 96 participants (51.9%) reported at least 1 betrayal trauma. Traumas characterized by high betrayal predicted alexithymia, anxiety, depression, dissociation, physical health complaints, and the number of days students reported being sick during the past month, whereas other traumas did not. Structural equation modeling revealed that traumatic stress symptoms and alexithymia mediated the association between betrayal trauma and physical health complaints. These results indicate that betrayal trauma is associated with young adults' physical and mental health difficulties to a greater extent than are other forms of trauma. Results may inform assessment, intervention, and prevention efforts.

Alexithymia in adolescents with borderline personality disorder

OBJECTIVE

The aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.

METHODS

The study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N=140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.

RESULTS

The ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.

LIMITATIONS

Since BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.

CONCLUSIONS

BPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.

Cognitive and physiological dissociations in response to emotional pictures in patients with anorexia

Recent studies suggest that patients with anorexia may express dissociated cognitive and physiological reactivities to emotional stimuli. The present research aimed to compare subjective and autonomic responses to pleasant, unpleasant and neutral scenes during a categorization task and an activation rating task in anorexic (AN), alexithymic (AL), depressed (DEP) and control participants (CONT). The participants first categorized pictures according to their emotional valence, followed by a rating of their activation level, concomitant with the recording of skin conductance responses (SCRs). Main findings showed that the AN patients presented major difficulty in categorizing pictures, particularly neutral ones. Contrary to the AL participants, this difficulty did not induce significant increases of SCR amplitude in the AN patients. In the second task, the AN patients rated the intensity of activation of unpleasant pictures higher than the AL participants and that of pleasant ones higher than the AL and CONT participants. In addition, no significant linear correlation was observed between the intensity of activation ratings and SCR amplitude in the AN, AL or DEP participants contrarily to what was observed for control participants. This lack of relation suggests a non-specific disconnection between physiological and cognitive self-reported responses to emotional stimuli. Our results highlight a specific form of emotional processing in the AN patients distinct from that observed in alexithymia or depression and characterized by a dissociation between cognitive and physiological responses. This kind of disconnection could be associated with emotional regulation processes and may benefit the AN patients by lowering the psychological stress response.

Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions

Previous studies have indicated that obsessive-compulsive disorder (OCD) is associated with alexithymic traits. The purpose of the current study was to evaluate the difference of alexithymia in OCD patients and healthy controls. This study was also designed to elucidate a specific link between certain OCD symptom dimensions and alexithymia. Forty-five patients with OCD and 45 healthy controls completed measures of the OCD symptom severity, alexithymia, anxiety, and depression. Patients with OCD had significantly higher scores of alexithymia than did the healthy controls. Multiple regression analysis revealed that age at onset and the level of anxiety were significantly associated with alexithymia. "Sexual/religious obsessions" was the only symptom dimension that showed a positive association with alexithymia in OCD patients. These findings suggest that OCD patients with a high level of anxiety and an early age of onset may have greater alexithymic tendency. We also found the first evidence for a specific link between sexual/religious obsessions and alexithymia in patients with OCD.

Hormonal contraception usage is associated with altered memory for an emotional story

Substantial evidence now documents sex-related influences on the neurobiology of emotional memory. Robust sex influences exist, for example, on the amygdala's role in emotional memory formation, as well as on retention of central information (gist) and detail for an emotional event. Evidence also suggests that the well-documented effects of stress hormones on memory depend upon sex hormone levels. Since hormonal contraception alters sex hormone levels, and must by extension alter sex/stress hormone interactions in memory, we examined whether the use of hormonal contraception also alters memory for an emotional story. Two groups of healthy female subjects--one naturally cycling, one using hormonal contraception--viewed either a brief, emotionally arousing story, or a closely matched, but more emotionally neutral story. Each subject's eye movements and pupil dilation changes were recorded as they viewed the story. Additionally, saliva samples were taken throughout the experimental session to examine salivary alpha-amylase, a biomarker for norepinephrine. A surprise free recall test one week later measured story memory in all subjects. Naturally cycling women exhibited enhanced memory of story details, but not of central information (gist), in the emotional compared with neutral story conditions. In contrast, women using hormonal contraception exhibited enhanced memory of gist, but not story details, in the emotional compared with neutral story conditions. Analysis of eye movements made while watching the stories indicated that the differences in memory could not be attributed either to a differential attention focus or to the degree of arousal induced by the stories in the two groups. These findings suggest that the use of hormonal contraception alters memory for an emotional event, perhaps by altering sex/stress hormone interactions in memory formation. They also suggest that further investigation of the mnemonic effects of these very widely used treatments is warranted.

Audiovisual speech from emotionally expressive and lateralized faces

Emotional expression and how it is lateralized across the two sides of the face may influence how we detect audiovisual speech. To investigate how these components interact we conducted experiments comparing the perception of sentences expressed with happy, sad, and neutral emotions. In addition we isolated the facial asymmetries for affective and speech processing by independently testing the two sides of a talker's face. These asymmetrical differences were exaggerated using dynamic facial chimeras in which left- or right-face halves were paired with their mirror image during speech production. Results suggest that there are facial asymmetries in audiovisual speech such that the right side of the face and right-facial chimeras supported better speech perception than their left-face counterparts. Affective information was also found to be critical in that happy expressions tended to improve speech performance on both sides of the face relative to all other emotions, whereas sad emotions generally inhibited visual speech information, particularly from the left side of the face. The results suggest that approach information may facilitate visual and auditory speech detection.

Psychological profile of patients with bronchial asthma and functional dyspnea: a comparison with a non-asthmatic population and impact on the disease

BACKGROUND

Few studies have analysed the relationship between anxiety and alexithymia with functional dyspnea (FD) and its impact on quality of life and asthma control. The aim of this study was to assess the prevalence of DD in asthma, its impact on quality of life and asthma control and its relationship with anxiety and alexithymia.

PATIENTS AND METHODS

We performed a cross-sectional study of 264 asthmatic patients and 111 controls. Both groups completed the following questionnaires: quality of life (AQLQ), alexithymia (TAS-20), anxiety (STAI) and FD (Nijmegen). In asthmatics were evaluated: asthma severity, dyspnoea, exacerbation and control of the disease (ACT test).

RESULTS

38% of asthmatics and 5.5% of non-asthmatics had FD. Asthmatics had more anxiety and were more alexithymic. Asthmatics with FD had significantly more anxiety, more alexithymia, poor control of asthma, more exacerbations and poorer quality of life, that asthma without DD. Asthmatics with an ACT<19, a score >3 in the emotion subscale of the AQLQ, who were being treated for anxiety and scored >19 on the alexithymia subscale that assesses difficulty in identifying emotions, showed ORs for FD of 2.6 (1.1-5.9), 6.8 (2.9-15.8), 4.4 (1.9-9.8) and 3.3 (1.5-7), respectively. A predictive model of FD was constructed.

CONCLUSIONS

We demonstrated the close relationship between anxiety, alexithymia and DD in asthmatics, as well as the significant impact of FD on the control and quality of life of this asthmatics.

Validation of a Greek adaptation of the 20-item Toronto Alexithymia Scale

BACKGROUND

The purpose of the current investigation was (1) to test whether the 3-factor structure of the 20-item Toronto Alexithymia Scale (TAS-20) corresponding to the theoretical conceptualization of the alexithymia construct could be recovered in a Greek translation of the scale (the TAS-20-G), (2) to assess if a 3-factor structure provides a better fit to the TAS-20-G compared with the recently proposed alternative factor structures, and (3) to evaluate the internal reliability of the TAS-20-G.

METHODS

The English version of the TAS-20 was translated into Greek and then back-translated and modified until cross-language equivalence was established. The Greek version was then administered to 340 university students. Confirmatory factor analyses were conducted, and 4 different factor structure models were compared. Internal consistency and item-to-scale homogeneity of the TAS-20-G and its factor scales were also evaluated.

RESULTS

The 3-factor model provided a good fit to the data and proved superior to alternative 1-, 2-, and 4-factor models. Apart from a coefficient alpha below the recommended range for the externally oriented thinking factor, the TAS-20-G and its factor scales demonstrated adequate internal consistency and homogeneity.

CONCLUSION

The TAS-20-G is a valid and reliable measure of alexithymia in university students and may be suitable for investigations of alexithymia in other Greek-speaking population samples.

The impact of alexithymia on somatization after traumatic brain injury

INTRODUCTION

High rates of alexithymia have been reported following traumatic brain injury (TBI). Difficulty modulating emotional states has been shown to increase the risk of affective distress and the tendency to express this distress in the form of physical symptoms. The current study therefore examined relationships between alexithymia, affective distress and somatization in a TBI sample.

METHOD

Eighty-three patients with TBI completed the Toronto Alexithymia Scale (TAS-20) and the Symptom Checklist (SCL-90-R).

RESULTS

Alexithymic individuals reported higher ratings of anxiety, low mood and somatic symptoms. Alexithymia accounted for a significant amount of variance in anxiety, depression and somatization ratings. Scores on sub-scale 1 of the TAS-20 (difficulty identifying feelings) made a significant unique contribution to explaining somatization ratings after controlling for the influence of anxiety and depression ratings.

CONCLUSION

Alexithymia after TBI increases the risk of affective disturbance and somatization. It needs to be identified at an early stage to direct rehabilitation interventions and improve prospects for psychosocial outcome.

Alexithymia and cognitive dysfunctions in patients with panic disorder

BACKGROUND

In patients with panic disorder (PD), the difficulty to identify and manage emotional experience might contribute to the enduring vulnerability to panic attacks. Such a difficulty might reflect a dysfunction of fronto-temporo-limbic circuits. The present study was designed to test the hypothesis that drug-free patients with PD, as compared with healthy subjects (HS), show a higher prevalence of alexithymia, greater difficulty in emotional stimuli processing and poorer performance on neuropsychological tests exploring the activity of fronto-temporo-limbic circuits.

METHODS

Alexithymia, general cognitive abilities, focused and sustained attention, working memory, secondary memory, incidental learning, susceptibility to interference from both cognitive and emotional stimuli, and ability to recognize facial emotional expressions were assessed in 32 drug-free patients with PD and 32 HS.

RESULTS

Alexithymia was more frequent in patients with PD than in HS. Patients with PD, as compared to HS, had lower verbal cognitive abilities and more difficulty to inhibit interference from nonverbal stimuli and from panic-related words; they performed better than HS on the test assessing spatial incidental learning. Anxiety, panic symptomatology and verbal cognitive abilities (VIQ) were associated with alexithymia.

CONCLUSIONS

Findings are compatible with a dysfunction of frontolimbic circuits, in particular orbitofrontal and cingulate cortices. A reduction in verbal cognitive abilities was also observed, which might suggest reduced abstraction and symbolization in these patients.