Alexithymia and alcohol use disorders: a critical review

Mothers' alexithymia in the context of parental Substance Use Disorder: Which implications for parenting behaviors?

BACKGROUND

Maternal substance use disorder (SUD) represents a severe risk for caregiving, affecting diverse domains of parenting behaviors, such as sensitivity, structuring, intrusiveness, and hostility. Various studies highlighted that difficulties in parenting behaviors in the context of SUD are exacerbated by the co-occurrence of psychopathological symptoms. A large body of research points out the presence of high rates of alexithymia in individuals with SUD, and some studies provide evidence of an association between this psychopathological aspect and parenting. Nevertheless, no prior research has explored how alexithymic traits could affect quality of parenting behaviors in mothers with SUD.

OBJECTIVE

To investigate the impact of maternal alexithymia on parenting behaviors in mothers with SUD.

METHODS

Sixty women in residential treatment for SUD and their children participated in the study. The participants were assessed with respect to alexithymia, quality of parenting behaviors, and depressive symptoms.

RESULTS

Forty-three percent of the mothers reported the presence of alexithymia. These mothers presented with significantly low scores on sensitivity (β = -.25, p < .05) and structuring (β = -.32, p < .05). After controlling for depressive symptomatology, the effect of alexithymia on parenting behaviors remained only for structuring (β=.35, p < .05).

CONCLUSIONS

In the context of SUD, maternal alexithymia significantly impacts the quality of parenting behaviors, specifically structuring, indicating that difficulties in becoming aware of one's own feelings jeopardize the ability to scaffold interactions and set age-appropriate limits in an emotionally attuned way. Clinical implications of the findings are discussed.

Early-life adversities and adult attachment in depression and alexithymia

Alexithymia is a personality construct characterized by difficulties in identifying and verbalizing feelings, a restricted imagination, and an externally oriented thinking style. As alexithymia shows marked overlap with depression, its independent nature as a personality construct is still being debated. The etiology of alexithymia is unknown, although childhood emotional neglect and attachment formation are thought to play important roles. In the FinnBrain Birth Cohort Study, experiences of early-life adversities (EA) and childhood maltreatment (CM) were studied in a sample of 2,604 men and women. The overlap and differences between depression and alexithymia were investigated by comparing their associations with EA types and adult attachment style. Alexithymia was specifically associated with childhood emotional neglect (odds ratio (OR) 3.8, p < .001), whereas depression was related to several types of EA. In depression co-occurring with alexithymia, there was a higher prevalence of emotional neglect (81.3% vs. 54.4%, p < .001), attachment anxiety (t = 2.38, p = .018), and attachment avoidance (t = 4.03, p < .001). Early-life adversities were markedly different in the alexithymia group compared to those suffering from depression, or healthy controls. Depression with concurrent alexithymia may represent a distinct subtype, specifically associated with childhood experiences of emotional neglect, and increased attachment insecurity compared to non-alexithymic depression.

Emotional dysregulation features and problem gambling in university students: a pilot study

Undergraduate students typically cope with various changes in their lives and experience many stressors associated with academic issues. Distress can make them more vulnerable to particular behavioral patterns in order to cope with negative affect. The association of problematic gambling with particular emotion regulation characteristics-some of which are developmentally dependent-becomes a recent focus of research with clinical and preventive implications. We carried out a pilot study enrolling voluntarily young adults of a public university in the Lisbon area, and 117 Portuguese-speaking individuals were interviewed. Participants, mainly female (M = 20.6; SD = 3.9), were investigated taking into consideration their gambling practices, characteristics of impulsivity and alexithymia, along with the symptoms of depression and anxiety. Portuguese versions of the South Oaks Gambling Scale (SOGS) and Short-Version of Impulsive Behavior Scale (S-UPPSP) were prepared (i.e., translation and back-translation of the original versions were performed). The prevalence of gambling problems in this sample is modest, although they were associated with negative urgency and sensation-seeking, as well as with depression symptoms. Multiple correspondence analysis, a particular multivariate model associating gambling problems with socio-demographic and psychological variables, allowed identifying different profiles of individuals. Trace and state emotional dysregulation features are selectively associated with distinctive gambling patterns, according to some previous findings in studies with other groups. Results may address new findings in terms of morbidity, risk factors and the design of future preventive strategies among such individuals.

Transdiagnostic mechanisms involved in nonsuicidal self-injury, risky drinking and disordered eating: Impulsivity, emotion regulation and alexithymia

Objective: The aim of the present study was to explore common and differential relationships between nonsuicidal self-injury (NSSI), risky drinking, and disordered eating attitudes and impulsivity, emotion dysregulation, and alexithymia. Methods: We investigated these associations in a sample of 951 college students (79.4% female, Mage = 21.86 years) by means of self-report questionnaires assessing the constructs of interest. Results: Overall, 28% of the students reported a history of NSSI, one third engaged in risky drinking, and less than 5% reported disordered eating symptoms. Negative urgency and difficulties in emotion regulation were both related to each of the three behaviors and can be considered as common transdiagnostic mechanisms. Conclusions: We discuss the implications of transdiagnostic mechanisms involved in these three dysregulated behaviors with respect to their assessment and treatment in college counseling settings.

The role of alexithymia in social cognition: Evidence from a non-clinical population

BACKGROUND

Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment.

METHODS

We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills.

RESULTS

Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states.

LIMITATIONS

The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships.

CONCLUSIONS

These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

Ideal cardiovascular health in adolescents and young adults is associated with alexithymia over two decades later: Findings from the cardiovascular risk in Young Finns Study: Department: Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland

We evaluated the association of cardiovascular health in adolescence and young adulthood with alexithymia 25 years later. The study sample (n = 1122) participated in evaluations conducted in 1986 (baseline) and in 2011-2012 (T2). Baseline health factors and behaviors were assessed utilizing seven ideal cardiovascular health metrics (ICH index) including blood pressure, cholesterol and glucose levels, smoking, physical activity, body-mass-index, and diet. The stability of the ICH index was evaluated with corresponding assessments in 2007 (T1). At T2, alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). The main analyses were conducted using ANCOVA and adjusted for depression, age, and present social and lifestyle factors. TAS-20 subscales, Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally Oriented Thinking, were analyzed separately. The ICH index was significantly associated with the TAS-20 total score, as well as both with DIF and DDF. A less ideal cardiovascular health was associated with higher alexithymia scores. However, regarding the separate factors, only the association between non-ideal dietary habits and DIF was significant in the multivariate analyses. The baseline ICH index score was stable from baseline to T1. We conclude that non-ideal cardiovascular lifestyle habits in adolescence and young adulthood are significantly associated with later alexithymia.

Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts

INTRODUCTION

Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI).

METHODS

A literature search was conducted for original articles examining the general and psychiatric populations.

RESULTS

There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts.

CONCLUSION

The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.

Mindful self-regulation of attention is a key protective factor for emotional dysregulation and addictive behaviors among individuals with alcohol use disorder

Individuals with alcohol use disorder (AUD) and other substance use disorders (SUDs) frequently show co-occurrent behavioral addictions (BAs) (i.e., gambling and compulsive sex) and other inflexible behaviors (IBs) (i.e., compulsive buying and dysfunctional eating behaviors). The covariation of these conditions might be explained by a role of emotion dysregulation (ED) and executive dysfunctions. This study aims at investigating whether ED and self-regulation of attention (SRA) could be common processes that underpin BAs and other IBs among individuals with AUD. The study hypothesized that SRA should represent a key protective factor for the relationships between ED and BAs/IBs. The research included 319 treatment-seeking individuals with a primary diagnosis of AUD. Five independent multiple parallel mediational models were tested. Self-report instruments were administered in order to assess ED, BAs and other IBs, which represented independent and dependent variables respectively. SRA was self-report assessed and, it was considered the key mediator variable. The analyses highlighted significant total effects of ED on the severity of BAs and IBs. SRA fully mediated the relationships between ED and BAs/IBs, with exception of gambling. ED and SRA should be considered common dimensions that explain the covariation of BAs and IBs among individuals with AUD. SRA represents an adaptive form of emotion regulation that sustains the engagement in goal-oriented behaviors. Future neuroimaging and longitudinal studies are recommended in order to demonstrate the role of ED and SRA on development, maintenance and treatment of BAs and IBs among individuals with SUDs.

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Cannabis Use and Emotional Awareness Difficulties in Adolescents with Co-Occurring Substance Use and Psychiatric Disorders

Background: Assessing predictors of cannabis use following adolescent substance use treatment may inform essential treatment elements to be emphasized before discharge. Adolescents with low emotional awareness may have limited resources for identifying and overcoming negative emotions, and therefore, use cannabis to regulate emotions. Purpose/objectives: The purpose of this study was to test the hypothesis that emotional awareness difficulties are associated with increased cannabis use across the transition out of substance use treatment. This hypothesis was investigated by applying an autoregressive random-intercept cross-lagged panel-modeling framework to test the fit of alternative models and inform hypotheses about directional associations between cannabis use and emotional awareness difficulties over time. Methods: Participants were 110 adolescents with co-occurring disorders and their families participating in an intensive home-based treatment trial. Adolescents reported on past 7-day cannabis use and difficulties in emotional awareness at baseline and three follow-up assessments across 12 months. Results: At baseline, 54% of the sample reported past-week cannabis use. A directional effect was supported such that difficulties with emotional awareness at 3 months' post-baseline, which corresponded to the approximate end of the treatment program, were associated with increased cannabis use at 6 months' post-baseline, controlling for the stability of cannabis use, and emotional awareness over time. Cannabis use, however, was not associated with subsequent difficulties in emotional awareness (i.e., effects in the opposite direction were not supported). Conclusions/Importance: Emotional awareness difficulties toward the end of a course of intensive outpatient treatment may be associated with increased cannabis use after the completion of treatment.

Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon

Background

International research showed that common mental disorders such as depression, anxiety, social anxiety, stress, alexithymia and having insecure attachment styles are risk factors for alcohol use disorder (AUD). Our objective was to study the factors associated withAUD in a sample of the Lebanese population.

Methods

During the period lasting from November 2017 to March 2018, a sample of 789 Lebanese participants agreed to contribute to a cross-sectional study (53.23% males). Alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

Results

A high risk of AUD was associated with higher alexithymia (ORa = 1.030; CI 1.009–1.051), depression (ORa = 1.076; CI 1.050–1.103) and suicidal ideation (ORa = 1.253; CI 1.026–1.531) in a significant manner. In opposition, a higher number of kids (ORa = 0.863; CI 0.752–0.991), being a female (ORa = 0.460; CI 0.305–0.694) and higher emotional management (ORa = 0.962; CI 0.937–0.988) were significantly associated with lower AUD risk.

A cluster analysis derived three mutually exclusive clusters. Cluster 1 formed 45.4% of the sample and assembled people with psychological difficulties (work fatigue and high stress, high emotional work fatigue and low emotional intelligence, low self-esteem, high social phobia, high alexithymia); Cluster 2 formed 34.4% of the sample and assembled people with high wellbeing (low suicidal ideation, low emotional work fatigue, depression and anxiety, high emotional intelligence, high self-esteem and low social phobia); whereas cluster 3 formed 20.2% of the sample and represented people with mental dysfunction (high anxiety and depression, high suicidal ideation, low self-esteem and high social phobia, low emotional intelligence, high emotional work fatigue). People with psychological difficulties (cluster 1) (Beta = 5.547; CI 4.430–6.663), and people in distress (cluster 3) (Beta = 7.455; CI 5.945–8.965) were associated with higher AUDIT scores than those with high wellbeing (cluster 2).

Conclusion

AUD seems to be influenced by several factors among the Lebanese population, including alexithymia, stress, anxiety and work fatigue. Healthcare professionals should spread awareness to reduce the prevalence of these factors.

Attachment Style, Early Childhood Trauma, Alexithymia, and Dissociation Among Persons Addicted to Alcohol: Structural Equation Model of Dependencies

AIM

Attachment theory is a broadly used paradigm for understanding human affective development. It is recognized that alexithymia is a key factor responsible for the non-adaptive strategies of regulating emotions in people addicted to alcohol. In addition, an important role is attributed to early childhood trauma and dissociation. The theoretical model was examined, in which connections between attachment styles, trauma, and alexithymia and dissociation were investigated in persons addicted to alcohol.

METHODS

The total number of study participants amounted to 268 persons, including 116 women (43% of all subjects) and 152 men (57% of all subjects) at the age of 18-73 (M = 39.19; SD = 13.45). In order to measure the analyzed variables, the following questionnaires were applied: Michigan alcoholism screening test (MAST), attachment styles questionnaire (ASQ), 20-item Toronto Alexithymia Scale (TAS-20), traumatic experiences checklist (TEC), and curious experiences survey (CES).

RESULTS

A comparative analysis between the group of alcohol addicts and non-addicts showed statistically significant differences related to attachment style, intensity of trauma, alexithymia, and dissociation. With structural equation models (i.e., AMOS and GLS), the adjustment of theoretical model to data was examined, which allowed the description of dependency paths. As a result of the conducted analysis of paths, it was found out that the model was accurately fitted to data, but only when an impact path related to a direct connection between an attachment style and an addiction was deleted. This impact is indirect, and from one side, it results from affective and cognitive deficits, i.e., alexithymia, and on the other side, from the intensity of traumatic experiences. No direct impact of dissociation on the development of an inclination to addiction was found, if contextual variables, i.e., alexithymia and trauma, are taken into account. The strongest direct relation was proven in the case of the anxious-ambivalent attachment style and alexithymia (β = 0.389; p < 0.01) and avoidant attachment style and alexithymia (β = 0.497; p < 0.01), which turned out a strong predictor fostering the development of alexithymia and the occurrence of traumas related to emotional negligence and mental violence and finally addiction.

CONCLUSION

Our studies revealed how important it is to investigate the role of individual variables in the context of developmental models. An extremely important element of the scientific achievement presented here is showing pillars of trauma, alexithymia, and dissociation in their cumulative impact on the development of emotional disorders resulting in addiction.

The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis

BACKGROUND

Nonsuicidal self-injury (NSSI; direct harm to the body without suicidal intent) and risky drinking are two behaviours that serve emotion regulatory functions. When underlying emotional problems are untreated, individuals may shift between NSSI and risky drinking. Both behaviours are associated with alexithymia, difficulties identifying and describing emotions and retaining an externally orientated thinking style. However, it is unknown to what extent the associations are similar and under what circumstances (e.g. sex, age) they may differ.

METHOD

To compare both associations we conducted an extensive review using several databases. Overall, 20 NSSI-related articles and 33 risky drinking-related articles met the inclusion criteria.

RESULTS

A meta-analysis revealed significant positive associations between total alexithymia scores, difficulties identifying feelings, difficulties describing feelings and both NSSI and risky drinking. However, these associations appear stronger for NSSI. Further, externally orientated thinking was associated with risky drinking but not NSSI. Age had opposing moderating effects on the relationships, with the association between alexithymia and NSSI being stronger in younger samples and the association between alexithymia and risky drinking being stronger in older samples. Further, the association between alexithymia and NSSI was stronger for female only samples compared to male only samples.

LIMITATIONS

The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional.

CONCLUSION

These results imply that NSSI and risky drinking may have both shared and distinguishable correlates. Alexithymia can be targeted in treatment to potentially reduce the likelihood of individuals shifting between behaviours to regulate their emotions.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study

Background

To our knowledge, no research project on alexithymia has been conducted in Lebanon. The objective of this study was to assess risk factors associated with alexithymia in a representative sample of the Lebanese population.

Methods

This is a cross-sectional study, conducted between November 2017 and March 2018, which enrolled 789 participants from al districts of Lebanon. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, the Alcohol Use Disorders Identification Test to assess alcohol use, drinking patterns, and alcohol-related issues, the Rosenberg self-esteem scale to evaluate self-worth, the Hamilton depression rating scale and Hamilton Anxiety Scale to screen for depression and anxiety respectively, the Three-Dimensional Work Fatigue Inventory to measure physical, mental and emotional work fatigue respectively, the Columbia–Suicide Severity Rating Scale to evaluate suicidal ideation and behavior, the Perceived Stress Scale to measure stress, the Liebowitz Social Anxiety Scale to help identify a social anxiety disorder and the Quick Emotional Intelligence Self-Assessment to measure emotional intelligence.

Results

The results showed that 395 (50.4%) were not alexithymic, 226 (28.8%) were possible alexithymic, whereas 163 (20.8%) were alexithymic according to established clinical cutoffs. Stress (Beta = 0.456), emotional exhaustion (Beta = 0.249), the AUDIT score (Beta = 0.225) and anxiety (Beta = 0.096) were associated with higher alexithymia, whereas low emotional work fatigue (Beta = −0.114) and being married (Beta = −1.933) were associated with lower alexithymia.

People in distress (Beta = 7.33) was associated with higher alexithymia scores, whereas people with high wellbeing (Beta = −2.18), an intermediate (Beta = −2.90) and a high (Beta = −2.71) family monthly income were associated with lower alexithymia compared to a low one.

Conclusion

Alexithymia appears to be influenced by many factors, including stress, anxiety, and burnout. To reduce its prevalence, it is important that health professionals educate the public about these factors. Further studies on a larger scale are needed to confirm our findings.

Alcohol usage predicts holistic perception: A novel method for exploring addiction

Holistic perception is a special form of automatic and experience dependent processing that prioritises objects of interest through the visual system. We therefore speculated that higher levels of alcohol consumption may be associated with enhanced holistic perception for alcohol cues. In our first experiment, we confirmed this hypothesis by showing that increasing regular alcohol usage was associated with greater holistic perception of alcohol, but not non-alcohol, cues. We replicated this finding in a second experiment, but confirmed drink-specific holistic perception for lager cues was not predicted by experience with that drink, but general alcohol usage. In our final experiment when alcohol images were absent from the task, higher levels of alcohol consumption predicted decreased holistic perception for non-rewarding cues. Alcohol use is therefore linked to inverse alterations in holistic perception for alcohol versus non-alcohol cues, with the latter's effects context dependent. We hypothesise that such inverse relationships may be due to limited cortical resources becoming reutilised for alcohol cues at the expense of other stimuli. Future work will be required to determine holistic perception's role in maintaining addiction, its predictive value in successful abstinence, and its relationship with characteristics of addiction such as cue reactivity, attentional biases and personality traits.

Personality and Alcohol-Related Risk: Neuroticism, Extraversion, and Alexithymia

Previous research has established associations of neuroticism and extraversion with risky or problematic alcohol use in both clinical and nonclinical samples. More recently, alexithymia—a personality trait defined by difficulties in identifying and describing feelings as well as concrete thinking—has been implicated as a risk factor for problematic drinking; however, whether it is an independent risk factor or overlaps with others has not been determined. The present study examined neuroticism, extraversion, and alexithymia in relation to risky drinking in a nonclinical sample of 285 alcohol consumers aged 18-60 years. Neuroticism and extraversion were measured with the International Personality Item Pool Big Five Factor Markers, whereas alexithymia was measured with the Toronto Alexithymia Scale 20. The Alcohol Use Disorders Identification Test provided an index of alcohol-related risk. Hierarchical regression indicated that neuroticism, extraversion, and alexithymia were all significant positive predictors of risky drinking after controlling for demographic and mood variables. Alexithymia was positively related to neuroticism, and both were negatively related to extraversion. The relationship between alexithymia and risky drinking was partially mediated by neuroticism, and the association of alexithymia with neuroticism was partially mediated by negative mood. Neuroticism, extraversion, and alexithymia appear to be independently related to alcohol-related risk, although the influence of alexithymia may partially overlap with that of neuroticism. Both alexithymia and neuroticism are associated with proneness to negative moods; a reliance on drinking to cope with such states may account for the links of both traits to risky or problematic drinking in line with Cloninger’s type I alcoholism. However, additional aspects of alexithymia may also contribute to its role in alcohol-related risk. The relationship of extraversion to risky drinking appears congruent with Cloninger’s type II alcoholism, where high reward sensitivity motivates drinking to enhance positive states.

The prediction of alexithymia as a state or trait characteristic in patients with substance use disorders and PTSD

Alexithymia is common in patients with a substance use disorder (SUD) and is possibly a negative prognostic factor in their treatment. The aim of this study was twofold. First, we explored whether SUD patients with posttraumatic stress disorder (PTSD) are more alexithymic than SUD patients without PTSD. Next, we explored whether trait and state-related parts of alexithymia could be differentiated in these patients. This phenomenon was studied in 197 SUD patients with the Toronto Alexithymia Scale-20 (TAS-20); Clinician Administered PTSD Scale; Self-Report Inventory for PTSD; Traumatic Experiences Checklist; European Addiction Severity Index; and the Depression, Anxiety and Stress Scale in a cross-sectional design. SUD patients with current PTSD showed more alexithymic characteristics than patients without PTSD or with previous lifetime/not current PTSD. The severity of PTSD complaints; alcohol addiction; and the combination of depression, anxiety and stress symptoms, all of which are more related to alexithymia as a state, explained 38.1% of the TAS-20. In conclusion, we advise that SUD patients be assessed for alexithymia and that its degree is taken into account. We also tentatively assume that a considerable part of alexithymia is more state- than trait-related in these patients.

Neuro-cognitive correlates of alexithymia in patients with circumscribed prefrontal cortex damage

Alexithymia has been extensively reported in studies of psychiatric patients. However, little attention has been paid regarding its occurrence in the context of patients with circumscribed prefrontal cortex lesions. Moreover, the neuro-cognitive impairments that lead to alexithymia remain unclear and limited numbers of studies have addressed these issues. The authors investigated the impact of prefrontal cortex lesions on alexithymia and its neuro-cognitive correlates in a population of 20 patients with focal frontal lesions, 10 patients with parietal lesions and 34 matched control participants. Alexithymia was screened using the Toronto Alexithymia Scale (TAS-20) and executive functions were assessed using a large battery of executive tasks that address inhibition, flexibility and the planning process. Results showed that patients with prefrontal cortex damage showed significantly increased difficulty in facets of identifying feelings (DIF) and externally oriented thinking (EOT) on TAS-20, compared to parietal patients and control participants. Moreover, both correlation and regression analysis revealed that higher alexithymia levels on the three facets of TAS-20 were consistently but differentially associated with impairment in inhibition, flexibility and planning tasks for frontal patients and both control groups. These findings provide clinical evidence of the implication of prefrontal cortex damage and executive control in alexithymia. Our results were also discussed in the light of the cognitive appraisal concept as a mechanism involved in emotion episode processing. This study suggests that increased neuropsychological attention should be directed to the relation between the neuro-cognitive model of executive functions and cognitive appraisal theory in processing emotion.

Emotional processing and social cognition in alcohol use disorder

OBJECTIVE

To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research.

METHOD

First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed.

RESULTS

Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition).

CONCLUSIONS

The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Alexithymia, body mass index and gestational diabetes in pregnant women - FinnBrain birth cohort study

OBJECTIVE

Overweight, obesity, and associated problems in metabolic health are an increasing public health concern. Personality traits and emotional processing styles may play a role in the regulation of food intake and reward. Alexithymia is a personality construct involving difficulties in identifying and expressing emotions and has been previously associated with eating disorders and metabolic problems. We examined associations between alexithymia dimensions, Body Mass Index (BMI) and gestational diabetes in pregnant women.

METHODS

The participants were 1660 pregnant women living in Finland from the FinnBrain Birth Cohort Study. We investigated the associations between alexithymia and its dimensions as measured by the Toronto Alexithymia Scale (TAS-20), overweight, and gestational diabetes. The effects of age, education, and depressive symptoms were controlled for using hierarchical regression analysis.

RESULTS

Alexithymic individuals had a higher prevalence of overweight compared to those with low or moderate levels of alexithymia (66.0% vs. 34.8%, OR 3.6, adjusted OR 3.6, CI95% 1.9-6.8, p < .001). The dimension of Externally Oriented Thinking (EOT) accounted for this association. Compared to the lowest quartile, women in the highest EOT quartile had a higher BMI (24.3 vs. 25.6, p < .001), and a higher prevalence of overweight [adjusted OR 1.94, CI95% 1.43-2.62, p < .001] and gestational diabetes [OR 1.75, CI95% 1.19-2.55, p = .005].

CONCLUSIONS

Alexithymia, and especially its dimension of EOT is associated with overweight and gestational diabetes in pregnant women. Future studies should clarify causality and examine potential mechanisms and associations with pregnancy outcomes and fetal health.

Gambling Problems and Alexithymia: A Systematic Review

Among the factors that are thought to underlie gambling problems, alexithymia has been recognized to contribute to their development. For the first time, we reviewed the literature on the relationship between alexithymia and gambling. A systematic search of literature was run in the major reference databases including PubMed, Cochrane Database for Systematic Review, PsycINFO, Web of Science, Scopus until April 2019. The search produced 182 articles that produced 20 papers included in the review. Fourteen studies were conducted with community samples of pathological gamblers while six studies with clinical samples of disordered gamblers. All studies assessed alexithymia with the Toronto Alexithymia Scale while gambling problems were assessed mostly with the South Oaks Gambling Screen. Alexithymic features were significantly more prevalent in pathological gamblers both at the community and clinical levels, increased symptom severity, and showed interactive mechanisms with personality, psychiatric, and cognitive factors. Alexithymia is likely to associate with gambling as a coping behavior to increase emotional arousal and avoid negative emotions, according to the affect dysregulation model. Further studies are needed to widen the knowledge on this association.

Analysis of the emotional experiences of Japanese Alcoholics Anonymous members striving for sobriety

BACKGROUND

Japan's tolerance of alcohol consumption and intoxication pose extreme difficulties for community-dwelling alcoholics who wish to abstain from alcohol and maintain sobriety. Emotional problems triggered in daily life can easily lead to relapse, especially after abstinence. Alcoholics Anonymous places great emphasis on dealing with attendees' emotional experiences. However, the specific nature of this support is not well understood. Therefore, this study aimed to elucidate the emotional experiences of AA members who strive for sobriety while attending AA and to identify suggestions for new methods of support.

METHODS

The present study employed an interview method. Data were analyzed using the KJ Method, which was developed by Japanese cultural anthropologist Jiro Kawakita. Study participants were 36 men chosen from AA groups in the Kanto and Kyushu regions of Japan.

RESULTS

Long-term abstinence was achieved through the following process: 1) gaining objectivity, 2) striving to maintain an attitude of acceptance, and 3) remaining devoted to discipline for one's goals, thereby 4) recovering one's contradictory self. This was an unending process that unfolded as the individual tasks affected each other. To facilitate this process, AA members dealt with risk cues that destabilized post-cessation emotional balance while making daily efforts to regulate their own emotions.

CONCLUSIONS

To maintain sobriety, AA members strove to regulate their emotions. By doing so, they experienced personal growth and attained a life in which they did not require alcohol (i.e., sobriety). The present study indicated that Japanese nursing and health care workers should be willing to learn from AA members, such as by understanding the 12-step culture. The data also suggest the need to create environments conducive to AA activities, from which many alcoholics derive emotional support.

Prospective relations between alexithymia, substance use and depression: findings from a National Birth Cohort

Purpose: This study examined a developmental model that links affect-regulation difficulties in childhood with three dimensions of alexithymia in adolescence (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) and substance use and depression in adulthood, while accounting for cumulative contextual risk in childhood, and testing potential gender moderation. Methods: Multiple group path analyses were conducted using data from the Northern Finland Birth Cohort 1986 (N = 6963). Analyses used data collected during prenatal/birth, childhood, adolescence, and young adulthood periods. Results: Our examination of early precursors for alexithymia indicated that the associations of affect-regulation problems in childhood with alexithymia were stronger for girls, potentially putting girls with affect-regulation difficulties in childhood at higher risk for developing alexithymia in adolescence. The associations of cumulative contextual risk in childhood with alexithymia, substance use disorder, and depression diagnosis in adulthood were significant for both girls and boys. Our findings in regard to substance use and depression disorders revealed that alexithymia in adolescence predicted depression diagnosis in adulthood, particularly due to a contribution from the alexithymia domain of 'difficulties identifying feelings.' However, none of the alexithymia domains was directly associated with substance use disorder in adulthood. Conclusions: Our study contributes to research that links alexithymia with difficulties in affect regulation and cumulative contextual risk in childhood, yielding findings that may be relevant for preventive interventions.

The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia

Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.

Alcoholism gender differences in brain responsivity to emotional stimuli

Men and women may use alcohol to regulate emotions differently, with corresponding differences in neural responses. We explored how the viewing of different types of emotionally salient stimuli impacted brain activity observed through functional magnetic resonance imaging (fMRI) from 42 long-term abstinent alcoholic (25 women) and 46 nonalcoholic (24 women) participants. Analyses revealed blunted brain responsivity in alcoholic compared to nonalcoholic groups, as well as gender differences in those activation patterns. Brain activation in alcoholic men (ALCM) was significantly lower than in nonalcoholic men (NCM) in regions including rostral middle and superior frontal cortex, precentral gyrus, and inferior parietal cortex, whereas activation was higher in alcoholic women (ALCW) than in nonalcoholic women (NCW) in superior frontal and supramarginal cortical regions. The reduced brain reactivity of ALCM, and increases for ALCW, highlighted divergent brain regions and gender effects, suggesting possible differences in the underlying basis for development of alcohol use disorders.

Alexithymic traits are closely related to impulsivity and cognitive and empathic dysfunctions in intimate partner violence perpetrators: New targets for intervention

Clinical psychologists are interested in studying factors that interfere with the behavioral regulation of perpetrators of intimate partner violence against women (IPVAW), as well as the way these factors affect the risk of future recidivism after interventions that are designed for them are completed. Although several variables have been proposed as risk factors for IPVAW, the role of alexithymia and its relationships with other cognitive and empathic variables in IPVAW perpetrators has been neglected. Thus, the main aim of this study was to compare the alexithymic and cognitive and empathic traits in a carefully selected sample of IPVAW perpetrators (n = 47; mean age = 39) with a control group matched on sociodemographic characteristics (n = 41; mean age = 42). Moreover, we also aimed to study whether alexithymic traits are related to cognitive and empathic alterations in IPVAW perpetrators. Compared to controls, IPVAW perpetrators had higher alexithymic and self-reported impulsivity traits and worse attention and executive functioning (e.g., verbal fluency and cognitive flexibility) performance than controls. Moreover, they also presented greater personal distress, compared to controls. Notably, we observed that higher alexithymia was associated with high self-reported impulsivity, worse cognitive and empathic performance in both groups. Our study identifies different cognitive targets for specific neuropsychological rehabilitation interventions designed to prevent violence recidivism in the long term through their effects on emotional information processing and behavioral regulation.

Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science

Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk or confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.

Association Between Interoception and Emotion Regulation in Individuals With Alcohol Use Disorder

INTRODUCTION

Sensing body-related information includes interoceptive sensibility (the tendency to focus on internal body sensations) and accuracy (precision in perceiving real internal processes). Interoception and emotion regulation have both been linked to alcohol use disorder (AUD). However, the association between these factors have not been investigated within a clinical group of individuals with AUD.

OBJECTIVES

The current study examines associations between emotion regulation and interoceptive accuracy and sensibility among individuals with AUD and healthy controls (HCs).

METHODS

The sample comprised 165 individuals meeting criteria for AUD and 110 HCs. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). Emotion regulation domains: non-acceptance of negative emotions, inability to engage in goal-directed behaviors when experiencing negative emotions, difficulties controlling impulsive behaviors when experiencing negative emotions, limited access to effective emotion regulation strategies, and lack of own emotional awareness and clarity were assessed with the Difficulties in Emotion Regulation Scale (DERS). Associations between interoception and emotion regulation were assessed while controlling for sleep problems, depressive symptoms, age, and sex.

RESULTS

Higher interoceptive accuracy was negatively associated with DERS subscale of non-acceptance of negative emotions in the AUD group (but not in the HC group). Higher interoceptive sensibility was significantly associated with problems in controlling impulsive behaviors when experiencing negative emotions. This association was moderated by symptoms of AUD. Higher interoceptive sensibility was associated with higher emotional awareness, but only in the HC group.

CONCLUSIONS

Individuals with AUD who are more interoceptively accurate may be more effective in regulating their emotions. On the other hand, individuals with AUD who are more interoceptively sensible, may have problems with controlling their behaviors while experiencing negative emotional states.

Alexithymia and Alcohol Dependence: The Roles of Negative Mood and Alcohol Craving

Background: Alexithymia is a personality trait associated with emotion regulation difficulties. Up to 67% of alcohol-dependent patients in treatment have alexithymia. Objectives: The objective of this study was to investigate the direct and indirect effects of alexithymia, negative mood (stress, anxiety, and depression) and alcohol craving on alcohol dependence severity. Methods: Three hundred and fifty-five outpatients (mean age = 38.70, SD = 11.00, 244 males, range 18-71 years) undergoing Cognitive-Behavioral Therapy for alcohol dependence completed the Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scales (DASS-21), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Use Disorders Identification Test (AUDIT) prior to the first treatment session. Results: Alexithymia had an indirect effect on alcohol dependence severity, via both negative mood and alcohol craving (b = 0.03, seb = 0.008, 95% CI: 0.02-0.05). An indirect effect of negative mood on alcohol dependence via alcohol craving was also observed (b = 0.12, seb = 0.03, 95% CI: 0.07-0.16). Conclusions/importance: Alexithymia worked through negative mood and alcohol craving leading to increased alcohol dependence severity, indicating that craving had an indirect effect on the relationship between alexithymia and alcohol dependence severity. Targeting alcohol craving and negative mood for alcohol-dependent patients with alexithymia seems warranted.

Is it the Taste or the Buzz? Alexithymia, Caffeine, and Emotional Eating

BACKGROUND

Alexithymia, a relatively stable personality trait characterized by difficulties identifying and describing feelings and externally oriented thinking, has been linked to both substance use disorders and eating disorders. In nonclinical samples, alexithymia is associated with heavier consumption of alcohol and caffeine. Both are psychoactive drugs, but unlike most drugs they are typically consumed in the context of palatable and calorie-rich products.

OBJECTIVES

Given the association of alexithymia with disordered eating, the present study evaluated the hypothesis that heavier consumption of caffeine by those with high levels of alexithymia may be motivated by the palatable and caloric aspects of common caffeine products rather than by drug-seeking.

METHODS

There were 224 participants aged 17-63 years who completed instruments assessing demographics, alexithymia, emotional eating, caffeine consumption, alcohol consumption, negative moods, and reward sensitivity.

RESULTS

As predicted, alexithymia was positively related to emotional eating as well as consumption of caffeine and alcohol, and alexithymia was a significant predictor of caffeine intake in regression models. However, there was no indication of mediation by emotional eating.

CONCLUSIONS

Alexithymia is characterized by deficient emotion regulation and negative moods, hence use of drugs and/or foods to regulate emotions, combined with poor interoceptive awareness, may account for excessive consumption of drugs or foods as alternative emotion regulation strategies in those with high levels of this trait.

Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviour-specific beliefs

We examined the relationship between self-efficacy and three behaviours that can serve similar affect-regulatory functions (self-injury, risky alcohol use, disordered eating). We proposed that general self-efficacy would be indirectly related to each outcome, operating via emotion regulatory self-efficacy and behaviour-specific self-efficacy. A path analysis confirmed this proposal in a sample of 490 university students, who completed questionnaires assessing the constructs of interest. Emotion regulatory self-efficacy was a salient predictor of self-injury and disordered eating, evidencing both direct and indirect relationships. Self-efficacy to resist each of the behaviours was uniquely related to its target behaviour. We discuss these findings, outlining the implications for a theoretical understanding of emotion-regulatory behaviours, and offer suggestions for prevention and early intervention initiatives.

Alexithymia and reactive aggression: The role of the amygdala

Past research suggests an association between reactive aggression and alexithymia, but neural mechanisms underlying this association remain unknown. Furthermore, the relationship between proactive aggression and alexithymia remains untested. This study aimed to: (1) test whether alexithymia is more related to reactive than proactive aggression; and (2) determine whether amygdala, insula, and/or anterior cingulate cortical (ACC) volume could be neurobiological mechanisms for this association. One hundred and fifty-six community males completed the Reactive-Proactive Aggression Questionnaire and the Toronto Alexithymia Scale. Amygdala, insula, and ACC volumes were assessed using MRI. Alexithymia was positively associated with reactive but not proactive aggression. Alexithymia was positively and bilaterally associated with amygdala and anterior cingulate volumes. Reactive aggression was positively associated with right amygdala volume. Controlling for right amygdala volume rendered the alexithymia-reactive aggression relationship non-significant. Results suggest that increased right amygdala volume is a common neurobiological denominator for both alexithymia and reactive aggression. Findings suggest that greater right hemisphere activation may reflect a vulnerability to negative affect, which in turn predisposes to experiencing negative emotions leading to increased aggression. Findings are among the first to explicate the nature of the alexithymia-aggression relationship, with potential clinical implications.

Relationship Between Attachment Style in Adulthood, Alexithymia, and Dissociation in Alcohol Use Disorder Inpatients. Mediational Model

Background: Attachment theory is a widely used framework for understanding emotion regulation as well as alexithymia, and dissociation and this perspective has also been applied to understand alcohol use disorders. Apart from these theoretical suggestions, there has been scarce empirical research on this subject-matter. Therefore, the objective of the present study was to investigate potential associations between attachment style in adulthood, alexithymia, and dissociation in alcohol use disorder inpatients. Methods: The Revised Adult Attachment Scale (RAAS), the Toronto Alexithymia Scale-20 (TAS-20), the Michigan Alcoholism Screening Test (MAST), and the Curious Experiences Survey (CES) were administered to a sample of 97 alcohol use disorder inpatients recruited from drug and alcohol treatment centers in Warsaw, and 104 persons in control groups, Poland. Results: A comparative analysis between the group of alcohol addicts and non-addicts showed statistically significant differences related to: alexithymia, dissociation, and attachment styles. The analysis of models related to the impact of attachment styles on the level of alcohol addiction with regard to a mediatory role of alexithymia and dissociation showed that all models are well fitted to data and statistically significant: intimacy F(3.197) = 34.41; p < 0.001 and explains 34% (R ² = 0.3438); depend F(3.197) = 36.55; p < 0.001, and explains 36% (R ² = 0.3576); anxiety F(3.197) = 34.71; p < 0.001, and explains 35% (R ² = 0.3458) of the variability of alcohol addiction scores. Mediation analysis found that alexithymia and dissociation enhance the fear of intimacy and rejection in a romantic relationship. Conclusion: These findings support the broad attachment theory suggesting that attachment is associated with and predicts alexithymia and dissociation in the sample of substance use disorder inpatients. Alexithymia and dissociation, by inhibiting the processes of emotions' identification and verbalization, cause that language does not serve for the purpose of changing self or others, as the communication is distorted. Absent are common meanings and accurate mutual understanding in a relationship.

Facets of impulsivity and alcohol use: What role do emotions play?

Alcohol misuse is a major public concern. Impulsivity has been recognised as a significant risk factor predisposing for the initiation of alcohol use, continuation and excessive alcohol use. Evidence suggests that impulsivity is also a result of both acute alcohol intoxication and long-term alcohol abuse. The multifaceted character of impulsivity and the various ways of assessing it in humans and animal models, hampers the full understanding of how impulsivity relates to alcohol use and misuse. Therefore, in this review we evaluate recent developments in the field, trying to disentangle the contribution of different impulsivity subtypes as causes and effects of alcohol use. Moreover, we review a growing body of evidence, including brain imaging, suggesting the importance of emotional states in engaging in alcohol consumption, particularly in highly impulsive individuals. We also present recent insights into how emotional processing is manifested in alcoholism and binge drinking and suggest novel approaches to treatment and prevention opportunities which target emotional-regulation as well as emotional perception and insight.

A scoping review of suicidality and alexithymia: The need to consider interoception

BACKGROUND

Alexithymia is a problem of emotion regulation and for this reason alone may relate to suicidality. This article investigates the evidence for a direct relationship. It explores the possibility of an additional role for interoception in future research.

METHODS

A scoping review of peer-reviewed journal articles examining alexithymia and suicidality was undertaken, followed by a critical assessment of the overall state of the evidence base in relation to interoception.

RESULTS

The review identified 27 journal articles. The evidence base was heterogeneous, involving a variety of clinical and non-clinical samples, and displays mixed findings. The measurement of alexithymia (using the Toronto Alexithymia Scale) and management of confounding variables were identified as problematic in determining its relationship with suicidality.

LIMITATIONS

The review was limited to published research in the English language. The review findings were not tested and refined by stakeholders. Some of the research studies cited in the critical assessment of interoception were themselves subject to the limitations of the Toronto Alexithymia Scale.

CONCLUSION

The scoping review identified a collection of articles that were too diverse to permit a definitive answer to the research question. Interoception may provide a fruitful new avenue in understanding the relationship between emotion regulation and suicide.

Social Interaction Anxiety, Alexithymia, and Drinking Motives in Australian University Students

In young adults at university, social interaction anxiety has been linked to elevated risk of alcohol-related problems, as has alexithymia. The present study sought to assess whether social interaction anxiety is, like alexithymia, associated with the primary motive of drinking to cope with negative affect. There were 126 undergraduates (76 females, 50 males), aged 18-25 years, who were recruited from two southeast Queensland universities to complete validated self-report measures of problematic drinking, alexithymia, drinking motives, and social interaction anxiety. As predicted, social interaction anxiety was positively related to problematic drinking and coping motives for drinking. Alexithymia mediated the relationship of social interaction anxiety with coping motives. Findings were consistent with a developmental hypothesis of the links between social anxiety, alexithymia, and drinking motives. Given the cross-sectional design of the current study, longitudinal research is ultimately needed to confirm such interpretations of alexithymia and alcohol use among socially anxious young adults at university.

Traits associated with treatment retention in a therapeutic community for substance dependence

Purpose

The treatment of severe and chronic substance dependence is challenged by high rates of treatment attrition, highlighting the need to identify factors that hinder treatment retention. The paper aims to discuss this issue.

Design/methodology/approach

The present study examined certain neurocognitive and personality traits in relation to treatment retention in a sample of 46 residents of an Australian therapeutic community (TC). The traits examined were previously found to be associated with problematic substance use in non-clinical samples and were also previously shown to differentiate TC clients from social drinkers. The hypothesis was thus that traits that appear to be risk factors for addictions are also likely to impact on TC treatment retention.

Findings

Group comparisons of those retained for more than the recommended 90 days vs those who left treatment prematurely showed that after controlling for the influence of depression, those who left treatment prematurely reported significantly higher levels of trait impulsivity, punishment sensitivity and executive cognitive dysfunction. There was a very high rate of alexithymia in the sample (52 per cent), but alexithymia was unrelated to retention.

Research limitations/implications

The final sample size was less than planned but reflected the strict participation criteria and temporal limitations of this study. No statistical assumptions were violated and the reliability indices of the scales completed by clients ranged from acceptable to excellent. Another limitation was that dropout cannot be assumed to mean relapse, as the reasons for client dropout were not available.

Originality/value

Findings highlight the important roles of trait factors in TC treatment retention in addition to the motivational and interpersonal factors identified in previous work.