The 20-Item Toronto Alexithymia Scale. III. Reliability and factorial validity in a community population

Association of Internet addiction and alexithymia - A scoping review

It has been hypothesized that individuals with alexithymia who have difficulty in identifying, expressing, and communicating emotions may overuse Internet as a tool of social interaction to better regulate their emotions and to fulfill their unmet social needs. Similarly, an increasing body of evidence suggests that alexithymia may also play an essential role in the etiopathogenesis of addictive disorders. We conducted a scoping review of questionnaire-based studies of problematic Internet use/Internet addiction and alexithymia. From initial 51 studies, all of the final 12 included studies demonstrated a significant positive association between scores of alexithymia and severity of Internet addiction. However, the causal direction of the association is not clear because the interplay of numerous other variables that could affect the relation has not been studied. There are limitations in the methodology of the studies conducted. Hence, we emphasise the need for longitudinal studies with stronger methodologies.

Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity

Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.

Alexithymia in Gastroenterology and Hepatology: A Systematic Review

Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation. Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies. Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10-15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings. Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes.

Critical role of the right VLPFC in emotional regulation of social exclusion: a tDCS study

There is abundant evidence suggesting that the right ventrolateral prefrontal cortex (rVLPFC) plays an important role in down-regulating the emotional response to social exclusion. However, a causal relationship between rVLPFC function and explicit emotional regulation is not clear in the context of social exclusion. This study employed anodal transcranial direct current stimulation (tDCS) to activate rVLPFC while participants used emotional regulation to reappraise pictures of social exclusion. Forty-four participants were randomly assigned to an active tDCS group or a sham group. Both groups viewed social exclusion images under two conditions: in the no-reappraisal condition, participants were instructed to passively view social exclusion images; in the reappraisal condition, they reappraised the images to down-regulate negative emotional responses. Compared to sham stimulation, anodal tDCS over the rVLPFC resulted in less negative emotion ratings, and produced significantly smaller pupil diameter in the reappraisal, compared to no-reappraisal block. The tDCS also led to longer fixation durations to rejectees and shorter fixation durations to rejecters. Taken together, these findings suggest a causal role for rVLPFC in down-regulation of negative emotions produced by social exclusion. This study has implications for clinical interventions targeting emotional regulation deficits.

Changes in attachment organization, emotion dysregulation, and interpersonal problems among women in treatment for abuse

OBJECTIVE

Women who have experienced childhood abuse often have interpersonal difficulties. The current study examines whether changes in emotion dysregulation mediate the relationship between changes in attachment patterns and changes in interpersonal problems among women who completed treatment for the sequelae of childhood abuse.

METHOD

Participants were 36 women who completed a program targeting the psychological consequences of childhood maltreatment. At pre-and posttreatment, participants completed a projective assessment of adult attachment, and self-report measures of emotion dysregulation and interpersonal problems.

RESULTS

Changes in emotion dysregulation mediated the relationship between shifts toward resolved attachment and changes in interpersonal problems. Compared to participants who maintained their pretreatment attachment patterns, those who shifted toward a resolved pattern became significantly more able to clarify and describe their emotions. Improvements in these abilities were associated with decreased problems with being nonassertive, overly accommodating, self-sacrificing, and socially inhibited. Additionally, improvements in emotional clarity uniquely mediated the relationship between shifts to resolved attachment and reductions in problems with being domineering and intrusive. Moreover, decreased difficulty describing feelings uniquely mediated the relationship between shifts to resolved attachment and decreases in problems with being cold.

CONCLUSIONS

Among women who complete treatment for the sequelae of childhood abuse, shifts to resolved attachment were indirectly related to decreases in interpersonal problems through improved emotional processing.

Alexithymia and Cancer-Related Fatigue: A Controlled Cross-Sectional Study

Aims and background

The study aims to investigate the alexithymia construct in patients with a recent or longtime diagnosis of cancer as well as in healthy people, and whether alexithymia and fatigue are linked in the mentioned groups.

Methods

A first group, diagnosed less than 3 months previously (n = 63), and a second group whose cancer diagnosis dated back more than 30 months (n = 53), matched for sex, age, educational level and cancer site were assessed. Matched healthy controls (n = 50) were also evaluated. Alexithymia was assessed with the Toronto Alexithymia Scale-20, while fatigue was assessed with the Brief Fatigue Inventory.

Results

Alexithymia scores were higher in the recently diagnosed group than in the group with a longtime cancer diagnosis (t = 2.18, P <0.05). Both groups had higher scores than controls (t = 4.3, P <0.001; t = 2.01, P <0.05). Alexithymic subjects were 45.6% in the recently diagnosed and 21.4% in the longtime diagnosed group (χ2 = 6.3, P <0.05) and 18% in controls. Fatigue was more severe in patients with a longtime diagnosis compared with recently diagnosed patients (t = 7.079, P = 0.000). A weak but significant association between fatigue and alexithymia was found in recently diagnosed patients (r = 0.27.2; P <0.05).

Conclusions

Our study confirms that alexithymia scores are higher in cancer patients than in controls. The study suggests that alexithymia could be considered a dynamic reaction to illness in recently diagnosed patients, declining during subsequent phases. High fatigue rates in patients with a longtime diagnosis of cancer underline the role of the long course of illness in the perception of fatigue. The association between fatigue and alexithymia was weak in the recently diagnosed group and not significant in patients with a longtime diagnosis, in whom fatigue was an important complaint.

The specificity of the link between alexithymia, interoception, and imitation

Alexithymia is a subclinical condition traditionally characterized by difficulties identifying and describing one's own emotions. Recent formulations of alexithymia, however, suggest that the condition may result from a generalized impairment in the perception of all bodily signals ("interoception"). Interoceptive accuracy has been associated with a variety of deficits in social cognition, but recently with an improved ability to inhibit the automatic tendency to imitate the actions of others. The current study tested the consequences for social cognition of the hypothesized association between alexithymia and impaired interoception by examining the relationship between alexithymia and the ability to inhibit imitation. If alexithymia is best characterized as a general interoceptive impairment, then one would predict that alexithymia would have the same relationship with the ability to control imitation as does interoceptive accuracy. Forty-three healthy adults completed measures of alexithymia, imitation-inhibition, and as a control, inhibition of nonimitative spatial compatibility. Results revealed the predicted relationship, such that increasing alexithymia was associated with an improved ability to inhibit imitation, and that this relationship was specific to imitation-inhibition. These results support the characterization of alexithymia as a general interoceptive impairment and shed light on the social ability of alexithymic individuals-with implications for the multitude of psychiatric, neurological, and neurodevelopmental disorders associated with high rates of alexithymia. (PsycINFO Database Record

Caring for Caregivers (C4C): study protocol for a pilot feasibility randomised control trial of Positive Written Disclosure for older adult caregivers of people with psychosis

Background

The caregivers of people who experience psychosis are themselves at risk of developing physical and mental health problems. This risk is increased for older adult caregivers who also have to manage the lifestyle and health changes associated with ageing. As a consequence, older adult caregivers are in particular need of support; we propose a Written Emotional Disclosure (WED) intervention, called Positive Written Disclosure (PWD).

Methods/design

This is a pilot randomised controlled trial of PWD compared to a neutral writing control and a no writing condition. We aim to recruit 60 participants, 20 in each arm. This study will utilise a mixed-methods approach and collect quantitative (questionnaires) and qualitative (interviews) data. Quantitative data will be collected at baseline and 1, 3, and 6 months post baseline. Participants who complete a writing task (PWD or neutral writing control) will be invited to complete an exit interview to discuss their experiences of the intervention and study. The study is supported by a patient and public involvement group.

Discussion

The results of this trial will determine whether a definitive trial is justified. If so, the quantitative and qualitative findings will be used to refine the intervention and study protocols.

Trial registration

ISRCTN, ISRCTN79116352. Registered on 23 January 2017

Electronic supplementary material

The online version of this article (10.1186/s40814-017-0206-z) contains supplementary material, which is available to authorized users.

The role of emotion regulation in predicting personality dimensions

Dimensional models of personality have been widely acknowledged in the field as alternatives to a trait-based system of nomenclature. While the importance of dimensional models has been established, less is known about the constructs underlying these personality dimensions. Emotion regulation is one such potential construct. The goal of the current study was to examine the relationship between personality dimensions and emotion regulation. More specifically, the predictive capacity of emotion regulation in accounting for personality dimensions and symptoms on the Schedule for Nonadaptive and Adaptive Personality-2 above and beyond a measure of general distress was evaluated. Emotion regulation was found to be predictive of most personality dimensions and symptoms of most personality disorders. Consistent with hypotheses, emotion regulation variables associated with undercontrol of emotions were most predictive of traits associated with Cluster B personality disorders whereas Cluster A and C traits were most associated with emotion regulation related to overcontrol of emotions. These findings provide preliminary evidence that some personality dimensions never assessed in relation to emotion regulation are strongly predicted by emotion regulation variables. Thus, the present study facilitates an initial step in understanding the relationship between personality dimensions and a multidimensional model of emotion regulation. Copyright © 2017 John Wiley & Sons, Ltd.

Alexithymia Components Are Differentially Related to Explicit Negative Affect But Not Associated with Explicit Positive Affect or Implicit Affectivity

Alexithymia represents a multifaceted personality construct defined by difficulties in recognizing and verbalizing emotions and externally oriented thinking. According to clinical observations, experience of negative affects is exacerbated and experience of positive affects is decreased in alexithymia. Findings from research based on self-report indicate that all alexithymia facets are negatively associated with the experience of positive affects, whereas difficulties identifying and describing feelings are related to heightened negative affect. Implicit affectivity, which can be measured using indirect assessment methods, relates to processes of the impulsive system. The aim of the present study was to examine, for the first time, the relations between alexithymia components and implicit and explicit positive and negative affectivity in healthy adults. The 20-item Toronto Alexithymia Scale, the Implicit Positive and Negative Affect Test and the Positive and Negative Affect Schedule (PANAS) were administered to two hundred and forty-one healthy individuals along with measures of depression and trait anxiety. Difficulties identifying feelings were correlated with explicit negative trait affect, depressive mood and trait anxiety. Difficulties describing feelings showed smaller but also significant correlations with depressive mood and trait anxiety but were not correlated with explicit state or trait affect as assessed by the PANAS. Externally oriented thinking was not significantly correlated with any of the implicit and explicit affect measures. According to our findings, an externally oriented, concrete way of thinking appears to be generally unrelated to dispositions to develop positive or negative affects. Difficulties identifying feelings seem to be associated with increased conscious negative affects but not with a heightened disposition to develop negative affects at an automatic response level.

Prevalence of nonsuicidal self-injury and its risk and protective factors among adolescents in Taiwan

The present study aimed to investigate the prevalence of nonsuicidal self-injury (NSSI) in a large representative sample of secondary school students and identified the psychosocial risk and protective factors. Using a cross-sectional design, 2170 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling. The one-year prevalence of NSSI was found to be 20.1%. Results suggested that compared to non-injurers, episodic self-injurers reported higher levels of neuroticism and openness, while repetitive self-injurers reported higher levels of neuroticism, openness, avoidance/emotion-focused coping, and virtual social support, and lower levels of self-esteem and cognitive reconstruction/problem-focused coping. Compared to episodic self-injurers, repetitive self-injurers reported a higher level of avoidance/ emotion-focused coping. Additionally, compared to non-injurers, mild self-injurers reported higher levels of neuroticism and openness, while severe self-injurers reported higher levels of neuroticism, openness, avoidance/emotion-focused coping, and virtual social support, and lower levels of self-esteem and cognitive reconstruction/problem-focused coping. Our study found that NSSI is fairly prevalent among secondary school students in Taiwan. Psychosocial risk factors, especially maladaptive coping strategies, should be given special attention when examining adolescents with NSSI. Regarding protective factors, enhancing self-esteem should be the focus of formulating effective intervention strategies for NSSI.

Relationships among alexithymia, therapeutic alliance, and psychotherapy outcome in major depressive disorder

Previous studies have found that alexithymia predicts process and outcome of psychodynamic psychotherapy across a range of psychiatric disorders. There is preliminary evidence that alexithymia may exert its effects on outcome through the therapist. Other studies have found that alexithymia does not influence outcome of cognitive-behavioral therapy (CBT). The aim of the current study was to investigate the capacity of alexithymia to predict therapist- and patient-rated therapeutic alliance and response to CBT and interpersonal psychotherapy (IPT) for major depressive disorder. A total of 75 adults with major depressive disorder were randomized to receive weekly sessions of manualized individual CBT or IPT for a period of 16 weeks. Pre-treatment alexithymia exhibited a positive direct effect on depression change, and a negative indirect effect on depression change via patient-rated alliance at week 13. There was no mediating role of therapist-rated alliance. Although these findings are preliminary, they suggest that pre-treatment alexithymia has meaningful links to psychotherapy process and outcome, and that nuanced analyses incorporating intervening variables are necessary to elucidate the nature of these links.

"Lacking warmth": Alexithymia trait is related to warm-specific thermal somatosensory processing

Alexithymia is a personality trait involving deficits in emotional processing. The personality construct has been extensively validated, but the underlying neural and physiological systems remain controversial. One theory suggests that low-level somatosensory mechanisms act as somatic markers of emotion, underpinning cognitive and affective impairments in alexithymia. In two separate samples (total N=100), we used an established Quantitative Sensory Testing (QST) battery to probe multiple neurophysiological submodalities of somatosensation, and investigated their associations with the widely-used Toronto Alexithymia Scale (TAS-20). Experiment one found reduced sensitivity to warmth in people with higher alexithymia scores, compared to individuals with lower scores, without deficits in other somatosensory submodalities. Experiment two replicated this result in a new group of participants using a full-sample correlation between threshold for warm detection and TAS-20 scores. We discuss the relations between low-level thermoceptive function and cognitive processing of emotion.

Coping strategies, alexithymia and anxiety in young patients with food allergy

BACKGROUND

Food allergy is major public health concern affecting nearly 15 million Americans and 80 million Europeans. Risk of anaphylaxis and implications for social activities affect patients' quality of life and psychological well-being. We previously found that young patients reported higher levels of alexithymia (difficulty in recognizing and expressing emotions) compared with healthy peers and may influence affect, management style and clinical outcomes. This study aimed to explore links between coping strategies, alexithymia and anxiety among food-allergic adolescents and young adults.

METHODS

Ninety-two patients with IgE-mediated food allergy (mean age 18.6 years) completed Coping Orientation to Problems Experienced Inventory, Toronto Alexithymia Scale and Trait Anxiety subscale of State-Trait Anxiety Inventory. Multivariate analyses of variance assessed differences and associations between subgroups on the scales.

RESULTS

Significant differences found between alexithymia levels in coping style were explained by Avoidance strategies. 'Avoidance' had the highest contribution in explaining alexithymia, followed by trait anxiety, age, anaphylaxis and social support. Respondents with higher alexithymia use avoidance as coping strategy over and above other coping strategies such as problem-solving and positive thinking, are younger, will have experienced anaphylaxis and will have lower social support.

CONCLUSIONS

Recognizing the specific role of affect regulation in health behaviours may constitute an important step in supporting patients to explore more adaptive strategies.

Theory of mind is not theory of emotion: A cautionary note on the Reading the Mind in the Eyes Test

The ability to represent mental states (theory of mind [ToM]) is crucial in understanding individual differences in social ability and social impairments evident in conditions such as autism spectrum disorder (ASD). The Reading the Mind in the Eyes Test (RMET) is a popular measure of ToM ability, validated in part by the poor performance of those with ASD. However, the RMET requires recognition of facial emotion, which is impaired in those with alexithymia, which frequently co-occurs with ASD. Thus, it is unclear whether the RMET indexes emotion recognition, associated with alexithymia, or ToM, associated with ASD. We therefore investigated the independent contributions of ASD and alexithymia to performance on the RMET. ASD and alexithymia-matched control participants did not differ on RMET performance, whereas ASD participants demonstrated impaired performance on an alternative test of ToM, the Movie for Assessment of Social Cognition (MASC). Furthermore, alexithymia, but not ASD diagnosis, significantly influenced RMET performance but did not affect MASC performance. These results suggest that the RMET measures emotion recognition rather than ToM ability and support the alexithymia hypothesis of emotion-related deficits in ASD.

This study suggests that a highly popular test of the ability to detect what someone else is thinking—the Reading the Mind in the Eyes Test—is instead a test of the ability to recognize another person’s emotional expression. This is important because it suggests that patients who perform badly on this test may still be able to understand another person’s mental state and that, conversely, patients who perform well on this test may still have difficulties in mental state understanding.

Deployment of attention to emotional pictures varies as a function of externally-oriented thinking: An eye tracking investigation

BACKGROUND AND OBJECTIVES

Alexithymia is a multidimensional personality construct including the components difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally oriented thinking (EOT). Different features of alexithymia are thought to reflect specific deficits in the cognitive processing and regulation of emotions. The aim of the present study was to examine for the first time patterns of deployment of attention as a function of alexithymia components in healthy persons by using eye-tracking technology. It was assumed that EOT is linked to avoidance of negative images.

METHODS

99 healthy adults viewed freely pictures consisting of anxiety-related, depression-related, positive, and neutral images while gaze behavior was registered. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale. Measures of anxiety, depression, and (visual-perceptual) intelligence were also administered.

RESULTS

A main effect of emotion condition on dwell times was observed. Viewing time was lowest for neutral images, longer for depression-related and happy images, and longest for anxiety-related images. Gender and EOT had significant effects on dwell times. EOT correlated negatively with dwell time on depression-related (but not anxiety-related) images. There were no correlations of dwell times with depression, trait anxiety, intelligence, DIF, or DDF.

LIMITATIONS

Alexithymia was assessed exclusively by self-report.

CONCLUSIONS

Our results show that EOT but not DIF or DDF influences attention deployment to simultaneously presented emotional pictures. EOT may reduce attention allocation to dysphoric information. This attentional characteristic of EOT individuals might have mood protecting effects but also detrimental impacts on social relationships and coping competencies.

Validation of the Empathy Quotient in Mainland China

This research aimed to validate a simplified Chinese version of the Empathy Quotient (EQ; 60 items) for use with Mainland Chinese people. The original English version of the EQ was translated into simplified Chinese. Through an online survey, 588 Mainland Chinese participants completed the EQ and 3 other questionnaires: the Interpersonal Reactivity Index (IRI), the Autism-Spectrum Quotient (AQ), and the 20-item Toronto Alexithymia Scale (TAS-20). Thirty-five participants completed retesting of the EQ 3 to 4 weeks later. Sex differences on the EQ scores and psychometric properties of the EQ items were examined. Confirmatory factor analysis suggested that an EQ 15-item structural model fitted the data quite well. Self-report empathy, as assessed by the current simplified Chinese version of the EQ, appeared to relate to participants' autistic and alexithymic traits but not sex.

Emotion dysregulation in alexithymia: Startle reactivity to fearful affective imagery and its relation to heart rate variability

Alexithymia is associated with deficiencies in recognizing and expressing emotions and impaired emotion regulation, though few studies have verified the latter assertion using objective measures. This study examined startle reflex modulation by fearful imagery and its associations with heart rate variability in alexithymia. Fifty-four adults (27 alexithymic) imagined previously normed fear scripts. Startle responses were assessed during baseline, first exposure, and reexposure. During first exposure, participants, in separate trials, engaged in either shallow or deep emotion processing, giving emphasis on descriptive or affective aspects of imagery, respectively. Resting heart rate variability was assessed during 2 min of rest prior to the experiment, with high alexithymic participants demonstrating significantly higher LF/HF (low frequency/high frequency) ratio than controls. Deep processing was associated with nonsignificantly larger and faster startle responses at first exposure for alexithymic participants. Lower LF/HF ratio, reflecting higher parasympathetic cardiac activity, predicted greater startle amplitude habituation for alexithymia but lower habituation for controls. Results suggest that, when exposed to prolonged threat, alexithymics may adjust poorly, showing a smaller initial defensive response but slower habituation. This pattern seems related to their low emotion regulation ability as indexed by heart rate variability.

Alexithymia in Kidney Transplantation Patients

Alexithymia is a marked difficulty in recognizing, exploring, and expressing inner feelings. Studies have proven the presence of a significant proportion of patients with alexithymia in samples from the transplantation population. This study aims to analyze the presence of alexithymia in a sample of 32 kidney transplantation patients from a deceased donor and to compare this construct with the presence of psychological symptoms and the physical and mental state of health perceived by the patients. Alexithymia assessment was analyzed using the Toronto Alexithymia Scale. The psychological symptoms were studied through the Symptom Checklist-90-R. The quality of life was studied through The Complete Form Health Survey. The study showed a high percentage of the presence of alexithymia in the examined transplant recipients. The construct is more present where the perception of their quality of life is low and where there is a greater presence of psychosomatic symptoms.

Autonomic Reactivity to Arousing Stimuli with Social and Non-social Relevance in Alexithymia

Emotional difficulties in alexithymia and their social consequences have been linked to alterations in autonomic nervous system. However, most of previous studies did not take into account the distinction between the affective and the cognitive dimensions of the alexithymia, leading to inconsistent results. Aim: In this study, we compared the effects of both dimensions of alexithymia on the autonomic arousal to emotional and social visual stimulations. Methods: Skin conductance responses (SCRs) to items of the International Affective Pictures System characterized by emotional (unpleasant, neutral, and pleasant), social (with humans) or non-social (without humans) content were recorded in non-alexithymic (NA), affective (AA) and cognitive alexithymic (CA) participants, selected on the basis of the Toronto Alexithymia Scale and the Bermond-Vorst Alexithymia Questionnaire. All participants responded to questionnaires of empathy, social phobia, depression, and anxiety before the experiment and evaluated the arousal of the pictures after it. Results: Cognitive alexithymic group showed lower amplitudes of SCRs to pictures with social than without social relevance whereas the opposite pattern was observed for the NA group. Arousal emotional effects of the pictures on SCRs did not differ among groups. In addition, CA participants showed lower scores than NA in the Personal Taking sub-scale of the empathy questionnaire, while AA showed lower scores than NA in the fantasy sub-scale. The CA group showed higher social phobia, depression and anxiety scores, than the other two groups. Conclusion: This work has two original outcomes: first, affective alexithymics expressed lower empathic affective scores than other groups; second, alexithymia modulated the impact of the social relevance of the stimuli on the autonomic reactivity, this impact vanishing in affective alexithymics and reversing in cognitive alexithymics. Thus, though the groups could not be distinguished on the basis of emotional effect on SCRs, they clearly differed when the empathic characteristics and the autonomic impact of social relevance were considered. Finally, the described autonomic signature to social relevant information could contribute to elucidate the difficulty of alexithymics to deal with emotions during social transactions.

Theory of Mind and Executive Control Deficits in Typically Developing Adults and Adolescents with High Levels of Autism Traits

Autism spectrum disorder (ASD) is characterised by profound difficulties in empathic processing and executive control. Whilst the links between these processes have been frequently investigated in populations with autism, few studies have examined them at the subclinical level. In addition, the contribution of alexithymia, a trait characterised by impaired interoceptive awareness and empathy, and elevated in those with ASD, is currently unclear. The present two-part study employed a comprehensive battery of tasks to examine these processes. Findings support the notion that executive function and theory of mind are related abilities. They also suggest that individuals with elevated levels of autism-like traits experience a partially similar pattern of social and executive function difficulties to those diagnosed with ASD, and that these impairments are not explained by co-occurring alexithymia.

The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome

In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R²=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.

Impulsivity, alexithymia and dissociation among pathological gamblers in different therapeutic settings: A multisample comparison study

Since many psychopathological traits seem to be related to Gambling Disorder (GD), impulsivity, alexithymia and dissociation could play a central role in gambling behaviors, particularly in pathological gambling. We test this hypothesis in four distinct samples of gamblers, three undergoing different types of treatments and a control group. The study sample consists of 204 subjects (males 87.3%, mean age=47.75 years, SD=12.08) divided into four groups: (1) 59 subjects belonging to an Outpatients Treatment Program in the National Health System (NHS); (2) 60 subjects of an Outpatients Self-Help Group Program; (3) 35 subjects belonging to a Residential Treatment Program (Inpatients Program); and (4) 50 subjects without gambling problems (Control Group). Results show a positive relationship between gambling behaviors, impulsivity and alexithymia, and a negligible link between gambling behaviors and dissociation. Findings also display the presence of higher levels of all these features in pathological gamblers with higher scores on the SOGS, and particularly, in participants attending a Residential Treatment Program (Inpatients Program). This study confirms the hypothesis of the presence of higher levels of impulsivity, alexithymia and dissociation in pathological gamblers with a greater severity and seems to indicate a significant importance of impulsivity and alexithymia in predicting gambling behaviors.

The impact of autism spectrum disorder and alexithymia on judgments of moral acceptability

One’s own emotional response toward a hypothetical action can influence judgments of its moral acceptability. Some individuals with autism spectrum disorder (ASD) exhibit atypical emotional processing, and moral judgments. Research suggests, however, that emotional deficits in ASD are due to co-occurring alexithymia, meaning atypical moral judgments in ASD may be due to alexithymia also. Individuals with and without ASD (matched for alexithymia) judged the moral acceptability of emotion-evoking statements and identified the emotion evoked. Moral acceptability judgments were predicted by alexithymia. Crucially, however, this relationship held only for individuals without ASD. While ASD diagnostic status did not directly predict either judgment, those with ASD did not base their moral acceptability judgments on emotional information. Findings are consistent with evidence demonstrating that decision-making is less subject to emotional biases in those with ASD.

This study suggests that typical people base their judgments of the moral acceptability of behavior on their emotional response to that behavior. People with autism spectrum disorder do not seem to use emotional information and may rely more on rules to judge moral acceptability.

Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition

Alexithymia is a personality trait frequently found in adults with autism spectrum disorder (ASD), and has been linked to impairments in emotion recognition and empathy. The presentation of alexithymia within ASD at younger ages remains unexplored, and was examined in the present study. Alexithymia rates were significantly elevated in ASD (55%; 31/56 scoring above cut-off) versus non-ASD adolescents (16%; 5/32 scoring above cut-off). Within individuals with ASD, alexithymia was associated with increased self-reported anxiety, parent-reported emotional difficulties, self-reported sensory processing atypicalities, and poorer emotion recognition, but was not associated with theory of mind ability. Overall, our results suggest that alexithymia is highly prevalent, and has selective cognitive correlates in young people with ASD.

Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder?

PURPOSE

Few studies have addressed the psychological characteristics of adolescents with binge eating disorder (BED). No research has focused on the psychological functioning of these adolescents' parents or on the prevalence of traumatic experiences among them.

METHODS

In this study, 202 adolescents aged 11-13 and their parents were recruited from mental health clinics to complete the youth self-report (YSR), the response evaluation measure for youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Check-List (SCL-90-R), and the traumatic experience checklist (TEC).

RESULTS

Female adolescents scored higher than males on withdrawal, internalizing problems, dissociation, and somatization subscales. Boys scored higher than girls on externalizing problems and acting out subscales. Maternal depression predicted withdrawal and dissociation in female adolescents. Maternal sexual abuse predicted social problems in males and self-destructive behaviors in females. Paternal physical abuse predicted delinquent behavior and acting out in males.

CONCLUSIONS

Our data suggest that parental traumatic experiences play a role in their offspring's mental health; the data also showed different psychopathological configurations in male and female adolescents with BED and their parents, suggesting the development of prevention and treatment polices specific to gender.

Emotional management and biological markers of dietetic regimen in chronic kidney disease patients

The aim of the study was to investigate the association between psychological characteristics and biological markers of adherence in chronic kidney disease patients receiving conservative therapy, hemodialysis, peritoneal dialysis (PD), or kidney transplantation.

Seventy-nine adult patients were asked to complete the following questionnaires: Toronto Alexithymia scale, Snaith–Hamilton Pleasure Scale, and Short Form Health Survey. Biological markers of adherence to treatment were measured.

Peritoneal dialysis patients showed a lower capacity to feel pleasure from sensorial experience (p = .011) and a higher values of phosphorus compared to the other patients’ groups (p = .0001).

The inability to communicate emotions was negatively correlated with hemoglobin levels (r = −(0).69; p = .001) and positively correlated with phosphorus values in the PD patients (r = .45; p = .050).

Findings showed higher psychological impairments and a lower adherence to the treatment in PD patients and suggest the implication of emotional competence in adherence to treatment.

Describe Your Feelings: Body Illusion Related to Alexithymia in Adolescence

Objective: Having access to bodily signals is known to be crucial for differentiating the self from others and coping with negative feelings. The interplay between bodily and emotional processes develops in adolescence, where vulnerability is high, as negative affect states often occur, that could hamper the integration of bodily input into the self. Aim of the present study in healthy adolescents was to examine, whether a disturbed emotional awareness, described by the alexithymic construct, could trigger a higher malleability in the sense of body-ownership.

Methods: Fifty-four healthy adolescents aged between 12 to 17 years participated in this study. The Strength and Difficulties Questionnaire (SDQ) and the Screening psychischer Störungen im Jugendalter were used to assess emotional distress and conduct problems. Alexithymia was assessed by the TAS-20. The rubber hand illusion was implemented for examining the malleability of body-ownership.

Results: A higher body illusion was found to be connected with “difficulties in describing feelings”. Moreover, a higher degree of self-reported conduct and emotional problems as assessed by the SDQ were associated with a more pronounced body illusion. Further findings revealed an association between emotional distress and the emotional alexithymia subscales “difficulties in identifying feelings” and “difficulties in describing feelings”.

Conclusion: Our findings emphasize a close link between the sense of body-ownership and emotional awareness as assessed by emotional facets of the alexithymic trait. We suggest that in adolescents with higher malleability of body-ownership, a vicious circle might occur where affect and integration of different proprioceptive signals regarding the body become more entangled.

"Identifying and Describing Emotions": Measuring the Effectiveness of a Brief, Alexithymia-Specific, Intervention for a Sex Offender Population

Certain individuals who sexually offend may have difficulty differentiating, identifying, and articulating emotions. These clients may prove challenging for therapists when engaging with them in treatment. Such clients may suffer from alexithymia. There has been a dearth of research regarding specific psychotherapeutic interventions for alexithymia in both the clinical and forensic fields. The present study provides results from a pilot study on the efficacy of a brief, four-session, alexithymia-specific intervention with adults who have sexually offended. The intervention also aimed to increase emotional awareness and psychological mindedness. The intervention was comprised of both mindfulness and mentalization treatment components. Thirty-two men (Mage = 41.8 years, SD = 11.9) convicted of sexual offences completed the intervention group. When compared with a matched control condition (n = 27; Mage = 39, SD = 10.8), the intervention was effective in decreasing alexithymia characteristics and increasing psychological mindedness. Results suggest that the intervention was an effective means of increasing emotional awareness in this population. These provisional results must be tempered by the limitations of the study. However, the positive findings warrant future investigation. Clinical implications and ideas for future work are also discussed.

Exploring the interrelationship between alexithymia, defense style, emotional suppression, homicide-related posttraumatic stress disorder and psychiatric co-morbidity

This study investigated the interrelationship between alexithymia, defense style, emotional suppression, posttraumatic stress disorder (PTSD) following homicide and psychiatric co-morbidity. One hundred and fifty male homicide perpetrators and 156 male perpetrators of non-violent crime completed the Posttraumatic Stress Diagnostic Scale (except for non-violent perpetrators), the General Health Questionnaire-28, the Defense Styles Questionnaire, the Courtauld Emotional Control Scale and the Toronto Alexithymia Scale-20. The results showed that 44% of homicide perpetrators met the criteria for PTSD. No significant differences were found between groups in alexithymia, defense style and psychiatric co-morbidity. Homicide perpetrators suppressed depression significantly more than the non-violent group. PLS analyses showed that alexithymia was significantly correlated with defense style. Defense styles were significantly correlated with emotional suppression which, in turn, was associated with homicide-related PTSD and psychiatric co-morbidity. To conclude, perpetrators can experience PTSD reactions following the act of homicide. The severity of these reactions and other psychological problems were related to difficulty getting in touch with distressing emotions, the defenses they used to protect themselves psychologically and the way they suppressed their emotion.

Reliability and Factorial Validity of a Farsi Version of the 20-Item Toronto Alexithymia Scale with a Sample of Iranian Students

This study investigated the psychometric properties of the Farsi version of the 20-item Toronto Alexithymia Scale for 587 undergraduate students (349 women and 238 men) at the University of Tehran. All participants were asked to complete the Farsi version of the TAS-20, the Emotional Intelligence Scale, and the Mental Health Inventory. Findings supported the internal consistency, test-retest reliability, concurrent validity, and three-factor structure of the Farsi version of the 20-item Toronto Alexithymia Scale. The factors found in the Farsi version of this scale are similar to the three factors found previously and were accordingly labeled as Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking. The results provide evidence for applicability of the TAS-20 and its cross-cultural validity.

Alexithymia and postpartum anxiety and depression symptoms: a follow-up study in a pregnancy cohort

INTRODUCTION

There is a lack of longitudinal studies assessing the significance of alexithymia on the emergence of mental illnesses. We aimed to evaluate the potential effect of alexithymia on postpartum anxiety and depression symptoms in a sample of parents to be.

METHODS

In a pregnancy cohort, longitudinal data were available from three time points (gestational weeks 18-20, and 3 and 12 months postpartum) for 100 mothers and 65 fathers. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the State-Trait Anxiety Inventory (STAI) to evaluate anxiety symptoms and the Edinburgh Postnatal Depression Scale (EPDS) to assess depression. Linear regression analyses were used to estimate the effect of alexithymia on the symptom scale score changes from baseline.

RESULTS

Both in mothers and fathers, the TAS-20 total score was significantly correlated with the STAI and EPDS scores at several time-points, with a higher TAS-20 score indicating more symptoms. In the regression analyses, the association of alexithymia with later symptoms became non-significant in mothers. However, in fathers, the TAS-20 score had a statistically significant effect on the increase of the STAI score at 3 months postpartum (p = 0.006). For the separate TAS-20 subscales, difficulty identifying feelings had a significant effect on the increase of anxiety by 12 months postpartum (p = 0.023) and difficulty describing feelings on the increase by 3 months postpartum (p < 0.001).

DISCUSSION

Although the setting did not facilitate the assessment of actual diagnoses regarding the anxiety and depression symptoms, alexithymia appears to have a significant effect on the increase of postpartum anxiety symptoms in fathers-to-be.

The role of alexithymia: An 8-year follow-up study of chronic pain patients

OBJECTIVE

The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome.

METHODS

Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability.

RESULTS

In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period.

CONCLUSION

Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.

Alexithymia in food-allergic versus healthy children and young adults

Alexithymia is a multifaceted personality construct associated with several medical illnesses. However, no studies have focused on food allergy. We investigated alexithymia among food-allergic youths, compared to a matched healthy sample. A total of 220 participants aged 9–25 years were assessed using the Toronto Alexithymia Scale and the Alexithymia Questionnaire for Children. Food-allergic patients reported higher levels of alexithymia compared to a matched healthy sample. Furthermore, an association between alexithymia and a clinical history of anaphylaxis was found among patients. Some possible hypotheses have been discussed considering physiological, psychological, developmental, and cognitive/behavioral factors.

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.

The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors

Alexithymia is a multifaceted personality trait that involves difficulties in identifying and describing feelings to others, a poor fantasy life and an externally oriented cognitive style. Alexithymia has been described as a vulnerability factor for mental and physical diseases. We investigated in a group of 158 alcohol-dependent patients (103 men, 55 women) the association between depression and craving for alcohol when these patients were starting a detoxification program, and the moderating impact of gender and alexithymia on this relation. We first found an interaction between depression and gender in the prediction of craving in the sense that only for women an increase in depressive mood was related to an increase in total craving. When examining gender separately, we found that alexithymia factors acted as moderators. For women, the link between depression and craving was strengthened for the ones scoring higher on "difficulties describing feelings". But for men, the link between depression and craving was reduced for the ones scoring higher on "externally-oriented thinking". These findings suggest that in some cases that need to be identified more systematically in the future, the "externally-oriented thinking" alexithymia factor can exert - at least in the short term - some protective effects.

Observer-Rated Alexithymia and its Relationship with the Five-Factor-Model of Personality

Studies examining the relationship between alexithymia and personality exclusively employed self-report measures of alexithymia. In the present study, we examined the relationship of both observer-rated and self-reported alexithymia with the Big Five personality dimensions. We administered the Toronto Structured Interview for Alexithymia (TSIA) as an interview-based measure of alexithymia and, in addition, two self-report questionnaires, the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Fifty-one university students were interviewed and completed the alexithymia scales and the NEO Five-Factor Inventory. In contrast to TAS-20 and BVAQ, the Difficulty identifying feelings (DIF) scale of the TSIA was found to be unrelated to neuroticism, suggesting that the frequently reported association between DIF and neuroticism could be due to the use of self-report scales. In contrast, the affective dimension of alexithymia, measured by the BVAQ, was even negatively related with neuroticism. Thus, a paucity of fantasy and little emotional arousal goes together with increased emotional stability. Furthermore, we revealed negative correlations between interview-based alexithymia scores and openness to experience and agreeableness, which cross-validated the self-report findings. Finally, extraversion and conscientiousness each showed only one negative correlation, namely with subscales of the BVAQ. Taken together, our findings show that on the basis of interviews there is no evidence for a relation of DIF with neuroticism, while associations of alexithymia with low openness to experience and low agreeableness emerged irrespective of assessment approach. The relations of alexithymia with personality are discussed in the light of different measurement approaches.

Alexithymia: Should This Personality Disorder Be Considered During Treatment of Patients With Mental Illness?

Alexithymia is characterized by impairment of an individual's ability to experience, identify, and express emotions, and is associated with impaired emotional intelligence and an externally oriented cognitive style. There has been increasing interest in the phenomenon, with numerous peer-reviewed articles published recently. Alexithymia may occur in patients with many psychiatric disorders, and more severe alexithymia is related to worse outcome. However, many clinicians remain unaware of the issue. The current article discusses alexithymia and its importance in the field of mental health.

Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing

Alexithymia, characterized by impairments in emotional awareness, is common among individuals with substance use disorders. Research on alexithymia suggests that it is a trait that may contribute to substance dependence. This paper will review alexithymia as it relates to substance use and substance use disorders, considering its potential role in the maintenance and treatment of these disorders. We will then describe how neural correlates associated with alexithymia may shed light on how alexithymia relates to addiction. Finally, we present preliminary fMRI data that examines how alexithymia may relate to the neurobiological correlates of reward/loss processing in individuals with cocaine dependence. While preliminary, these findings suggest a role of alexithymia in reward anticipation in cocaine-dependent individuals.

Cross-cultural validation of the 20-item Toronto Alexithymia Scale in Chinese adolescents

WHAT IS KNOWN ON THE SUBJECT?: The TAS-20 is the most widely used self-reported questionnaire to assess the level of alexithymia in students and community and clinical samples. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The TAS-20-C exhibited high levels of reliability and validity, indicating that it is appropriate for the assessment of alexithymia in Chinese adolescents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Screening adolescents who are at risk of alexithymia through the TAS-20 could help to perform necessary and effective precautions to decrease the adverse effects of alexithymia, such as the risks of developing depressive mood and behavioral problems.

ABSTRACT

Purpose The aim of this study was to examine the psychometric properties of the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20-C) in a sample of Chinese adolescents. Method Adolescents (n = 1260) recruited from three schools in mainland China completed the TAS-20-C, the somatization subscale of the Symptom Checklist 90 (SCL-90) and Center for Epidemiological Studies Depression Scale (CES-D). Five different factorial models of the TAS-20 were tested using confirmatory factor analysis (CFA). Cronbach's α, mean inter-item correlations and predictive validity were also evaluated. Results Among those five different factorial models, the four-factor structure model was suitable and invariant across gender and age in this sample. The TAS-20-C demonstrated adequate internal reliability. Gender and age accounted for insignificant amounts of variability in total TAS-20-C and factor scores. TAS-20-C total and subscale scores were correlated significantly with SCL-90 somatization subscale and CES-D. Girls scored higher than boys on difficulty identifying feelings (DIF) and pragmatic thinking (PR) subscales. DIF and lack of subjective significance or importance of emotions (IMs) subscale scores were higher among younger than among middle and older adolescents. Implications for Practice Validating the TAS-20 in adolescents is quite important to use it in evaluating adolescents' alexithymia, and screen those at risk of alexithymia.

Psychophysiological decoupling in alexithymic pain disorder patients

Considering that impaired coping with stress is closely linked with emergence of stress-sensitive disorders most notably in alexithymic individuals, we conducted the first study examining stress-related autonomic reactivity in alexithymic pain disorder patients. Twenty-one pain disorder patients with high and an equivalent patient group with low alexithymia scores were exposed to three types of affect-inductive stimuli with variable affective involvement: arithmetic task, watching arousing video material and giving an oral presentation. Subjective appraisal of the induced emotional experience and physiological reactivity (heart rate, muscle tension and skin conductance) was documented. During oral presentation high alexithymia patients showed significantly lower skin conductance in combination with increased subjective negative affect compared to low alexithymia patients. Our results thus demonstrate a decoupling between physiological and affect processing in pain disorder patients with high alexithymia during a stressful situation that was subjectively associated with negative affect.

Is alexithymia associated with metabolic syndrome? A study in a healthy adult population

Metabolic syndrome (MetS) is a constellation of risk factors for, in particular, cardiovascular diseases and increased mortality, and it constitutes a major clinical challenge affecting millions of lives. Alexithymia is a condition that has been linked with several mental diseases and symptoms, as well as somatic illnesses, including essential hypertension and diabetes mellitus. However, there is limited research on the association of alexithymia and MetS. The aim of the present study was to comprehensively explore this association in a large (n=1648) non-clinical sample of adults. Logistic regression analyses were applied to the five separate MetS components as well as the MetS diagnosis, and the analyses included a number of sociodemographic variables and depressive symptoms as covariates. The results confirmed the previous finding of alexithymic features being independently and significantly associated with hypertension. As a new finding, this association appears to be related to two particular dimensions of alexithymia, namely difficulty describing feelings and externally oriented thinking. Interestingly, alexithymic features were also separately significantly associated with waist circumference and triglycerides as well as the MetS diagnosis. Depressive symptoms did not have any significant effect on the relations of alexithymia and MetS.