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Clapham R, Laves E, Fergerson A, Nichols P, Brausch A. Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1612-1621. [PMID: 34242545 PMCID: PMC8742842 DOI: 10.1080/07448481.2021.1944165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
Objective: Interoceptive deficits have been linked to suicidality and eating disorders. The relationship between disordered eating symptoms and suicidality may depend on the level of interoceptive deficits. It was expected that interoceptive deficits would moderate the relationship between disordered eating symptoms (oral control, dieting, and bulimia) and suicidality (suicide attempts, ideation, and communication) when interoceptive deficits were high. Methods: University students (N = 417, Mage = 19.75, 78.2% white, 72.4% female) completed self-report measures that assessed disordered eating, interoceptive deficits, and suicide history. Results: Interoceptive deficits emerged as a significant moderator only in the association between bulimia symptoms and suicidality, when interoceptive deficits were high. Conclusions: The results of this study indicate that bulimia symptoms may have a unique interaction with interoceptive deficits and suicidality. Future research should focus on targeting interoceptive deficits in treatment to help reduce disordered eating symptoms and suicide risk, particularly for students with bulimia symptoms.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Eliza Laves
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Ava Fergerson
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
- Ava Fergerson is now in the School of Psychology, University of Southern Mississippi, Hattiesburg, MS
| | - Paige Nichols
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
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2
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
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.
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Takakura S, Aso CS, Toda K, Hata T, Yamashita M, Sudo N. Physical and psychological aspects of anorexia nervosa based on duration of illness: a cross-sectional study. Biopsychosoc Med 2019; 13:32. [PMID: 31889996 PMCID: PMC6929428 DOI: 10.1186/s13030-019-0173-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background We evaluated physical and psychological features of patients with anorexia nervosa (AN) who differed by duration of illness. Methods Data were obtained from 204 female patients with AN, divided into two groups based on illness duration: short-term illness duration (less than 5 years; n = 118); and long-term duration (5 years or more; n = 86). Physical parameters were measured using blood serum testing and psychological aspects were assessed using various instruments. Results A significantly higher proportion of restricting type AN was observed in the short-term group while the proportion of binge eating/purging type AN was higher in the long-term group. There was no difference in body mass index (BMI) between the groups. Serum total protein, albumin, potassium, chloride, and calcium in the long-term group were significantly lower than in the short-term group. Overall scores on the Eating Disorder Inventory as well as most of the subscales, except maturity fears, were higher in the long-term group than in the short-term group. The care subscale of the Parental Bonding Instrument (PBI) was lower in the long-term group than in the short-term group, while the overprotection subscale of the PBI was higher in the long-term group than in the short-term group. Results of a multiple regression analysis indicated that the overprotection subscale of the PBI was the only significant predictor of duration of illness. Conclusions Duration of illness may be associated with physical and psychological features of AN; thus, adapting therapeutic approaches to illness duration might be necessary.
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Affiliation(s)
- Shu Takakura
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Chie Suzuyama Aso
- 2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kenta Toda
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomokazu Hata
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Makoto Yamashita
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Nobuyuki Sudo
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan.,2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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Wallis DJ, Ridout N, Sharpe E. The influence of non-clinical eating-related psychopathology on the recognition of emotion from static faces and realistic social interactions. Eat Behav 2018; 29:19-24. [PMID: 29413820 DOI: 10.1016/j.eatbeh.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
Emotion recognition deficits have consistently been reported in clinical and sub-clinical disordered eating. However, most studies have used static faces, despite the dynamic nature of everyday social interactions. The current aims were to confirm previous findings of emotion recognition deficits in non-clinical disordered eating and to determine if these deficits would be more evident in response to static as compared to dynamic emotional stimuli. We also aimed to establish if these emotion recognition deficits could be explained by comorbid psychopathology (depression, anxiety or alexithymia). Eighty-nine females were assigned to groups based on scores on the Eating Disorders Inventory (EDI); high (n = 45) and low (n = 44). Participants were presented with emotional faces and video clips portraying fear, anger, disgust, sadness, happiness, surprise and neutral affect. As predicted, the high EDI group correctly recognised fewer emotional displays than did the low EDI group. However, this deficit was not more evident for negative as opposed to positive emotions. Furthermore, the deficit was not larger for static stimuli in comparison to dynamic. Overall emotion recognition accuracy was negatively associated with Drive for Thinness, but not Bulimia or Body Dissatisfaction. Importantly, the emotion recognition deficits observed in the high EDI group and that were associated with eating disorder symptoms were independent of depression, anxiety and alexithymia. Findings confirm that even minor elevations in disordered eating are associated with poorer emotion recognition. This is important, as problems in recognition of the emotional displays of others are thought to be a risk factor for clinical eating disorders.
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Affiliation(s)
- Deborah J Wallis
- Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Nathan Ridout
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK
| | - Emma Sharpe
- Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
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5
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Sharpe E, Wallis DJ, Ridout N. The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample: An eye-tracking study. Psychiatry Res 2016; 240:321-327. [PMID: 27138825 DOI: 10.1016/j.psychres.2016.04.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
This study aimed to: (i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; (ii) examine if the bias occurs during initial orientation or later strategic processing; and (iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.
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Affiliation(s)
- Emma Sharpe
- Loughborough University Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Deborah J Wallis
- Loughborough University Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Nathan Ridout
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
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Torres S, Guerra MP, Lencastre L, Miller K, Vieira FM, Roma-Torres A, Brandão I, Costa P. Alexithymia in anorexia nervosa: the mediating role of depression. Psychiatry Res 2015; 225:99-107. [PMID: 25467697 DOI: 10.1016/j.psychres.2014.10.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/03/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal.
| | | | - Leonor Lencastre
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Kylee Miller
- Carolina Institute for Developmental Disabilities, School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Filipa Mucha Vieira
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - António Roma-Torres
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B׳s, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Faculty of Psychology and Educational Sciences, University of Porto, Portugal
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Nowakowski ME, McFarlane T, Cassin S. Alexithymia and eating disorders: a critical review of the literature. J Eat Disord 2013; 1:21. [PMID: 24999402 PMCID: PMC4081716 DOI: 10.1186/2050-2974-1-21] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/25/2013] [Indexed: 02/05/2023] Open
Abstract
Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.
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Affiliation(s)
- Matilda E Nowakowski
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Traci McFarlane
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada ; Eating Disorder Program, The Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
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Ridout N, Wallis DJ, Autwal Y, Sellis J. The influence of emotional intensity on facial emotion recognition in disordered eating. Appetite 2012; 59:181-6. [PMID: 22542716 DOI: 10.1016/j.appet.2012.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/16/2012] [Accepted: 04/19/2012] [Indexed: 01/23/2023]
Abstract
Significant facial emotion recognition (FER) deficits have been observed in participants exhibiting high levels of eating psychopathology. The current study aimed to determine if the pattern of FER deficits is influenced by intensity of facial emotion and to establish if eating psychopathology is associated with a specific pattern of emotion recognition errors that is independent of other psychopathological or personality factors. Eighty females, 40 high and 40 low scorers on the Eating Disorders Inventory (EDI) were presented with a series of faces, each featuring one of five emotional expressions at one of four intensities, and were asked to identify the emotion portrayed. Results revealed that, in comparison to Low EDI scorers, high scorers correctly recognised significantly fewer expressions, particularly of fear and anger. There was also a trend for this deficit to be more evident for subtle displays of emotion (50% intensity). Deficits in anger recognition were related specifically to scores on the body dissatisfaction subscale of the EDI. Error analyses revealed that, in comparison to Low EDI scorers, high scorers made significantly more and fear-as-anger errors. Also, a tendency to label anger expressions as sadness was related to body dissatisfaction. Current findings confirm FER deficits in subclinical eating psychopathology and extend these findings to subtle expressions of emotion. Furthermore, this is the first study to establish that these deficits are related to a specific pattern of recognition errors. Impaired FER could disrupt normal social functioning and might represent a risk factor for the development of more severe psychopathology.
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Affiliation(s)
- Nathan Ridout
- Cognitive & Affective Neurosciences, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK.
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9
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Miyake Y, Okamoto Y, Onoda K, Shirao N, Okamoto Y, Yamawaki S. Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm. Psychiatry Res 2012; 201:113-9. [PMID: 22398299 DOI: 10.1016/j.pscychresns.2011.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 07/19/2011] [Accepted: 07/21/2011] [Indexed: 10/28/2022]
Abstract
Several studies have reported that anorexia nervosa (AN) patients have high levels of alexithymia. However, relatively little is known about the underlying neurobiological relationships between alexithymia and AN. We used functional magnetic resonance imaging to examine the brain responses in 30 AN patients and 20 healthy women during the processing of negative words concerning interpersonal relationships. We investigated the relationship between alexithymia levels and brain activation in AN. AN patients showed significant activation of the orbitofrontal cortex, dorsolateral prefrontal cortex and medial prefrontal cortex while processing negative words concerning interpersonal relationships, as compared to the processing of neutral words. Moreover, the subjective rating of unpleasantness with negative words and neural activities in the amygdala, posterior cingulate cortex (PCC) and anterior cingulate cortex (ACC) negatively correlated with the level of alexithymia in AN. Our neuroimaging results suggest that AN patients tend to cognitively process negative words concerning interpersonal relationships, resulting in activation of the prefrontal cortex. Lower activation of the amygdala, PCC and ACC in response to these words may contribute to the impairments of emotional processing that are hallmarks of alexithymia. Functional abnormalities associated with alexithymia may be involved in the emotional processing impairments in AN patients.
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Affiliation(s)
- Yoshie Miyake
- Health Service Center, Hiroshima University, Hiroshima, Japan.
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Marsero S, Ruggiero GM, Scarone S, Bertelli S, Sassaroli S. The relationship between alexithymia and maladaptive perfectionism in eating disorders: a mediation moderation analysis methodology. Eat Weight Disord 2011; 16:e182-7. [PMID: 22290034 DOI: 10.1007/bf03325130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This work aimed to explore the relationship between alexithymia and maladaptive perfectionism in the psychological process leading to eating disorders (ED). METHOD Forty-nine individuals with ED and 49 controls completed the Concern over Mistakes subscale of the Frost Multidimensional Perfectionism Scale, the Perfectionism subscale of the Eating Disorders Inventory, the total score of the Toronto Alexithymia Scale, and the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorders Inventory. We tested a model in which alexythimia is the independent variable and perfectionism is the possible mediator or moderator. RESULTS Analyses confirmed the assumed model. In addition, it emerged that perfectionism played a mediating or moderating role when measured by different instruments. This result suggested that different instruments measured subtly different aspects of the same construct. DISCUSSION Results could suggest that alexithymia is a predisposing factor for perfectionism, which in turn may lead to the development of eating disorders.
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Affiliation(s)
- S Marsero
- "Studi Cognitivi", Post-graduate Cognitive Psychotherapy School, Milano, Italy.
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11
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Torres S, Guerra MP, Lencastre L, Vieira F, Roma-Torres A, Brandão I. Prevalência da alexitimia na anorexia nervosa e sua associação com variáveis clínicas e sociodemográficas. JORNAL BRASILEIRO DE PSIQUIATRIA 2011. [DOI: 10.1590/s0047-20852011000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a prevalência da alexitimia numa amostra de pacientes com anorexia nervosa e sua relação com variáveis do foro clínico e sociodemográfico, em concreto, índice de massa corporal, duração da doença, idade, escolaridade e nível socioeconômico. MÉTODOS: Foram avaliados 2 grupos de participantes do sexo feminino, com idades compreendidas entre os 13 e os 34 anos. Um grupo foi composto por 80 participantes com anorexia nervosa (Grupo AN) e o outro por 80 participantes saudáveis (Grupo Controle). A versão portuguesa da Toronto Alexithymia Scale - 20 items - foi aplicada a ambos os grupos. RESULTADOS: A prevalência da alexitimia no Grupo AN foi 62,5% e no Grupo Controle, 12,5%. Os valores médios de alexitimia não diferiram significativamente entre os dois subtipos de AN, e ambos apresentaram valores estatisticamente superiores aos do Grupo Controle. A alexitimia não se correlacionou às variáveis clínicas e sociodemográficas consideradas, à exceção da escolaridade, cuja associação com a alexitimia foi positiva e baixa. CONCLUSÃO: Os pacientes com anorexia nervosa apresentaram, com elevada frequência, dificuldades na regulação dos afetos, independentemente de seu peso, tempo de evolução da doença, idade e nível socioeconômico. O tratamento deve privilegiar uma intervenção sistematizada no domínio das emoções.
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Torres S, Guerra MP, Lencastre L, Roma-Torres A, Brandão I, Queirós C, Vieira F. Cognitive processing of emotions in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2010; 19:100-11. [DOI: 10.1002/erv.1046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ridout N, Thom C, Wallis DJ. Emotion recognition and alexithymia in females with non-clinical disordered eating. Eat Behav 2010; 11:1-5. [PMID: 19962113 DOI: 10.1016/j.eatbeh.2009.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 06/20/2009] [Accepted: 07/06/2009] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aims were to determine if emotion recognition deficits observed in eating disorders generalize to non-clinical disordered eating and to establish if other psychopathological and personality factors contributed to, or accounted for, these deficits. DESIGN Females with high (n=23) and low (n=22) scores on the Eating Disorder Inventory (EDI) were assessed on their ability to recognise emotion from videotaped social interactions. Participants also completed a face memory task, a Stroop task, and self-report measures of alexithymia, depression and anxiety. RESULTS Relative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI. CONCLUSIONS In line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia.
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Affiliation(s)
- Nathan Ridout
- Clinical and Cognitive Neurosciences, School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom.
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Kong SS. Impact of Eating Psychopathology, Obsessive-Compulsion and Depression on Self-Harm Behavior in Patients with Eating Disorders. J Korean Acad Nurs 2009; 39:459-68. [DOI: 10.4040/jkan.2009.39.4.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seong Sook Kong
- Associate Professor, Department of Nursing, Soonchunhyang University, Cheonan, Korea
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Doba K, Pezard L, Lesne A, Vignau J, Christophe V, Nandrino JL. Dynamics of emotional expression in autobiographic speech of patients with anorexia nervosa. Psychol Rep 2007; 101:237-49. [PMID: 17958131 DOI: 10.2466/pr0.101.1.237-249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Emotional disturbances in persons with anorexia nervosa have mainly been documented using static descriptions. This study presents the temporal organisation of emotional expression in autobiographical speech of anorexic patients and thereby provides a first attempt to quantify the dynamics of emotions in patients' speech. The temporal pattern of emotional expression for persons with anorexia nervosa was studied after transforming the autobiographical narratives of 14 patients and 13 matched controls into symbolic sequences of positive, negative, and neutral emotional expressions. These symbolic sequences of emotional states and silences were analyzed using static and dynamic indices. Static indices showed that patients with anorexia nervosa expressed more negative emotions and fewer neutral states than control participants. Dynamic indices showed in patients' speech a cycle of negative emotions and silence. These results showed specific dynamics of emotional expression in persons with anorexia nervosa characterised by the presence of negative emotional perseveration. The possible clinical implications of these findings are discussed.
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Affiliation(s)
- Karyn Doba
- Université Lille 3, Department of Psychology, Domaine Universitaire, du Pont de Bois 59654 Villeneuve d'Ascq.
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Lawson R, Waller G, Sines J, Meyer C. Emotional awareness among eating-disordered patients: the role of narcissistic traits. EUROPEAN EATING DISORDERS REVIEW 2007; 16:44-8. [DOI: 10.1002/erv.838] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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DOBA KARYN. DYNAMICS OF EMOTIONAL EXPRESSION IN AUTOBIOGRAPHIC SPEECH OF PATIENTS WITH ANOREXIA NERVOSA. Psychol Rep 2007. [DOI: 10.2466/pr0.101.5.237-249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Peters RM, Lumley MA. Relationship of alexithymia to cardiovascular disease risk factors among African Americans. Compr Psychiatry 2007; 48:34-41. [PMID: 17145279 DOI: 10.1016/j.comppsych.2006.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/27/2006] [Accepted: 03/27/2006] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Alexithymia, a deficit in emotional awareness and expression, may contribute to cardiovascular disease (CVD) and other diseases. African Americans have a high prevalence of CVD, but almost nothing is known about alexithymia in this ethnic group. This study examined the relationship of alexithymia to a range of risk factors for CVD among African Americans. METHODS On a community sample of 162 African American adults, we assessed alexithymia (Toronto Alexithymia Scale-20) and several risk factor domains: physiological (body mass index, blood pressure), behavioral (smoking, exercise), emotional (trait anxiety, depression, and anger; forms of anger expression), racial discriminatory, and socioeconomic (income, education). RESULTS Alexithymia was positively correlated with all emotional risk factors (P < .01) and inversely correlated with socioeconomic status (P < .01). Alexithymia has a small, inverse relationship with responses to racism (P < .01) but was not significantly related to the experience of racism. Alexithymia was weakly related to smoking but was unrelated to physiological risk factors. These relationships were largely unchanged when only people without hypertension (n = 116) were studied. CONCLUSIONS This pattern of relationships is consistent with findings on ethnic majority samples and suggests that alexithymia as measured with the Toronto Alexithymia Scale-20 is a valid construct among African Americans. It correlates with socioeconomic and emotional variables in this population, but only minimally or not at all with behavioral or physiological factors. If alexithymia influences CVD and other diseases, it appears to do so through social and emotional pathways.
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Hund AR, Espelage DL. Childhood Sexual Abuse, Disordered Eating, Alexithymia, and General Distress: A Mediation Model. J Couns Psychol 2005. [DOI: 10.1037/0022-0167.52.4.559] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tylka TL, Subich LM. Examining a Multidimensional Model of Eating Disorder Symptomatology Among College Women. J Couns Psychol 2004. [DOI: 10.1037/0022-0167.51.3.314] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pinaquy S, Chabrol H, Simon C, Louvet JP, Barbe P. Emotional eating, alexithymia, and binge-eating disorder in obese women. OBESITY RESEARCH 2003; 11:195-201. [PMID: 12582214 DOI: 10.1038/oby.2003.31] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the relationships between alexithymia and emotional eating in obese women with or without Binge Eating Disorder (BED). RESEARCH METHODS AND PROCEDURES One hundred sixty-nine obese women completed self-report questionnaires, including the Beck Depression Inventory, the State Trait Anxiety Inventory, the Stress Perceived Scale, the Dutch Eating Behaviour Questionnaire, and the Toronto Alexithymia Scale. The presence of BED, screened using the Questionnaire of Eating and Weight Patterns, was confirmed by interview. RESULTS Forty obese women were identified as having BED. BED subjects and non-BED subjects were comparable in age, body mass index, educational level, and socioeconomic class. According to the Dutch Eating Behaviour Questionnaire, BED subjects exhibited higher depression, anxiety, perceived stress, alexithymia scores, and emotional and external eating scores than non-BED subjects. Emotional eating and perceived stress emerged as significant predictors of BED. The relationships between alexithymia and emotional eating in obese subjects differed between the two groups according to the presence of BED. Alexithymia was the predictor of emotional eating in BED subjects, whereas perceived stress and depression were the predictors in non-BED subjects. DISCUSSION This study pointed out different relationships among mood, alexithymia, and emotional eating in obese subjects with or without BED. Alexithymia was linked to emotional eating in BED. These data suggest the involvement of alexithymia in eating disorders among obese women.
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Affiliation(s)
- Sandrine Pinaquy
- Research Center for Psychopathology, Université Toulouse Le Mirail, Toulouse, France.
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Lundh LG, Johnsson A, Sundqvist K, Olsson H. Alexithymia, memory of emotion, emotional awareness, and perfectionism. Emotion 2002; 2:361-79. [PMID: 12899370 DOI: 10.1037/1528-3542.2.4.361] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Toronto Alexithymia Scale (TAS-20; R. M. Bagby, J. D. A. Parker, & G. J. Taylor, 1994) is a self-assessment instrument designed to measure deficits in meta-emotional functioning (e.g., difficulties in identifying and describing emotions). Four studies were carried out to examine the association between the TAS-20 and (a) performance measures of meta-emotional functioning (memory of emotion and emotional awareness; Studies 1-2) and (b) measures of perfectionistic standards that may possibly be involved in the self-assessment of abilities-difficulties (Studies 3-4). The TAS-20 failed to correlate in the predicted direction with the performance measures but showed sizable correlations with measures of perfectionism. Moreover, perfectionism was found to predict TAS-20 scores independent of depression, anxiety, and somatic complaints. The results are discussed in terms of the TAS-20 measuring primarily certain aspects of meta-emotional self-efficacy.
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Fukunishi I, Koyama K. Relations of alexithymic characteristics with eating attitudes and hostility in female college students. Psychol Rep 2001; 88:1245-50. [PMID: 11597082 DOI: 10.2466/pr0.2001.88.3c.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the correlations of alexithymic characteristics with the expression of unfavorable feelings such as anger and hostility and abnormal eating attitudes and behaviors in a sample of 278 Japanese female college students. Mean scores on the Eating Attitude Inventory, MMPI Hostility, and State-Trait Anger Expression Inventory were significantly higher for female college stUdents with alexithymic characteristics than for those with nonalexithymic characteristics. Multivariate analysis of covariance indicated that the significant relationships between alexithymic characteristics and oral control of the eating attitudes were controlled by scores on anger-in and anger control, suggesting that anger-in and anger control may mediate the relationship between alexithymic characteristics and abnormal eating attitudes.
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Posse M, Backenroth-Ohsako G, HåKanson CE, HÄllström T. ALEXITHYMIA AND PSYCHIATRIC SYMPTOMS IN A POPULATION OF NURSERY WORKERS: A STUDY USING THE 20-ITEM TORONTO ALEXITHYMIA SCALE. SOCIAL BEHAVIOR AND PERSONALITY 2001. [DOI: 10.2224/sbp.2001.29.5.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study investigated alexithymia in a sample of professional nursery workers in Huddinge community, Sweden. In a previous study in general practice it was found that alexithymia, in a mixed population seeking medical advice, was associated with higher age, male gender, low education
and the personality traits suspicion and distance as well as undetected depression. The choice of a professional female population allowed alexithymia to be studied in a refined way without the impact of some of the confounding elements of previous studies. The six variables investigated apart
from alexithymia were feelings of well-being, symptoms of somatic and psychic anxiety, depressive symptoms, gastro-intestinal symptoms, and level of social dysfunction. The prevalence of alexithymia was 7.9%. Fifty percent of the items assessing somatic anxiety and 28.5% of those
assessing depressive symptoms were related to high TAS- 20 scores in this healthy all-female population. The feeling factors of TAS-20, difficulty in identifying and expressing feelings, accounted in this study for the majority of relations to the other variables whilst the third factor, externally
oriented thinking, remained independent and mainly nonrelated to the other measured variables. It had been hypothesised that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal. Confirmation of
these theories was found in this study where subjects expressing high levels of vegetative and visceral symptoms of anxiety also scored high for alexithymia and depressive symptoms.
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FUKUNISHI ISAO. RELATIONS OF ALEXITHYMIC CHARACTERISTICS WITH EATING ATTITUDES AND HOSTILITY IN FEMALE COLLEGE STUDENTS. Psychol Rep 2001. [DOI: 10.2466/pr0.88.3.1245-1250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fukunishi I. Eating attitudes in female college students with self-reported alexithymic characteristics. Psychol Rep 1998; 82:35-41. [PMID: 9520532 DOI: 10.2466/pr0.1998.82.1.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several studies have indicated that there is a close relationship between eating attitudes and alexithymic characteristics. In this study, the influence of parental bonding on the association of alexithymic characteristics and eating attitudes was examined in a sample of 580 college students. Multivariate analyses of variance indicated that female students with two alexithymic characteristics, difficulty identifying feelings and difficulty describing feelings, exhibited more abnormal eating attitudes (poor oral control). Multivariate analysis of covariance gave significant associations with maternal care. Although these subjects were not patients with eating disorders the results suggest that the two alexithymic characteristics studied were associated with lack of maternal care and are a risk factor for eating disorders.
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Cox W, Blount JP, Rozak AM. Alexithymia and induced moods in alcohol-dependent males. PERSONALITY AND INDIVIDUAL DIFFERENCES 1998. [DOI: 10.1016/s0191-8869(97)00147-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fukunishi I, Mikami N, Kikuchi M. Alexithymic characteristics in responses to the Synthetic House-Tree-Person (HTP) Drawing Test. Percept Mot Skills 1997; 85:939-42. [PMID: 9399302 DOI: 10.2466/pms.1997.85.3.939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examined the association of certain complex personality traits assessed by the Synthetic House-Tree-Person Drawing Test and alexithymic characteristics assessed by the 20-item Toronto Alexithymia Scale for a sample of 589 Japanese college students. Alexithymic students who scored over 61 points on the Toronto Alexithymia Scale-20 exhibited two characteristics relative to the test: poor relationships between figures and additional written explanations. These two characteristics projected on the Synthetic House-Tree-Person Drawing Test may be related to alexithymic characteristics and related factors.
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Fukunishi I. Alexithymic characteristics of bulimia nervosa in diabetes mellitus with end-stage renal disease. Psychol Rep 1997; 81:627-33. [PMID: 9354117 DOI: 10.2466/pr0.1997.81.2.627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study examined the clinical characteristics including stress-related factors of eating disorders in a sample of 312 diabetic patients with end-stage renal failure. The prevalence rate of bulimia nervosa was 5.1% (16 of 312 patients). The 16 patients with bulimia nervosa were 8 men and 8 women over 58 years old. Looking at the subjects by cause of end-stage renal failure, those with diabetes mellitus exhibited significantly higher prevalence rate of bulimia nervosa than two nondiabetic groups (diabetes 10%; nephritis 1.6%; others 1.9%). As for the association of bulimia nervosa and stress-related factors, end-stage renal failure patients with diabetes who exhibited bulimia nervosa showed significantly higher scores on a measure of alexithymia. These results suggest that, when liaison psychiatrists see diabetic patients with end-stage renal failure who exhibit bulimia nervosa, they should pay close attention to stress-related symptoms including alexithymia.
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Abstract
The purpose was to examine the rate of alexithymia as measured by the Toronto Alexithymia Scale in a clinical sample of obese women without Binge Eating Disorder. Subjects included 165 inpatients in an eating disorder unit and 135 normal-weight individuals (comparison group). The obese subjects also completed a series of tests including the Minnesota Multiphasic Personality Inventory, the Anxiety Scale Questionnaire, and the Eating Attitude Test. Analysis showed that the subgroups of obese persons differ in important ways and cannot necessarily be treated, studied, or understood through a single paradigm. Alexithymic behaviour, too, was not characteristic of obesity, but it was present only in the subgroup of subjects with psychopathological characteristics.
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Affiliation(s)
- A Morosin
- Applied Technology for Psychology Laboratory, Centro Auxologico Italiano, Intra (VB)
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FUKUNISHI ISAO. ALEXITHYMIC CHARACTERISTICS OF BULIMIA NERVOSA IN DIABETES MELLITUS WITH END-STAGE RENAL DISEASE. Psychol Rep 1997. [DOI: 10.2466/pr0.81.6.627-633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lumley MA, Stettner L, Wehmer F. How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res 1996; 41:505-18. [PMID: 9032714 DOI: 10.1016/s0022-3999(96)00222-x] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We review the empirical literature and critique four possible pathways linking alexithymia and physical illness; (a) alexithymia leads to organic disease through physiological or behavioral mechanisms: (b) alexithymia leads to illness behavior (physical symptoms, disability, excessive health care use) through cognitive or social mechanisms: (c) physical illness leads to alexithymia; and (d) both alexithymia and physical illness result from sociocultural or biological factors. Our review suggests that alexithymia is associated with tonic physiological hyperarousal, certain types of unhealthy behavior, and a biased perception and reporting of somatic sensations and symptoms. Alexithymia also appears to influence health care use, but in a complex fashion. Although trauma may give rise to alexithymia, whether physical illness such as chronic pain does so is not known, and there is little evidence that sociocultural or biological factors lead to both alexithymia and physical illness. We conclude that alexithymia probably influences illness behavior, but there is little support for the hypothesis that alexithymia leads to chronic organic disease, especially when one distinguishes organic disease from illness behavior.
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Affiliation(s)
- M A Lumley
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
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Taylor GJ, Parker JD, Bagby RM, Bourke MP. Relationships between alexithymia and psychological characteristics associated with eating disorders. J Psychosom Res 1996; 41:561-8. [PMID: 9032719 DOI: 10.1016/s0022-3999(96)00224-3] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study examines the relationships between alexithymia and psychological characteristics and behaviors that are commonly associated with eating disorders. The 20-item Toronto Alexithymia Scale (TAS-20) and the Eating Disorder Inventory (EDI) were administered to a group of 48 female patients with anorexia nervosa, a matched comparison group of 30 normal women, and an unmatched comparison group of 116 male and 118 female university students. In the anorexic and male student groups, the TAS-20 correlated significantly and positively with the EDI subscales, Ineffectiveness, Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears. The TAS-20 correlated significantly only with Interpersonal Distrust in the matched comparison group, and only with Ineffectiveness and Interpersonal Distrust in the female student group. The results suggest that alexithymia is related to several psychological traits that are characteristic of patients with eating disorders and thought to play a role in the development of the disorders but is unrelated to attitudes and behaviors concerning abnormal eating and body weight and shape.
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Affiliation(s)
- G J Taylor
- Department of Psychiatry, University of Toronto, ON, Canada
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