Alexithymia and problematic alcohol use: A critical update

Adult symptoms of ASD in relation to excessive internet use: The roles of ADHD symptoms and negative mood

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) have been reportedly associated with excessive internet use, also known as internet addiction. As ADHD is the most common comorbidity in ASD, the present study examined the possibility that ADHD symptoms, and/or trait and mood factors linked to ASD, ADHD and internet addiction, could account for the association of ASD with internet addiction symptoms. A nonclinical young adult sample of 248 internet using men and women completed self-report measures of ASD and ADHD symptoms, alexithymia, impulsivity, negative moods and internet addiction symptoms. Scores on the ASD and ADHD symptom measures were normally distributed, consistent with the notion that the corresponding disorders represent extreme, impairing ends of population distributions of their symptoms. Hierarchical regression followed by path analysis indicated that the relationship between ASD and internet addiction symptoms was fully mediated by ADHD symptoms and negative moods. Further, the relationship between ADHD and internet addiction symptoms was partially mediated by impulsivity and negative moods. Present findings point to the mediating roles of ADHD symptoms and negative moods in the association of ASD with internet addiction symptoms.

Adult symptoms of ASD and ADHD in relation to alcohol use: Potential roles of transdiagnostic features

Attention Deficit Hyperactivity Disorder (ADHD) is the most common comorbidity in Autism Spectrum Disorder (ASD). ADHD is a risk factor for alcohol misuse whereas ASD is often regarded as protective; however, research on ASD and alcohol use has yielded conflicting findings, sometimes implicating the role of comorbid ADHD. The possibility that certain transdiagnostic features (i.e., characteristics associated with multiple disorders) may underlie relationships of both disorders to alcohol use in adults was examined in the present study. A nonclinical young adult sample of 248 alcohol users (117 men, 131 women) completed validated self-report measures of ASD and ADHD symptoms as well as the transdiagnostic features alexithymia, impulsivity, and negative moods. ASD and ADHD symptoms were normally distributed, suggesting that the respective disorders represent extreme, dysfunctional ends of population distributions of symptoms. Path analysis indicated that the significant positive association between ASD and ADHD symptom measures was fully mediated by alexithymia, impulsivity, and negative moods. Hierarchical regression and path analysis indicated that the positive relationship between ADHD symptoms and alcohol use severity was fully mediated by transdiagnostic features, particularly alexithymia and impulsivity, whereas the relationship between ASD and alcohol use severity was positively mediated by these features (especially alexithymia), with a highly significant and negative direct effect. Present findings may help reconcile previous conflicting evidence on the relationship of ASD to alcohol use, and the role of comorbid ADHD, by emphasizing the roles of alexithymia and impulsivity in both ASD and ADHD as transdiagnostic traits promoting excessive drinking.

Cluster analysis of patients with alcohol use disorder featuring alexithymia, depression, and diverse drinking behavior

AIM

This study aimed to identify subgroups of alcohol use disorder (AUD) based on a multidimensional combination of alexithymia, depression, and diverse drinking behavior.

METHOD

We recruited 176 patients with AUD, which were initially divided into non-alexithymic (n = 130) and alexithymic (n = 46) groups using a cutoff score of 61 on the Toronto Alexithymia Scale (TAS-20). Subsequently, the profiles of the two groups were compared. Thereafter, a two-stage cluster analysis using hierarchical and K-means methods was performed with the Z-scores from the TAS-20, the Quick Inventory of Depressive Symptomatology Self-Report Japanese Version, the 12-item questionnaire for quantitative assessment of depressive mixed state, and the 20-item questionnaire for drinking behavior pattern.

RESULTS

In the first analysis, Alexithymic patients with AUD showed greater depressive symptoms and more pathological drinking behavior patterns than those without alexithymia. Cluster analysis featuring alexithymia, depression, and drinking behavior identified three subtypes: Cluster 1 (core AUD type) manifesting pathological drinking behavior highlighting automaticity; Cluster 2 (late-onset type) showing relatively late-onset alcohol use and fewer depressive symptoms or pathological drinking behavior; and Cluster 3 (alexithymic type) characterized by alexithymia, depression, and pathological drinking behavior featuring greater coping with negative affect.

CONCLUSION

The multidimensional model with alexithymia, depression, and diverse drinking behavior provided possible practical classification of AUD. The alexithymic subtype may require more caution, and additional support for negative affect may be necessary due to accompanying mood problems and various maladaptive drinking behaviors.

Psychological dimensions in alcohol use disorder: comparing active drinkers and abstinent patients

Background

Alcohol use disorder (AUD) is a major public health concern due to its various physical, psychological, and social consequences. Despite regulatory differences, abstinence remains the primary treatment objective. Addressing the multifaceted nature of alcohol use disorder requires a comprehensive approach.

Methods

150 AUD patients (66%male) with a mean age of 54.10 ± 11.3 years were recruited for the study. Depression, impulsivity, alexithymia, and hopelessness were assessed to determine if there were significant differences in these dimensions between abstinent (N=72) and active drinkers (N=78).

Results

The study found significant differences in the psychological dimensions scores, active drinkers exhibited higher levels of depression, impulsivity, alexithymia, and hopelessness compared to abstinent patients.

Conclusion

Treatment outcomes for patients with AUD vary between regulatory agencies, but abstinence remains the safest and most preferred objective in managing AUD. Prioritizing abstinence-oriented interventions is crucial for achieving long term recovery and minimizing relapse risk. These results emphasize the intricate relationship between AUD and mental health issues, highlighting the need for comprehensive interventions addressing both alcohol consumption and associated psychological distress. Promoting abstinence (or at least reducing alcohol consumption) not only preserves mental health but also prevents life-threatening consequences such as suicide.

Comparison of psychological reactions, fear of negative evaluation and mood-emotional alexithymia in successful and unsuccessful people in addiction recovery: a survey of Baluchestan in Iran

The aim of this study was to examine psychological responses, fear of negative evaluation, and mood-related alexithymia in individuals in addiction recovery who have succeeded versus those who have not. This study employed a causal-comparative design. The research focused on all individuals who sought treatment for addiction at clinics within a specific district in Zahedan city, Iran. Out of the group, 100 individuals were chosen (50 who successfully stopped their addiction and 50 who were unsuccessful in their attempts to quit) through convenience sampling. Data were gathered using the depression, Anxiety, and Stress Scale (DASS-21), Lori's fear of negative evaluation scale, and Toronto's mood-emotional alexithymia scale. Data were examined through both descriptive statistics and multivariate analysis of variance. Based on the results, successful and unsuccessful individuals in addiction recovery showed varying levels of depression, stress, fear of negative evaluation, and having no fear of negative evaluation (p < .01). In simpler terms, unsuccessful individuals in addiction recovery scored higher in depression, stress, fear of negative evaluation, inability feeling emotions, inability to express feelings compared to successful individuals. But successful individuals in addiction recovery obtained higher mean scores than unsuccessful individuals in addiction recovery on having no fear of negative evaluation. According to the findings psychological reactions, fear of negative evaluation and mood-emotional alexithymia play a significant role in addiction treatment and can be helpful in addiction recovery in unsuccessful people in addiction recovery. It is feasible to enhance the effectiveness of addiction recovery by implementing interventions that target the reduction of depression, stress, fear of negative evaluation, and alexithymia.

Alexithymia in gaming addiction and engagement

BACKGROUND

It has been suggested that alexithymia plays a significant role in substance and behavioral addictions. However, only a handful of studies investigated this construct in relation to gaming addiction, and no study analyzed its differential effect on gaming engagement and addiction.

METHODS

A total of u adult gamers (Mage = 26.04, SD = 5.78, 94 % male) completed a questionnaire that included the Toronto Alexithymia Scale (and its subscales of difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), the Addiction-Engagement Questionnaire, and additional questions about gender, age, and time spent gaming. Structural equation modeling was used as the main analytical strategy.

RESULTS

Difficulty identifying feelings (β = 0.28) and externally oriented thinking (β = 0.19) showed a significant positive effect on gaming addiction. Contrary to addiction, externally oriented thinking showed a significant negative effect (β = -0.21) on gaming engagement. No other alexithymia subscales were significant. The model with alexithymia explained 32.7 % of the variance in gaming addiction while only 10.4 % of gaming engagement.

CONCLUSIONS

Alexithymia is a strong predictor of gaming addiction. Gaming engagement seems to be a qualitatively different phenomenon that shows an opposite association with alexithymia than gaming addiction. However, both are related to increased time spent gaming. This suggests a need to distinguish between problematic vs. non-problematic excessive gaming as they have different associations with affect dysregulation.

Emotion Recognition and Self-Reported Emotion Processing in Alcohol and Cannabis Co-Using Young Adults

Alcohol and cannabis use are each associated with impairments in emotion recognition accuracy, which may promote interpersonal problems. It is unclear if emotion recognition or self-reported emotion processing differs between young adult alcohol and cannabis co-users (ACCs) and healthy controls (HCs). This study examined whether ACCs and HCs differed in their emotion recognition across two different behavioral tasks with static or dynamic faces and determined if there were differences in self-reported socio-emotional processing and alexithymia. 22 ACCs (mean age = 21.27 ± 1.75) and 25 HCs (mean age = 21.48 ± 2.68), matched on age, sex, and IQ, completed the Metrisquare Emotion Recognition Task and CANTAB Emotion Recognition Task. The ACCs and HCs were compared on task accuracy and self-reported measures, including the Social Emotional Questionnaire (SEQ) and the Perth Alexithymia Questionnaire (PAQ). No significant main effects of the Group variable or the Emotion-Group interaction variable were present for either task. The ACCs had lower SEQ (p = 0.014) and higher PAQ (p = 0.024) scores relative to the HCs, indicating greater difficulties in socio-emotional processing and identifying one's own emotions, respectively. Understanding the behavioral correlates of the self-reported difficulties in emotion processing reported by ACCs is needed to develop interventions to reduce these symptoms and promote healthy socio-emotional functioning in this population.

Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool

OBJECTIVE

Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.

METHOD

As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.

RESULTS

The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).

CONCLUSION

These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.

PLAIN LANGUAGE TITLE

Does difficulty identifying/describing emotions or externally-oriented thinking influence the effectiveness of an intervention among people with both depression and hazardous alcohol use?

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

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

Bodily confusion: Lower differentiation of emotional and physiological states in student alcohol users

BACKGROUND

Alexithymia, difficulty in recognising and naming emotions, is common among people who use alcohol. There is also emerging evidence that people with alexithymia are unable to distinguish emotions from non-emotional physiological states. The project aimed to test if alcohol use is related to the way student drinkers experience emotions and physiological states in the body.

METHODS

We employed a novel method to study bodily sensations related to emotions and physiological states in the context of alcohol use: the emBODY tool, which allowed participants to mark areas of the body in which they experience various emotions and physiological states.

RESULTS

Students who showed a hazardous pattern of alcohol use (alcohol use disorders identification test [AUDIT] score ≥ 7, N = 91), overall, presented higher alexithymia levels and coloured larger areas for emotions and physiological states (showed less specificity) than those who show low-risk alcohol consumption (AUDIT ≤ 4, N = 90). Moreover, statistical classifiers distinguished feeling-specific maps less accurately for hazardous drinkers than low-risk drinkers [F(1,1998) = 441.16; p < 0.001], confirming that higher alcohol use is related to higher confusion of emotional and non-emotional bodily feelings.

CONCLUSIONS

Plausibly, this increased bodily confusion drives alcohol consumption: alcohol may serve as a means of dealing with undifferentiated changes in psychophysiological arousal accompanying emotional states.

How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD

Background: Alexithymia, an inability to recognise one's emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation.Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample.Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer.Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = -0.107, p = .355), oxytocin levels (β = -0.164, p = .161), insula (β = -0.170, p = .158) or amygdala (β = -0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations.Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia's relevance in the clinical phenotype of PTSD.

Press Play to Feel: The Role of Attachment Styles and Alexithymic Features in Problematic Gaming

Problematic gaming has been consistently associated with insecure attachment styles and alexithymia. However, there is limited knowledge regarding the impact of specific alexithymic features and insecure attachment styles on problematic gaming. The study included a sample of 358 online game players (242 males, 67.6%) between the ages of 18 and 59 (M = 28.46; SD = 8.76) who were recruited from online gaming communities. The participants completed a sociodemographic schedule and measures on attachment styles, alexithymia, and problematic gaming. The results provide evidence for a positive prediction of problematic gaming by dismissing attachment style and the alexithymic factors concerning the difficulty identifying feelings and externally oriented thinking, even when controlling for potentially confounding factors, such as age, sex, education, marital status, and self-reported time devoted to online games. Additionally, the analysis revealed a significant interaction effect between externally oriented thinking and dismissing attachment style in the prediction of problematic gaming. The interaction implies that the alexithymia factors pertaining to externally oriented thinking hold significant relevance in predicting problematic gaming behaviors, especially in cases where dismissive attachment levels are moderately to highly present. These findings emphasize the significance of considering specific insecure attachment styles and alexithymic features when studying problematic gaming behaviors.

Longitudinal patterns of alcohol use and psychological symptoms during COVID-19 pandemic and role of alexithymia: A latent transition analysis in the FinnBrain Birth Cohort Study

BACKGROUND

The COVID-19 pandemic has been posing widespread influence on mental well-being. However, research on the dynamic relations between alcohol use and psychological symptoms in the context of the pandemic and the role of alexithymic traits in predicting the development of mental health problems longitudinally remains scarce.

METHODS

Latent profile and transition analyses were conducted to model the longitudinal patterns of transitions in the profiles of alcohol use and psychological symptoms across 10 months during the pandemic (from May 2020 to March 2021) and to investigate the role of alexithymia and its dimensions Difficulty Identifying and Describing Feelings (DIF and DDF), and Externally Oriented Thinking (EOT) in 720 parents from the FinnBrain Birth Cohort Study.

RESULTS

Three profiles, Risky Drinking, Distressed Non-Risky Drinking, and Non-Distressed, Non-Risky Drinking, and their transitions were identified. The role of alexithymia appeared to be stronger in Risky Drinking than Non-Distressed, Non-Risky Drinking. DIF predicted the development of symptoms in Risky Drinking, whereas DDF predicted Risky Drinking remaining stable over time and showed a trend towards psychological distress in Risky Drinking and Non-Distressed, Non-Risky Drinking. EOT was more likely to be a risk factor for Risky Drinking remaining constant and Non-Distressed, Non-Risky Drinking becoming Risky Drinking.

LIMITATIONS

This study was mainly limited by the generalizability of the findings.

CONCLUSIONS

Our findings add deeper insights into the longitudinal development of alcohol use and psychological symptoms as well as evidence on the role of alexithymia in shaping mental health, providing implications for tailoring clinical preventive and therapeutic measures.

Interoception, alexithymia, and anxiety among individuals with alcohol use disorder

Background

Interoception (i.e., the ability to recognize bodily signals), alexithymia (i.e., the inability to recognize emotional states) and negative affect (i.e., unpleasant feelings such as anxiety) have been associated with alcohol use disorder (AUD). Previous research suggests that interoception may underlie alexithymia, which in turn may be associated with negative affectivity. However, this remains to be empirically tested. This study investigates whether alexithymia mediates the association between interoception and anxiety and whether this association differs across individuals with AUD and a healthy control (HC) comparison group.

Methods

The AUD group consisted of 99 participants enrolled in an 8-week abstinence-based inpatient treatment program. The HC group included 103 healthy individuals. The heartbeat counting task (HCT) was used to assess interoception (cardiac interoceptive accuracy). The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. The Brief Symptom Inventory (BSI) was used to assess anxiety.

Results

The moderated mediation model with interoception as the predictor, alexithymia as the mediator, and negative affect (i.e., state anxiety) as the dependent variable was tested. The analysis showed that the conditional indirect effect of interoception on anxiety via alexithymia was significant for individuals with AUD [ab = -0.300, bootstrap 95% CI = (-0.618, -0.088)], as well as for HCs [ab = -0.088, bootstrap 95% CI = (-0.195, -0.014)]; however, the conditional indirect effect significantly differed across HCs and individuals with AUD. Namely, the mediated effect was greater among individuals with AUD compared to the HC group.

Conclusion

The results suggests that interoceptive impairment contributes to greater negative affect (i.e., state anxiety) via alexithymia especially for individuals with AUD. Improving emotion recognition via therapeutic methods focused on strengthening interoceptive abilities could improve outcomes for individuals receiving treatment for AUD.

Differences in the associations between psychoactive substance use and alexithymia: A series of Meta-analyses

The present meta-analytic study examined the association between alexithymia and psychoactive substance use. Studies published from 1988 to August 20, 2022 were identified by a systematic search and 168 eligible studies were included in five meta-analyses. Results showed that (1) the correlation between substance use and alexithymia is small but significant (r = 0.177); (2) substance users have substantially higher alexithymia than nonusers (g = 0.545); (3) alexithymic participants have significantly but slightly higher levels of substance use than non-alexithymics (g = 0.242); (4) substance users are significantly but only slightly more likely to be alexithymic than nonusers (OR = 2.392); and (5) alexithymic individuals are not more likely to be substance users than non-alexithymics. Larger effects were observed among samples diagnosed with substance use disorder (SUD), and the use of depressants, alcohol, opiates, and illicit stimulants had stronger relation to alexithymia. We found a tendency for a larger association with problematic use as compared to other indicators (e.g., frequency and duration) of substance use. Among the components of alexithymia, difficulties in identifying feelings has the strongest association with substance use. Our findings support clinical practice by suggesting the improvement of emotion regulation in SUD.

Ready, set, …and difficultly slowing down: What role does alexithymia, emotional regulation and interoceptive awareness play in exercise dependence?

Alexithymia is associated with a diverse range of addictive behaviours including exercise addiction symptoms. In addition, emerging research indicates that emotional regulation and interoceptive processes may help explain this relationship. Thus, the current study tested the ability of emotion regulation to mediate the relationship between alexithymia and exercise addiction symptoms and whether interoceptive awareness moderates these relationships. A total of 404 physically active adults (86.8 % female) completed measures of alexithymia, exercise dependence symptoms, difficulties with emotion regulation and interoceptive awareness (Mage = 43.72, SD = 14.09). Alexithymia, emotion regulation, interoceptive awareness and exercise dependence symptoms were all significantly correlated. Further analysis revealed that emotional regulation mediated the relationship between alexithymia and exercise dependence, although the mediation model did not vary as a function of interoceptive awareness. These findings underscore the importance of considering emotion-focused processes in treatment planning and other initiatives designed to help individuals who display exercise dependence symptoms.

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness

Alexithymia has been linked to risky or problematic alcohol use, with a common interpretation invoking deficient emotion regulation and use of alcohol to cope with distress. An alternative explanation positing a general deficit of interoception in alexithymia suggested that poor awareness of internal cues of overconsumption may promote excessive drinking. The present study assessed predictions based on these hypotheses in 337 young adult alcohol users recruited online. Participants completed validated questionnaire indices of alcohol use, alexithymia, emotion regulation, interoceptive sensibility, and sensitivity to reward and punishment. Alcohol use was positively correlated with alexithymia and reward sensitivity, and negatively correlated with emotion regulation as expected, but was uncorrelated with interoceptive sensibility. Alexithymia was not significantly correlated with most dimensions of interoceptive sensibility but was highly negatively correlated with emotion regulation. Hierarchical regression controlling for demographic variables indicated that alexithymia, emotion regulation, sex, and sensitivity to reward and punishment were significant predictors of alcohol use levels. Bootstrapped mediation test controlling for all other variables indicated mediation of the association between alexithymia and alcohol use by deficient emotion regulation but not interoceptive sensibility. Results supported the emotion regulation deficit interpretation of the association of alexithymia with alcohol use. Limitations concerning interoception measurement, online samples, self-report measures, cross-sectional designs, and collection of data during the COVID-19 pandemic are discussed. Future research could follow up on these findings by testing interoceptive accuracy in addition to interoceptive sensibility in relation to alexithymia and alcohol use.

The mediating role of alexithymia in the relationship between affective temperament and craving: Cross-sectional study conducted in a sample of bipolar and alcohol use disorder patients

BACKGROUND

Bipolar disorder (BD) and alcohol use disorder (AUD) commonly co-occur and their interplay is influenced by several factors. Alexithymia is connected to BD and AUD; affective temperaments serve as risk factors for both; craving contributes to the development and maintenance of AUD. The present study tested whether alexithymia play a mediating role in the relationship between affective temperaments and craving in alcoholic bipolar patients.

METHODS

151 alcoholic bipolar patients (38 % females, mean age: 45.69 ± 9.04 years) were enrolled. The Mini International Neuropsychiatric Interview (MINI), the Brief Psychiatric Rating Scale (BPRS), the Toronto Alexithymia Scale (TAS-20), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego scale (TEMPS-A), and the Typology Craving Questionnaire (CTQ) were administered. Correlations among TAS-20, TEMPS-A, CTQ were conducted. Regression analyses were applied to verify the mediating hypothesis.

RESULTS

Difficulty in identifying feelings mediated the association between anxious temperament and craving (Indirect effect: 0.42, BCaCI: 0.22-0.69), cyclothymic temperament and craving (Indirect effect: 0.55, BCaCI: 0.30-0.87), irritable temperament and craving (Indirect effect: 0.45, BCaCI: 0.19-0.80). TAS-20 difficulty in communicating feelings to others mediated the association between anxious temperament and craving (Indirect effect: 0.20, BCaCI: 0.06-0.41).

LIMITATIONS

The sample size did not allow subgroup analyses. Data were collected cross-sectionally and in a single center. We did not investigate whether BD or AUD occurred first, although it might influence the mediation role of alexithymia.

CONCLUSION

Among alcoholic bipolar patients, assessing and targeting alexithymia may be useful to modulate craving and, in turn improve, the general mental status of patients.

Impact of alexithymia on suicidal ideation among patients with ovarian cancer: a moderated mediation model of self-perceived burden and general self-efficacy

PURPOSE

Suicidal ideation (SI) and alexithymia are common psychological problems among patients with cancer. Studying how alexithymia predicts SI is helpful for its intervention and prevention strategies. The present study aimed to investigate whether self-perceived burden (SPB) mediates the impact of alexithymia on SI and if general self-efficacy moderates the associations of alexithymia with SPB and SI.

METHODS

To measure SI, alexithymia, SPB, and general self-efficacy, 200 patients with ovarian cancer at all stages regardless of the type of treatment completed the Chinese version of the Self-Rating Idea of Suicide Scale, Toronto Alexithymia Scale, Self-Perceived Burden Scale, and General Self-Efficacy Scale in a cross-sectional study. The PROCESS macro for SPSS v4.0 procedure was applied to perform moderated mediation analysis.

RESULTS

SPB significantly mediated the positive impact of alexithymia on SI (a×b = 0.082, 95% confidence interval [CI]: 0.026, 0.157). General self-efficacy significantly moderated the positive association between alexithymia and SPB (β = -0.227, P < 0.001). The mediating role of SPB was gradually reduced as general self-efficacy grew (low: 0.087, 95% CI: 0.010, 0.190; medium: 0.049, 95% CI: 0.006, 0.108; high: 0.010, 95% CI: -0.014, 0.046). Thus, a moderated mediation model involving SPB and general self-efficacy for explaining how alexithymia causes SI was supported.

CONCLUSION

Alexithymia could cause SI by inducing SPB among patients with ovarian cancer. General self-efficacy could attenuate the association between alexithymia and SPB. Interventions aimed at reducing SPB and enhancing general self-efficacy could reduce SI by partially preventing and attenuating the impact of alexithymia.

Relationships between alexithymia and food addiction: The Finnish version of Yale Food Addiction Scale and preliminary test of its psychometric properties

Background

It has long been suggested that addictive behaviors are associated with alexithymia, a personality trait characterized by difficulties in emotional awareness and expression. However, little is known about the role of alexithymia in food addiction.

Objectives

The aim of this study was to investigate the relationship between alexithymia and food addiction. As part of the study, the validity of the Finnish version of Yale Food Addiction Scale (YFAS-F) was also investigated.

Methods

The sample consisted of 360 parents from the FinnBrain Birth Cohort Study. The structural validity of the YFAS-F was evaluated by confirmatory factor analysis (CFA). Exploratory factor analysis (EFA) was used to explore the structure when proposed models were not supported by CFA. The associations of alexithymia as measured by the 20-item Toronto Alexithymia Scale and food addiction were examined using regression analyses followed by structural equation modeling.

Results

Higher alexithymia was associated with more food addiction by conducting linear regression analysis (B = 0.013, p = 0.011) and structural equation modeling (β = 0.24, p < 0.001). Furthermore, a single-factor model for the 8 criteria of the YFAS-F was supported by CFA and showed acceptable internal reliability (KR-20 = 0.72), and a three-factor solution for the 20 items of the scale was suggested by EFA with good internal reliability (McDonald's ω = 0.91 for the YFAS-F, 0.91 for component 1, 0.87 for component 2, and Spearman-Brown coefficient = 0.89 for component 3).

Conclusion

The current study determined a significant relationship between alexithymia and food addiction, which suggests alexithymia as a relevant factor for food addiction and may provide clinical implications for interventions. Moreover, the YFAS-F appeared to be a valid and reliable tool to evaluate food addiction in our Finnish general population sample. Further studies on the psychometric properties of the YFAS-F in more diverse populations are recommended.

Association between alexithymia and substance use: A systematic review and meta-analysis

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.

Early Trauma and Later Sexual Victimization in College Women: A Multiple Mediation Examination of Alexithymia, Impulsivity, and Alcohol Use

Childhood abuse and sexual violence against women are prevalent in the United States. However, researchers have not fully explored the intersection among important predisposing factors that predict recent sexual violence experienced by women who are also survivors of childhood abuse. The purpose of this study was to examine the relationships among early childhood trauma, alexithymia, impulsivity, alcohol use severity, and sexual victimization in later life among female college students from the United States (n = 1,178). Participants were part of a larger cross-cultural study, conducted between 2012 to 2014, which examined sexual aggression and victimization in the context of alcohol use. The current study aimed to examine if: (a) early trauma, impulsivity, alexithymia, and alcohol use severity impact sexual victimization in later life, and (b) if impulsivity, alexithymia, and alcohol use severity mediate the relationship between early trauma and victimization in later life. It was hypothesized that impulsivity, alexithymia, and alcohol use severity would significantly mediate the relationship between early trauma and sexual victimization in later life. Using a multiple mediation path analysis, results indicated that early childhood trauma was significantly linked with impulsivity, alcohol use severity, and sexual victimization in later life. A partial mediation through impulsivity and alcohol use severity was observed. Alexithymia did not produce mediation effects. These findings align with previous research examining how early childhood trauma influences the occurrence of sexual victimization in later life and provides further recommendations for helping professionals as they attempt to stifle the sexual victimization rates among female college students.

Alexithymia and internet gaming disorder in the light of depression: A cross-sectional clinical study

BACKGROUND

Social and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers.

METHODS

In a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT).

RESULTS

Alexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors.

CONCLUSION

The results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients.

Alexithymia, reward sensitivity and excessive exercise in non-binge-eaters versus severe binge eaters: Implications for primary and secondary exercise dependence

A distinction has been made between primary and secondary exercise dependence, with the latter defined as excessive exercise secondary to disordered eating and weight concerns. Based on theoretical considerations from research on the roles of trait factors in addictions, the present study used validated scales to assess alexithymia, sensitivity to reward and punishment, emotion regulation and interoception in relation to exercise dependence symptoms in Australian male and female non-binge eaters (n = 228) and severe binge eaters (n = 126) aged 18-30 yr. In both groups, exercise dependence symptoms were significantly positively associated with reward sensitivity and interoceptive awareness, with the latter two variables predicting exercise dependence symptoms in hierarchical regression models; punishment sensitivity was significantly negatively related to such symptoms. Alexithymia was significantly associated with exercise dependence symptoms only in non-binge eaters; in severe binge eaters, alexithymia explained 0% of unique variance. Male sex was associated with more exercise dependence symptoms in severe binge eaters only. Participants in the severe binge group scored significantly higher on measures of exercise dependence, alexithymia, risky alcohol use, and sensitivity to reward and punishment, and significantly lower on emotion regulation, compared to those in the non-binge group. Hierarchical regression models explained 25% of variance in exercise dependence symptoms in non-binge-eaters and 43% in severe binge eaters. Findings are discussed in terms of the distinction between primary and secondary exercise dependence, the role of alexithymia, study limitations including data collection during the COVID-19 pandemic in Australia, and suggestions for future research.

Alexithymia and binge eating: Maladaptive emotion regulation strategy or deficient interoception?

Alexithymia has been linked to various excessive behaviors as a likely risk factor, including binge eating. Such relationships are often attributed to deficient emotional self-regulation in alexithymia, ostensibly leading to the use of maladaptive, externalized behaviors as strategies for coping with distress. An alternative view is that alexithymia reflects a fundamental deficit of interoceptive awareness that, in the case of binge eating, would suggest that internal satiety cues are poorly recognized, promoting overconsumption. The present study assessed the relationship between alexithymia and binge eating in the context of these competing hypotheses. A large online sample of young adults (n = 532) completed validated measures of alexithymia, emotion regulation, interoception, binge eating, emotional eating motivation, and sensitivity to reward and punishment. Correlations were as expected except for interoception, which showed minimal association with alexithymia or binge eating. In a hierarchical regression controlling for age, gender, education level and student status as covariates, binge eating was predicted by emotional eating motivation, emotion regulation (a negative predictor), alexithymia, and reward sensitivity, with the final model explaining 53% of variance in binge eating. Bootstrapped path analyses controlling for all other variables indicated that the relationship between alexithymia and binge eating was mediated by deficient emotion regulation but not deficient interoception, and that the relationships of both alexithymia and emotion regulation with binge eating were mediated by emotional eating motivation. Results are consistent with the notion that the association of alexithymia with binge eating reflects deficient emotion regulation in alexithymia, which can lead to adoption of maladaptive, externalized behaviors such as binge eating for coping with distress.

Emotion regulation difficulties as common and unique predictors of impulsive behaviors in university students

Objectives: Researchers examined associations between specific forms of emotion dysregulation and numerous behavioral manifestations of impulsivity (i.e., problematic alcohol use, drug use, risky sexual activity, binge eating, non-suicidal self-injury). Participants: Participants were 238 undergraduate students (69% female). Method: Emotion dysregulation was assessed using the Difficulties in Emotion Regulation Scale (DERS). Path models examined each DERS subscale on its own, and all DERS subscales together, as predictors of all impulsive behaviors. Results: Lack of emotional clarity predicted the largest number of impulsive behaviors, both on its own and after controlling for other forms of emotion dysregulation. Non-acceptance of emotions and difficulties achieving goals when upset also related to several impulsive behaviors. Conclusions: Certain emotion regulation difficulties, particularly poor emotional clarity, may represent specific mechanisms that lead to maladaptive impulsive behaviors. Findings provide useful information for incorporating specific emotion regulation skills in harm prevention programs and treatments for university students.

Alexithymia mediates the association between childhood trauma and adolescent E-cigarette use

BACKGROUND

Adolescent electronic cigarette use (e-cigarette) is a public health concern and factors associated with vaping remain to be understood. Childhood emotional abuse/neglect is a risk factor for e-cigarettes. Yet, pathways by which trauma impacts use remain unclear. Alexithymia (i.e., difficulties identifying and describing feelings) is one possible link. Indeed, emotional abuse/neglect leads to difficulties identifying and verbalizing emotions. This impairment may lead to distress and promote e-cigarette use as a coping strategy.

METHODS

Using parallel mediation, this study examined the degree to which alexithymia, assessed using the Toronto Alexithymia Scale, mediates the link between emotional abuse/neglect, assessed using the Child and Adolescent Trauma Screen, and e-cigarette use. The sample (n = 166) consisted of adolescents from a larger multi-wave study.

RESULTS

Emotional abuse/neglect predicted difficulty describing feelings (effect = 0.23, p = 0.001), which in turn predicted e-cigarette use (effect = 0.30, p = 0.004). Moreover, difficulty describing feelings mediated the link between emotional abuse/neglect and e-cigarette use (sum of indirect 95% CI [1.68, 16.48]). Difficulty identifying feelings was not a significant mediator and the externally-oriented thinking subscale was excluded due to low reliability.

CONCLUSIONS

As e-cigarettes are often used in social contexts, teens who experience difficulty describing feelings may vape as a means of connecting emotionally with others. Moreover, nicotine, found in most e-cigarettes, releases dopamine and noradrenaline in the brain modulating action, learning, and memory processes; plausibly, improving verbalization of emotions. Programming which identifies nuances in alexithymia among adolescents with emotional abuse/neglect could mitigate e-cigarette use or delay initiation.

Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients

BACKGROUND

Alexithymia, which is characterized by difficulty identifying and describing feelings, is a stable personality trait and it has been associated with early life experiences. Methamphetamine dependence patients with high level of alexithymia may be particularly vulnerable to engaging in more frequent methamphetamine use. Therefore, we aimed to evaluate whether alexithymia was associated with frequency of methamphetamine use. Additionally, the current study sought to examine early-life factors associated with the development of alexithymia, i.e., parental rearing styles.

METHOD

Participants were 108 non-injecting methamphetamine dependent patients from a male compulsory detoxification center. The level of alexithymia was assessed by Toronto Alexithymia Scale-20(TAS-20). In addition, we applied Egna Minneu av. Bardndosnauppforstran (EMBU) to assess the parental rearing styles, including the dimensions of warmth, rejection, punishment/strictness, overinvolvement, overprotection, and favoring.

RESULTS

The total score of TAS-20 was positively correlated with frequency of methamphetamine use (r = 0.26, p < 0.01). Specifically, except for externally oriented thinking, difficulty identifying feelings (r = 0.23, p < 0.05) and difficulty describing feelings (r = 0.25, p < 0.05) were positively correlated with frequency of methamphetamine use. Multiple linear regression showed that more maternal rejection (B = 0.59, p = 0.002), or less maternal warmth (B = -0.22, p = 0.004) was associated with higher levels of alexithymia. Ordinal logistic regression showed that for every 1 score increase in the total score of TAS-20, there was a 1.06 times risk of a one level increase in the level of methamphetamine use frequency (OR = 1.06, p = 0.01).

CONCLUSIONS

These results have major implications for understanding the role of alexithymia in craving and addiction, while providing a further and explicit entry point for addiction treatment. Moreover, more attention should be focused on parenting in relation to early experiences.

Perceptive and Affective Impairments In Emotive Eye-Region Processing in Alexithymia

Alexithymia is characterized by impairments in emotion processing, frequently linked to facial expressions of emotion. The eye-region conveys information necessary for emotion processing. It has been demonstrated that alexithymia is associated with reduced attention to the eyes, but little is known regarding the cognitive and electrophysiological mechanisms underlying emotive eye-region processing in alexithymia. Here, we recorded behavioral and electrophysiological responses of individuals with alexithymia (ALEX; n = 25) and individuals without alexithymia (NonALEX; n = 23) while they viewed intact and eyeless faces with angry and sad expressions during a dual-target rapid serial visual presentation task. Results showed different eye-region focuses and differentiating N1 responses between intact and eyeless faces to anger and sadness in NonALEX, but not in ALEX, suggesting deficient perceptual processing of the eye-region in alexithymia. Reduced eye-region focus and smaller differences in frontal alpha asymmetry in response to sadness between intact and eyeless faces were observed in ALEX than NonALEX, indicative of impaired affective processing of the eye-region in alexithymia. These findings highlight perceptual and affective abnormalities of emotive eye-region processing in alexithymia. Our results contribute to understanding the neuropsychopathology of alexithymia and alexithymia-related disorders.

Reduced calibration between subjective and objective measures of episodic future thinking in alcohol use disorder

BACKGROUND

A reduced capacity to mentally simulate future scenarios could be of clinical importance in alcohol use disorder (AUD). However, little is known about the mechanisms underlying episodic future thinking (EFT) impairment in AUD.

METHODS

We tested patients with severe AUD using two measures of EFT: the individual's own subjective experience of their imaginings (phenomenology) and the objective number of details included in imagined events, as assessed by an independent observer (examination). The comparison between the two measures allowed us to investigate the extent to which the subjective and objective characteristics of EFT are calibrated in healthy and AUD participants matched for age, education, and gender. The possible impact of cognitive functioning and disturbed mood on EFT measures was also investigated.

RESULTS

In terms of objective details of EFT, patients with AUD (n = 40) generated fewer episodic components and more non-episodic components than control participants (n = 40), even when controlling for cognitive functioning. However, self-ratings of phenomenological characteristics indicated that participants with AUD perceived imagined future events at a similar level of detail as control participants. Additionally, there was a significant correlation between objective and subjective measures in healthy individuals but not in the AUD group. A higher depression score in the AUD group was not associated with the EFT measures.

CONCLUSIONS

These results suggest a distorted self-assessment of the richness of imagined future events in individuals with AUD. We discuss these apparent limitations in metacognitive abilities and verbal descriptions of imagined events among individuals with AUD and their clinical implications.

Alexithymia disrupts emotion regulation processes and is associated with greater negative affect and alcohol problems

OBJECTIVE

Alexithymia is common among people who abuse alcohol, yet the mechanisms by which alexithymia exerts its influence remain unclear. This analysis tested a model whereby the three subscales of the Toronto Alexithymia Scale exert an indirect effect on alcohol problems through difficulties with emotion regulation and psychological distress.

METHOD

Men and women (n = 141) seeking alcohol use disorder (AUD) treatment completed the Toronto Alexithymia Scale, the Difficulties with Emotion Regulation Scale, the Brief Symptom Inventory, the Short Inventory of Problems, and the Alcohol Dependence Scale.

RESULTS

The Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale was positively associated with alcohol problems through emotion dysregulation and psychological distress. The other two subscales, Difficulty Describing Feelings and Externally oriented Thinking, were not associated with any other variables.

CONCLUSION

People with alexithymia may consume alcohol to help regulate undifferentiated states of emotional arousal. Given the prevalence of alexithymia among people who abuse alcohol, treatment supplements that enhance the identification of emotions are needed.

Mediation role of alexithymia, sensory processing sensitivity and emotional-mental processes between childhood trauma and adult psychopathology: a self-report study

BACKGROUND

There is overwhelming evidence for a strong association between childhood trauma and adult psychopathology. This study aimed to investigate the mediation roles of alexithymia, sensory processing sensitivity, and emotional-mental processes in the relationship between childhood traumas and adult psychopathology.

METHODS

The sample consisted of 337 people (78.9% female, 21.1% male) aged between 20 and 64 years. Participants filled the scales online via a Google form. Reading Mind in the Eyes (EYES), Sensory Processing Sensitivity Scale (SPS), Toronto Alexithymia Scale (TAS-26), Childhood Trauma Questionnaire (CTQ), and the Brief Symptom Inventory (BSI) were used. PROCESS (Model 4) macro was used to examine the mediating role of sensory processing sensitivity, alexithymia, and the EYES test results in the relationship between childhood trauma and psychopathology.

RESULTS

The results of mediation analysis demonstrated that sensory processing sensitivity and alexithymia mediated the relationship between childhood trauma and adult psychopathology. However, the EYES test (mentalization) did not mediate in this relationship.

CONCLUSION

This study shows that childhood traumas may relate to more psychological symptoms in individuals with high sensory processing sensitivity and alexithymia. Our study may contribute to the understanding of what may lead to a person's vulnerability to experiencing psychological symptoms after childhood trauma. It may be crucial that future treatment and intervention programs should include sensory sensitivity and alexithymia. Sensory processing sensitivity and alexithymia can be examined in the treatment of psychological problems of individuals who have experienced childhood trauma.

Social-Specific Impairment of Negative Emotion Perception in Alexithymia

Alexithymia has been characterized as an impaired ability of emotion processing and regulation. The definition of alexithymia does not include a social component. However, there is some evidence that social cognition may be compromised in individuals with alexithymia. Hence, emotional impairments associated with alexithymia may extend to socially relevant information. Here, we recorded electrophysiological responses of individuals meeting the clinically relevant cutoff for alexithymia (ALEX; n = 24) and individuals without alexithymia (NonALEX; n = 23) while they viewed affective scenes that varied on the dimensions of sociality and emotional valence during a rapid serial visual presentation task. We found that ALEX exhibited lower accuracy and larger N2 than NonALEX in the perception of social negative scenes. Source reconstruction revealed that the group difference in N2 was localized at the dorsal anterior cingulate cortex. Irrespective of emotional valence, ALEX showed stronger alpha power than NonALEX in social but not non-social conditions. Our findings support the hypothesis of social processing being selectively affected by alexithymia, especially for stimuli with negative valence. Electrophysiological evidence suggests altered deployment of attentional resources in the perception of social-specific emotional information in alexithymia. This work sheds light on the neuropsychopathology of alexithymia and alexithymia-related disorders.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).

Investigating defensive functioning and alexithymia in substance use disorder patients

BACKGROUND

Substance Use Disorder (SUD) causes a great deal of personal suffering for patients. Recent evidence highlights how defenses and emotion regulation may play a crucial part in the onset and development of this disorder. The aim of this study was to investigate potential differences in the defensive functioning between SUD patients and non-clinical controls. Secondly, we aimed at investigating the relationships between alexithymia and maladaptive/assimilation defenses.

METHODS

The authors assessed defensive functioning (Response Evaluation Measure-71, REM-71), personality (MMPI-II), and alexithymia (TAS-20) of 171 SUD patients (17% female; mean age = 36.5), compared to 155 controls. Authors performed a series of ANOVAs to investigate the defensive array in SUD patients compared to that of non-clinical controls. Student t test for indipendent samples was used to compare clinical characteristics between the SUD group and the controls. To investigate the role of single defenses in explaining alexithimia's subscores, stepwise multiple regression analysis were carried out on socio-demographic characteristics of participants (gender, age, and years of education), with REM-71 defenses as predictors.

RESULTS

SUD patients presented a more maladaptive/assimilation (Factor 1) defensive array (p < .001). Among SUD sub-groups, Alcohol Use Disorder patients showed more disfuncional defenses. Factor 1 defenses were related to a worse psychological functioning. In addition, alexyhimia (particularly DIF) was strongly related to Factor 1 defenses, expecially Projection (38% of variance explained, β = .270, p < .001).

CONCLUSION

The REM-71 and the TAS-20 might be useful screening instruments among SUD patients.

A unifying translational framework to advance treatment research for comorbid PTSD and substance use disorders

We provide a unifying translational framework that can be used to synthesize extant lines of human laboratory research in four neurofunctional domains that underlie the co-occurrence of posttraumatic stress and substance use disorders (PTSD+SUD). We draw upon the Alcohol and Addiction Research Domain Criteria (AARDOC) to include executive functioning, negative emotionality, reward, and added social cognition from the National Institute of Mental Health (NIMH) Research Domain Criteria into our framework. We review research findings across each of the four domains, emphasizing human experimental studies in PTSD, SUD, and PTSD+SUD for each domain. We also discuss the implications of research findings for treatment development by considering new ways of conceptualizing risk factors and outcomes at the level of the individual patient, which will enhance treatment matching and advance innovations in intervention.

Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

BACKGROUND

Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults.

METHODS

We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample.

RESULTS

The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism.

LIMITATIONS

Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations.

CONCLUSIONS

These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).

Is alexithymia related to retention and relapses in patients with substance use disorders?: A one year follow-up study

Alexithymia is related to a higher severity of substance use disorders (SUD); however, few longitudinal studies have been performed on how alexithymia impacts treatment outcomes. This study aims to evaluate alexithymia as a factor that could influence retention and the time of the first relapse in a one-year follow-up in an outpatient treatment center for SUD. In total, 126 SUD outpatients (74.60% males; M age = 43.71, SD = 14.61 years) were evaluated at baseline with an AdHoc questionnaire for sociodemographic variables, the European Addiction Severity Index (EuropASI), the Semi-structured Clinical Interview for Axis I and Axis II Disorders of the DSM-IV, and the Toronto Alexithymia Scale (TAS-20). The prevalence of alexithymia was 41.3% and the mean score of TAS-20, was 57.27 (SD = 12.84). At baseline, alexithymia was related to a lower education level, cannabis use disorder, the psychological item of EuropASI, and mood spectrum disorders. In the Kaplan-Meier analysis, SUD patients with alexithymia were in treatment for less time and presented earlier relapses than non-alexithymic patients. In the Cox regression, alexithymia was only associated with less time in treatment. Therefore, alexithymia may have an important role in the outcomes of SUD treatment, and hence, therapeutic approaches for SUD that cover emotional impairments associated with alexithymia should be investigated and developed.

Alexithymia in Patients With Substance Use Disorders and Its Relationship With Psychiatric Comorbidities and Health-Related Quality of Life

Background: Alexithymia frequently correlates with several psychiatric disorders, including substance use disorder (SUD). However, most studies reporting the associations between alexithymia and psychiatric disorders have been performed in populations without SUD. This research, therefore, evaluates alexithymia in Spanish patients with SUD and the relationship among alexithymia, psychiatric comorbidities, psychological symptoms/traits, SUD variables, and health-related quality of life (HRQoL). Methodology: A cross-sectional study was conducted with 126 Spanish outpatients with SUD (75.4% males; mean age 43.72 ± 14.61 years), correlating their alexithymia levels (using the Toronto Alexithymia Scale 20 [TAS-20]) to their psychiatric comorbidities, psychological symptoms/traits, SUD variables, and HRQoL. Results: Alexithymia was significantly higher in patients who had cannabis use disorder. Higher alexithymia scores were also related to higher levels of depression, anxiety, impulsivity, and lower HRQoL. After multivariate analysis, trait anxiety, impulsivity, and the physical component summary of the HRQoL were found to be independently related to alexithymia. Conclusions: SUD patients with higher alexithymia levels have more frequently psychiatric comorbidities, present specific psychological features, and have worse HRQoL. Hence, it is important to evaluate these factors and offer more accurate psychotherapeutic approaches for this patient population.

Deter the emotions: Alexithymia, impulsivity and their relationship to binge drinking

Introduction

The relevance of both emotion processing and impulsivity to alcohol use and misuse is increasingly recognised, yet there is a scarcity of studies addressing their reciprocal interaction. The present study aimed to examine the role that difficulties in emotion processing and trait impulsivity play in explaining binge drinking pattern of alcohol use in student population. We looked at binge drinking, as it is a risk factor to later alcohol abuse and is a common alcohol drinking habit among students. Alexithymia (from Greek as "deter/repel emotions"), a difficulty in identifying and describing feelings in self and others is increasingly recognised as a feature of alcohol misuse.

Methods

One-hundred and seventy-four student alcohol drinkers were assessed for their drinking habits (Alcohol Use Questionnaire), as well as for alexithymia (Toronto Alexithymia Scale) and impulsivity trait (Barratt Impulsiveness Scale); facial emotional expression judgements were also tested.

Results

A direct relationships between, both, alexithymia and impulsivity, and binge drinking was found. When combined, trait impulsivity partially mediated the relationship between alexithymia and binge drinking. Facial emotional expression judgements also showed a relationship with binge drinking.

Conclusions

These findings highlight the importance of both emotion processing and impulsivity in understanding binge drinking and indicate potential routes for prevention and intervention techniques, especially towards those who may be at risk of later alcohol abuse.