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Telli B, Bilge AR. Literally or prosodically? Recognising emotional discourse in alexithymia. Cogn Emot 2024:1-15. [PMID: 39039748 DOI: 10.1080/02699931.2024.2380762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
Alexithymia is characterised by difficulties in identifying, recognising, and describing emotions. We studied alexithymia in the context of speech comprehension, specifically investigating the incongruent condition between prosody and the literal meaning of words in emotion-based discourse. In two experiments, participants were categorised as having high or low alexithymia scores based on the TAS-20 scale and listened to three-sentence narratives where the emotional prosody of a key phrase or a keyword was congruent or incongruent with its literal meaning. The incongruent condition resulted in slower reaction times and lower accuracy in recognition of emotions. This incongruence effect was also evident for individuals with high alexithymia, except for anger. They recognised anger as accurately in both congruent and incongruent conditions. Contrary to our hypothesis, however, individuals with high alexithymia did not show an overall difference in emotion recognition compared to the low alexithymia group. These findings highlight the nuanced relationship between emotional prosody and literal meaning, offering insights into how individuals with varying levels of alexithymia process emotional discourse. Understanding these dynamics has implications for both cognitive research and clinical practice, providing valuable perspectives on speech comprehension, especially in situations involving incongruence between prosody and word meaning.
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Affiliation(s)
| | - A Reyyan Bilge
- Department of Psychology, Northeastern University, Boston, MA, USA
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2
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Morie KP, Lord KA, Diefenbach GJ, Basuchoudhary O, Lewis S, Assaf M. Subscales of alexithymia show unique pathways through reappraisal and suppression to anxiety, depression and stress. J Affect Disord 2024; 347:445-452. [PMID: 38007105 PMCID: PMC10842914 DOI: 10.1016/j.jad.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/26/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
The goal of this work was to explore associations of constituent factors of alexithymia on mental health and potential mediating effects of emotion regulation strategies, specifically suppression and reappraisal. Data were collected through the crowd-sourcing platform Amazon Mechanical Turk (MTURK). Three hundred seventy-seven individuals completed questionnaires related to distress (Depression Anxiety Stress Scales [DASS]), emotion regulation (Emotion Regulation Questionnaire [ERQ]) and Alexithymia (Bermond-Vorst Alexithymia Questionnaire [BVAQ]). Three mediation models were constructed for depression, anxiety and stress, with BVAQ subscales (verbalizing, identifying, emotionalizing, fantasizing, and analyzing) as predictors and ERQ subscales (suppression and reappraisal) as mediators. Results indicated 37.3 % variance in depression, 25.2 % variance in anxiety, and 35.3 % variance in stress was explained by each model. Direct associations revealed emotionalizing and fantasizing were negatively associated with depression, anxiety, and stress, while verbalizing was additionally associated with depression, identifying was additionally associated with anxiety, and all four BVAQ subscales were associated with stress. BVAQ subscales demonstrated negative associations with reappraisal and positive associations with suppression that mediated anxiety and depression. However, suppression did not mediate relationships between BVAQ subscales with stress. Findings support the importance of examining multiple factors of alexithymia and associations with emotion regulation strategies and distress.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Kayla A Lord
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Anxiety Disorders Center, The Institute of Living, Hartford, CT 06106, USA
| | - Gretchen J Diefenbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Anxiety Disorders Center, The Institute of Living, Hartford, CT 06106, USA
| | - Oishani Basuchoudhary
- Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, CT 06106, USA
| | - Stephanie Lewis
- Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, CT 06106, USA
| | - Michal Assaf
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, CT 06106, USA
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3
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Zhou Y, Peng P, Yuan N, Xiong Y, Luo Y, Liu L, Tan R, Nie W, Wang Y, Zhang X. Suicidal ideation in Chinese patients with chronic schizophrenia: prevalence, clinical correlates, and relationship with alexithymia. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01630-w. [PMID: 37310424 DOI: 10.1007/s00406-023-01630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
Suicidal ideation (SI) is common among people with schizophrenia. However, it has received less attention than suicide attempts (SA), especially in the Chinese population. Alexithymia is a well-established risk factor for SI across different populations. Nevertheless, very few studies evaluated their relationship in schizophrenia patients. We aimed to determine the prevalence and clinical correlates of SI and its relationship with alexithymia in 812 Chinese chronic schizophrenia inpatients. We assessed SI, clinical symptoms, and alexithymia by the Beck Scale for Suicidal Ideation, the Positive and Negative Syndrome Scale (PANSS), and the Toronto Alexithymia Scale, respectively. A multiple logistic regression model was conducted to identify independent correlates of SI. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were performed to determine the ability of our model to distinguish between patients with and without SI. 10% (n = 84) reported current SI. Lifetime SA (OR, 4.68; 95% CI 2.76-7.94, p < 0.001), PANSS depressive factor (OR, 1.24; 95% CI 1.12-1.38, p < 0.001), PANSS positive subscale (OR, 1.055; 95% CI 1.004-1.108, p = 0.035), and difficulty identifying emotions (OR, 1.07; 95% CI 1.03-1.12, p = 0.002) were associated with SI. The AUC value was 0.80, indicating excellent distinguishing capabilities. Timely assessments of these factors may help identify schizophrenia patients who are at risk for SI.
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Affiliation(s)
- Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ning Yuan
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yifan Xiong
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yinli Luo
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Lini Liu
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Rongrong Tan
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Wei Nie
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yuan Wang
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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4
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Elwyn R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 2023; 11:2. [PMID: 36604749 PMCID: PMC9815687 DOI: 10.1186/s40337-022-00729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Çavdar Toraman M, Sarigedik E, Özçetin A. Evaluation of Psychological Resilience, Alexithymia, and Impulsivity Characteristics in Persons Who Attempted Suicide with Drugs. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221142092. [PMID: 36441644 DOI: 10.1177/00302228221142092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE In this study, it was aimed to research the connection between psychological resilience, alexithymia, depression, anxiety and impulsivity in patients who attempted suicide with drugs. METHODS The patient group (n = 66) who attempted suicide with drugs and the control group (n = 66) without any psychiatric diagnosis were examined in the study. Sociodemographic data form, Psychological Resilience Scale, Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale (BIS-11) were used in the study. RESULTS It was found that PRS dedication and challenge are significantly higher in the control group (p = .039 and p = .003, respectively). When the undiagnosed group who attempted suicide were compared with the control group, it was observed that there is a significant difference between BIS-11 total and TAS total after bonferonni correction (respectively; p = .002; p = .001), while, there is no statistically significant difference in terms of PRS total score (p = .483). CONCLUSION It was observed that patients who attempted suicide with drugs had low levels of psychological resilience, high alexithymia levels. In the absence of an additional diagnosis of depression, psychological resilience did not differ in terms of suicide attempts. In the suicide group, those who did not receive any additional diagnosis were not more impulsive than those who were depressed.
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Affiliation(s)
| | - Enes Sarigedik
- Department of Child and Adolescent Psychiatry, Sakarya University, Sakarya, Turkey
| | - Adnan Özçetin
- Department of Psychiatry, Duzce University, Duzce, Turkey
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6
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Creating Inclusive Classrooms for Highly Dysregulated Students: What Can We Learn from Existing Literature? EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12080504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The ability to self-regulate is a key focus for educators, especially for neurodivergent students, such as those with ADHD, fetal alcohol syndrome, mental health difficulties, autism, and/or anxiety. Students not being able to self-regulate frequently results in their behaviours being labelled as “naughty” or “challenging” by teachers. Continued dysregulation can lead to periods of suspension and exclusion, impacting both attendance rates for students and their broader families. Previous research has shown that the impacts of poor self-regulation can be wide-ranging, spanning both social and academic outcomes. The broad negative impact of poor self-regulation means that it is important to support families and classroom teachers to effectively improve children’s self-regulation. However, to support families and educators, there is a need to develop and deploy a theoretical framework to suggest why self-regulation may be under-developed and, conversely, how self-regulation may be effectively developed across a wide range of contexts. This paper considers current literature exploring the links between individual experiences of emotions and connections with core abilities of interoception, self-regulation, emotional intelligence, and metacognition. It outlines a hypothesised model of how these abilities intertwine and how supporting core building blocks within educational settings can enable supportive and inclusive educational contexts, providing positive experiences for students and teachers alike.
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Sun G, Liu Z, Ma Z, Lew B, Jia C. The Relationship Between Negative Focused Disposition and Suicidal Ideation Among College Students: The Mediating Effects of Somatic Anxiety, General Distress, and Depression. Front Psychiatry 2022; 13:928666. [PMID: 35836665 PMCID: PMC9275592 DOI: 10.3389/fpsyt.2022.928666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Suicide among college students is a major public health problem. Research has confirmed that negative focused disposition had a significant effect on suicidal ideation. This study aims to evaluate somatic anxiety, general distress and depression as mediators of the relationship between negative focused disposition and suicidal ideation. METHODS A total of 1798 college students (942 males) were recruited to complete measures of negative focused disposition, somatic anxiety, general distress, positive affect and suicidal ideation. The mediation models were conducted to assess the mediating effects of somatic anxiety, general distress and depression. RESULTS There was a significant and positive correlation between negative focused disposition and suicidal ideation in Chinese college students. On mediation analysis, somatic anxiety, general distress and depression mediated the relationship between negative focused disposition and suicidal ideation. CONCLUSIONS Negative focused disposition appears to directedly associate with suicidal ideation and can indirectly relate to suicidal ideation through the relation with somatic anxiety, general distress and depression. College students with few positive expectations of the future may benefit from interventions focusing on somatic anxiety, general distress and depression.
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Affiliation(s)
- Guoxiao Sun
- School of Physical Education, Shandong University, Jinan, China
| | - Zongyu Liu
- School of Physical Education, Shandong University, Jinan, China
| | - Zhiyao Ma
- School of Physical Education, Shandong University, Jinan, China
| | - Bob Lew
- Griffith University, School of Applied Psychology, Australian Inst Suicide Res & Prevent, Brisbane, QLD, Australia
| | - Cunxian Jia
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Lloyd CS, Stafford E, McKinnon MC, Rabellino D, D'Andrea W, Densmore M, Thome J, Neufeld RWJ, Lanius RA. Mapping alexithymia: Level of emotional awareness differentiates emotion-specific somatosensory maps. CHILD ABUSE & NEGLECT 2021; 113:104919. [PMID: 33476805 DOI: 10.1016/j.chiabu.2020.104919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Emotions have been associated with culturally universal and distinct bodily sensation "maps". Despite this knowledge, to date few studies have explored emotion-specific topography along clinically relevant dimensions, such as alexithymia. OBJECTIVE We aimed to investigate emotion-specific topographies among individuals exposed to childhood maltreatment or neglect with absent (n = 51) or with probable (n = 46) alexithymia in adulthood, as defined by scores on the Toronto Alexithymia Scale (TAS-20). PARTICIPANTS AND SETTING Ninety eight adult participants with exposure to childhood maltreatment or neglect were recruited to complete an online survey. METHODS Using the well-validated emBODY tool (Nummenmaa et al., 2014), participants reported on their somatic experience of 17 emotions. RESULTS Random effects analyses revealed topographically distinct bodily sensation t-maps that differentiated participants who endorsed probable alexithymia from those who did not (p-FDR < .05). Consistent with our a priori hypothesis, the probable alexithymia group reported a muted, diffuse and undifferentiated pattern of emotion-specific bodily sensation, whereas the non-alexithymia group reported a more distinct and localized pattern. CONCLUSIONS These results suggest that difficulty identifying and labeling emotions, as observed in alexithymia, may arise, in part, from an altered perception of somatic activation. It is well-established that childhood maltreatment predicts the development of alexithymia symptoms. The preliminary findings presented here expand our working understanding of the physical markers of childhood trauma, which may be used in practice to aid detection and to monitor treatment outcomes.
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Affiliation(s)
- Chantelle S Lloyd
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada
| | - Erin Stafford
- The New School for Social Research, New York, NY, USA
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada
| | - Daniela Rabellino
- Department of Psychiatry, Western University, London, Ontario, Canada; Imaging Department, Lawson Health Research Institute, London, Ontario, Canada
| | | | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada; Imaging Department, Lawson Health Research Institute, London, Ontario, Canada
| | - Janine Thome
- Department of Psychiatry, Western University, London, Ontario, Canada; Department of Theoretical Neuroscience, Heidelberg University, Heidelberg, Germany
| | - Richard W J Neufeld
- Department of Psychiatry, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada; Department of Neuroscience, Western University, London, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada; Department of Neuroscience, Western University, London, Ontario, Canada; Imaging Department, Lawson Health Research Institute, London, Ontario, Canada; Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada.
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9
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Abstract
Suicide is a preventable health problem. Multiple definitions and inconsistent use of the term suicidality can result in failure to properly recognize suicide risk and behavior and confuses suicide research. Clarification of the suicidality concept is needed to facilitate the care for individuals at risk for suicide. Using Rodgers' evolutionary concept analysis method, this analysis describes the breadth and scope of the suicidality concept. Findings indicate suicidality covers a spectrum of suicidal risk and levels of emotional suffering and intent. The analysis does not draw definite conclusions, but outlines a direction for further research.
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Affiliation(s)
- Tamara Pike Keefner
- Nursing, South Dakota State University - College of Nursing, Rapid City, South Dakota, USA
| | - Thomas Stenvig
- Graduate Nursing, South Dakota State University - College of Nursing, Brookings, Rapid City, South Dakota, USA
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10
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Conner CM, Golt J, Righi G, Shaffer R, Siegel M, Mazefsky CA. A Comparative Study of Suicidality and Its Association with Emotion Regulation Impairment in Large ASD and US Census-Matched Samples. J Autism Dev Disord 2020; 50:3545-3560. [PMID: 31939083 DOI: 10.1007/s10803-020-04370-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Evidence suggests increased rates of suicidality in autism spectrum disorder (ASD), but the research has rarely used comparison samples and the role of emotion dysregulation has not been considered. We compared the prevalence of parent-reported suicidality ideation and considered the role of emotion dysregulation in 330 psychiatric inpatient youth with ASD, 1169 community youth with ASD surveyed online, and 1000 youth representative of the US census. The prevalence of suicidal ideation was three and five times higher in the community and inpatient ASD samples, respectively, compared to the general US sample. In the ASD groups, greater emotion dysregulation was associated with suicidal ideation. Implications include consideration of emotion regulation as a potential mechanism and treatment target for suicidality in ASD.
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Affiliation(s)
- Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA
| | - Josh Golt
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA
| | - Giulia Righi
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Providence, RI, USA
- Division of Biology and Medicine, Rhode Island Consortium for Autism Research and Treatment (RI-CART), and the Hassenfeld Child Health Innovation Institute (HCHII), Brown University, Providence, RI, USA
| | - Rebecca Shaffer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew Siegel
- Maine Medical Center Research Institute, Spring Harbor Hospital, Tufts University School of Medicine, Westbrook, ME, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA.
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11
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Bergmans Y, Guimond T, Lambert C, McInerney S, O'Brien K. Alexithymia in People With Recurrent Suicide Attempts. CRISIS 2020; 42:425-433. [PMID: 33241742 DOI: 10.1027/0227-5910/a000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Alexithymia, an inability to identify or describe emotions, is associated with suicidality yet the correlation with single or repeated suicide attempts is less clear. Aims: We aimed to assess the modifiability of alexithymia following a group psychosocial intervention focused on improving emotional literacy in those with a history of recurrent suicide attempts (RSA). Method: A total of 169 participants with self-reported RSA completed pre- and postgroup assessments of a 20-week group therapy intervention. Questionnaires assessed alexithymia, depression, impulsivity, and hopelessness; the Toronto Alexithymia Scale (TAS-20) was the primary outcome. Data were analyzed using multiple imputation. Results: Participants had on average 7.8 lifetime suicide attempts, 73% were female, and 16.6% had a >13-point reduction in TAS-20 scores after 20 weeks. Directed acyclic graph (DAG) analysis demonstrated significant relationships between alexithymia, depression, hopelessness, problem-solving, and satisfaction with life. Age of onset of suicidality was the only factor predictive of postintervention TAS-20 score in univariate linear regression. Limitations: The study limitations were its sample size, insufficient resources, and missing data. Conclusion: A change in TAS scores indicated that alexithymia can be a modifiable treatment target. Being able to identify and describe feelings may lead to improvement in depression, hopelessness, problem-solving, and satisfaction with life in this population.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada
| | - Tim Guimond
- Department of Psychiatry, University of Toronto, ON, Canada
| | - Clare Lambert
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Royal College of Surgeons, Dublin, Ireland
| | - Shane McInerney
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada.,Department of Psychiatry, University Hospital Galway, Ireland
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12
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Norman H, Oskis A, Marzano L, Coulson M. The relationship between self‐harm and alexithymia: A systematic review and meta‐analysis. Scand J Psychol 2020; 61:855-876. [DOI: 10.1111/sjop.12668] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Hilary Norman
- Faculty of Science and Technology Middlesex University London UK
| | - Andrea Oskis
- Faculty of Science and Technology Middlesex University London UK
| | - Lisa Marzano
- Faculty of Science and Technology Middlesex University London UK
| | - Mark Coulson
- School of Psychology University of East Anglia Norwich UK
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13
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De Berardis D, Fornaro M, Valchera A, Rapini G, Di Natale S, De Lauretis I, Serroni N, Orsolini L, Tomasetti C, Bustini M, Carano A, Vellante F, Perna G, Core L, Alessandrini M, Fraticelli S, Martinotti G, Di Giannantonio M. Alexithymia, resilience, somatic sensations and their relationships with suicide ideation in drug naïve patients with first-episode major depression: An exploratory study in the "real world" everyday clinical practice. Early Interv Psychiatry 2020; 14:336-342. [PMID: 31402575 DOI: 10.1111/eip.12863] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/20/2019] [Accepted: 07/14/2019] [Indexed: 12/15/2022]
Abstract
AIM The present study is aimed at revaluating alexithymia, somatic sensations, resilience and their relationships with suicide ideation in drug naïve adult outpatients suffering from first episode major depression (MD). METHODS Data of 103 adult outpatients (49 men, 56 women) with a diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) diagnosis of MD were analysed. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20) and resilience with the 25 items Connor-Davidson Resilience Scale (CD-RISC) whereas depression was evaluated using the 17-item Hamilton Depression Rating Scale, somatic sensations with the Body Sensations Questionnaire and suicide ideation with Scale of Suicide Ideation (SSI). RESULTS Gender comparisons between all demographic and clinical variables showed no significant differences in all variables. Subjects who were found positive for alexithymia showed higher scores on all clinical variables controlling for age, gender and duration of the current episode. In a linear regression model, lower scores on CD-RISC and Difficulty in Identifying Feelings dimension of TAS-20 were significantly predictive of higher scores on SSI. CONCLUSIONS Alexithymia and low resilience were significant predictors of increased suicide ideation in a first MD episode. However, study limitations must be considered and future research needs are being discussed.
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Affiliation(s)
- Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy.,Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Michele Fornaro
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy
| | - Alessandro Valchera
- Polyedra Research Group, Teramo, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Gabriella Rapini
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy
| | - Serena Di Natale
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy
| | - Ida De Lauretis
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Nicola Serroni
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Laura Orsolini
- Polyedra Research Group, Teramo, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Carmine Tomasetti
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | | | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", San Benedetto del Tronto, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, Italy.,Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, Florida
| | - Laura Core
- NHS, Department of Mental Health, Center of Mental Health, ASL 4, Giulianova, Italy
| | - Marco Alessandrini
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Silvia Fraticelli
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
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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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Duquette P. More Than Words Can Say: A Multi-Disciplinary Consideration of the Psychotherapeutic Evaluation and Treatment of Alexithymia. Front Psychiatry 2020; 11:433. [PMID: 32523552 PMCID: PMC7261853 DOI: 10.3389/fpsyt.2020.00433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Alexithymia is a disorder that stands at the border of mind and body, with psychological/affective and physiological/experiential disturbances. The purpose of this article is to propose a new clinical access point for the evaluation and treatment of the deficits in emotional awareness demonstrated in alexithymia. This will be based on insights from recent neuroscientific research, which is adding to the psychodynamic understanding of alexithymia, regarding clinical presentation and etiology. Following a brief review of definitions, forms of measurement, and potential etiologic elements of alexithymia, current neuroscientific theory and research into "predictive processing" approaches to brain function will be outlined, including how "interoception" and "interoceptive inference" underpins emotion and emotional awareness. From this synergistic perspective, I will outline how interoceptive inference provides a key to the link between: problems in early life relational experiences and the patient's long held, but suboptimal models of their inner and outer world. This is reflected in the deficits in affective experiencing and emotional awareness described in alexithymia. Three clinical cases will be presented to illustrate this nuanced consideration of alexithymic etiology and treatment. The implications of the historical, psychological, and somatic aspects of experience will be considered, regarding the patients' diminished ability to: experience and represent emotional experience as distinct feeling states; signify the relevant meaning of affective experience; and incorporate such with cognitions to adaptively guide behavior. These will be addressed using psychometric, psychological, neuro-cognitive, and neurocomputational approaches. Elements from current theory, research, and treatment of alexithymia, will be highlighted that are salient to the clinician, in order to support their understanding of patients against the backdrop of current psychodynamic and neuroscientific research, which will thereby increase treatment options and benefits. The focus, and conclusion, of this article is the role that attention to interoception can play (within the safety of the therapeutic relationship and within any therapeutic process) in allowing updating of the patient's strongly held but dysfunctional beliefs.
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Meulewaeter F, De Pauw SSW, Vanderplasschen W. Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective. Front Psychiatry 2019; 10:728. [PMID: 31681040 PMCID: PMC6813727 DOI: 10.3389/fpsyt.2019.00728] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/11/2019] [Indexed: 01/23/2023] Open
Abstract
Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.
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