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

Development and validation of a nomogram for predicting cognitive frailty in patients on maintenance haemodialysis

AIMS

This study aimed to construct a nomogram for predicting the risk of cognitive frailty in patients on maintenance haemodialysis.

DESIGN

An explorative cross-sectional design was adopted.

METHODS

From April 2022 to July 2022, 496 participants were recruited from five haemodialysis centres in Qingdao, Shandong Province, China. Participants with cognitive frailty were screened by Frailty Phenotype scale and Mini-Mental State Examination. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression were utilized to determine predictors. The predictive performance of the nomogram was validated by calibration and discrimination. Decision curve analysis was used to assess clinical utility. Internal validation was implemented using 1000 bootstrap samples to mitigate overfitting.

RESULTS

The prevalence of cognitive frailty was 17.5% (n = 87). Six risk predictors, namely health empowerment, alexithymia, age, educational level, marital status and dialysis vintage, were screened and used to develop a nomogram model. The nomogram had satisfactory discrimination and calibration, and decision curve analysis revealed considerable clinical utility.

CONCLUSIONS

A nomogram incorporated with the six risk predictors was developed, and it exhibited excellent prediction performance. The nomogram may strengthen the effective screening of patients at high risk of cognitive frailty.

IMPACT

This study established a tool for healthcare staff to predict cognitive frailty probability and identify risk factors in patients on maintenance haemodialysis. The nomogram can meet the needs of personalized care and precision medicine simultaneously.

PATIENT OR PUBLIC CONTRIBUTION

Data were collected from patients on maintenance haemodialysis by using questionnaire survey.

REPORTING METHOD

STROBE checklist was used.

An fMRI study on alexithymia and affective state recognition in the Reading the Mind in the Eyes Test

Recognizing others' affective states is essential for successful social interactions. Alexithymia, characterized by difficulties in identifying and describing one's own emotions, has been linked to deficits in recognizing emotions and mental states in others. To investigate how neural correlates of affective state recognition are affected by different facets of alexithymia, we conducted a functional magnetic resonance imaging study with 53 healthy participants (aged 19-36 years, 51% female) using the Reading the Mind in the Eyes Test (RMET) and three different measures of alexithymia [Toronto Structured Interview for Alexithymia (TSIA), Toronto Alexithymia Scale (TAS-20), and Bermond-Vorst Alexithymia Questionnaire]. In addition, we examined brain activity during the RMET and replicated previous findings with task-related brain activation in the inferior frontal and temporal gyri, as well as the insula. No association was found between alexithymia and behavioral performance in the RMET, possibly due to the low number of participants with high alexithymia levels. Region of interest based analyses revealed no associations between alexithymia and amygdala or insula activity during the RMET. At the whole-brain level, both a composite alexithymia score and the unique variance of the alexithymia interview (TSIA) were associated with greater activity in visual processing areas during the RMET. This may indicate that affective state recognition performance in alexithymia relies on a higher compensatory activation in visual areas.

'The Relationship Between Childhood Traumas and Social Cognition Through Theory of Mind and Alexithymia in Bipolar Disorder'

This study aimed to investigate the potential differences in childhood trauma (CT), theory of mind (ToM), a significant component of social cognition, and alexithymia in bipolar disorder (BD) patients and healthy controls. The study included 50 BD patients who met the study criteria and were under follow-up at our clinic along with 50 healthy controls. The two groups were matched for age, gender, and educational status. A sociodemographic questionnaire, Childhood Trauma Questionnaire (CTQ), Toronto Alexithymia Scale (TAS), Dokuz Eylul Theory of Mind Index (DEZIKO), Hamilton Depression Rating Scale (HDRS), and Young Mania Rating Scale (YMRS) were applied to all participants. The CTQ-Total, TAS total, and DEZIKO total scores were significantly higher in the BD group compared to the healthy group (p < .001). A significant positive correlation was identified between the TAS total score and CTQ physical neglect (r = 0.472, p = .001), CTQ emotional neglect (r = 0.449, p = .001) and CTQ total scores (r = 0.5, p < .001) in the BD group. A statistically significant negative correlation was identified between the DEZIKO faux pas score and the CTQ physical neglect score (r = -0.437, p = .002). BD patients had more adverse childhood experiences, lower ToM abilities despite being in remission, and more pronounced alexithymic personality features compared to healthy controls. We also identified a relationship between ToM, alexithymia, and adverse childhood experiences in BD.

Intimate Partner Violence and Alexithymia: Do Emotions Matter? A Systematic Review and Meta-Analysis

Intimate partner violence (IPV) encompasses physical, sexual, or psychological abuse. Recent evidence suggests that victims and perpetrators might share some common psychological characteristics. Particularly, high levels of alexithymia, a difficulty in identifying and expressing emotions, and an externally oriented thinking style were found in both victims and perpetrators when compared to the general population. This systematic review and meta-analysis aimed to quantify the levels of alexithymia in victims and perpetrators of IPV and compare these levels to controls. We systematically searched PubMed, PsycINFO, Web of Science, and Scopus databases, using the following strings: ("intimate partner violence" OR "IPV" OR "partner abuse") AND ("alexithymia" OR "alexithymic"). The inclusion criteria were: adult perpetrators or victims of IPV; with or without a rehabilitation program; having or not a comparison group from the general population; alexithymia as outcome; all types of study design. Seventeen studies met the inclusion criteria. Data were meta-analyzed with random-effects models. Results showed comparable levels of alexithymia in victims and perpetrators of IPV (mean = 55.92 vs. 55.15, respectively). Furthermore, we found increased alexithymia in victims (Hedges' g, 0.87 [95% CI 0.43, 1.31]) and perpetrators (Hedges' g, 0.94 [95% CI 0.77, 1.12]) compared to controls. These results highlight that both perpetrators and victims exhibited high levels of alexithymia. A deeper understanding of this psychological dimension can help professionals to plan better-tailored interventions, in which all relevant factors associated with IPV are considered.

Emotion Processing in Peripheral Neuropathic Pain: An Observational Study

BACKGROUND

In clinical practice, the implementation of tailored treatment is crucial for assessing the patient's emotional processing profile. Here, we investigate all three levels of analysis characterizing emotion processing, i.e., recognition, representation, and regulation, in patients with peripheral neuropathic pain (PNP).

METHODS

Sixty-two patients and forty-eight healthy controls underwent quantitative sensory testing, i.e., psychophysical tests to assess somatosensory functions such as perception of cold (CDT), heat-induced pain (HPT), and vibration (VDT), as well as three standardized tasks to assess emotional processing: (1) the Ekman 60-Faces Test (EK-60F) to assess recognition of basic facial emotions, (2) the Reading the Mind in the Eyes Test (RME) to assess the ability to represent the feelings of another person by observing their eyes, and (3) the 20-item Toronto Alexithymia Scale (TAS-20) to assess emotional dysregulation, i.e., alexithymia.

RESULTS

General Linear Model analysis revealed a significant relationship between left index finger VDT z-scores in PNP patients with alexithymia. The RME correlated with VDT z-scores of the left little finger and overall score for the EK-60F.

CONCLUSIONS

In patients with PNP, emotion processing is impaired, which emphasizes the importance of assessing these abilities appropriately in these patients. In this way, clinicians can tailor treatment to the needs of individual patients.

Emotional competencies and psychological distress: Is loneliness a mediating factor?

Emotional competencies, such as emotion regulation and empathy, are essential for social interaction. Impairment of these skills has been associated with increased rates of anxiety/depressive symptoms and loneliness, which has been defined as the discrepancy between the desired and actual quality and quantity of social relationships a person maintains. The aim of the present study was to shed light on the associations between these constructs and to examine the possible mediating role of loneliness in the relationship between emotional competencies and anxiety/depressive symptoms in a sample of non-clinical individuals. A total of 298 participants were recruited for this study and were asked to complete a series of measures assessing difficulties in emotion regulation, empathy, loneliness, and anxiety/depressive symptoms. Regression and mediation models were tested to analyze the associations between these variables. Results showed that reduced emotional competencies in emotion regulation and empathy were both directly and indirectly associated with increased anxiety/depressive symptoms and emotional loneliness, which in turn was related to higher levels of psychological distress (with a partial mediation of loneliness). Overall, the present findings seem to indicate that emotional competencies play a key role in the experience of loneliness and psychological distress. Therefore, individuals reporting high levels of loneliness in combination with anxious/depressive symptoms should receive appropriate assessment and treatment of emotion regulation and empathic skills.

Cognitive, behavioral, and psychological phenotypes in small fiber neuropathy: A case-control study

OBJECTIVE

Small fiber neuropathy (SFN) is a well-defined chronic painful condition causing severe individual and societal burden. While mood disorders have been described, cognitive and behavioral profiles of SFN patients has not been investigated.

METHODS

Thirty-four painful SFN patients underwent comprehensive cognitive, behavioral, psychological, quality of life (QoL), and personality assessment using validated questionnaires. As control samples, we enrolled 36 patients with painful peripheral neuropathy (PPN) of mixed etiology and 30 healthy controls (HC). Clinical measures of neuropathic pain, duration, frequency, and intensity of pain at the time of assessment were recorded. Between-group and correlation analyses were performed and corrected for multiple comparisons.

RESULTS

No differences in clinical measures were found between SFN and PPN, and all groups had similar cognitive profiles. SFN patients showed higher levels of anxiety and alexithymia (p < .005) compared to PPN and HC, considering also pain intensity. Maladaptive coping strategies characterized both patient groups, but only SFN revealed higher levels of acceptance of pain (p < .05). Pain intensity and neuropathic symptoms were associated with mood, low QoL and catastrophism (p < .001), particularly, the higher the perceived pain intensity, the higher the use of maladaptive coping strategies (p < .001). The personality assessment revealed significant feelings of worthlessness and somatization traits both in SFN and PPN (p < .002 vs HC).

DISCUSSIONS

our results suggest that SFN patients had a normal-like cognitive profile, while their behavioral profile is characterized by mood disorders, alexithymia, maladaptive coping strategies, and poor QoL, as other chronic pain conditions, possibly related to pain intensity. Personality assessment suggests that somatization and feelings of worthlessness, which may worsen the neuropsychological profile, deserve clinical attention when considering patients' therapeutic approaches. At the same time, the high level of acceptance of pain is promising for therapeutic approaches based on psychological support.

Alexithymia modulates emotion concept activation during facial expression processing

Alexithymia is characterized by difficulties in emotional information processing. However, the underlying reasons for emotional processing deficits in alexithymia are not fully understood. The present study aimed to investigate the mechanism underlying emotional deficits in alexithymia. Using the Toronto Alexithymia Scale-20, we recruited college students with high alexithymia (n = 24) or low alexithymia (n = 24) in this study. Participants judged the emotional consistency of facial expressions and contextual sentences while recording their event-related potentials. Behaviorally, the high alexithymia group showed longer response times versus the low alexithymia group in processing facial expressions. The event-related potential results showed that the high alexithymia group had more negative-going N400 amplitudes compared with the low alexithymia group in the incongruent condition. More negative N400 amplitudes are also associated with slower responses to facial expressions. Furthermore, machine learning analyses based on N400 amplitudes could distinguish the high alexithymia group from the low alexithymia group in the incongruent condition. Overall, these findings suggest worse facial emotion perception for the high alexithymia group, potentially due to difficulty in spontaneously activating emotion concepts. Our findings have important implications for the affective science and clinical intervention of alexithymia-related affective disorders.

Basolateral Amygdala Functional Connectivity in Alexithymia: Linking Interoceptive Sensibility and Cognitive Empathy

Emotions rely on bodily states, and perceiving the emotions of others depends on awareness of one's own emotional state. However, the intercorrelations among interoception, alexithymia, and empathy are not well understood, and the neural mechanisms behind this connection are also largely unknown. To address these issues, 297 college students participated in this study, completing measures of interoceptive sensibility (IS), empathy and alexithymia and undergoing resting-state fMRI scans. The functional connectivity of the amygdala was analysed to identify the neural substrates of alexithymia, and mediation analyses were conducted to examine the mediation effect of alexithymia and alexithymia-specific amygdala functional connectivity on the relationship between IS and empathy. The results showed that higher levels of IS were associated with increased cognitive empathy through weakened alexithymia. Functional connectivity analysis indicated that right basolateral amygdala (BLA)-left precuneus connectivity was negatively related to alexithymia, while right BLA-left precentral gyrus connectivity was positively related to alexithymia. Furthermore, right BLA-left precuneus connectivity was found to mediate the impact of interoception on cognitive empathy. In conclusion, this study provides valuable insights into the relationships among IS, alexithymia, and empathy. The right BLA-left precuneus connectivity may serve as a shared neural substrate between interoception and cognitive empathy.

Alexithymia in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates, and relationship with neurocognition and empathy

INTRODUCTION

Alexithymia is highly prevalent and strongly related to adverse consequences in patients with schizophrenia. However, its associated factors remain largely unexplored. The present study aimed to determine the prevalence of alexithymia and its association with sociocultural characteristics, clinical symptoms, neurocognition, and empathy in 854 Chinese patients with schizophrenia.

METHOD

Demographic information was collected through a self-designed questionnaire. Alexithymia was assessed by the Toronto Alexithymia Scale (TAS-20). We assessed clinical symptoms, neurocognition, and empathy via the following instruments: Positive and Negative Syndrome Scale, Repeatable Battery for the Assessment of Neuropsychological Status, and Interpersonal Reactivity Index. A multiple logistic regression model was conducted to determine the independent correlates of alexithymia.

RESULTS

Approximately one-third (n = 277, 32%) of patients with schizophrenia had alexithymia. Patients with alexithymia had significantly more severe negative symptoms, neurocognition, and empathy impairment than patients without alexithymia. Being male, negative symptoms, personal distress, empathic concern, and language functioning were independently associated with alexithymia.

DISCUSSION

Our findings demonstrate a high prevalence of alexithymia and its strong association with clinical symptoms, neurocognition, and empathy, which calls for timely screening and intervention for alexithymia in patients with schizophrenia. Targeting impaired language function, negative symptoms, and impaired affective empathy might help reduce alexithymia and its related negative consequences.

A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial

BACKGROUND

Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation.

METHODS

In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment.

RESULTS

While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity.

CONCLUSIONS

CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

Effects of Alexithymia on Moral Decision-Making in Sacrificial Dilemmas: High Alexithymia is Associated with Weaker Sensitivity to Moral Norms

Purpose

Although several studies have investigated the association between alexithymia and moral decision-making in sacrificial dilemmas, the evidence remains mixed. The current work investigated this association and how alexithymia affects moral choice in such dilemmas.

Methods

The current research used a multinomial model (ie, CNI model) to disentangle (a) sensitivity to consequences, (b) sensitivity to moral norms, and (c) general preference for inaction versus action irrespective of consequences and norms in responses to moral dilemmas.

Results

Higher levels of alexithymia were associated with a greater preference for utilitarian judgments in sacrificial dilemmas (Study 1). Furthermore, individuals with high alexithymia showed significantly weaker sensitivity to moral norms than did those with low alexithymia, whereas there were no significant differences in sensitivity to consequences or a general preference for inaction versus action (Study 2).

Conclusion

The findings suggest that alexithymia affects moral choice in sacrificial dilemmas by blunting emotional reactions to causing harm, rather than through increased deliberative cost-benefit reasoning or general preference for inaction.

Alexithymia and emotion regulation

BACKGROUND

Alexithymia is a key transdiagnostic risk factor for emotion-based psychopathologies. Conceptual models specify that this is because alexithymia impairs emotion regulation. However, the extent of these putative emotion regulation impairments remains underexplored. Our aim in this study was to begin to address this gap by examining whether people with high, average, or low levels of alexithymia differ in the types of emotion regulation strategies they typically use.

METHOD

General community adults from the United States (N = 501) completed a battery of alexithymia and emotion regulation measures. Participants were grouped into high, average, and low alexithymia quantiles.

RESULTS

After controlling for demographics and current levels of distress, the high, average, and low alexithymia groups differed in their use of cognitive and behavioral emotion regulation strategies. Compared to the other groups, the high alexithymia group reported lesser use of generally adaptive regulation strategies (cognitive reappraisal, approaching problems, and seeking social support) and greater use of generally maladaptive regulation strategies (expressive suppression, behavioral withdrawal, ignoring).

LIMITATIONS

Our data were cross-sectional and from self-report questionnaires. Future work in other cultural groups would be beneficial.

CONCLUSIONS

Our results support the view that alexithymia is associated with impaired emotion regulation. In particular, people with high alexithymia seem to exhibit a less adaptive profile of emotion regulation strategies. Direct targeting of these emotion regulation patterns in psychotherapy may therefore be a useful pathway for the treatment of emotional disorder symptoms in people with high alexithymia.

Alexithymia and sensory processing sensitivity account for unique variance in the prediction of emotional contagion and empathy

Introduction

Empathy-the ability to identify and share another person's emotional state-is an important socio-emotional process arising, in part, from emotional contagion. In the current study, we assessed unique variance in emotional contagion and other empathy-related constructs accounted for by two personality traits, alexithymia and sensory processing sensitivity (SPS), when controlling for childhood emotional abuse and current depressed mood.

Methods

A sample of 305 adults (M _age = 20.1 years) watched brief film clips chosen to induce various emotional states. After each film, the participants rated how strongly they experienced each of nine different emotions. They then completed self-report measures of alexithymia, SPS, empathy-related constructs, childhood emotional abuse, and current mood.

Results

Those scoring high (vs. low) on SPS reported stronger primary emotions and a larger range of emotions when watching the films and were more apt to believe that their emotions matched those of the individuals featured in the films. They also scored higher on both self-oriented processes (such as the tendency to feel personal distress in tense situations) and other-oriented processes (such as perspective taking and empathic concern) related to empathy. Individuals scoring high (vs. low) on alexithymia reported feeling a larger range of emotions while watching the films but scored lower on other-oriented processes related to empathy. After controlling for SPS and alexithymia, current depressed mood predicted experiencing less varied reactions to mixed valence films that elicited strong feelings of embarrassment/humiliation, and less amusement when watching positive films. Childhood emotional abuse did not emerge as a predictor of emotional contagion or empathy.

Discussion

We propose that the strong and nuanced feelings elicited in those scoring high on SPS by observing others support their personal view that they are highly empathic. In contrast, by failing to closely examine their own mixed reactions to others, individuals with alexithymia may find it difficult to connect with, understand, and respond to others' feelings.

Constructing and Verifying an Alexithymia Risk-Prediction Model for Older Adults with Chronic Diseases Living in Nursing Homes: A Cross-Sectional Study in China

Alexithymia is a critical global public health concern. This questionnaire-based cross-sectional study explored the risk factors of alexithymia in older adults living in nursing homes with chronic diseases. It also developed and evaluated an alexithymia risk-prediction model. A total of 203 older adults with chronic diseases were selected from seven nursing homes in Changsha, China, using simple random and cluster sampling. The participants were surveyed using the Toronto Alexithymia Scale (TAS-20), Geriatric Depression Scale-15 (GDS-15), Connor-Davidson Resilience Scale (CD-RISC), Perceived Social Support Scale (PSSS), and a socio-demographic characteristics questionnaire. The alexithymia total score was 43.85 ± 9.570, with an incidence rate of 8.9%. Alexithymia had a partial mediating effect on the relationship between social support and psychological resilience (the effect value was 0.12), accounting for 19.04% of the total effect. Gender, depression, and psychological resilience were the main independent influencing factors of alexithymia (p < 0.05). The area under the receiver operating characteristic (AUC-ROC) curve of the risk-prediction model was 0.770. The participants, especially those who were male and depressed, exhibited a certain degree of alexithymia. Additionally, it partially mediated the association between social support and psychological resilience, which is a protective factor against alexithymia. The risk-prediction model showed good accuracy and discrimination. Hence, it can be used for preliminary screening of alexithymia in older adults with chronic diseases living in nursing homes.

Relationship between the Broader Autism Phenotype and empathy among students

Previous research has shown that persons with a higher level of the broad autism phenotype (BAP) experience deficits in empathy. The aim of the present study is to investigate a multivariate relationship between the BAP and different aspects of empathy. In a sample of 293 university students, we explored the relationship between the BAP and the following aspects of empathy: fantasy, empathic concern, perspective taking, and personal distress. The BAP level was measured using The Broad Autism Phenotype Questionnaire (BAPQ), and the Interpersonal Reactivity Index was used for multidimensional assessment of empathy disposition. Canonical correlation analysis yielded two functions (Function 1  ̶  Rc2 = 17.31%, Function 2  ̶  Rc2 = 10.82%). In Function 1, IRI subscales Personal Distress (PD) (rs = .92) and Perspective Taking (PT) (rs = -.39) are associated significantly with all three domains of the BAP. The strongest correlation PD and PT show with Rigid and Pragmatic Language domains of the BAP, while they demonstrate a weaker relationship with the Aloofness domain. In Function 2, IRI subscales Empathic Concern (EC) (rs = -.98), Fantasy (FS) (rs = -.46), PT (rs = -.43) and PD (rs = -.31) are related to the Aloofness domain of the BAP. The results imply that the relationship between BAP and empathy differs for different aspects of these two constructs. The more detailed understanding of the relationship between BAP and empathy obtained through the multivariate approach provides a basis from which to create programs for the more efficient promotion of empathy skills.

Effects of Primary and Secondary Psychopathy on Deontological and Utilitarian Response Tendencies: The Mediator Role of Alexithymia

(1) Background: The purpose of this study is to provide more nuanced insights into the effects of sub-dimensional levels of psychopathy on moral dilemma judgments. To this end, this study examined the effects of primary and secondary psychopathy on utilitarian and deontological response tendencies. Moreover, this study also explored the mediating role of alexithymia as well as the moderating role of gender in these effects. (2) Methods: A total of 1227 participants were recruited through the online questionnaire service wjx.cn. After deleting unfinished questionnaires, the remaining 1170 participants were included in the final data analysis. Each participant completed a demographic information questionnaire, the Levenson Self-Report Psychopathy Scale, the Toronto Alexithymia Scale-20, and six pairs of moral dilemmas. Descriptive and correlational analyses of study variables were conducted in SPSS 22.0. Mediation and gender difference analyses were conducted in AMOS 23.0. (3) Results: Primary psychopathy was negatively correlated with deontological response tendencies and uncorrelated with utilitarian response tendencies. By contrast, secondary psychopathy also correlated negatively with deontological response tendencies, but it correlated positively with utilitarian response tendencies. Mediation analysis revealed that alexithymia only mediated the relationship between secondary psychopathy and deontological response tendencies. Multi-group analysis revealed that there was no difference between females and males in the indirect effect model. (4) Conclusions: People with high primary psychopathy are less likely to reject harm in moral dilemmas. By contrast, people with high secondary psychopathy have high alexithymia, which causes them to be less concerned about avoiding harm, and they are more likely to maximize outcomes in moral dilemmas. These findings shed new light on the moral dilemma judgments of individuals with primary and secondary psychopathy.

Social anxiety and behavioral assessments of social cognition: A systematic review

BACKGROUND

Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning, identifying aspects of social cognition that may be impaired can increase our understanding of the development and maintenance of social anxiety disorder. However, to date, studies examining associations between social anxiety and social cognition have resulted in mixed findings.

METHODS

The aim of this systematic review was to summarize the literature on the association between social anxiety and social cognition, while also considering several potential moderators and covariates that may influence findings.

RESULTS

A systematic search identified 52 studies. Results showed mixed evidence for the association between social anxiety and lower-level social cognitive processes (emotion recognition and affect sharing) and a trend for a negative association with higher-level social cognitive processes (theory of mind and empathic accuracy). Most studies examining valence-specific effects found a significant negative association for positive and neutral stimuli.

LIMITATIONS

Not all aspects of social cognition were included (e.g., attributional bias) and we focused on adults and not children, limiting the scope of the review.

CONCLUSIONS

Future studies would benefit from the inclusion of relevant moderators and covariates, multiple well-validated measures within the same domain of social cognition, and assessments of interpersonal functioning outside of the laboratory. Additional research examining the moderating role of attention or interpretation biases on social cognitive performance, and the potential benefit of social cognitive skills training for social anxiety, could inform and improve existing cognitive behavioral interventions.

Psycho-Behavioral Profiles of Pediatric Inpatients with Past and Recent Onset of Nonsuicidal Self-Injury: A Cluster Analysis Approach

Few studies have focused on the persistence of nonsuicidal self-injury (NSSI) over time in developmental age. This study aimed to define the psycho-behavioral profiles of young inpatients according to past or recent NSSI onset (i.e., NSSI for more or less than one year, respectively), and identify possible risk factors for maintaining NSSI over time. A total of 118 Italian NSSI inpatients aged 9–17 were involved. The Youth Self-Report (YSR) was administered. K-means cluster analyses were conducted using the YSR affective disorders, social competencies, and social problems scales as clustering variables. A binomial logistic regression was run to clarify which of these variables discriminate between the past and recent NSSI onset groups. Chi-square tests were performed to pinpoint the variables associated with long-standing NSSI. The final cluster solution displayed four psycho-behavioral profiles; a greater number of inpatients with recent NSSI onset was found in the clusters characterized by scarce social competencies. Affective disorders and social competencies were significant predictors, and higher scores on both scales were more likely in the past NSSI onset group. School problems and alcohol/substance use were related to long-standing NSSI. Therefore, a lack of social skills may be involved in recent NSSI onset, while affective disorders and other problem behaviors may dictate the continuation of NSSI over time.

The influence of alexithymia on problematic mobile phone use among Chinese adolescent students: Multiple mediating roles of social interaction anxiousness and core self-evaluations

BACKGROUND

Alexithymia can lead to problematic mobile phone use (PMPU). However, the underlying mechanisms remain unclear.

METHODS

Drawing on the Interaction of Person-Affect-Cognition-Execution model, the present study tests the mediating effects (parallel and serial) of social interaction anxiety (SIA) and core self-evaluations (CSE) on the relationship between alexithymia and PMPU. We obtained 1267 valid responses from adolescent students (mean age, 20.36, standard deviation, 0.97) from southeast China who completed the Mobile Phone Addiction Index, Toronto Alexithymia-20 Scale, Social Interaction Anxiousness Scale, and Core Self-Evaluation Inventory.

RESULTS

After controlling for demographic variables (i.e., gender) as covariates, the results revealed that: (1) alexithymia had a positive predictive effect on PMPU in adolescent students; (2) SIA and CSE mediated the association between alexithymia and PMPU; and (3) a series of indirect pathways (i.e., from alexithymia to PMPU via SIA and CSE) were detected. Thus, alexithymia can directly affect (parallel mediation) PMPU by increasing SIA and lowering CSE simultaneously. However, alexithymia can also indirectly affect (serial mediation) PMPU by increasing the level of SIA by decreasing CSE.

LIMITATIONS

Data were collected by participant self-report. This method may lead to recall bias. Further, we adopted a cross-sectional rather than an experimental design, thus precluding causal conclusions. Lastly, it would be useful to validate our findings with other age groups outside southeast China.

CONCLUSIONS

The current study findings are conducive to understanding the relationship between alexithymia and PMPU and inspire the prevention and intervention of PMPU.

Reduced salivary oxytocin after an empathic induction task in Intimate Partner Violence perpetrators: Importance of socio-affective functions and its impact on prosocial behavior

Intimate Partner Violence (IPV) has been linked to difficulties in socio-affective functions. Nevertheless, the underlying psychobiological mechanisms that might be responsible for them remain unclear. Oxytocin (OXT) stands out as an important hormone that may favor the salience of social information, due to its relevance in empathy and prosocial behavior. Thus, the study of salivary OXT (sOXT) may provide further information about potential impairments in social cognition in IPV perpetrators. This study analyzed the effects of an empathic induction task, performed through negative emotion-eliciting videos, on endogenous sOXT levels, mood state, and emotional perception in 30 IPV perpetrators compared to 32 controls. Additionally, we explored their performance on prosocial behavior after the empathic induction task, using Hare's donation procedure. Lower sOXT levels were found in IPV perpetrators after the task compared to controls, along with a general decreasing tendency in their sOXT levels. Additionally, IPV perpetrators exhibited no change in their mood state and perceived others' emotions as more positive and less intense. Moreover, the mood state response and alexithymia traits, respectively, positively and negatively predicted the sOXT levels after the empathic induction task in the entire sample. Finally, we did not observe a lower appearance of prosocial behaviors in IPV perpetrators; however, higher sOXT levels after the empathic induction task were found in subjects who donated when considering the whole sample. In sum, IPV perpetrators exhibited differences in their sOXT levels when empathizing, compared to controls, with alexithymia and the emotional response potentially explaining the sOXT levels after the task. Furthermore, prosocial behavior was more related to these sOXT levels than to IPV. As our knowledge about the emotional processing of IPV perpetrators increases, we will be better able to develop and include coadjutant treatments in current psychotherapeutic programs, in order to focus on their emotional needs, which, in turn, would reduce the future risk of recidivism.

French drivers' behavior: Do psychological resources and vulnerabilities matter?

INTRODUCTION

Driving is a risky activity, and road users' behavior is one of the many factors that participate in increasing the risk of road-traffic crashes. Drivers must constantly adapt their behavior to the environment and control their vehicles, and must also anticipate the behavior of others, which may pose a threat to their own safety. Interactions between road users can therefore be stressful and elicit strong negative emotions. Psychological resources and vulnerabilities may be important in understanding how drivers perceive and respond to these driving interactions. The aim of this study was to investigate the role of empathy, self-compassion, personal distress, and alexithymia in both dangerous and prosocial driving behaviors.

METHOD

Our sample (N = 550) of French drivers was recruited via snowball sampling. The drivers filled in paper-and-pencil questionnaires including the Driver Behavior Questionnaire (DBQ), the French adaptation of the Toronto Empathy Questionnaire (Short-FTEQ), the Interpersonal Reactivity Index (IRI), the Self-Compassion Scale - Short Form (SCS-SF), and the Toronto Alexithymia Scale (TAS-20).

RESULTS

After controlling for gender and age, regression analyses revealed that road traffic violations were positively predicted by alexithymia and negatively predicted by cognitive empathy; errors were positively predicted by alexithymia and personal distress, and prosocial driving was positively predicted by emotional and cognitive empathy. A two-step cluster analysis identified three groups of drivers: unsafe and psychologically vulnerable (n = 176), self-focused and less prosocial (n = 151), and safe and resourceful (n = 223).

CONCLUSIONS

Empathy seems to promote safe driving behaviors. Moreover, cognitive empathy appears to safeguard drivers against deliberate violations, whereas psychological vulnerabilities seem to increase the probability of engaging in dangerous behaviors. Practical Applications: These results could open new research avenues for the prevention of dangerous driving behaviors and the promotion of road safety.

A cross-modal component of alexithymia and its relationship with performance in a social cognition task battery

BACKGROUND

The personality trait alexithymia describes an altered emotional awareness that is associated with a range of social impairments and constitutes a transdiagnostic risk factor for various psychopathologies. Despite the characteristic interoceptive deficits in alexithymia, it is predominantly assessed via self-reports. This can result in unreliable measurements and arguably contributes to the prevailing uncertainty regarding its components, including constricted imaginal processes and emotional reactivity.

METHODS

The current study employed an interview and two validated questionnaires to derive a shared component of multi-modally assessed alexithymia in a German non-clinical sample (n = 78) via prinicipal component analysis. This component was used as a predictor for performance in four behavioural social cognition tasks. The relative importance of this predictor against related variables was assessed via dominance analysis.

RESULTS

The identified component reflected cognitive alexithymia. Higher cognitive alexithymia scores were associated with less affective distress in an ostracizing task. Dominance analysis revealed the dominance of competing autism traits relative to cognitive alexithymia and competing predictors empathy, depression, and anxiety, in predicting affective distress.

LIMITATIONS

Emotional reactivity was only assessed via self-report and no implicit measures of alexithymia were employed. Due to the low reliability of the self-report measure, no measure of emotional reactivity could be included in the principal component analysis.

CONCLUSIONS

Our results provide compelling evidence that cognitive interoceptive deficits are at the core of alexithymia across assessment modalities. Behavioural data suggest that these deficits result in diminished emotional sensitivity to high-pressure social situations, which may cause a lack of behavioural adaptation.

Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety

BACKGROUND

Major depressive disorder (MDD) and social anxiety disorder (SAD) are commonly occurring conditions, either alone or together (MDD-SAD). Recent research linked insecure attachment and alexithymia to MDD and/or SAD, indicating that the way affected individuals relate interpersonally and their ability to identify and communicate emotions are pertinent issues. The current study investigated the mediating role of alexithymia in the relationship between insecure attachment and severity of MDD and SAD symptoms.

METHOD

Using the SCID-I, participants (N=159) were identified as MDD-only (n=43), MDD-SAD (n=56), or a healthy control (n=60). Participants completed measures of adult attachment, depression, social anxiety and alexithymia (defined as difficulty identifying and describing feelings). A two-step mediation analysis approach recommended by Shrout and Bolger determined if alexithymia mediates the relationship between attachment-depression and attachment-social anxiety.

RESULTS

While alexithymia was high in MDD-only and MDD-SAD groups, individuals with MDD-SAD had significantly greater difficulty describing feelings. Alexithymia was a full mediator between attachment avoidance and depression, but only a partial mediator between attachment anxiety and depression. Meanwhile, alexithymia was a partial mediator for both attachment dimensions and social anxiety.

LIMITATIONS

Causal inferences regarding insecure attachment, alexithymia, and MDD and SAD cannot be assumed given the cross-sectional data. The 'externally oriented thinking' component in alexithymia was also excluded from analyses due to low reliability.

CONCLUSION

The results suggest emotional awareness and expression play a role in the illness severity for MDD and SAD-particularly in those with high attachment avoidance, offering a possible target for treatment and prevention strategies.

Impaired complex theory of mind and low emotional self-awareness in outpatients with borderline personality disorder compared to healthy controls: A cross-sectional study

Studies on the theory of mind (TOM) and alexithymia in borderline personality disorder (BPD) have yielded inconsistent results. Also, the relationship between TOM abilities and alexithymia facets as two domains of social cognition has not been studied in BPD. This study aimed to fill this gap. Participants were 50 outpatients with BPD and 50 age and gender-matched healthy controls. Assessments performed using Reading the Mind in Eyes Task (RMET), Toronto Alexithymia Scale (TAS-20), Faux Pas Task (FPT), and Digit Span subtest of Wechsler Adult Intelligence Scale. Results showed that BPD patients scored lower on overall FPT (p < .001) and its cognitive (p < .001) and affective TOM (p < .001) subtests but were comparable with healthy controls in emotion recognition ability assessed by RMET (p = .241). The BPD group also scored significantly lower in overall alexithymia (p < .001) and subscales of difficulty identifying feelings (DIF; p < .001) and difficulty describing emotions (DDF; p = .001). However, they performed similarly to the healthy control group in externally oriented thinking (EOT; p = .164). Correlation analysis revealed a significant negative correlation between EOT and RMET in the BPD group (r = -0.33, p < .05). No association, however, was found between FPT and RMET. This study suggests that BPD patients are impaired in the complex TOM abilities and have lower self-awareness of emotions, but their recognition of others' emotions is intact. Also, the results demonstrate that a heightened level of EOT is associated with difficulties in facial emotion recognition in BPD patients.

Associations between socioemotional alterations, quality of life, and social functioning in multiple sclerosis: A scoping review

The main aim of the present scoping review is to systematically review the available studies that investigated the associations between socioemotional alterations (i.e., social cognition impairments/alexithymia/difficulties in emotion regulation) and both reduced QoL and social functioning in patients with Multiple Sclerosis (MS). The articles were selected from the PubMed, PsycINFO, and Scopus databases. The main exclusion criteria were qualitative studies, articles that did not use validated instruments, and studies that did not investigate the association between socioemotional skills and QoL/social functioning in MS. Of the eight studies fulfilling the inclusion criteria, six found significant associations between social cognitive and emotion regulation abilities and QoL/social functioning in patients with MS, while two found no significant relationships particularly between the performance on social cognition tasks and QoL measures. Overall, the majority of findings seem to highlight that socioemotional alterations contribute to impaired QoL and social functioning in MS. However, given the still limited evidence, future studies are needed to replicate and confirm the available results, paying attention to two principal aspects: the use of standardized and ecological tasks for the assessment of social cognition skills and the recruitment of samples involving patients with different types of MS.

Perceived parental over-protection in non clinical young adults is associated with affective vulnerability: A cross-sectional study

OBJECTIVE

High levels of perceived parental over-protection are hypothesized to be related to relational problems, psychological distress, and development of psychiatric symptoms. Here, the main aim was to extend previous findings investigating the unique contribution of parental over-protection in predicting affective vulnerability.

METHOD

296 students were recruited and tested individually. All participants were administered self-report measures assessing parental styles [i.e., The Measure of Parental Style (MOPS)], several clinical dimensions (i.e., depressive symptoms, trait anxiety and alexithymia), and a checklist assessing socio-demographic variables.

RESULTS

Affective vulnerability was investigated combining anxiety, depression and alexithymia through principal axis factoring which accounted for 70.90% of the variance of the data. All MOPS subscale were positively associated with all clinical dimensions (r > 0.13; p < 0.05) and with the Affective Vulnerability factor (r > 0.25; p < 0.001). Among different forms of dysfunctional parenting, only maternal (β = 0.19; p = 0.007) and paternal (β = 0.18; p = 0.010) over-protection were independently associated with Affective Vulnerability in the linear regression analysis, even when controlling for sex, age, and education.

CONCLUSIONS

All forms of dysfunctional parenting investigated were associated with affective vulnerability. However, at a multivariate level, only maternal and paternal over-protection remained independently associated with affective vulnerability. This study contributes to our understanding of the role of parental over-protection as a risk factor for the development of affective vulnerability and on the potentially pathogenic role played by this parental style in the development of clinical and sub-clinical conditions.

Disentangling interoceptive abilities in alexithymia

In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia—a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience—remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants’ level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R² = 0.29 and R² = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R² = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.

The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy

In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.