Genetic influences on alexithymia and their relationship with depressive symptoms

Emotion Regulation in Families: Exploring the Link between Parent-Child Alexithymia and Child Post-Traumatic Stress Symptoms Amidst the COVID-19 Pandemic

The COVID-19 pandemic comprises a mass trauma for children and families, and children may face particular vulnerability to post-traumatic stress symptoms (PTSS) through processes of parent and child emotional dysregulation, such as alexithymia. With 88 U.S. children (Mage = 9.94 years; 54.5% female; 59.1% White) and their parents/caregivers (68.2% female; 59.1% White), a path model was tested in which child alexithymia symptoms partially mediated the association between parent alexithymia symptoms and child COVID-19-related posttraumatic stress symptoms (PTSS). We also tested an alternative model in which child alexithymia symptoms moderated the association between parent alexithymia symptoms and child PTSS. The hypothesized mediation model was supported (β = 0.15, SE = 0.05, 95% CI: [0.07, 0.25], p < 0.001), whereas the hypothesized moderator model was not (β = 0.06, p = 0.44). Findings highlight the importance of parents' emotional understanding and regulation for child mental health during mass traumas such as pandemics.

The impact of family alexithymia on the severity of restrictive eating disorders in adolescent patients

BACKGROUND

Alexithymia is the inability to identify and describe one's own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population.

METHODS

The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients' ability to recognize their emotions. The study also aimed to evaluate if patients' emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children's Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients' levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman's correlation shows a statistically significant correlation between mothers and patients' levels of alexithymia.

RESULTS

Our findings also suggest that fathers and mothers' TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters.

CONCLUSIONS

In conclusion, mothers' level of alexithymia could influence both fathers and patients' difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients' levels of alexithymia.

Brief Report: Alexithymia Trait Severity, Not Autistic Trait Severity, Relates to Caregiver Reactions to Autistic Children's Negative Emotions

Alexithymia impacts an individual's ability to recognize and understand emotions and frequently co-occurs with autism. This study investigated the relationship between children's alexithymia, autistic traits, and caregiver reactions to their child's negative emotions. Caregivers of 54 autistic and 51 non-autistic children between the ages of 7 and 12 years rated their child's alexithymia and autistic trait severity and their reactions to their child's negative emotions. Caregivers of autistic children reported greater supportive reactions and fewer restrictive/controlling reactions to their child's negative emotions when their child had more alexithymia traits. This study extends previous research by demonstrating that caregivers of autistic children with co-occurring alexithymia traits represent a specific subgroup of caregivers that respond more positively to their child's negative emotions.

Emotional dysregulation, alexithymia and neuroticism: a systematic review on the genetic basis of a subset of psychological traits

Neuroticism, alexithymia and emotion dysregulation are key traits and known risk factors for several psychiatric conditions. In this systematic review, the aim is to evaluate the genetic contribution to these psychological phenotypes. A systematic review of articles found in PubMed was conducted. Search terms included 'genetic', 'GWAS', 'neuroticism', 'alexithymia' and 'emotion dysregulation'. Risk of bias was assessed utilizing the STREGA checklist. Two hundred two papers were selected from existing literature based on the inclusion and exclusion criteria. Among these, 27 were genome-wide studies and 175 were genetic association studies. Single gene association studies focused on selected groups of genes, mostly involved in neurotransmission, with conflicting results. GWAS studies on neuroticism, on the other hand, found several relevant and replicated intergenic and intronic loci affecting the expression and regulation of crucial and well-known genes (such as DRD2 and CRHR1). Mutations in genes coding for trascriptional factors were also found to be associated with neuroticism (DCC, XKR6, TCF4, RBFOX1), as well as a noncoding regulatory RNA (LINC00461). On the other hand, little GWAS data are available on alexythima and emotional dysregulation.

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.

Plasma circulating micro-RNAs associated with alexithymia reflect a high overlap on neuropsychiatric outcomes

BACKGROUND

Alexithymia ("no word for feelings") is a personality feature that is common in patients with psychiatric disorders. However, little is known about biological causes and mechanism behind. Research so far focusses on genetic risk variants primary associated with depression, but analyses on epigenetic mechanisms are still missing.

METHODS

In a sample of n = 813 subjects from the "Study of Health in Pomerania" we analyzed the association between alexithymia and plasma circulating micro RNAs (miRNA). Significant miRNAs were compared to associations regarding depression and pathway analyses were performed.

RESULTS

Two miRNAs were significantly associated with at least one of the alexithymia scores (hsa-miR-324-3p, hsa-miR-33a-5p) and three miRNAs additionally revealed a strong association pattern to alexithymia (hsa-miR-106b-5p, hsa-miR-484, hsa-miR-25-3p). None of these miRNAs was significantly associated with depressive symptoms in our sample. Literature research showed that all of the miRNAs have been found in association with several neuropsychiatric phenotypes.

LIMITATIONS

Main limitations are the lack of a replication sample as well as the limited number of miRNAs analyzed.

CONCLUSIONS

This is the first analysis investigating the association between miRNAs and alexithymia. Results indicate that miRNAs are not specific for one psychiatric disorder but may influence biological mechanisms that are involved in various psychiatric conditions which might be relevant for future treatment options and improve the biological understanding of psychiatric conditions.

The genetic background of the associations between sense of coherence and mental health, self-esteem and personality

PURPOSE

Sense of coherence (SOC) represents coping and can be considered an essential component of mental health. SOC correlates with mental health and personality, but the background of these associations is poorly understood. We analyzed the role of genetic factors behind the associations of SOC with mental health, self-esteem and personality using genetic twin modeling and polygenic scores (PGS).

METHODS

Information on SOC (13-item Orientation of Life Questionnaire), four mental health indicators, self-esteem and personality (NEO Five Factor Inventory Questionnaire) was collected from 1295 Finnish twins at 20-27 years of age.

RESULTS

In men and women, SOC correlated negatively with depression, alexithymia, schizotypal personality and overall mental health problems and positively with self-esteem. For personality factors, neuroticism was associated with weaker SOC and extraversion, agreeableness and conscientiousness with stronger SOC. All these psychological traits were influenced by genetic factors with heritability estimates ranging from 19 to 66%. Genetic and environmental factors explained these associations, but the genetic correlations were generally stronger. The PGS of major depressive disorder was associated with weaker, and the PGS of general risk tolerance with stronger SOC in men, whereas in women the PGS of subjective well-being was associated with stronger SOC and the PGSs of depression and neuroticism with weaker SOC.

CONCLUSION

Our results indicate that a substantial proportion of genetic variation in SOC is shared with mental health, self-esteem and personality indicators. This suggests that the correlations between these traits reflect a common neurobiological background rather than merely the influence of external stressors.

Relationship between alexithymia and depression: A narrative review

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.

[Alexithymia and its relation with eating disorders and obesity]

This manuscript provides a review of current literature on the relationship between overweight and alexithymia as a psychological factor associated with obesity, as well as the role of alexithymia in the development of various abnormalities and eating disorders (ED). Obesity is a multifactorial disease, and lifestyle characteristics are the most important pathogenetic links on its development, as well as a complex of genetic, epigenetic, biological and psychological factors that cause accumulation of excessive fat and prevent effective reduction and retention of body weight. One possible reason for the increased prevalence of obesity in adults is poor emotional management, which can affect healthy eating behavior and lifestyle. It was found that overweight and obese people have a high prevalence of alexithymia, and also the study shows its prognostic role in the development of ED. Alexithymia is a factor that not only predisposes to weight gain, but is also a significant predictor of inefficiency and premature termination of programs for the treatment of obesity and ED. Timely diagnosis and correction of alexithymic syndrome can help in developing the effective treatment strategies for obese patients.

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

BACKGROUND

Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment.

METHODS

We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills.

RESULTS

Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states.

LIMITATIONS

The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships.

CONCLUSIONS

These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

The rs6311 of serotonin receptor 2A (5-HT2A) gene is associated with alexithymia and mental health

BACKGROUNDS

Alexithymia, difficulties in identifying and describing one's own feelings, is related to substantial clinical practice. Inspired by the links between serotonin functions and affective disorders, this study investigated associations of the serotonin receptor 2A (5-HT2A) gene with alexithymia and mental health.

METHODS

We differentiated subjects according to two functional polymorphisms (i.e., rs6311 and rs6313) of 5-HT2A gene and scored alexithymia and mental health of college students with the Toronto Alexithymia Scale (TAS-20) and the Symptom Check List-90 (SCL-90), respectively.

RESULTS

The analyses basing on sample 1 (N = 566) and sample 2 (N = 602) indicated that the G allele of rs6311 was related to higher score on the TAS-20 as compared to the AA genotype. The analysis with 467 individuals from sample 2 indicated that the rs6311 was associated with mental health, and this association was mediated by alexithymia.

LIMITATIONS

The potential confounding variables such as depression and anxiety were neglected in the analyses.

CONCLUSIONS

These findings demonstrate the contribution of the 5-HT2A to alexithymia, and highlight the link between alexithymia and mental health at genetic level.

Eating disorders among patients with borderline personality disorder: understanding the prevalence and psychopathology

BACKGROUND

Treatment protocols can be bolstered and etiological and maintenance factors can be recognized more easily by a superior understanding of emotions and emotion regulation in the comorbidity of borderline personality disorder (BPD) and feeding and eating disorders (FEDs). Therefore, the present study aimed at investigating the prevalence and psychopathology of FEDs in patients with BPD.

METHODS

In this cross-sectional study, 220 participants were examined in three groups, namely BPD (n = 38), BPD + FEDs (n = 72), and healthy controls (n = 110), from August 2018 to November 2019. The participants were selected by systematic random sampling among the patients who referred to Baharan psychiatric hospital in Zahedan, Iran, with the sampling interval of 3. The subjects were evaluated by 28-item General Health Questionnaire (GHQ-28), Borderline Personality Inventory (BPI), Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), Structured Clinical Interviews for DSM-5: Research Version (SCID-5-RV), the 26-item Eating Attitudes Test (EAT-26), 20-item Toronto Alexithymia Scale (TAS-20), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II).

RESULTS

The results showed a 65.4% (n = 72) prevalence of FEDs in patients with BPD. Also, the highest and lowest prevalence rates were reported for other specified feeding and eating disorders (51.3%) and bulimia nervosa (6.9%), respectively. Although the highest mean score of TAS-20 was related to anorexia nervosa, there was no significant difference between the scores of various types of FEDs. The mediation analysis showed that anxiety and depression would play a mediating role in the relationship between alexithymia and eating-disordered behaviors.

CONCLUSIONS

The results have suggested that alexithymia, anxiety, and depression should receive clinical attention as potential therapeutic targets in the comorbidity of BPD and FEDs. The clinical implications of the research have been conducted to date, and directions for future research have been discussed.

5-HTTLPR and COMT Val158Met are not associated with alexithymia: New evidence and meta-analyses

BACKGROUNDS

Alexithymia refers to the difficulties in identifying and describing one's own emotions, lacking of imagination, and an externally oriented thinking style. Studies up to date have examined the associations of 5-HTTLPR and COMT Val158Met polymorphisms with alexithymia. However, the previous findings were mixed.

METHODS

We replicated the associations by scoring on alexithymia with the 20-item Toronto Alexithymia Scale and genotyping the polymorphisms of 5-HTTLPR and COMT Val158Met in a large population of college students (N = 1698). Moreover, we also meta-analyzed the associations with five samples (N = 7517) for the 5-HTTLPR and with five samples (N = 2186) for the COMT Val158Met.

RESULTS

Neither the replicated study nor the meta-analyses indicated the 5-HTTLPR and COMT Val158Met were associated with alexithymia.

CONCLUSIONS

The findings suggest that the 5-HTTLPR and COMT Val158Met polymorphisms are not associated with alexithymia. However, genetic-environmental studies with different ethnicity and psychopathology should be carried in future.

The BDNF Val66Met gene polymorphism is associated with increased alexithymic and anticipatory anxiety in patients with panic disorder

A large body of evidence indicates that patients with panic disorder(PD) report more obvious alexithymia, and previous studies suggest genetic factors may be play an important role in alexithymia. This study aims to examine the association between the Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and alexithymia, and then to evaluate the association of the BDNFVal66Met polymorphism with PD risk. 223 patients with PD and 218 healthy controls were enrolled in the study. The Toronto Alexithymia Scale (TAS-20), and Panic Disorder Severity Scale (PDSS) were administered to all subjects. And genotyping of the BDNF Val 66Met polymorphism was evaluated. Our results showed that both PD patients and normal controls with the BDNF Met/Met genotype had significantly higher total and difficulty describing feelings(DDF) subdimension scores on the TAS-20 than those with the Val/Val genotype.The patients with the BDNF Met/Met genotype were more severity of anticipatory anxiety than patients with Val/Val genotype.

Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia

Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients’ quality of life, especially regarding the psychosocial functioning.

Interoception and Its Interaction with Self, Other, and Emotion Processing: Implications for the Understanding of Psychosocial Deficits in Borderline Personality Disorder

PURPOSE OF REVIEW

We review evidence for the potential importance of interoception, i.e., the processing of signals arising from inside the body, for deficient psychosocial functioning in borderline personality disorder (BPD).

RECENT FINDINGS

Evidence suggests that variability in interoception interacts with higher-order psychological functions such as self, other, and emotion processing. These domains are characteristically impaired in BPD, suggesting a likely causal role of disturbed interoception in the etiology of the disorder. The inability to identify and describe one's own emotional states represents a proxy of impaired interoception which might further mediate between the perception of inner physiological conditions and psychosocial functioning in BPD. There is preliminary evidence explaining how early life stress might adversely affect central interoceptive representation and psychosocial functioning in BPD. Based on these findings and the specific pattern of disturbances in BPD, we propose the crucial role of interoception in an integrated biobehavioral model for BPD.

Headache and Alexithymia in Children and Adolescents: What Is the Connection?

Background: Headache is one of the most common complaints in children and adolescents and comorbidity rates are very high and the major associated diseases are depression, anxiety, atopic disorders, sleep, and behavioral disorders. In recent years, it has been highlighted that difficulties regulating emotions such as alexithymia have also been associated with diagnosis of somatization. Methods: We carried out a mini review analyzing the relation between alexithymia and primary headache (e.g., migraine and tension type headache) in children and adolescents by synthesizing the relevant studies in the literature on PubMed, PsycINFO, and Google Scholar. Search terms were "alexithymia" combined with the "primary headache," "migraine," "tension type headache," "children," and "adolescents." Results: All analyzed studies found higher levels of alexithymia in children and adolescents with headache than control groups but there are different opinions about the relationship between headache and alexithymia. For example, some studies suggest that the association between headache and alexithymia in children may be due to an incomplete development of emotive competency or a general immature cognitive development, instead other studies found a correlation between headache symptoms, insecure attachment, and alexithymia. There seems to be also differences between children with migraine compared to those with tension type headache (TTH). Conclusion: There are some studies on adults suffering from headache or migraine and alexithymia, but there is only a moderate amount of research on pediatric age with different opinions and theories about this relationship. Further studies on children and adolescents are necessary to effectively understand this relationship and to help children to reduce headache and improve emotional consciousness.

Measuring Alexithymia via Trait Approach-I: A Alexithymia Scale Item Selection and Formation of Factor Structure

INTRODUCTION

It is not clear in the literature whether available instruments are sufficient to measure alexithymia because of its theoretical structure. Moreover, it has been reported that several measuring instruments are needed to measure this construct, and all the instruments have different error sources. The old and the new forms of Toronto Alexithymia Scale are the only instruments available in Turkish. Thus, the purpose of this study was to develop a new scale to measure alexithymia, selecting items and constructing the factor structure.

METHODS

A total of 1117 patients aged from 19 to 82 years (mean = 35.05 years) were included. A 100-item pool was prepared and applied to 628 women and 489 men. Data were analyzed using Explanatory Factor Analysis, Confirmatory Factor Analysis, and Item Response Theory and 28 items were selected. The new form of 28 items was applied to 415 university students, including 271 women and 144 men aged from 18 to 30 (mean=21.44).

RESULTS

The results of Explanatory Factor Analysis revealed a five-factor construct of "Solving and Expressing Affective Experiences," "External Locused Cognitive Style," "Tendency to Somatize Affections," "Imaginary Life and Visualization," and "Acting Impulsively," along with a two-factor construct representing the "Affective" and "Cognitive" components. All the components of the construct showed good model fit and high internal consistency. The new form was tested in terms of internal consistency, test-retest reliability, and concurrent validity using Toronto Alexithymia Scale as criteria and discriminative validity using Five-Factor Personality Inventory Short Form.

CONCLUSION

The results showed that the new scale met the basic psychometric requirements. Results have been discussed in line with related studies.

The Big Five personality dimensions and mental health: The mediating role of alexithymia

The role of personality constructs on mental health has attracted research attention in the last few decades. The Big Five personality traits have been introduced as parsimonious dimensions of non-pathological traits. The five-factor model of personality includes neuroticism, agreeableness, conscientiousness, extraversion, and openness to experience. The present study aimed to examine the relationship between the Big Five dimensions and mental health considering the mediating role of alexithymia as an important emotional-processing construct. A total of 257 participants were recruited from non-clinical settings in the general population. All participants completed the Ten-Item Personality Inventory (TIPI), 20-item Toronto Alexithymia Scale (TAS-20), and General Health Questionnaire-28 (GHQ-28). Structural equation modeling was utilized to examine the hypothesized mediated model. Findings indicated that the Big Five personality dimensions could significantly predict scores of alexithymia. Moreover, alexithymia could predict mental health scores as measured by indices of depression, anxiety, social functioning, and somatic symptoms. The fit indices (GFI=0.94; CFI=0.91; TLI=0.90; RMSEA=0.071; CMIN/df=2.29) indicated that the model fits the data. Therefore, the relationship between the Big Five personality dimensions and mental health is mediated by alexithymia.

Association between the Catechol-O-Methyltransferase (COMT) Val¹⁵⁸Met Polymorphism and Alexithymia in Patients with Obsessive-Compulsive Disorder

PURPOSE

Alexithymia, defined as a deficit in the ability to recognize and describe one's own feelings, may be related to the development and maintenance of obsessive-compulsive symptoms. The aim of this study was to evaluate the association between the catechol-O-methyltransferase (COMT) Val¹⁵⁸Met polymorphism and alexithymia in patients with obsessive-compulsive disorder (OCD).

MATERIALS AND METHODS

We recruited 244 patients with OCD (169 males, 75 females). Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20), and genotyping of the COMT Val¹⁵⁸Met polymorphism was evaluated.

RESULTS

Patients with the COMT Val/Val genotype had significantly higher total and "difficulty identifying feelings" (DIF) subdimension scores than those with the Val/Met or Met/Met genotypes. Patients with the COMT Val/Val genotype had significantly higher "difficulty describing feelings" (DDF) subdimension scores than those with the COMT Val/Met genotype. However, there were no differences in the scores for the "externally oriented thinking" (EOT) subdimension among the three genotypes.

CONCLUSION

These results indicate that the high-activity Val allele of the COMT Val¹⁵⁸Met polymorphism is associated with increased alexithymic traits in patients with OCD. The present finding suggests that alexithymia is an endophenotype of OCD that is mediated by the COMT Val¹⁵⁸Met polymorphism.

Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity

Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.

The Role of Alexithymia in the Incidence of Poststroke Depression

Poststroke depression (PSD) is the most frequent neuropsychiatric consequence of stroke, and alexithymia is a construct characterized by the inability to identify and describe emotions. Our study aimed to determine whether alexithymia is a risk factor for the development of PSD. Patients with ischemic stroke admitted to a general teaching hospital were enrolled in this 6-month study. The patients were evaluated with the Toronto Alexithymia Scale-20 (TAS-20), Beck Anxiety Inventory (BAI), National Institute of Health Stroke Scale (NIHHS), and Mini-Mental Status Examination at baseline and then followed up each month for detection of PSD using the Center for Epidemiologic Studies of Depression scale. In all, 285 patients with ischemic stroke were enrolled, and 93.3% completed the 6-month study. The overall incidence of PSD within 6 months was 16.5%. In multivariate regression analyses, the incidence of PSD was significantly associated with higher BAI, higher NIHSS, and higher TAS-20 scores. In conclusion, our study highlights the importance of alexithymic symptoms as a risk factor for PSD.

Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache

Background

Alexithymia is a personality construct characterized by difficulties in verbal emotional expression and a limited ability to use one’s imagination. Evidence of alexithymic characteristics was found in adults suffering from headache, while little is known about children. The aim of this study was to establish the prevalence of alexithymia in two different subgroups of children and adolescents suffering from primary headache. We also looked for correlation between alexithymia in children and in their mothers.

Methods

This study involved 89 participants: 47 (11 males, 36 females, aged 8 to 17 years) suffering from tension-type headache (TTH), and 42 (18 males, 24 females, aged 8 to 17 years) suffering from migraine (M), based on the International Classification of Headache Disorders (ICHD 2013). A control group of 32 headache-free subjects (26 females and 6 males, aged 8 to17 years) was also considered. Two questionnaires were administered to measure alexithymia: the Alexithymia Questionnaire for Children to young patients and controls, and the Toronto Alexithymia Scale (TAS-20) to the mothers.

Results

Higher rates of alexithymia emerged in the TTH group compared to the M group. In particular, TTH sufferers had difficulty identifying their feelings. The mothers of children with headaches didn’t score higher in alexithymia compared to other mothers. In the M and in the control group, there was a significant correlation between the rates of alexithymia in young people and in their mothers.

Conclusions

To date no other study has investigated alexithymia in subgroups of primary headaches in developmental age. Our results suggest that patients suffering from TTH are more alexithymic than M patients. This pave the way to etiopathogenetic and clinical considerations, calling for a comprehensive and multidisciplinary approach to tackle the problem of headache.

Lack of Association between Oxytocin Receptor (OXTR) Gene Polymorphisms and Alexithymia: Evidence from Patients with Obsessive-Compulsive Disorder

Oxytocin receptor gene single nucleotide polymorphisms have been associated with structural and functional alterations in brain regions, which involve social-emotional processing. Therefore, oxytocin receptor gene polymorphisms may contribute to individual differences in alexithymia, which is considered to be a dysfunction of emotional processing. The aim of this study was to evaluate the association between oxytocin receptor gene single nucleotide polymorphisms or haplotypes and alexithymia in patients with obsessive-compulsive disorder. We recruited 355 patients with obsessive-compulsive disorder (234 men, 121 women). Alexithymia was measured by using the Toronto Alexithymia Scale. We performed single-marker and haplotype association analyses with eight single nucleotide polymorphisms (rs237885, rs237887, rs2268490, rs4686301, rs2254298, rs13316193, rs53576, and rs2268498) in the oxytocin receptor gene. There were no significant associations between any of the eight single nucleotide polymorphism of the oxytocin receptor gene and alexithymia. In addition, a six-locus haplotype block (rs237885-rs237887-rs2268490-rs4686301-rs2254298-rs13316193) was not significantly associated with alexithymia. These findings suggest that genetic variations in the oxytocin receptor gene may not explain a significant part of alexithymia in patients with obsessive-compulsive disorder.

Do alexithymic individuals avoid their feelings? Experiential avoidance mediates the association between alexithymia, psychosomatic, and depressive symptoms in a community and a clinical sample

OBJECTIVE

Alexithymia is defined as the trait associated with difficulty in identifying and describing feelings as well as poor fantasy and imagery. While alexithymia is related to psychopathology in general, it has been associated with increased reporting of medically unexplained symptoms and depression in particular. This study attempts to assess the extent to which alexithymia represents a learned, avoidant coping strategy against unwanted emotions. In this way the study aims to identify a potential mechanism that may elucidate the relationship between alexithymia and psychological symptoms.

METHOD

Alexithymia is examined in two different samples, students from two universities in Cyprus and intensive outpatients/residents in an American anxiety disorder treatment program. We examine whether alexithymia predicts psychosomatic and depressive symptoms respectively through the mediating role of experiential avoidance, a coping mechanism believed to be reinforced because of the immediate relief it provides.

RESULTS

Experiential avoidance was found to correlate strongly with alexithymia, especially its difficulty in identifying feelings factor, while the mediation hypothesis was supported in all models tested. Furthermore, results from the clinical sample suggest that clinical improvement in depression was associated with a decrease in alexithymia, especially difficulty in identifying feelings, mediated by decreased experiential avoidance.

CONCLUSIONS

Alexithymia, and more specifically its difficulty in identifying feelings aspect, may be a learned behavior used to avoid unwanted emotions. This avoidant behavior may form the link between alexithymia and psychopathology. Implications for alexithymia theory and treatment are discussed.

Genetic Associations of Alexithymia in Predicting Interferon-Induced Depression in Chronic Hepatitis C

BACKGROUND

Previous studies have shown that alexithymia is associated with gene polymorphisms that regulate the availability of serotonin (5-HT) in the brain. Since the 5-HT network is involved in interferon (IFN)-induced depression, this paper aimed to investigate the role of alexithymia and the functional gene variants of the 5-HT1A receptor (HTR1A) and the 5-HT transporter (5-HTTLPR) in induction of depression during antiviral treatment.

METHODS

The depressive symptoms of 130 consecutive patients with chronic hepatitis C and no current psychopathology were measured during treatment with IFN and ribavirin (6-12 months) and at a 6-month follow-up. At baseline, alexithymia and 2 genotypes (5-HTTLPR and HTR1A) were also assessed.

RESULTS

Patients with homozygosity for HTR1A-G and 5-HTTLPR long alleles had significantly higher levels of alexithymia. After controlling for sociodemographic and disease-related factors, alexithymia and HTR1A-G polymorphism, both separately (20-22%) and jointly (14-16%), significantly and independently predicted the development of IFN-induced depression.

CONCLUSIONS

Subjects carrying HTR1A-G and 5-HTTLRP double long alleles are more vulnerable to alexithymia. Also patients with a higher level of alexithymia and the HTR1A-G gene variant are more vulnerable to experiencing IFN-induced depressive symptoms. The clinical implications of targeting alexithymia and HTR1A receptors as a possible treatment option for mood disorders should be investigated in further studies.

Musical activity and emotional competence - a twin study

The hypothesis was tested that musical activities may contribute to the prevention of alexithymia. We tested whether musical creative achievement and musical practice are associated with lower alexithymia. 8000 Swedish twins aged 27–54 were studied. Alexithymia was assessed using the Toronto Alexithymia Scale-20. Musical achievement was rated on a 7-graded scale. Participants estimated number of hours of music practice during different ages throughout life. A total life estimation of number of accumulated hours was made. They were also asked about ensemble playing. In addition, twin modelling was used to explore the genetic architecture of the relation between musical practice and alexithymia. Alexithymia was negatively associated with (i) musical creative achievement, (ii) having played a musical instrument as compared to never having played, and – for the subsample of participants that had played an instrument – (iii) total hours of musical training (r = -0.12 in men and -0.10 in women). Ensemble playing added significant variance. Twin modelling showed that alexithymia had a moderate heritability of 36% and that the association with musical practice could be explained by shared genetic influences. Associations between musical training and alexithymia remained significant when controlling for education, depression, and intelligence. Musical achievement and musical practice are associated with lower levels of alexithymia in both men and women. Musical engagement thus appears to be associated with higher emotional competence, although effect sizes are small. The association between musical training and alexithymia appears to be entirely genetically mediated, suggesting genetic pleiotropy.

Alexithymia and adult attachment representations: associations with the five-factor model of personality and perceived relationship adjustment

Several studies have demonstrated associations between alexithymia, adult attachment styles, personality traits, and relationship adjustment. Only two studies, however, have explored associations between alexithymia and attachment representations. As part of a larger investigation of maternal and infant attachment, the current study explored this association in a sample of 97 pregnant women; in addition, measures of alexithymia and domains of the five-factor model (FFM) of personality were compared in predicting attachment security, assessed with the Adult Attachment Interview Coherence of Mind mind scale, and perceived relationship adjustment. Alexithymia negatively predicted coherence of mind; the domains of the FFM did not add significantly to the prediction. The Openness-to-Experience domain predicted relationship adjustment better than alexithymia. Contrary to findings from studies that assessed adult attachment styles, coherence of mind was unrelated to relationship adjustment and the FFM. The results suggest that alexithymia does not uniquely predict relationship adjustment beyond the domains of the FFM.

A family history of alcoholism relates to alexithymia in substance use disorder patients

OBJECTIVES

Previous research identified alexithymia as a potential risk factor for substance use disorders (SUD). More insight into the relation between alexithymia and SUD is needed in order to treat SUD effectively. Therefore, we investigated whether a familial vulnerability to alcoholism relates to the presence and severity of alexithymia in SUD patients.

METHOD

Hospitalized, abstinent SUD-patients (n=187), were assessed with the Toronto Alexithymia Scale (TAS-20) and Addiction Severity Index (EuropASI). A maternal, paternal, and total continuous measure of the Family History of Alcohol (FHA) was developed. Kruskal-Wallis tests and Spearman correlations were used to relate the composite scores of FHA to alexithymia as a categorical and continuous measure. Multivariate regression models were performed to control for the effects of confounders on the relation between FHA and alexithymia.

RESULTS

Compared to moderate (33%) and low (17%) alexithymic SUD-patients, high alexithymic (50%) patients were more likely to have fathers with alcohol problems (P=0.004). Such a difference was not found for mothers with alcohol problems. The composite FHA-score was significantly associated with alexithymia (Rs=.19, P=0.01). However, only a paternal FHA, independent from disturbed family functioning, related to the degree of alexithymia (β=.13, P=0.06), especially to the Difficulty Identifying Feelings as measured by the TAS-20 (β=.16, P=0.02).

CONCLUSIONS

The relation between a paternal FHA and a higher degree of alexithymia in SUD-patients suggests that alexithymia could mediate the familiality of alcoholism or SUD in the paternal line.

Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia-a condition that frequently co-occurs with autism-rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this 'alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.

Emotional aspects of anorexia nervosa: results of prospective naturalistic cognitive behavioral group therapy

BACKGROUND

Anorexic girls have difficulties in handling their emotions. We examined emotional problems of adolescent girls with anorexia nervosa (AN) during the course of cognitive behavioral group therapy (G-CBT).

METHODS

Overall, 29 girls with AN (age 13-17 years) participated in four groups of manual based G-CBT. We assessed the body mass index (BMI), eating behavior psychopathology, emotions, depression, hedonistic activities, self-care and-efficacy, social phobia, sense of coherence (SOC), and alexithymia before, during and up to 1 year after therapy.

RESULTS

Out of 29, 16 (55 %, intent to treat, or 76 %, per protocol) girls were successfully treated, 5 (17 or 24 %) had a "poor outcome", and 8 (28 %) dropped out. BMI, eating behavior, mood, social anxiety, self-care, and self-efficacy persistently improved. Anorexic girls had multiple emotional deficits, low self-confidence, and exaggerated needs of control and of being accepted. Emotional deficits were resistant to change. Hedonistic activities, social skills, and recovery from depression were positive, comorbid disorders and parental psychopathology negative prognostic factors.

Blunted feelings: alexithymia is associated with a diminished neural response to speech prosody

How we perceive emotional signals from our environment depends on our personality. Alexithymia, a personality trait characterized by difficulties in emotion regulation has been linked to aberrant brain activity for visual emotional processing. Whether alexithymia also affects the brain's perception of emotional speech prosody is currently unknown. We used functional magnetic resonance imaging to investigate the impact of alexithymia on hemodynamic activity of three a priori regions of the prosody network: the superior temporal gyrus (STG), the inferior frontal gyrus and the amygdala. Twenty-two subjects performed an explicit task (emotional prosody categorization) and an implicit task (metrical stress evaluation) on the same prosodic stimuli. Irrespective of task, alexithymia was associated with a blunted response of the right STG and the bilateral amygdalae to angry, surprised and neutral prosody. Individuals with difficulty describing feelings deactivated the left STG and the bilateral amygdalae to a lesser extent in response to angry compared with neutral prosody, suggesting that they perceived angry prosody as relatively more salient than neutral prosody. In conclusion, alexithymia may be associated with a generally blunted neural response to speech prosody. Such restricted prosodic processing may contribute to problems in social communication associated with this personality trait.

Psychoanalysis and empirical research: the example of alexithymia

An extensive body of research on the alexithymia construct is reviewed to show how various empirical methodologies can be used to evaluate the validity and increase our understanding of theoretical and clinically derived psychoanalytic concepts. The historical background of alexithymia and the theoretical framework in which the construct was formulated are presented, after which measurement- and experiment-based approaches to construct validation are described. This is followed by a review of empirical investigations that have yielded evidence that alexithymia is a dimensional personality trait associated with several illnesses of interest to psychoanalysts. Empirical research also supports clinical observations and impressions that individuals with high degrees of alexithymia principally employ primitive defenses, have a limited capacity for empathy, exhibit deficits in mentalization, and do not respond well to traditional interpretive psychotherapies. Also reviewed is empirical research that implicates genetic and environmental/developmental factors in the etiology of alexithymia, in particular childhood trauma and insecure attachments, factors generally associated with deficits in affect development and affect regulation. The clinical relevance of the empirical research findings is discussed in the final section.

A Behavior Genetic Analysis of Trait Emotional Intelligence and Alexithymia: A Replication

This replication study examines relations between alexithymia and trait emotional intelligence (trait EI) at the phenotypic, genetic, and environmental levels. A sample of 1,444 same-sex twin pairs (850 MZ pairs and 594 DZ pairs) completed the Toronto Alexithymia Scale-20. A subset of 494 same-sex twin pairs (287 MZ pairs and 207 DZ pairs) had earlier completed the Trait Emotional Intelligence Questionnaire. Individual differences in alexithymia were attributable to genetic, non-shared environmental, and shared environmental factors. All but one of the facets of alexithymia were negatively and significantly correlated with the factors of trait EI, and these phenotypic correlations were entirely attributable to correlated genetic and correlated non-shared environmental factors. These bivariate results provide a valuable replication of those of Baughman et al. (Twin Research and Human Genetics, Vol. 14, 2011, pp. 539–543), which was conducted with substantially smaller samples of twins.

Alexithymia and eating disorders: a critical review of the literature

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies

The number of articles on alexithymia has been steadily increasing since the word “alexithymia” was coined in the 1970s to denote a common characteristic that is observed among classic psychosomatic patients in whom therapy was unsuccessful. Alexithymia, a disorder of affect regulation, has been suggested to be broadly associated with various mental and physical health problems. However, most available evidence is based on anecdotal reports or cross-sectional observations. To clarify the predictive value of alexithymia for health problems, a systematic review of prospective studies was conducted. A search of the PubMed database identified 1,507 articles on “alexithymia” that were published by July 31, 2011. Among them, only 7 studies examined the developmental risks of alexithymia for health problems among nonclinical populations and 38 studies examined the prognostic value of alexithymia among clinical populations. Approximately half of the studies reported statistically significant adverse effects, while 5 studies demonstrated favorable effects of alexithymia on health outcomes; four of them were associated with surgical interventions and two involved cancer patients. The studies that showed insignificant results tended to have a small sample size. In conclusion, epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems remains un-established. Even though alexithymia is considered to be an unfavorable characteristic for disease control and health promotion overall, some beneficial aspects are suggested. More prospective studies with sufficient sample sizes and follow-up period, especially those involving life course analyses, are needed to confirm the contribution of alexithymia to health problems.

An Update on the Italian Twin Register: Advances in Cohort Recruitment, Project Building and Network Development

The Italian Twin Register has been in place for more than 10 years. Since its establishment, it has been focusing, on the one hand, on a continuous update of the existing information, and on the other hand, on new phenotypes and sample collection. Demographic data on about 140,000 twins have been updated using the municipality registries. The Italian Twin Register has been carrying out several new studies during the last few years. A birth cohort of twins, Multiple Births Cohort Study, has been started and the enrolment is ongoing. For this cohort, data on pregnancy and birth are collected, and periodical follow-ups are made. DNA is being collected for the twins and their parents. In the area of behavioral genetics, most efforts have been directed to psychological well being assessed with self-reported tools. Research on age-related traits continues with studies on arteriosclerosis development, early biomarkers in mild cognitive impairment, and the relation between lifestyle habits and mutagen sensitivity. The Italian Twin Register biobanking has grown in its size and in its know-how in terms of both technical issues and ethical procedures implementation. Furthermore, attitudes toward biobank-based research, together with willingness and motivation for donation, are being investigated. A valuable key resource for the Italian Twin Register is the possibility of linking twin data with disease registries. This approach has been yielding several important results, such as the recent study on the heritability of type 1 diabetes.