Are alexithymia, depression, and anxiety distinct constructs in affective disorders?

Intolerance of Uncertainty and Anxiety (but not Alexithymia) Mediate the Association Between Autistic Traits and Quality of Life

Previous research has indicated that autistic individuals report lower quality of life (QoL) than non-autistic people. It is unclear whether it is the autism traits themselves or co-occurring thinking styles or mental health difficulties that most impair QoL. This study tested a hypothesised model to explore how 'intolerance of uncertainty' (IU), alexithymia (difficulty in identifying and describing own emotions), and anxiety play into the association between autistic traits and QoL. Online survey data were analysed from 116 autistic and 51 non-autistic adults who completed six standardised questionnaires measuring autistic traits, alexithymia, IU, anxiety and QoL (physical health, psychological health, social relations, and environment domains). The autistic group reported higher scores for alexithymia, IU and anxiety, and lower scores for QoL across domains, compared to the non-autistic group. Across the entire sample, autistic traits, alexithymia, IU and anxiety were positively correlated with one another, and negatively related to the four domains of QoL. Finally, IU and anxiety partially serially mediated the pathways from autistic traits to physical health and environment domains of QoL, and fully mediated the pathways from autistic traits to psychological health and social relations domains of QoL, across the full sample. The lower QoL experienced by autistic people may be explained in part by the mediating effect of both IU and anxiety (but not alexithymia). This study highlights the need for evidence-based interventions to address both IU and anxiety to improve QoL for autistic people/those with high levels of autistic traits.

The relationship of personality, alexithymia, anxiety symptoms, and odor awareness: a mediation analysis

OBJECTIVE

Personality, emotions, and olfaction exhibit partial anatomical overlap in the limbic system structure, establishing potential mechanisms between personality, affective disorders, and olfactory-related aspects. Thus, this study aims to investigate the associations among the Big Five personality traits, alexithymia, anxiety symptoms, and odor awareness.

METHODS

A total of 863 college participants were recruited for this study. All participants completed the Chinese Big Five Personality Inventory-15, the Odor Awareness Scale (OAS), the Toronto Alexithymia Scale-20, and the Generalized Anxiety Disorder Screener-7. Structural equation modeling was employed to examine the hypothesized mediated model.

RESULTS

The findings revealed the majority of significant intercorrelations among the dimensions of the Big Five personality traits, alexithymia, anxiety symptoms, and OAS (|r| = 0.072-0.567, p < 0.05). Alexithymia and anxiety symptoms exhibited a serial mediation effect between neuroticism and OAS (95%CI[0.001, 0.014]), conscientiousness and OAS (95%CI[-0.008, -0.001]), and extraversion and OAS (95%CI[-0.006, -0.001]). Anxiety symptoms mediated the relationship between agreeableness and OAS (95%CI[-0.023, -0.001]) and between openness and OAS (95%CI [0.004, 0.024]).

CONCLUSION

The mediating roles of alexithymia and anxiety symptoms between the Big Five personality traits and odor awareness support the idea of a certain level of association among personality, emotions, and olfaction, with the underlying role of the limbic system structure. This enhances our understanding of personality, emotions, and olfaction and provides insights for future intervention measures for affective disorders and olfactory dysfunctions.

Trajectories of COVID-19 pandemic-related depressive symptoms and potential predictors: the FinnBrain Birth Cohort Study

PURPOSE

In the context of the COVID-19 pandemic, mental health problems have been reported, and parents of young children may be more vulnerable to psychological distress due to increased caregiving responsibilities. However, research on the heterogeneity of the longitudinal course of psychological symptoms during the pandemic and the predispositions linked with these courses is still scarce. This study aimed to identify differential trajectories of depressive symptoms among the parents of young children and investigate the role of temperament traits, alexithymia, and coping styles in the heterogeneity of the symptom trajectories.

METHODS

The sample consists of 844 parents from the FinnBrain Birth Cohort Study. Latent growth mixture modeling was utilized to identify trajectories of depressive symptoms from pre-pandemic between 2014 and 2019 (T0, the closest available measurement was used) to May/June 2020 (T1) and December 2020 (T2) during the pandemic. Multinomial logistic regression was used to examine temperament, alexithymia, and coping as predictors of symptom trajectories, controlling for various background factors.

RESULTS

Four trajectories of depressive symptoms were identified. Most parents experienced low and stable depressive symptoms. Negative affect, effortful control, alexithymia, emotion-diverting coping (self-distraction and venting), and avoidant coping (denial and behavioral disengagement) were predictors for subclinical stable depressive symptoms. Constructive coping (positive reframing, acceptance, and humor) protected the cohort parents from increasing or moderately high depressive symptoms.

CONCLUSIONS

The findings have implications for identifying vulnerable individuals with specific traits and strengthening of constructive coping strategies as possible foci in interventions for depression during global crises.

Alexithymia as a risk factor for poor emotional outcomes in adults with acquired brain injury

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (β = .43 p = <.001), Anxiety (β = .40, p <.001), Stress (β = .49, p <.001), and Adjustment (β = .26, p = .001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (β = -.15, p = .033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation.

What is the relationship between alexithymia and experiential avoidance? A latent analysis using three alexithymia questionnaires

Alexithymia is a clinically relevant personality trait characterized by poor emotional awareness and associated with several psychological and physical health concerns. Individuals with high alexithymia tend to engage in experiential avoidance and this may mediate psychological distress. However, little is known about what specific processes of experiential avoidance are involved, and the nature of the relation between alexithymia, experiential avoidance, and psychological distress remains unclear at a latent construct level. To examine this relationship at the latent construct level, a representative sample of 693 U.S. adults completed alexithymia (TAS-20, BVAQ, PAQ), general distress (DASS-21), multi-dimensional experiential avoidance (MEAQ), and general health (PROMIS-G-10) questionnaires. Structural equation modeling revealed that alexithymia significantly predicted experiential avoidance (β = 0.966, t = 82.383, p < .01), experiential avoidance significantly predicted general distress (β = 0.810, t = 2.017, p < .05), and experiential avoidance fully mediated the relationship between alexithymia and general distress (βindirect = -0.159, t = -0.398, p > .05). Correlations between alexithymia and experiential avoidance subfactors revealed a strong relationship to the repression and denial subfactor. Experiential avoidance is a promising target for clinical interventions, though longitudinal research is necessary to elucidate how the relationship between alexithymia and experiential avoidance unfolds over time.

Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping

BACKGROUND AND OBJECTIVES

Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments.

METHODS

Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure.

RESULTS

Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies.

LIMITATIONS

Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports.

CONCLUSIONS

Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.

Prevalence of autistic traits in functional neurological disorder and relationship to alexithymia and psychiatric comorbidity

INTRODUCTION

In a cohort of adults with Functional Neurological Disorder (FND), we aim to: METHODS: 91 patients participating in a FND 5-week outpatient program completed baseline self-report questionnaires for total phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) and dyslexia. Patients were grouped by Autism Spectrum Quotient (AQ-10) score of <6 or ≥ 6 and compared for significant differences in tested variables. This analysis was repeated with patients grouped by alexithymia status. Simple effects were tested using pairwise comparisons. Multistep regression models tested direct relationships between autistic traits and psychiatric comorbidity scores, and mediation by alexithymia.

RESULTS

36 patients (40%) were AQ-10 positive (scoring ≥6 on AQ-10). A further 36 patients (across AQ-10 positive and AQ-10 negative groups) (40%) screened positive for alexithymia. AQ-10 positive patients scored significantly higher for alexithymia, depression, generalised anxiety, social phobia, ADHD, and dyslexia. Alexithymia positive patients scored significantly higher for generalised anxiety, depression, somatic symptoms severity, social phobia, and dyslexia. Alexithymia score was found to mediate the relationship between autistic trait and depression scores.

CONCLUSION

We demonstrate a high proportion of autistic and alexithymic traits, in adults with FND. A higher prevalence of autistic traits may highlight a need for specialised communication approaches in FND management. Mechanistic conclusions are limited. Future research could explore links with interoceptive data.

A comprehensive review on emerging trends in the dynamic evolution of digital addiction and depression

Introduction

Using digital addiction as an umbrella term to cover any type of addictions to digital technologies such as the internet, smartphones, social media, or video games, the current study aimed to reveal the intellectual structure and evolution of research addressing digital addiction-depression relationship.

Methods

The study combined bibliometric and science mapping analysis methods for this purpose. Data for the study was gathered from Web of Science Core Collection after a comprehensive process of data search/extraction, and 241 articles were included in the final data set. A period-based, comparative science mapping analysis was performed using the SciMAT software.

Results

The analysis of data over three periods, Period 1 (1983-2016), Period 2 (2017-2019), and Period 3 (2020-2022) showed that internet addiction was the most significant theme across all three periods, which was followed by social media addiction. Depression, which emerged as a significant theme during Period 1, was later covered under anxiety disorder theme. Research interest was mostly on factors related to both addiction and depression such as cognitive distortion, insomnia, loneliness, self-esteem, social support, alexithymia, as well as cybervictimization or academic performance.

Discussion

The results suggested that much research is warranted on the digital addiction-depression relationship in different age cohorts, especially children and elderly. Similarly, the current analysis showed that this line of research particularly focused on internet, gaming and social media addiction, and evidence with regard to other types of digital addiction or related compulsive behaviors was almost absent. In addition, research was mostly inclined to understanding cause-effect relationships, which is significant, but preventive strategies seemed to be barely addressed. Likewise, the smartphone addiction-depression relationship arguably garnered less research interest, so future research would contribute to the field in this respect.

Attentional Processing of Unpleasant Stimuli in Alexithymia

Alexithymia is a multi-faceted personality trait defined by difficulties in identifying and describing emotions and is considered a risk factor for multiple psychiatric disorders. Current alexithymia research debates the type of attention bias involved in the processing of negative emotional information, especially in anxiety-evoking situations that are frequently associated with stress states. Relatedly, this study aims to examine the role of emotional influence on the attentional processing of Taiwanese alexithymic individuals. Using the Chinese version of the Toronto Alexithymia Scale-20 (TAS-20), individuals with high alexithymia (HA: TAS > 60, n = 26; Mage = 23.36) and individuals with low alexithymia (LA: TAS < 39, n = 26; Mage = 25.76) were recruited. Participants performed an emotional counting Stroop task preceded by anxiety-evoking (threatening and aversive pictures) or neutral pictures. Reaction times (RTs) of the emotional Stroop task were compared between HA and LA groups. Our results demonstrate that compared to individuals with LA, individuals with HA show early avoidance tendency (i.e., allocate less attentional resources to anxiety-evoking stimuli), and that negative affect therefore does not interfere with subsequent attention processing during the Stroop task, resulting in faster RT for unpleasant stimuli (Mthreatening = 683.87, Maversive = 685.87) than neutral stimuli (Mneutral = 695.64) (ps < .05). In addition, the attentional bias toward specific types of negative emotion was not differentiated in individuals with HA (p < .05), suggesting that alexithymic individuals' emotion schemas may be underdeveloped in terms of ability to specify exact emotions. This study provides evidence regarding early sensitization to negative stimuli during information processing, consistent with the notion that alexithymia is related to avoidant emotion regulation processes.

Shared and unique interoceptive deficits in high alexithymia and neuroticism

Interoception is the perception of internal bodily signals. It is considered fundamental to developing emotional awareness. For this reason, interoceptive deficits are often associated with alexithymia, a condition characterized by difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and an externally-oriented style of thinking (EOT). Yet, the atypical interoception found in alexithymia might be of a similar type and/or more serious than those found in other partially overlapping constructs that entail emotional difficulties and behavioural patterns associated with specific emotional styles. Our study explores this issue by examining the relationship between the interoceptive deficits associated with alexithymia and the Big Five personality traits. A non-clinical sample (N = 504) completed the Toronto Alexithymia Scale, the Big Five Inventory and the Multidimensional Assessment of Interoceptive Awareness. Data were analysed using a network analytic approach that conceives psychological traits as networks of interacting symptoms. The estimated network highlighted that EOT is the alexithymia component least associated with interoception and most associated with lower Openness to Experience. Conversely, DIF and Neuroticism are, respectively, the dimensions of alexithymia and the Big Five most highly associated with interoception. We also compared interoceptive abilities in the four groups of participants whose scores were a) high for both alexithymia and neuroticism, b) high only for alexithymia c), high only for neuroticism, and d) low for both. High alexithymia was especially associated with the tendency to ignore sensations of pain or discomfort, while neuroticism was more indicative of the tendency to worry about these sensations. These results suggest that while high alexithymia and neuroticism share some interoceptive deficits, others are unique to alexithymia and contribute to overall lower interoceptive ability in this condition. Our findings suggest that interventions to enhance awareness of bodily sensations can be beneficial especially for profiles who present high neuroticism and alexithymia.

Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire

BACKGROUND

Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community.

METHODS

The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored.

RESULTS

Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established.

LIMITATIONS

The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI.

CONCLUSION

Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.

The Relationship between Alexithymia and Mental Health Is Fully Mediated by Anxiety and Depression in Patients with Psoriasis

Background: Psoriasis is a common skin disease that affects quality of life, especially mental health. Alexithymia has been considered a relevant feature in psoriasis patients. Moreover, psoriasis was found to be associated with negative psychological health, including anxiety and depression. As the pathways linking alexithymia and mental health remain unclear among patients with psoriasis, we aimed to examine the mediating role of anxiety and depression in the relationship between alexithymia and mental health in these patients. Methods: To explore our variables of interest, we used the Toronto Alexithymia Scale (TAS-20), the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS). Results: Forty-four percent of patients were alexithymic and reported higher anxiety and depression, and lower quality of life compared to non-alexithymic patients. Alexithymic patients also had lower educational attainment. A correlation analysis showed positive associations between alexithymia and both anxiety and depression, whereas mental and physical health were negatively associated with alexithymia. Moreover, anxiety and depression fully mediated the relationship between alexithymia and mental health. Conclusions: Our findings highlight the importance of assessing alexithymia and psychological distress in clinical practice to identify vulnerable patients and to implement interventions aimed at improving negative emotional states.

A Semantic Scale Network analysis of the revised Mystical Experiences Questionnaire: A call for collaboration

Background and aims

Multiple laboratories have proposed measures of subjective effects of psychedelics as potential mediators of their therapeutic impact. Other work has identified individual differences that covary with subjective responses in informative ways. The range of potential measures of responses, traits, and outcomes is vast. Ideas for new measures are likely numerous. The field will progress efficiently if proposed new scales can add incremental validity. Semantic Scale Network analyses identify conceptual overlap among scales based on items (rather than participant ratings), which could help laboratories avoid putting effort into measures that are unlikely to account for unique variance. Semantic Scale Network analyses can also reveal links to constructs from disparate research literatures, potentially helping investigators generate novel hypotheses and explain connections among disparate findings. The results of Semantic Scale Network analyses have the potential to improve as more investigators enter their scales into the corpus.

Method

Example analyses using the revised Mystical Experiences Questionnaire (MEQ) underscore the uniqueness and discriminant validity of the MEQ subscales.

Results

Findings dovetail with published theorizing and suggest potentially novel links with different therapeutic effects. The MEQ total or subscales overlap with measures of awe, inspiration, regret, dissatisfaction, transcendence, depression, fatigue, and spirituality. Links with measures of stress, alexithymia, and gender identity suggest lines of further work.

Conclusions

This analytic approach might suggest unique applications for psychedelic-assisted treatments and provide perspectives on phenomena outside the field. As psychedelic researchers enter their scales to the corpus for Semantic Scale Network analyses, the field will benefit.

The role of alexithymia and autistic traits in predicting quality of life in an online sample

BACKGROUND

Autistic people tend to report poorer Quality of Life (QOL) than comparison groups, though some studies do report more optimistic findings. Higher autistic traits are also related to poorer QOL. However, the role of alexithymia in this relationship has not been explored.

METHOD

A total of 163 participants (N = 53 autistic and N = 111 comparison) consented to take part; however, 30 participants were excluded due to missing data (who did not differ from those who were retained on age, gender, education, employment, or living status), leaving a final sample of 133 (N = 42 Autistic and 91 Comparison participants). Demographic information (including age, gender) was collected, alongside self-report measures of autistic traits, mental health, alexithymia, and QOL. We estimated regression models based on pre-registered analysis, and we conducted exploratory network analyses.

RESULTS

Alexithymic traits did not predict QOL when controlling for covariates. Depression significantly predicted Physical, Psychological, and Social QOL. When examining the impact of just alexithymic traits and autistic traits, both were significantly associated with Physical and Psychological QOL. For participants with a low depression score, the correlation between alexithymia and QOL was strong; suggesting that depression occludes the association between alexithymia and QOL. Network analyses suggested that depression and anxiety exert direct effects on Physical and Psychological QOL, whereas alexithymia scores may influence Physical QOL via autistic traits.

CONCLUSION

In sum, depression is a pervasive negative predictor of multiple QOL domains. The role of alexithymia in predicting QOL dimensionally and categorically was not ruled out, given our exploratory analyses, we suggest that interventions which target alexithymia may positively impact QOL for those who score low on depressive symptoms.

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.

Stability of alexithymia is low from adolescence to young adulthood, and the consistency of alexithymia is associated with symptoms of depression and dissociation

BACKGROUND

The aims of this study were to investigate the stability of alexithymia from adolescence to young adulthood, as well as the association between alexithymia, peer relationships, and symptoms of depression and dissociation.

METHODS

The participants (n = 755, aged 13-18 years) were assessed with self-rated questionnaires and the 20-item Toronto Alexithymia Scale (TAS-20) at baseline in 2005 and on follow-up in 2011.

RESULTS

The changes in the TAS-20 total score (t = -12.26) and the scores for its subscales, difficulty identifying feelings (DIF) (t = -4.04), difficulty describing feelings (DDF) (t = -5.10), and externally oriented thinking (EOT) (t = -18.23), were statistically significant (p < 0.001). Effect sizes (Cohen's d) for the change indicating absolute stability were small for DIF (-0.15) and DDF (-0.19), medium for TAS-20 total (-0.45), and large for EOT (-0.66) scores. Moderate correlations in test-retests with Spearman's ρ (TAS-20 total 0.46, DIF 0.41, DDF 0.39, EOT 0.43) indicated relative stability, whereas low intraclass correlation coefficients (ICCs) (respectively 0.41, 0.39, 0.37, 0.37) indicated poor reliability of test-retests. In regression analyses, poor relationships with peers, loneliness, and symptoms of depression and dissociation at baseline associated with alexithymia at baseline and on follow-up. Unlike EOT, increases in the TAS-20 total, DIF, and DDF scores during the 6-year follow-up associated with baseline symptoms of depression and dissociation.

CONCLUSIONS

Alexithymia in adolescence is not always a reliable predictor of alexithymia in young adulthood. Mental health symptoms appear to affect the consistency of alexithymia during adolescent development.

Psychometric evaluation of the Norwegian Toronto Alexithymia Scale (TAS-20) in a multisite clinical sample of patients with personality disorders and personality problems

OBJECTIVE

Psychometric properties of 20-item Toronto Alexithymia Scale (TAS-20) have been widely analyzed, but the validity and psychometric qualities of the TAS-20 in populations with personality disorders are still poorly understood. The aim of the current study was to analyze the factor structure and validity of TAS-20.

METHOD

Data were extracted from a multisite clinical sample of patients with personality disorders or personality-related problems referred to specialist mental health services in Norway.

RESULTS

With one exception, TAS-20 revealed acceptable psychometric properties. Variations of TAS-20 are associated with other clinical measures of distress and severity. Anxiety disorders, borderline, and avoidant personality disorders were all highly related to levels of TAS-20. The TAS-20 also revealed unique variance not accounted for by subjective distress, symptom disorders, or dysfunctional personality traits.

CONCLUSION

The TAS-20 is a relevant instrument for use in assessment of personality disorders, but one subscale should be improved.

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.

Characterization of alexithymia in clinically isolated syndrome

BACKGROUND

In multiple sclerosis (MS), the prevalence of alexithymia, defined as an inability to identify and describe emotions, is close to 50% but the prevalence of this symptom in clinically isolated syndrome (CIS) is unknown. Characterizing alexithymia at an early stage of the disease can help to clarify psychobehavioural disturbances in CIS patients.

METHODS

Forty CIS patients, who fulfilled the MRI criteria for dissemination in space, were matched with 40 healthy subjects. They completed self-assessment scales for alexithymia, depression, anxiety, apathy and empathy. Cognitive functions were assessed using a battery of neuropsychological tests.

RESULTS

The mean delay (± standard deviation) between the occurrence of CIS and inclusion in the study was 3.9 (2.8) months. The frequency of alexithymia was higher in CIS patients than in controls, with a prevalence of 42% (P<0.0001). Alexithymia correlated with anxiety and depression but not with cognition. Alexithymia was dependent only on depression (P=0.003).

CONCLUSION

Alexithymia, characterized by difficulty identifying feelings, is present in patients in the early stage of MS, and seems to be strongly associated with depression. Difficulty in social interaction could be a risk of future affective disorders.

Alexithymia Is Linked with a Negative Bias for Past and Current Events in Healthy Humans

Although research provides a rich literature about the influence of emotional states on temporal cognition, evidence about the influence of the style of emotion processing, as a personality trait, on temporal cognition is extremely limited. We provide a novel contribution to the field by exploring the relationship between difficulties of identifying and describing feelings and emotions (alexithymia) and time perspective. One hundred and forty-two healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and the Zimbardo Time Perspective Inventory, which monitors individual differences in time-orientation regarding the past, present, and future. The results show greater attention to past negative aspects in participants whose TAS-20 score was indicating borderline or manifest alexithymia, as compared to non-alexithymic individuals. Moreover, the higher the TAS-20 score, the higher the tendency was to focus on negative aspects of the past and interpret the present fatalistically. These results suggest that difficulties in identifying and describing feelings and emotions are associated with a negative bias for past and present events. Theoretical and clinical implications of this finding are discussed.

How do you feel during the COVID-19 pandemic? A survey using psychological and linguistic self-report measures, and machine learning to investigate mental health, subjective experience, personality, and behaviour during the COVID-19 pandemic among university students

Background

The WHO has raised concerns about the psychological consequences of the current COVID-19 pandemic, negatively affecting health across societies, cultures and age-groups.

Methods

This online survey study investigated mental health, subjective experience, and behaviour (health, learning/teaching) among university students studying in Egypt or Germany shortly after the first pandemic lockdown in May 2020. Psychological assessment included stable personality traits, self-concept and state-like psychological variables related to (a) mental health (depression, anxiety), (b) pandemic threat perception (feelings during the pandemic, perceived difficulties in describing, identifying, expressing emotions), (c) health (e.g., worries about health, bodily symptoms) and behaviour including perceived difficulties in learning. Assessment methods comprised self-report questions, standardized psychological scales, psychological questionnaires, and linguistic self-report measures. Data analysis comprised descriptive analysis of mental health, linguistic analysis of self-concept, personality and feelings, as well as correlational analysis and machine learning. N = 220 (107 women, 112 men, 1 = other) studying in Egypt or Germany provided answers to all psychological questionnaires and survey items.

Results

Mean state and trait anxiety scores were significantly above the cut off scores that distinguish between high versus low anxious subjects. Depressive symptoms were reported by 51.82% of the student sample, the mean score was significantly above the screening cut off score for risk of depression. Worries about health (mental and physical health) and perceived difficulties in identifying feelings, and difficulties in learning behaviour relative to before the pandemic were also significant. No negative self-concept was found in the linguistic descriptions of the participants, whereas linguistic descriptions of feelings during the pandemic revealed a negativity bias in emotion perception. Machine learning (exploratory) predicted personality from the self-report data suggesting relations between personality and subjective experience that were not captured by descriptive or correlative data analytics alone.

Conclusion

Despite small sample sizes, this multimethod survey provides important insight into mental health of university students studying in Egypt or Germany and how they perceived the first COVID-19 pandemic lockdown in May 2020. The results should be continued with larger samples to help develop psychological interventions that support university students across countries and cultures to stay psychologically resilient during the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00574-x.

Alexithymia is associated with increased all-cause mortality risk in men, but not in women: A 10-year follow-up study

OBJECTIVE

Alexithymia is associated with various mental as well as physical disorders. Some evidence also suggested high alexithymia to increase mortality risk, but these results are few and based on specific sample compositions. We aimed to investigate the impact of alexithymia on mortality risk in a large population based cohort. In addition, we sought to elucidate the effects of the subfactors of alexithymia and sex differences.

METHODS

In a sample of N = 1380 individuals from the Study of Health in Pomerania (SHIP), we investigated the hazard-ratio (HR) of alexithymia as obtained by the Toronto Alexithymia Scale-20 (TAS-20) on all-cause mortality over an average observation time of 10 years. Sex-by-TAS-20-interactions as well as sex-stratified analyses were performed.

RESULTS

Alexithymia was significantly associated with enhanced mortality risk (HR = 1.033; 95%-CI = 1.008-1.058); p = 0.009). While sex-by-TAS-20 interactions remained insignificant, sex-stratified analyses showed that this effect was only significant in men (HR = 1.050; 95%-CI = 1.022-1.079; p ≤ 0.001), but not in women (HR: 1.008; 95%-CI = 0.960-1.057; p = 0.76). The effect was validated for the "difficulties identifying feelings" (DIF) and "difficulties describing feelings" (DDF) subfactors of the TAS-20.

CONCLUSION

Our study supports and extents previous findings by indicating that mortality risk enhancing effects of alexithymia are specific to male subjects and validated for the DIF and DDF facets. Socioeconomic, clinical and metabolic factors were associated with this relationship. Finding that the impact of alexithymia remains stable in the fully adjusted models suggests that yet unidentified additional factors must be considered.

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.

Interoception moderates the relation between alexithymia and risky-choices in a framing task: A proposal of two-stage model of decision-making

Decision-making depends on the context (frame) in which questions and alternatives are presented. Moreover, research has showed that the ability to detect bodily sensations (interoception) and being able to attribute these changes to emotions correctly (alexithymia) influence how we make decisions. The aim of the present research was to study how interoception and alexithymia might affect the Framing effect (FE), a cognitive bias closely related to emotional system. 42 healthy participants completed the Risky-choice Framing task and their interoception and alexithymia levels were measured. Results showed that the participants were more risk-taking under the negative frames in comparison to the positive ones. In addition, we found that alexithymia and interoception were negatively and positively correlated with the FE, respectively. Finally, the moderation analyses revealed that alexithymia predicted a lower FE only when the interoception was high. Based on previous literature and in our results, we propose a two-stage model of intuitive decision-making.

Alexithymia

Humans are highly adept at differentiating, regulating, and responding to their emotions. At the core of all these functions is emotional awareness: the conscious feeling states that are central to human mental life. Disrupted emotional awareness-a subclinical construct commonly referred to as alexithymia-is present in a range of psychiatric and neurological disorders and can have a deleterious impact on functional outcomes and treatment response. This chapter is a selective review of the current state of the science on alexithymia. We focus on two separate but related issues: (i) the functional deficits associated with alexithymia and what they reveal about the importance of emotional awareness for shaping normative human functioning, and (ii) the neural correlates of alexithymia and what they can inform us about the biological bases of emotional awareness. Lastly, we outline challenges and opportunities for alexithymia research, focusing on measurement issues and the potential utility of formal computational models of emotional awareness for advancing the fields of clinical and affective science.

Assessing Alexithymia: Psychometric Properties of the Perth Alexithymia Questionnaire in a Spanish-Speaking Sample

Alexithymia is a trait composed of difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally orientated thinking (EOT). It is an important transdiagnostic risk factor for psychosomatic disorders and other types of emotion-based psychopathologies, and can reduce the efficacy of some treatment approaches. Alexithymia assessments are therefore important in psychiatric and research settings. The Perth Alexithymia Questionnaire (PAQ) was recently developed to enable more comprehensive alexithymia assessments, however, its psychometric properties need further examination and it is so far only available in English. In this study, we sought to address this by translating the PAQ into Spanish and testing its psychometric properties in an adult sample from Chile (N = 370). Confirmatory factor analyses found the PAQ to have a theoretically congruent factor structure, supporting the contemporary status of alexithymia as a multifaceted construct and the PAQ's capacity to assess the DIF, DDF, and EOT facets of alexithymia across negative and positive emotions. All subscale and composite scores had high internal consistency reliability, and demonstrated good concurrent and discriminant validity. The PAQ therefore appears to provide a robust and detailed alexithymia profile. This Spanish version should help to enable more comprehensive cross-cultural research into alexithymia and its role in and psychological disorders.

Alexithymia in Alzheimer's Disease

Alexithymia is widely recognized as the inability to identify and express emotions. It is a construct which consists of four cognitive traits such as difficulty in identifying feelings, describing feelings to others, externally oriented thinking, and limited imaginative capacity. Several studies have linked alexithymia to cognitive functioning, observing greater alexithymia scores associated with poorer cognitive abilities. Despite Alzheimer's disease (AD) being a neurodegenerative pathology characterized by cognitive troubles from the early stages, associated to behavioral and emotional disturbances, very few investigations have studied the alexithymia in AD. These studies have shown that alexithymia scores-assessed with Toronto Alexithymia Scale (TAS)-were greater in AD patients than healthy participants. The objective of the study was to investigate if the alexithymia was present in patients with mild AD. We hypothesized that the AD group would show more alexithymia features than the control group. We evaluated 54 subjects, including 27 patients diagnosed with mild AD and 27 normal healthy controls, using the Shalling Sifneos Psychosomatic Scale (SSPS-R) and a neuropsychological test battery. Using non-parametric statistical analyses-Wilcoxon and Mann-Whitney U tests-we observed that the SSPS-R scores were similar in the AD and control groups. All participants showed SSPS-R scores below to 10 points, which means no-alexithymia. We did not find significant correlations between SSPS-R scores and cognitive variables in both groups (p > 0.22), but we observed a negative association between name abilities and alexithymia, but it does not reach to significance (p = 0.07). However, a significant correlation between SSPS-R score and mood state, assessed using Zerssen Rating Scale, was found in both groups (p = 0.01). Because we did not find a significant difference in the alexithymia assessment between both subject groups, pot hoc analyses were computed for each item of the SSPS-R. We made comparisons of alexithymic responses percentages in each SSPS-R item between AD and control groups, using Fisher's test. We observed that AD patients produced more alexithymic responses in some items of SSPS-R test than the control group, particularly about difficulties to find the words to describe feelings, as well as difficulties of imagination capacity and externally oriented thinking. The present results do not confirm our hypothesis and they do not support the results of previous studies revealing great alexithymia in AD.

Alexithymia in People With Recurrent Suicide Attempts

Background: Alexithymia, an inability to identify or describe emotions, is associated with suicidality yet the correlation with single or repeated suicide attempts is less clear. Aims: We aimed to assess the modifiability of alexithymia following a group psychosocial intervention focused on improving emotional literacy in those with a history of recurrent suicide attempts (RSA). Method: A total of 169 participants with self-reported RSA completed pre- and postgroup assessments of a 20-week group therapy intervention. Questionnaires assessed alexithymia, depression, impulsivity, and hopelessness; the Toronto Alexithymia Scale (TAS-20) was the primary outcome. Data were analyzed using multiple imputation. Results: Participants had on average 7.8 lifetime suicide attempts, 73% were female, and 16.6% had a >13-point reduction in TAS-20 scores after 20 weeks. Directed acyclic graph (DAG) analysis demonstrated significant relationships between alexithymia, depression, hopelessness, problem-solving, and satisfaction with life. Age of onset of suicidality was the only factor predictive of postintervention TAS-20 score in univariate linear regression. Limitations: The study limitations were its sample size, insufficient resources, and missing data. Conclusion: A change in TAS scores indicated that alexithymia can be a modifiable treatment target. Being able to identify and describe feelings may lead to improvement in depression, hopelessness, problem-solving, and satisfaction with life in this population.

Increased Alexithymia But No Profound Emotion Processing Disorder in Burnout Syndrome

Our objectives were to investigate alexithymia in burnout patients while controlling for depression and anxiety, as well as to evaluate whether alexithymia may be part of a profound emotional processing disorder or of a mentalization deficit. Alexithymia, depressive, and anxious feelings were compared in patients with burnout, depression, and healthy controls using an age-, sex-, and education-matched cross-sectional design (n = 60). A facial emotion recognition task and an emotional mentalizing performance test as well as physical and emotional violation experiences were conducted. Alexithymia was significantly increased in burnout patients, mediated by negative affect in this group. No impairment of facial emotion recognition or mental attribution could be shown. Burnout patients demonstrated slightly increased emotional abuse experiences in early childhood. The present results corroborate the supposition that alexithymia in burnout primarily depends on affect and may rise due to current strain and overload experience, rather than based on a profound developmental disorder in emotion processing.

Early-life adversities and adult attachment in depression and alexithymia

Alexithymia is a personality construct characterized by difficulties in identifying and verbalizing feelings, a restricted imagination, and an externally oriented thinking style. As alexithymia shows marked overlap with depression, its independent nature as a personality construct is still being debated. The etiology of alexithymia is unknown, although childhood emotional neglect and attachment formation are thought to play important roles. In the FinnBrain Birth Cohort Study, experiences of early-life adversities (EA) and childhood maltreatment (CM) were studied in a sample of 2,604 men and women. The overlap and differences between depression and alexithymia were investigated by comparing their associations with EA types and adult attachment style. Alexithymia was specifically associated with childhood emotional neglect (odds ratio (OR) 3.8, p < .001), whereas depression was related to several types of EA. In depression co-occurring with alexithymia, there was a higher prevalence of emotional neglect (81.3% vs. 54.4%, p < .001), attachment anxiety (t = 2.38, p = .018), and attachment avoidance (t = 4.03, p < .001). Early-life adversities were markedly different in the alexithymia group compared to those suffering from depression, or healthy controls. Depression with concurrent alexithymia may represent a distinct subtype, specifically associated with childhood experiences of emotional neglect, and increased attachment insecurity compared to non-alexithymic depression.

Mentalizing self and others: A controlled study investigating the relationship between alexithymia and theory of mind in major depressive disorder

BACKGROUND

Theory of mind (ToM) and alexithymia have been reported to relate with depression in recent studies. However, data regarding the role of alexithymia and ToM in depression remain uncertain.

AIM

The aim of the current study was to determine the levels of alexithymia and ToM abilities as well as their relationship with each other and clinical features in major depressive disorder (MDD).

MATERIALS AND METHODS

Patients diagnosed with MDD and healthy controls were undergone sociodemographic data, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale (TAS-20), and reading the mind in the eyes test (RMET) to determine the depression, anxiety, alexithymia, and ToM abilities.

RESULTS

Depression, anxiety, and alexithymia levels were higher, while ToM abilities were found to be decreased in MDD patients relative to controls. A positive correlation was observed between depression levels and alexithymia levels in terms of difficulty in identifying feelings subscale and total scores of TAS-20 (P = 0.006, P = 0.036, respectively), while a positive correlation was also observed between anxiety levels and alexithymia levels in terms of difficulty in describing feelings subscale scores of TAS-20 (P = 0.02) in depressed group. No correlation was found between depression, anxiety levels, and RMET accuracy scores.

CONCLUSION

Our results suggest alexithymia and impaired ToM abilities might be prominent but prone to be distinct clinical constructs in MDD patients.

The association between communication impairments and acquired alexithymia in chronic stroke patients

INTRODUCTION

Language dysfunction has recently been suggested to be one route to alexithymia, an impairment in recognizing and communicating one's own emotions. Neuropsychological evidence is needed to investigate the possibility that acquired language problems could underlie acquired alexithymia.

METHOD

This project examined data from a large group of chronic stroke patients (N = 118) to test whether self-reported or behavioral measures of language and communication problems were associated with alexithymia. We also examined the impact of hemisphere of damage on alexithymia.

RESULTS

We found no differences in alexithymia levels for patients with observed language impairments on brief tests of picture naming, comprehension, and reading vs unimpaired patients. However, self-reported communication difficulties were found to be associated with higher scores of alexithymia, even after controlling for depression and anxiety. Patients with left- versus right-hemisphere damage did not differ in their alexithymia scores.

CONCLUSIONS

We found partial support for the language hypothesis of alexithymia. We discuss potential reasons for the discrepant findings between the self-report and objective language measures and suggest that self-report measures may be more sensitive to milder, more pragmatic language impairments, as opposed to the severe structural language impairments measured by the cognitive screening tests.

The effect of alexithymia and depressive feelings on pain perception in somatoform pain disorder

OBJECTIVE

To investigate the relationship between alexithymia and depression and their influence on the subjective versus experimental pain perception in somatoform pain disorder.

METHODS

Three groups consisting of 40 patients with somatoform pain disorder, 40 patients with depression, and 40 healthy controls were matched. They completed questionnaires regarding alexithymia (TAS26) and depressive feelings (BDI-II). In addition, pain patients rated their subjective pain intensity (NRS). Quantitative sensory testings were conducted in all participants examining temperature (CPT, HPT) and mechanical (MPT, PPT) thresholds.

RESULTS

Analysis of variance showed that alexithymia was significantly increased in both patient groups compared to healthy controls, but with the highest amount in somatoform pain. Regression analyses confirmed that this finding was in part due to a high comorbidity of depressive feelings in both patient groups. We found a discrepancy between increased clinical pain ratings and elevated pressure pain thresholds, indicating a less intense mechanical pain perception in somatoform pain. Correlation analyses demonstrated a significant connection of subjective pain ratings and pressure pain thresholds with depressive feelings.

CONCLUSION

Contrary to the results of other experimental pain studies on chronic muskuloskeletal pain syndromes, we could not confirm central sensitization in somatoform pain disorder. Our findings place the somatoform pain disorder more in the direction of affective disorder such as depression. These findings may improve a better understanding of the disease and also have direct therapeutic implications. The high occurrence of alexithymia and depressive feelings in somatoform pain should be considered in diagnostic and therapeutic regimens of these patients.

Cognitive Reappraisal of Negative Emotional Images in Borderline Personality Disorder: Content Analysis, Perceived Effectiveness, and Diagnostic Specificity

Individuals with borderline personality disorder (BPD) report using cognitive reappraisal less often than healthy individuals despite the long-term benefits of the emotion regulation strategy on emotional stability. Individuals with BPD, mixed anxiety and/or depressive disorders (MAD), and healthy controls (HC) completed an experimental task to investigate the tactics contained in cognitive reappraisal statements vocalized for high and low emotional intensity photographs. Self-reported effectiveness after using cognitive reappraisal to decrease negative emotions was also evaluated. Although BPD and MAD used a similar number of cognitive reappraisal tactics, they perceived themselves as less effective at reducing their negative emotions compared to HC. During cognitive reappraisal, BPD and MAD uttered fewer words versus HC, while BPD uttered fewer words versus MAD. Results suggest that individuals with BPD and MAD are less fluent and perceive themselves as less effective than HC when using cognitive reappraisal to lower negative emotions regardless of stimulus intensity.

Brain structural correlates of alexithymia in patients with major depressive disorder

BACKGROUND

Alexithymia is a risk factor for major depressive disorder (MDD) and has been associated with diminished treatment response. Neuroimaging studies have revealed structural aberrations of the anterior cingulate cortex and the fusiform gyrus in healthy controls with high levels of alexithymia. The present study tried to corroborate and extend these results to patients with MDD compared with healthy controls.

METHODS

We investigated the relationship between alexithymia, depression and grey matter volume in 63 patients with MDD (mean age ± standard deviation = 42.43 yr ± 11.91; 33 female) and 46 healthy controls (45.35 yr ± 8.37; 22 female). We assessed alexithymia using the Toronto Alexithymia Scale. We conducted an alexithymia × group analysis of covariance; we used a region-of-interest approach, including the fusiform gyrus and anterior cingulate cortex, and conducted whole brain analysis using voxelbased morphometry.

RESULTS

Our analysis revealed a significant alexithymia × group interaction in the fusiform gyrus (left, pFWE = 0.031; right, pFWE = 0.010). Higher alexithymia scores were associated with decreased grey matter volume in patients with MDD (pFWE = 0.009), but with increased grey matter volume of the fusiform gyrus in healthy controls (pFWE = 0.044). We found no significant main effects in the region-of-interest analysis.

LIMITATIONS

Owing to the naturalistic nature of our study, patients with MDD and healthy controls differed significantly in their alexithymia scores.

CONCLUSION

Our results showed the fusiform gyrus as a correlate of alexithymia. We also found differences related to alexithymia between patients with MDD and healthy controls in the fusiform gyrus. Our study encourages research related to the transition from risk to MDD in people with alexithymia.

Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals

BACKGROUND

Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature.

METHODS

The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants.

RESULTS

Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = <.001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005).

LIMITATIONS

The study is limited by the small sample size and its cross-sectional nature.

CONCLUSIONS

Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.

A systematic review of structural MRI investigations within borderline personality disorder: Identification of key psychological variables of interest going forward

Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.

Panic Disorder as Unthinkable Emotions: Alexithymia in Panic Disorder, a Croatian Cross-Sectional Study

OBJECTIVES

Previous research on alexithymia has led to controversy over its prevalence in panic disorder. The aim of this study was to assess the difference in the prevalence of alexithymia in panic disorder and other anxiety disorders.

DESIGN AND METHODS

We performed a cross-sectional study on a sample of 71 patients diagnosed with panic disorder and 113 patients diagnosed with other anxiety disorders; both groups were 18-50 years old. Primary outcome was the 20-item Toronto Alexithymia Scale (TAS) score. Secondary outcome was the prevalence of alexithymia defined as a TAS score ≥61.

RESULTS

Patients diagnosed with panic disorder had a 25% higher score on the TAS subscale of difficulty identifying feelings than patients diagnosed with other anxiety disorders. The prevalence of alexithymia was 27% in patients with panic disorder and 13% in patients with other anxiety disorders. Patients diagnosed with panic disorder had significantly higher odds for alexithymia.

CONCLUSIONS

The results of our study support the hypothesis of higher prevalence of alexithymia in individuals with panic disorder than in individuals with other anxiety disorders. In addition, difficulty identifying feelings as a salient feature of alexithymia is higher in panic disorder than in other anxiety disorders.

Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study

Background

To our knowledge, no research project on alexithymia has been conducted in Lebanon. The objective of this study was to assess risk factors associated with alexithymia in a representative sample of the Lebanese population.

Methods

This is a cross-sectional study, conducted between November 2017 and March 2018, which enrolled 789 participants from al districts of Lebanon. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, the Alcohol Use Disorders Identification Test to assess alcohol use, drinking patterns, and alcohol-related issues, the Rosenberg self-esteem scale to evaluate self-worth, the Hamilton depression rating scale and Hamilton Anxiety Scale to screen for depression and anxiety respectively, the Three-Dimensional Work Fatigue Inventory to measure physical, mental and emotional work fatigue respectively, the Columbia–Suicide Severity Rating Scale to evaluate suicidal ideation and behavior, the Perceived Stress Scale to measure stress, the Liebowitz Social Anxiety Scale to help identify a social anxiety disorder and the Quick Emotional Intelligence Self-Assessment to measure emotional intelligence.

Results

The results showed that 395 (50.4%) were not alexithymic, 226 (28.8%) were possible alexithymic, whereas 163 (20.8%) were alexithymic according to established clinical cutoffs. Stress (Beta = 0.456), emotional exhaustion (Beta = 0.249), the AUDIT score (Beta = 0.225) and anxiety (Beta = 0.096) were associated with higher alexithymia, whereas low emotional work fatigue (Beta = −0.114) and being married (Beta = −1.933) were associated with lower alexithymia.

People in distress (Beta = 7.33) was associated with higher alexithymia scores, whereas people with high wellbeing (Beta = −2.18), an intermediate (Beta = −2.90) and a high (Beta = −2.71) family monthly income were associated with lower alexithymia compared to a low one.

Conclusion

Alexithymia appears to be influenced by many factors, including stress, anxiety, and burnout. To reduce its prevalence, it is important that health professionals educate the public about these factors. Further studies on a larger scale are needed to confirm our findings.

Alexithymia and Cardiac Outcome in Patients at First Acute Coronary Syndrome

BACKGROUND

This cohort study was aimed to verify whether subjects at their first acute coronary syndrome (ACS) were more alexithymic than healthy controls (HC) and whether alexithymia can predispose patients with coronary artery disease to new major adverse cardiac events (MACE) during a 24-month follow-up period.

METHODS

The sample included 100 HC with no history of depression or ACS and 304 never depressed patients with a first-ever ACS. A total of 266 patients completed the 2-year follow-up.

RESULTS

Patients and HC reported similar Toronto Alexithymia Scale (TAS-20) scores. During the follow-up, 69 (22.69%) patients developed incident depression and 57 (18.75%) developed a new MACE. In a proportional hazard model, developing a first-ever depressive episode, but not alexithymia (hazard ratio = 1.008, 95% confidence interval = 0.984-1.033; p = 0.500), was associated with almost 3 times the risk of a recurrent cardiac event.

CONCLUSION

Incident depression, but not TAS-20 scores, represented risk factor for MACE.

Alexithymia and reaching group consensus

One characteristic of human nature is the ability to align our behavior with others. Previous research has linked poor communication skills to alexithymia. This may suggest the possibility that individuals with high alexithymia do not adhere to the principles of social alignment. One form of cognitive alignment is consensus with a group. So far, little research attention has been given to the possible link between alexithymia and this form of cognitive social alignment. In this study, we address this gap by investigating the association between consensus-reaching abilities and alexithymia. A sample comprising of 122 participants completed the Toronto Alexithymia Scale and then played a specially designed game called "Consensus under a deadline". In each game, a participant played with either seven bots designed to act rationally and always seek a consensus, or with seven other participants. The participants were unaware who they were playing with. The results of the study confirm the link between alexithymia and impaired cognitive social alignment, showing that the alexithymia cognitive component (EOT) is associated with a deficit in reaching a consensus with humans (that sometimes act irrationally). However, this association was not evident when group members were bots (that always act rationally).

The Feeling of Me Feeling for You: Interoception, Alexithymia and Empathy in Autism

Following recent evidence for a link between interoception, emotion and empathy, we investigated relationships between these factors in autism spectrum disorder (ASD). 26 adults with ASD and 26 healthy participants completed tasks measuring interoception, alexithymia and empathy. ASD participants with alexithymia demonstrated lower cognitive and affective empathy than ASD participants without alexithymia. ASD participants showed reduced interoceptive sensitivity (IS), and also reduced interoceptive awareness (IA). IA was correlated with empathy and alexithymia, but IS was related to neither. Alexithymia fulfilled a mediating role between IA and empathy. Our findings are suggestive of an alexithymic subgroup in ASD, with distinct interoceptive processing abilities, and have implications for diagnosis and interventions.

Addressing Evidence Linking Secondary Alexithymia to Aberrant Humor Processing

In this review, we explore current literature and assess evidence linking secondary (acquired) alexithymia to aberrant humor processing, in terms of their neurobiological underpinnings. In addition, we suggest a possible common neuropathological substrate between secondary alexithymia and deficits in humor appreciation, by drawing on neurophysiologic and neuroradiological evidence, as well as on a recent and unique single-case study showing the cooccurrence of secondary alexithymia and deficit in humor appreciation. In summary, what emerges from the literature is that the cortical midline structures, in particular the medial prefrontal cortex (mPFC), the anterior cingulate cortex (ACC), and the insular cortex, seem to play a crucial role in the expression of both alexithymia and defective humor processing, while though to a lesser extent, a right hemisphere and bilateral frontoparietal contribution becomes evident. Neurobiological evidence of secondary alexithymia and aberrant humor processing points to the putative role of ACC/mPFC and the insular cortex in representing crucial processing nodes whose damage may produce both the above clinical conditions. We believe that the association of secondary alexithymia and aberrant humor processing, especially humor appreciation deficit, and their correlation with specific brain regions, mainly ACG/mPFC, as emerged from the literature, may be of some heuristic importance. Increased awareness on this topic may be of aid for neurosurgeons when accessing emotion-relevant structures, as well as for neuropsychologists to intensify their efforts to plan evidence-based neurorehabilitative interventions to alleviate the deleterious effects of such interpersonal communication deficits.

The association between alexithymia and eating behavior in children and adolescents

OBJECTIVE

Alexithymia, or the difficulty identifying or describing one's own emotions, may be a risk factor for dysregulated eating and excess weight gain. However, the relationships between alexithymia and eating behaviors in community samples of non-clinical youth have not been well-characterized. We hypothesized that alexithymia would be positively associated with disordered and disinhibited eating in a community-based sample of boys and girls without an eating disorder.

METHOD

Two hundred children (8-17 years old) across the weight spectrum completed an interview to assess loss of control (LOC) eating and eating-related psychopathology, a laboratory test meal designed to induce disinhibited eating, and questionnaires to assess alexithymia, eating in the absence of hunger, and emotional eating. Linear and logistic regressions were conducted to examine the relationship between alexithymia and eating variables, with age, sex, race, and fat mass as covariates. Test meal analyses also adjusted for lean mass. Given the overlap between alexithymia and depression, all models were repeated with depressive symptoms as an additional covariate.

RESULTS

Alexithymia was associated with an increased likelihood of reporting LOC eating (p < .05). Moreover, alexithymia was positively associated with disordered eating attitudes, emotional eating, and eating in the absence of hunger (ps < .05). Greater alexithymia was associated with more carbohydrate and less fat intake at the test meal (ps < .05). After adjusting for depressive symptoms, alexithymia remained associated with eating in the absence of hunger and carbohydrate and fat intake (ps < .05).

DISCUSSION

In healthy children, alexithymia is associated with some facets of eating behavior and food intake. If supported prospectively, these preliminary findings suggest alexithymia may be a modifiable risk factor to reduce disordered eating and excess weight gain in youth.

The effect of families' alexithymic status and social skill levels on directing their children with intellectual disabilities to sports

The aim of this study was to investigate the social skill levels of families who have children with mild intellectual disabilities and the effect of alexithymic status on their orientation to sports. The study group consisted of 194 families who have children with mild intellectual disabilities. Personal Information Form, Toronto Alexithymia Scale and Social Problem Solving Inventory-Short Form (SPSI-R/SF) were used as data collection tools. The families' alexithymic status and social problem solving skills were moderate. There was a relationship between alexithymia levels of families and positive orientation to the problem (r = 0.147; p < 0.01) and avoidance of problem solving sub-dimension and directing their children to sports (r = 0.145; p < 0.01). The total alexithymia levels and their sub-dimensions of the families whose children were engaged in sports were significantly higher than the children who did not do sports (p < 0.05). In conclusion; families' alexithymic status and social skill levels may affect their children's orientation to sports. As the alexithymia levels of the families increase, their children's orientation to sports shows a moderate increase.