Depression is strongly associated with alexithymia in the general population

Inner experiences, mental health, and well-being in autistic and non-autistic adults

The nature of autistic adults' everyday inner experiences has been largely unstudied. The purpose of this study was to examine patterns of inner experiences and how they relate to mental health and wellness among autistic and non-autistic adults. Autistic (n = 303) and non-autistic (n = 289) adults (ages 21-82) completed online surveys assessing their anxiety, depression, happiness, life satisfaction, and inner thinking patterns, (inner speaking [i.e., verbal thinking], inner seeing [i.e., visual thinking], unsymbolized thinking, feelings, sensory awareness, self-talk). Group differences in inner thinking were examined using Mann-Whitney U and chi-square tests. Correlations and multiple linear regressions examined associations between inner experiences, mental health, and well-being. Autistic adults had greater use of inner speaking and sensory awareness, compared to non-autistic adults. The most common primary mode of inner experience for both groups was inner speaking, while fewer autistic adults reported that experiencing thoughts as feelings was their primary modality. Autistic adults reported greater use of self-talk for social assessment, self-criticism, and self-management purposes, compared to non-autistic adults. Experiencing thoughts as inner speech and as feelings were associated with anxiety in both groups. Using self-talk for social assessment and self-criticism purposes was correlated with anxiety and depression in both groups, while using self-talk for self-management was associated with depression and anxiety only among autistic adults. The results suggest that autistic and non-autistic adults have similarities in overall patterns of inner thinking, yet autistic adults may be more likely to engage in self-talk as a strategy to manage challenging day-to-day experiences.

Training to Reconnect With Emotional Awareness Therapy: A Randomized Controlled Trial in Participants With Traumatic Brain Injury

OBJECTIVE

To examine the efficacy of an intervention, Training to Reconnect with Emotional Awareness Therapy (TREAT) at improving alexithymia, emotion dysregulation, anxiety, depression, anger, and global positive and negative affect in participants with traumatic brain injury (TBI).

DESIGN

Randomized, waitlist control (WLC) trial with 3-month follow-up.

SETTING

Outpatient brain injury rehabilitation center.

PARTICIPANTS

Adult participants, who were on average 11.37 years postcomplicated mild-to-severe TBI and also had elevated alexithymia (n=44), who were randomized to immediate treatment (TREAT; n=20) or WLC (WLC=24).

INTERVENTIONS

Eight sessions, structured training program that teaches emotional awareness and discrete labeling of emotions.

MAIN OUTCOME MEASURES

Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9; State-Trait Anger Expression Inventory (STAXI), Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change.

RESULTS

Thirty-four participants completed the study per protocol. Compared with WLC participants (n=16) who had not yet received the intervention, TREAT participants (n=18) had significantly less alexithymia, emotion dysregulation, anxiety, and depression (all P's<.05) within approximately 1 week of completing the intervention. Before/after results from the pooled sample (n=34) showed significant improvements, immediately and 3 months after the intervention, on all outcomes except the STAXI and the Positive Affect subscale of the PANAS. On the Patient Global Impression of Change, a noticeable change in global emotional function and quality of life was reported by 80%. Intent-to-treat analyses (n=38) revealed similar results to the per protocol sample.

CONCLUSIONS

Findings support the efficacy of TREAT for reducing alexithymia and emotion dysregulation in individuals with chronic TBI. Although outcomes were also promising for anxiety and depression, more research using attention-control designs are warranted to control for the attention received during treatment.

The implication of alexithymia in personality disorders: a systematic review

BACKGROUND

Alexithymia, characterized by difficulty identifying and expressing emotions, is often associated with various psychiatric disorders, including personality disorders (PDs). This study aimed to explore the relationship between alexithymia and PD, focusing on their common origins and implications for treatment.

METHODS

A systematic review was conducted following PRISMA guidelines using databases such as MEDLINE (PubMed), Scopus, and Web of Science. The inclusion criteria were studies assessing adults with DSM-5-diagnosed personality disorders using validated alexithymia scales. The Newcastle‒Ottawa Scale was used to assess the quality of the included studies.

RESULTS

From an initial yield of 2434 citations, 20 peer-reviewed articles met the inclusion criteria. The findings indicate a significant association between alexithymia and personality disorders, particularly within Clusters B and C. Patients with these disorders exhibited higher levels of alexithymia, which correlated with increased emotional dysregulation and interpersonal difficulties. The review also highlighted the comorbidity burden of conditions such as psychosomatic disorders, eating disorders, depression, anxiety, suicidal behavior, and substance use disorders.

CONCLUSIONS

These findings underscore the need for integrating alexithymia-focused assessments into clinical practice to enhance therapeutic approaches, allowing for more personalized and effective interventions. Addressing the emotional processing challenges in patients with personality disorders could significantly improve patient outcomes. Future research should prioritize establishing clinical guidelines and conducting longitudinal studies to explore the relationship between alexithymia and specific personality disorder subtypes, ensuring the practical translation of these findings into clinical practice.

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

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

Alexithymia Prevalence, Characterization, and Associations With Emotional Functioning and Life Satisfaction: A Traumatic Brain Injury Model System Study

OBJECTIVES

Alexithymia an emotional processing deficit that interferes with a person's ability to recognize, express, and differentiate emotional states. Study objectives were to (1) determine rates of elevated alexithymia among people with moderate-to-severe traumatic brain injury (TBI) 1-year post-injury, (2) identify demographic and injury-related variables associated with high versus low-average levels of alexithymia, and (3) examine associations among alexithymia with other aspects of emotional functioning and life satisfaction.

SETTING

Data were collected during follow-up interviews across four TBI Model System (TBIMS) centers.

PARTICIPANTS

The sample consisted of 196 participants with moderate-to-severe TBI enrolled in the TBIMS. They were predominately male (77%), White (69%), and had no history of pre-injury mental health treatment (66.3%).

DESIGN

Cross-sectional survey data were obtained at study enrollment and 1-year post-injury.

MAIN MEASURES

Toronto Alexithymia Scale-20 (TAS-20) as well as measures of anger, aggression, hostility, emotional dysregulation, post-traumatic stress, anxiety, depression, resilience and life satisfaction. Sociodemographic information, behavioral health history and injury-related variables were also included.

RESULTS

High levels of alexithymia (TAS-20 score > 1.5 standard deviation above the normative mean) were observed for 14.3%. Compared to individuals with low/average levels of alexithymia, the high alexithymia group tended to have lower levels of education. At 1-year follow-up, high TAS-20 scores were strongly associated with emotional dysregulation and post-traumatic stress; moderately associated with anger, hostility, depression, anxiety, lower resilience and lower satisfaction with life; and weakly associated with aggression.

CONCLUSION

These findings provide further evidence that alexithymia is associated with poor emotional functioning and life satisfaction after TBI. Longitudinal studies are needed to determine if alexithymia is a risk factor that precipitates and predicts worse emotional outcomes in the TBI population. This line of work is important for informing treatment targets that could prevent or reduce of psychological distress after TBI.

The association among negative life events, alexithymia, and depressive symptoms in a psychosomatic outpatient sample

BACKGROUND

Depression is a life-threatening mental health problem. Various factors have been demonstrated to be associated with depressive symptoms, including negative life events (NLEs) and alexithymia. A retrospective study was conducted to investigate the relationship among negative life events, alexithymia, and depression symptoms in a psychosomatic outpatient sample in China.

METHODS

A total of 2747 outpatients (aged 18 - 65) were included in this investigation. The Life Events Scale (LES), Toronto alexithymia scale (TAS-26), and 9-item Patient Health Questionnaire (PHQ-9) were used to assess NLEs, alexithymia, and depressive symptoms, respectively. A stepwise regression analysis model was established to investigate the relationship among alexithymia, NLEs, and depressive symptoms.

RESULTS

Overall, 67.0% of the patient sample had a PHQ-9 score of 10 or higher. The stepwise regression analysis model showed a well-fitted model, in which NLEs and alexithymia explain a total of 34.2% of the variance of depressive symptoms in these participants. NLEs (β = 0.256, p < 0.001) and dimensions of alexithymia (difficult describing feelings (β = 0.192, p < 0.001) and identifying feelings (β = 0.308, p < 0.001)) were positively correlated with symptoms of depression.

CONCLUSIONS

Previous studies have confirmed the correlation between NLEs and depression, alexithymia and depression, respectively. In our study, we used a stepwise regression model to explain the relationship among those variables simultaneously, and found that NLEs and alexithymia could function as predictors of depressive symptoms. Based on this discovery, alexithymia-focused treatment strategies could be alternative in depressive patients with alexithymia, but this remains to be verified in the future.

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 mediating effect of internet addiction and the moderating effect of physical activity on the relationship between alexithymia and depression

There is a certain relationship between alexithymia and depression, but further investigation is needed to explore their underlying mechanisms. The aims of this study was to explore the mediating role of internet addiction between alexithymia and depression and the moderating role of physical activity. A total of 594 valid responses were included in the analysis, with a mean age of 18.72 years (SD = 1.09). The sample comprised 250 males (42.09%) and 344 females (57.91%). These responses were utilized for descriptive analysis, correlation analysis, regression analysis, and the development of mediation and moderation models. Alexithymia showed positive correlations with depression and internet addiction, and physical activity was negatively correlated with internet addiction and depression. Internet addiction partially mediated the relationship between alexithymia and depression, while physical activity weakened the association between internet addiction and depression, acting as a moderator. Our findings suggest that excessive Internet engagement may mediate the relationship between alexithymia and depression as an emotional regulatory coping strategy, and that physical activity attenuates the predictive effect of Internet addiction on depression.

Recognizing and Looking at Masked Emotional Faces in Alexithymia

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one's emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.

Deployment of attention to facial expressions varies as a function of emotional quality-but not in alexithymic individuals

Background

Alexithymia is a risk factor for emotional disorders and is characterized by differences in automatic and controlled emotion processing. The multi-stimulus free-viewing task has been used to detect increased negative and reduced positive attentional biases in depression and anxiety. In the present eye-tracking study, we examined whether lexical emotional priming directs attention toward emotion-congruent facial expressions and whether alexithymia is related to impairments in lexical priming and spontaneous attention deployment during multiple face perception.

Materials and methods

A free-viewing task with happy, fearful, angry, and neutral faces shown simultaneously was administered to 32 alexithymic and 46 non-alexithymic individuals along with measures of negative affect and intelligence. Face presentation was preceded by masked emotion words. Indices of initial orienting and maintenance of attention were analyzed as a function of prime or target category and study group.

Results

Time to first fixation was not affected by prime category or study group. Analysis of fixation duration yielded a three-way interaction. Alexithymic individuals exhibited no prime or target category effect, whereas non-alexithymic individuals showed a main effect of target condition, fixating happy faces longer than neutral and angry faces and fearful faces longer than angry faces.

Discussion

Our results show evidence of attentional biases for positive and fearful social information in non-alexithymic individuals, but not in alexithymic individuals. The lack of spontaneous attentional preference for these social stimuli in alexithymia might contribute to a vulnerability for developing emotional disorders. Our data also suggest that briefly presented emotion words may not facilitate gaze orientation toward emotion-congruent stimuli.

Childhood maltreatment and insomnia in college students: The role of alexithymia and psychological distress

Insomnia, which is highly prevalent among college students, has been identified as one of the negative consequences of childhood maltreatment. While prior studies have uncovered distinct correlations between childhood maltreatment, insomnia, and other variables, the potential underlying mechanisms need to be further explored. This study focused on the chain-mediating role of alexithymia and psychological distress in the relationship between childhood maltreatment and insomnia. An online cross-sectional survey was conducted among Chinese college students, yielding 999 valid questionnaires that included demographic information, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Toronto Alexithymia Scale (TAS), the 21-item Depression Anxiety Stress Scales (DASS-21), and the Insomnia Severity Index (ISI). A chain-mediating model was then tested. The results revealed significant positive correlations between each pair of the four variables. Alexithymia and psychological distress separately mediated the link between childhood maltreatment and insomnia (effect of alexithymia was 0.06 with 95 % CI [0.03, 0.09]; effect of psychological distress was 0.24 with 95 % CI [0.19, 0.29]). Additionally, a chain-mediating effect of alexithymia and psychological distress was observed (chain-mediating effect was 0.12 with 95 % CI [0.09, 0.15]). The findings suggest that emotional interventions may mitigate the long-term effect of childhood maltreatment on sleep problems among college students, by improving the ability to recognize emotions and decreasing emotional problems.

Subscales of alexithymia show unique pathways through reappraisal and suppression to anxiety, depression and stress

The goal of this work was to explore associations of constituent factors of alexithymia on mental health and potential mediating effects of emotion regulation strategies, specifically suppression and reappraisal. Data were collected through the crowd-sourcing platform Amazon Mechanical Turk (MTURK). Three hundred seventy-seven individuals completed questionnaires related to distress (Depression Anxiety Stress Scales [DASS]), emotion regulation (Emotion Regulation Questionnaire [ERQ]) and Alexithymia (Bermond-Vorst Alexithymia Questionnaire [BVAQ]). Three mediation models were constructed for depression, anxiety and stress, with BVAQ subscales (verbalizing, identifying, emotionalizing, fantasizing, and analyzing) as predictors and ERQ subscales (suppression and reappraisal) as mediators. Results indicated 37.3 % variance in depression, 25.2 % variance in anxiety, and 35.3 % variance in stress was explained by each model. Direct associations revealed emotionalizing and fantasizing were negatively associated with depression, anxiety, and stress, while verbalizing was additionally associated with depression, identifying was additionally associated with anxiety, and all four BVAQ subscales were associated with stress. BVAQ subscales demonstrated negative associations with reappraisal and positive associations with suppression that mediated anxiety and depression. However, suppression did not mediate relationships between BVAQ subscales with stress. Findings support the importance of examining multiple factors of alexithymia and associations with emotion regulation strategies and distress.

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.

Personality traits related to cognitive functioning in patients with functional neurological disorder

Cognitive symptoms are prevalent in patients with functional neurological disorder (FND). Several studies have suggested that personality traits such as neuroticism may play a pivotal role in the development of FND. FND has also been associated with alexithymia: patients with FND report difficulties in identifying, analyzing, and verbalizing emotions. Whether or not alexithymia and other personality traits are associated with cognitive symptomatology in patients with FND is unknown. In the current study, we explored whether the Big Five personality model factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and alexithymia were associated with cognitive functioning in FND. Twenty-three patients with FND were assessed using a neuropsychological assessment and questionnaire assessment to explore personality traits (Neuroticism-Extraversion-Openness Five-Factor Inventory) and alexithymia (Bermond-Vorst Alexithymia Questionnaire). The results indicated that high conscientiousness was associated with lower planning scores (ρ = -0.52, p = .012) and high scores on alexithymia were associated with lower scores on verbal memory scores (ρ = -0.46, p = .032) and lower sustained attention scores (ρ = -0.45, p = .046). The results did not remain significant after controlling for multiple testing. The preliminary results of our study suggest that personality and cognitive symptomatology in patients with FND are topics that should be further explored in future studies, as cognitive symptomology can affect treatment results.

The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model

AIM

The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents.

METHODS

This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data.

RESULTS

Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization.

CONCLUSIONS

This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia.

PRACTICE IMPLICATIONS

Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Perception of facial expressions involves emotion specific somatosensory cortex activations which are shaped by alexithymia

Somatosensory cortex (SCx) has been shown to crucially contribute to early perceptual processes when judging other's emotional facial expressions. Here, we investigated the specificity of SCx activity to angry, happy, sad and neutral emotions and the role of personality factors. We assessed participants' alexithymia (TAS-20) and depression (BDI) levels, their cardioceptive abilities and recorded changes in neural activity in a facial emotion judgment task. During the task, we presented tactile probes to reveal neural activity in SCx which was then isolated from visual carry-over responses. We further obtain SCx emotion effects by subtracting SCx activity elicited by neutral emotion expressions from angry, happy, and sad expressions. We find preliminary evidence for distinct modulations of SCx activity to angry and happy expressions. Moreover, the SCx anger response was predicted by individual differences in trait alexithymia. Thus, emotion expressions of others may be distinctly presented in the observer's neural body representation and may be shaped by their personality trait.

Experiments on real-life emotions challenge Ekman's model

Ekman's emotions (1992) are defined as universal basic emotions. Over the years, alternative models have emerged (e.g. Greene and Haidt 2002; Barrett 2017) describing emotions as social and linguistic constructions. The variety of models existing today raises the question of whether the abstraction provided by such models is sufficient as a descriptive/predictive tool for representing real-life emotional situations. Our study presents a social inquiry to test whether traditional models are sufficient to capture the complexity of daily life emotions, reported in a textual context. The intent of the study is to establish the human-subject agreement rate in an annotated corpus based on Ekman's theory (Entity-Level Tweets Emotional Analysis) and the human-subject agreement rate when using Ekman's emotions to annotate sentences that don't respect the Ekman's model (The Dictionary of Obscure Sorrows). Furthermore, we investigated how much alexithymia can influence the human ability to detect and categorise emotions. On a total sample of 114 subjects, our results show low within subjects agreement rates for both datasets, particularly for subjects with low levels of alexithymia; low levels of agreement with the original annotations; frequent use of emotions based on Ekman model, particularly negative one, in people with high levels of alexithymia.

Alexithymia modulates the attitudes towards odors but not the olfactory abilities or the affective reactions to odors

Although emotion and olfaction are closely linked, only a few studies have investigated olfactory processing in alexithymia, a condition characterized by altered emotional processing. These results do not allow comprehensive conclusions on whether individuals with alexithymia present lower olfactory abilities or only altered affective reactions and awareness of odors. Three pre-registered experiments were conducted to clarify this relation. We assessed olfactory functions, the affective qualities of odors, the awareness of odors, the attitudes towards them, and the ability to form olfactory images in the mind. Bayesian statistics were used to assess differences between low, medium and high alexithymia groups, and Linear Mixed Models (LMMs) were applied to investigate the modulation of the affective and cognitive components of alexithymia. We observed that individuals with a high level of alexithymia presented the same olfactory abilities, and did not show differences in their rating of odors compared to individuals with low alexithymia levels, while they reported lower levels of social and common odor awareness and a more indifferent attitude towards odors. Olfactory imagery was not affected by alexithymia level, and the affective and cognitive components of alexithymia, when considered separately, modulated olfactory perception differently. Learning more about olfactory perception in individuals with alexithymia leads to a better understanding of how alexithymia impacts the perception of hedonic stimuli coming from different sensory modalities. Our results imply that treatment goals for alexithymia should be the enhancement of the conscious perception of odors, supporting the use of mindfulness-based protocols in the alexithymia treatment.

Association between alexithymia and non-suicidal self-injury in psychiatric patients: the mediating role of self-esteem and the moderating role of emotional intelligence

BACKGROUND

Raffagnato's theory claims that if people have no words to express their emotions (alexithymia), they express themselves by venting or through non-suicidal self-injury (NSSI). However, these associations have not been confirmed in psychiatric patients. This study explored the relationship between alexithymia and NSSI in psychiatric patients and the potential underlying psychological mechanisms.

METHODS

This retrospective study involved face-to-face interviews with 449 outpatients consecutively recruited from West China Hospital. Alexithymia, self-esteem, NSSI, and emotional intelligence (EI) were measured. The moderating role of EI and the mediating role of self-esteem between alexithymia and NSSI were also explored. Logistic regressions were used to examine whether sociodemographic, clinical variables and alexithymia were independently associated with NSSI.

RESULTS

The DSM-5 NSSI disorder and alexithymia prevalences were found to be 32.5% and 45.2%. When the other covariables were controlled for, the alexithymic patients were found to be at increased odds (OR 2.76) of engaging in NSSI behaviors. These results confirmed the strong associations between alexithymia, low self-esteem, and NSSI risk. Lower EI was found to be related to the connections between alexithymia and NSSI. Except for the lower risk in anxiety patients, the risk of NSSI was similar for patients with other mental disorders, CONCLUSION: This study revealed the psychological mechanisms through which alexithymia increases the risk of NSSI. Therefore, to reduce NSSI risk, screening for alexithymia should be emphasized. Self-esteem as a targeted psychological intervention could also assist in mitigating the process from alexithymia to NSSI behaviors, and EI training for psychiatric patients could weaken the relationship between alexithymia and NSSI.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.

Psychopathology, Personality and Depression after Acute Coronary Syndrome: A Network Analysis in an Italian Population

Several biopsychosocial factors are associated with the onset of a Major Depressive Episode (MDE) after cardiovascular events. However, little is known of the interaction between trait- and state-like symptoms and characteristics and their role in predisposing cardiac patients to MDEs. Three hundred and four subjects were selected among patients admitted for the first time at a Coronary Intensive Care Unit. Assessment comprised personality features, psychiatric symptoms and general psychological distress; the occurrences of MDEs and Major Adverse Cardiovascular Events (MACE) were recorded during a two-year follow-up period. Network analyses of state-like symptoms and trait-like features were compared between patients with and without MDEs and MACE during follow-up. Individuals with and without MDEs differed in sociodemographic characteristics and baseline depressive symptoms. Network comparison revealed significant differences in personality features, not state-like symptoms: the group with MDEs displayed greater Type D personality traits and alexithymia as well as stronger associations between alexithymia and negative affectivity (edge differences between negative affectivity and difficulty identifying feelings was 0.303, and difficulty describing feelings was 0.439). The vulnerability to depression in cardiac patients is associated with personality features but not with state-like symptoms. Personality evaluation at the first cardiac event may help identify individuals more vulnerable to development of an MDE, and they could be referred to specialist care in order to reduce their risk.

Alexithymia, depression, and cognition in patients with Parkinson's disease

BACKGROUND

Basal ganglia are connected to dorsal prefrontal and orbitofrontal structures, which have an important role in emotional experience. Alexithymia is defined as the inability to recognize and verbalize emotions. There is little known about alexithymia and cognitive dysfunction and its relationship with depression. In this study, we examined the relation of alexithymia with cognition and depression in non-demented patients with Parkinson's disease (PD).

MATERIALS AND METHODS

Fort-two consecutive non-demented patients PD and 40 healthy controls were enrolled in the study. The Turkish version of the Montreal Cognitive Assessment scale (MOCA-TR), 20-item Toronto Alexithymia Scale (TAS-20) (F1, F2, F3 subgroups), and Beck Depression Inventory (BDI-I) were used to evaluate cognitive functions, alexithymia, and depression, respectively, in both groups.

RESULTS

The total TAS-20 score was 55.71 ± 19 in the PD group and 46.33 ± 8.21 in the control group. There was a statistically significant difference in the total TAS-20 scores between the groups (p < 0.001). In subgroups of alexithymia, all mean scores of F1, F2, and F3 were higher in the PD group (p = 0.019, p < 0.001, and p = 0.005, respectively). In the MOCA-TR test, the mean scores in visuospatial and delayed recall of patients with PD were statistically lower than in the control group (p = 0.044 and p = 0.04, respectively). The MOCA-TR and BDI total scores were significantly correlated with TAS-20 total scores. In subgroup analysis, we only found an association between the visuospatial domain of MOCA-TR and the F3 subgroup of TAS-20 (r = - 0.22, p = 0.03). There was no relation between alexithymia and disease duration or total levodopa dose (p < 0.05).

CONCLUSION

Alexithymia is not a rare symptom in PD. It should be accepted as an independent non-motor symptom, and patients should be interrogated accordingly.

Sex-specific role of alexithymia in associations between parental bonding and mental health: A moderated mediation model

OBJECTIVE

This study aimed to explore the role of alexithymia and potential sex differences in the associations between perceived parental bonding and mental health.

METHODS

The sample consists of 2421 parents from the FinnBrain Birth Cohort Study who completed the parental bonding instrument, the Toronto alexithymia scale, the Edinburgh postnatal depression scale, and the anxiety subscale of the symptom checklist-90. Moderated mediation analyses were conducted to examine the possible mediating role of alexithymia and moderating role of sex in the associations between parental bonding and depressive/anxiety symptoms.

RESULTS

Alexithymia was found to be a potential mediator and sex be a moderator in the relations between perceived dysfunctional parental bonding and the psychological symptoms. Specifically, dysfunctional paternal bonding, especially paternal overprotection, had stronger indirect effects (via alexithymia) on the psychological symptoms in males.

CONCLUSIONS

This study indicates the importance of alexithymia in the parenting-related mental health impacts and highlights the significance of paternal bonding for the development of alexithymia and mental health problems in male populations. The findings improve the limited understanding of sex-related parental factors for alexithymia and mental health problems. Future studies in longitudinal designs are warranted to clarify the causal process of the mediation.

Depression in Chinese men with methamphetamine dependence: Prevalence, correlates and relationship with alexithymia

BACKGROUND

The comorbidity between substance use disorder and major depressive disorder is a typical dual diagnosis in the field of substance addiction. However, the prevalence and correlates of depression in methamphetamine addicts and whether it is associated with drug craving and alexithymia have been rarely reported in the Chinese population.

METHODS

We recruited 585 methamphetamine-dependent males from a drug rehabilitation center in China and 203 healthy controls. Demographic and drug use data were collected. Depression was assessed using the Mini International Neuropsychiatric Interview (M.I.N·I.). Methamphetamine cravings and alexithymia were assessed using the Desire for Drugs Questionnaire (DDQ) and the Toronto Alexithymia Scale (TAS).

RESULTS

The prevalence rate of depression in methamphetamine-dependent men was 16.58 % (97/585). The scores of DDQ desire and intention, DDQ negative reinforcement, total DDQ, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and total TAS score of depressed patients were higher than those of non-depressed patients. However, only DDQ negative reinforcement score, DIF, DDF, and total TAS score remained significant after Bonferroni correction. Additionally, logistic regression analysis found that age, DIF score, and DDQ negative reinforcement score were significant factors contributing to depression in methamphetamine-dependent men.

CONCLUSION

Our findings suggest that the prevalence of depression is significantly higher in methamphetamine-dependent men than in the healthy Chinese population. Furthermore, age, components of alexithymia and drug craving are risk factors for depression in methamphetamine addicts.

Mood regulation, alexithymia, and personality disorders in female patients with opioid use disorders

Background

Opioid use disorders are rising among females. So, there is a need for more recognition of the various factors contributing to this trend in women, to help us to plan effective interventions to this group of patients. Hence, we conducted this research to identify risk factors associated with opioid use in females including mood regulation, alexithymia, and personality disorders. The study included 60 females ranging from 18 to 45 years [30 females diagnosed with opioid use disorder according DSM-IV (case group), and 30 females with no mental illness diagnosis according to general health questionnaire (control group)]. The subjects were recruited from inpatients and outpatient clinic of Al-Abbassia Hospital, Cairo, Egypt. Both groups were assessed by the Structured Clinical Interview for DSM-IV axis II disorders (SCID II) for personality, Trait Meta-Mood Scale (TMMS) for emotional regulation and Toronto Alexithymia Scale-20 (TAS-20) for alexithymia.

Results

Regarding sociodemographic data, cases were significantly different from controls as they are less educated (P < 0.001), more 73% (22) unemployed (P <0.001) and 56.7% (17) of cases had positive family history of first degree relatives with drug use (P = 0.001).

SCID II showed more significant personality disorders diagnosis among cases as (borderline, antisocial, paranoid, schizotypal, and schizoid personality disorder) (P < 0.001, < 0.001, 0.01, 0.003, and 0.005, respectively) and also multiple personality disorders (P < 0.001) diagnosis. As regards alexithymia all cases were classified as having alexithymia 100% versus 56.7% among controls. Meanwhile, cases showed more difficulty in identifying (P < 0.001) and describing feelings (P = 0.001) and more externally oriented thinking (P = 0.010). Results of TMMS showed cases had lower total score on TMMS (p = 0.016). Signifying their inability to regulate their emotions in comparison to controls. There was no significant association between alexithymia, sociodemographic data, TMMS, and SCID II among cases group.

Conclusions

The present study found that females with opioid use disorders tend to be less educated, unemployed with positive family history of substance abuse, and diagnosed mainly with cluster A and B personality disorders. Moreover, had difficulty in identifying, describing, and regulating their emotions.

Association of Pre-existing Mental Health Conditions with Acute Mountain Sickness at Everest Base Camp

Hüfner, Katharina, Fabio Caramazza, Evelyn R. Pircher Nöckler, Agnieszka E. Stawinoga, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Hermann Brugger, and Barbara Sperner-Unterweger. Association of pre-existing mental health conditions with acute mountain sickness at Everest Base Camp. High Alt Med Biol. 23:338-344, 2022. Background: Mental health disorders are common, but limited data are available regarding the number of people with a past medical history of psychiatric diagnoses going to high altitude (HA). It is also unknown whether mental health conditions are associated with an increased risk of acute mountain sickness (AMS). Methods: We analyzed data from a previous study at Everest Base Camp. Participants self-reported their past medical history and history of substance use and had a brief history taken by a physician. AMS was assessed using the self-reported 2018 Lake Louise AMS Score. Results: Eighty-five participants (66 men and 19 women, age 38 ± 9 years) were included. When questioned by a physician, 28 participants reported prior diagnoses or symptoms compatible with depression (23%), anxiety disorder (6%), post-traumatic stress disorder (1%), and psychosis/psychotic experiences (9%). The prevalence of psychiatric diagnoses in the past medical history was much lower in the self-reported data (2/85) compared to data obtained via physician assessment (28/85). Increased risks of AMS were associated with a past medical history of anxiety disorder (odds ratio [OR] 22.7; confidence interval [95% CI] 2.3-220.6; p < 0.001), depression (OR 3.6; 95% CI 1.2-11.2; p = 0.022), and recreational drug use ever (OR 7.3; 95% CI 1.5-35.5; p = 0.006). Conclusions: Many people who travel to HA have a past medical history of mental health conditions. These individuals have an increased risk of scoring positive for AMS on the Lake Louise Score compared with people without a history of mental health conditions.

Alexithymia Among People Living with HIV: A Scoping Review

The present scoping review aimed to identify studies that investigated alexithymia, defined as a difficulty in identifying and describing one's own emotions, in people living with HIV (PLWH).A literature search, in line with the guidelines of PRISMA-ScR, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Web of Science. The databases were queried using the following strings (using Boolean operators): ("alexithymia" OR "alexithymic") AND ("HIV" OR "Human Immunodeficiency Virus"). In line with the eligibility criteria, fourteen articles were found.Ten studies showed the involvement of alexithymia in disease severity (e.g., viral load levels), and adherence to antiretroviral therapy. Three studies revealed an association between alexithymia and cardiovascular disease, and three studies highlighted the implication of alexithymia in cognitive impairment.This review revealed the complex role of alexithymia in HIV disease. A careful clinical assessment of the emotional regulation process of PLWH can provide useful prognostic information.

The effect of COVID-19 on employees' mental health

Long lockdowns, food shortages, and the inability to receive basic primary healthcare have aggravated the effects of pandemics. However, most studies have focused on the health problems of the infected people or the measures employed to keep the disease under control. This cross-sectional study focused primarily on the mental health issues of employees. By employing a convenient sampling method, we reached 237 respondents (135 with coronavirus history) to assess the impact of the pandemic on employees. Multivariate causal relationships were assessed with Structural Equation Modeling (SEM). The predictors included internal entrapment (INT) and difficulty identifying feelings (DIF), which are significant predictors of depression (DEPR). DIF was found to be a significant predictor of INT and EXT feelings, while FEAR was found to be a significant predictor of INT, DIF, and DEPR. Quality of life (QoL) was found to be a significant predictor of DIF and DDF, DEPR, EXT and INT, and FEAR. The results also showed that DIF mainly manifested its effect on depression through INT. The DEPR level of employees working only from home was higher than that of other employees. The depression levels of women, young employees, and those whose QoL was adversely affected by the coronavirus were higher than the rest.

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.

Olfactory meta-cognition in individuals with depressive and anxiety symptoms: The differential role of common and social odors

BACKGROUND

Diminished olfactory functioning has been reported in depression, whereas evidence in anxiety disorders is still controversial. Olfactory meta-cognitive abilities (i.e., olfactory awareness, imagery and reactivity, and the importance of odors) are essential in shaping olfaction. Few studies examined these meta-cognitive abilities in relation to depressive, anxiety, and social anxiety symptoms, and none of them considered the awareness of social odors (i.e., body odors).

METHODS

This pre-registered study examined the relationship between olfactory meta-cognitive abilities and symptoms of depression, general anxiety, and social anxiety in 429 individuals. Self-report measures of symptoms of depression, general anxiety, and social anxiety, along with self-report olfactory meta-cognitive scales, were collected using an online survey.

RESULTS

Linear regression analyses revealed that olfactory awareness and importance of common odors were significantly directly predicted by symptoms of general anxiety, while affective importance to odors was negatively predicted by symptoms of depression. Regarding social odors, higher symptoms of depression and lower symptoms of social anxiety predicted increased awareness.

LIMITATIONS

Higher prevalence of women and narrow age range of the participants. Depressive and anxiety symptoms were assessed only with self-report questionnaires.

CONCLUSIONS

Symptoms of anxiety seem to be associated with higher levels of common odor awareness, corroborating the importance of olfactory functions in anxiety. In addition, results on social odors seem to reflect dysfunctional social behaviour that characterized symptoms of depression and social anxiety. Hence, the assessment of meta-cognitive abilities may represent a useful tool in the prevention and assessment of depressive, anxiety, and social anxiety symptoms.

Mediating role of depression in the association between alexithymia and nonsuicidal self-injury in a representative sample of adolescents in Taiwan

BACKGROUND

Nock's (2009) integrated theoretical model suggests that specific intrapersonal vulnerability factors caused by distal risk factors contribute to the development of nonsuicidal self-injury (NSSI). Alexithymia and depression have been found to predict NSSI. Based on Nock's model, alexithymia plays a distal risk factor role to increase the risk of depression-an intrapersonal vulnerability factor-and further increase the risk of NSSI. However, small or unrepresentative samples in past studies limit the generalizability of the results. This study examined the roles of depression and alexithymia in predicting NSSI, as well as the mediating effect of depression in the relation between alexithymia and NSSI in a large representative sample of adolescents in Taiwan.

METHODS

Using a cross-sectional study design, a large representative sample of 2,170 senior high school students in Taiwan was assessed by self-report measures of alexithymia, depression, and NSSI. Mediation analyses were performed to examine whether the relation between alexithymia and NSSI was mediated by depression. The questionnaires were administered in classrooms.

RESULTS

Results showed that alexithymia positively predicted NSSI (β = 0.23, p < .001) and depression can also positively predict NSSI (β = 0.41, p < .001). Additionally, the association between alexithymia and NSSI was fully mediated by depression.

CONCLUSIONS

This study data provided evidence for the mediating role of depression between alexithymia and NSSI, which can be explained by Nock's (2009) integrated theoretical model. The implications of the findings for future research and intervention were discussed.

High-definition transcranial direct current stimulation modulates eye gaze on emotional faces in college students with alexithymia: An eye-tracking study

BACKGROUND

Atypical eye gaze on emotional faces is a core feature of alexithymia. The inferior frontal gyrus (IFG) is considered to be the neurophysiological basis of alexithymia-related emotional face fixation. Our aim was to examine whether anodal high-definition transcranial direct current stimulation (HD-tDCS) administered to the right (r)IFG would facilitate eye gaze of emotional faces in alexithymia individuals.

METHOD

Forty individuals with alexithymia were equally assigned to anodal or sham HD-tDCS of the rIFG according to the principle of randomization. The individuals then completed a free-viewing eye tracking task (including happy, sad, and neutral faces) before and after 5 consecutive days of stimulation (twice a day).

RESULTS

The results showed that twice a day anodal HD-tDCS of the rIFG significantly increased the fixation time and fixation count of the eye area on happy and neutral faces, but there was no significant effect on sad faces. According to the temporal-course analysis, after the intervention, the fixation time on neutral faces increased significantly at almost all time points of the eye tracking task. For happy faces, the improvement was demonstrated between 500 and 1000 ms and between 2500 and 3500 ms. For sad faces, the fixation time improved but not significantly.

CONCLUSIONS

Applying high-dose anodal HD-tDCS to the rIFG selectively facilitated eye gaze in the eye area of neutral and happy faces in individuals with alexithymia, which may improve their face processing patterns.

The role of alexithymia and perceived stress in mental health responses to COVID-19: A conditional process model

BACKGROUND

Little is known about the psychological mechanisms underlying the mental health problems related to the COVID-19 pandemic. Hypothetically, perceived stress and alexithymia may be factors involved in the mental distress response to the pandemic; however, this remains largely unstudied. This study aims to explore the moderating role of alexithymia and the moderated mediation effects of perceived stress on the mental health change due to the pandemic.

METHODS

The conditional process model was used to examine the moderated mediation. The sample consists of 659 parents from the FinnBrain Birth Cohort Study who completed the Toronto Alexithymia Scale (TAS-20) at 6 months after delivery, the Edinburgh Postnatal Depression Scale (EPDS) and the Symptom Checklist-90 (SCL-90) at 2 or 4 years postpartum between 2014 and 2019; and a questionnaire for pandemic events, a brief 4-item version of the Perceived Stress Scale (PSS-4) and the follow-up EPDS/SCL-90 in 2020 after 3 months from the outbreak of COVID-19 pandemic in Finland.

RESULTS

Alexithymia moderated the perceived stress-mediated relations between the pandemic events and the changes of depressive and anxiety symptoms through enhancing the detrimental effect of perceived stress on mental health.

LIMITATIONS

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

CONCLUSIONS

Our findings indicate the moderated mediation effects of alexithymia and perceived stress on the psychological symptoms, which has implications for understanding how and when stressful situations translate to mental health problems, identifying vulnerable individuals, and tailoring preventive and psychotherapeutic interventions.

Investigation of the Relationship Between the Alexithymic Characteristics of Secondary Students and Their Childhood Maltreatment Experiences

This research is a descriptive study aiming at revealing the difference between alexithymia levels and childhood period trauma experience levels according to variables discussed, of students who study in different high schools. In the study, quantitative method and relational survey model have been used. Five hundred ninety-nine students (57.3% female, 42.7% male) studying in 7 different high schools located in a city in the Southeastern Anatolian Region of Turkey in 2018-2019 school year constitutes the study group of the research. A proper sampling method has been used to determine the study group. In the scope of the study, Personal Information Form, Toronto Alexithymia Scale, and Childhood Trauma Questionnaire-Short Form have been used as data collection tools. In data analysis, IBM SPSS 23 Pack software has been used. In the study, it has been observed that according to multivariate analysis of variance test, which is used with the purpose of determining the effects of independent variables, difficulty in expressing feelings and childhood trauma experiences that are the lower dimension of alexithymia become drastically distinct according to school type-class level joint interaction variable. It has been observed that levels of expressing feelings, physical neglect, and emotional neglect become distinct according to school type and childhood trauma experiences, school type-age joint interaction variables.

Enhancing Brain Connectivity With Infra-Low Frequency Neurofeedback During Aging: A Pilot Study

Aging is associated with decreased functional connectivity in the main brain networks, which can underlie changes in cognitive and emotional processing. Neurofeedback is a promising non-pharmacological approach for the enhancement of brain connectivity. Previously, we showed that a single session of infra-low frequency neurofeedback results in increased connectivity between sensory processing networks in healthy young adults. In the current pilot study, we aimed to evaluate the possibility of enhancing brain connectivity during aging with the use of infra-low frequency neurofeedback. Nine females aged 52 ± 7 years with subclinical signs of emotional dysregulation, including anxiety, mild depression, and somatoform symptoms, underwent 15 sessions of training. A resting-state functional MRI scan was acquired before and after the training. A hypothesis-free intrinsic connectivity analysis showed increased connectivity in regions in the bilateral temporal fusiform cortex, right supplementary motor area, left amygdala, left temporal pole, and cerebellum. Next, a seed-to-voxel analysis for the revealed regions was performed using the post- vs. pre-neurofeedback contrast. Finally, to explore the whole network of neurofeedback-related connectivity changes, the regions revealed by the intrinsic connectivity and seed-to-voxel analyses were entered into a network-based statistical analysis. An extended network was revealed, including the temporal and occipital fusiform cortex, multiple areas from the visual cortex, the right posterior superior temporal sulcus, the amygdala, the temporal poles, the superior parietal lobule, and the supplementary motor cortex. Clinically, decreases in alexithymia, depression, and anxiety levels were observed. Thus, infra-low frequency neurofeedback appears to be a promising method for enhancing brain connectivity during aging, and subsequent sham-controlled studies utilizing larger samples are feasible.

The mediating role of alexithymia and cognitive flexibility in the relationship between behavioral inhibition system/behavioral activation system and depression in Turkish population

This study aims to examine the relationships between the behavioral inhibition system (BIS)/behavioral activation system (BAS), depression, cognitive flexibility, and alexithymia, and to determine the mediator role of cognitive flexibility and alexithymia in the relationship between BIS/BAS and depression. Data were collected from a community sample, consisting of 1,275 people, 904 women (70.90%) and 371 (29.10%) men, aged 18-65 years. It was detected that the whole variables in this research were interrelated. Additionally, for the mediation analyses, two significant models in which were determined the mediator role of cognitive flexibility and alexithymia in the relationship between the dimensions of BIS-Fear and BAS-Reward and depression were created. Consequently, high BIS-Fear and low BAS-Reward were associated with susceptibility to depression through decreased cognitive flexibility and increased alexithymia. Moreover, it may be possible to identify which subdimensions of alexithymia and cognitive flexibility play a role in the relationship between depression and reward/punishment systems and which of these are risk factors via the models tested in this study. In this way, clinical interventions for the factors that are both associated with depressive symptoms and mediators for depression can be planned and this can help to achieve effective results in the therapy process.

Erfassung der Lebendigkeit mentaler Vorstellungsbilder

Zusammenfassung. Mentale Vorstellungsfähigkeit bezeichnet ein Konstrukt von enormer Bedeutung für diverse psychische Funktionen (z. B. Motivation, Emotion und Handlungssteuerung). Die Lebendigkeit gilt hierbei als ein zentrales und interindividuell variierendes Merkmal mentaler Vorstellungen. Bislang mangelt es allerdings an validierten deutschsprachigen Fragebögen zur Erfassung der Lebendigkeit. Daher wurden an einer Stichprobe von N = 300 Personen aus der Allgemeinbevölkerung (81 % Studierende) deutschsprachige Versionen des Vividness of Visual Imagery Questionnaire (VVIQ; visuelle Vorstellungen) und des Plymouth Sensory Imagery Questionnaire (PSI-Q; multisensorische Erfassung) adaptiert und validiert. Für den VVIQ und PSI-Q konnten die faktorielle (mittels Exploratory Structural Equation Modeling), konvergente und diskriminante Validität belegt werden. Es ergaben sich akzeptable bis hohe interne Konsistenzen, die Retest-Korrelationen (8 Monate) variierten je nach Subskala. Die Lebendigkeit mentaler Vorstellungen zeigte erwartungskonform negative Zusammenhänge mit Defiziten in der emotionalen Verarbeitung (Alexithymie). Insgesamt stellen die beiden Fragebögen ökonomische, reliable und valide Verfahren dar, um die Lebendigkeit mentaler Vorstellungen zu erfassen.

The process of emotion identification: Considerations for psychiatric disorders

Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.

Theory of Mind and Alexithymia in Deaf and Hard-of-Hearing Young Adults

The aim of the current study was to examine theory of mind (ToM), the ability to infer the mental states of others, in young adults who are deaf and hard-of-hearing (DHH), and to explore the influence of alexithymia, an inability to understand emotions of the self and others, on ToM performance in this group. Compared to participants with typical hearing, DHH participants displayed significantly lower affective ToM skills and greater alexithymia. After accounting for verbal intelligence quotient, hearing status and alexithymia significantly contributed to poorer ToM performance, accounting for over 14% of the variance. Having a parent who is deaf and being part of the Deaf community were associated with better emotion processing and appear to be important protective factors. Findings provide support that ToM difficulties may linger into young adulthood among DHH individuals and that alexithymia may be a contributing factor. Early intervention programs emphasizing emotional understanding, perspective-taking, and communication skills are warranted for DHH children as well as their caregivers.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Room to breathe: Using adaptive architecture to examine the relationship between alexithymia and interoception

OBJECTIVE

Individuals with alexithymia experience difficulties interpreting emotional states in self and others, which has been associated with interoceptive impairment. Current theories are primarily based on subjective and conscious measures of interoceptive sensitivity, such as heartrate detection, but it is unclear whether similar observations would be found for objective or implicit psychophysiological measures. The present exploratory study assesses the potential of a novel assay through the use of adaptive immersive architecture [ExoBuilding].

METHODS

N = 88 participants were screened for alexithymic traits and N = 27 individuals, representing the range of scores, were sampled to participate in the behavioural task. In a repeated-measures design, participants were placed within ExoBuilding and asked to match their respiration to its movement. Performance was compared to a two-dimensional pacer condition. Behavioural (accuracy) and psychophysiological (Respiratory Sinus Arrhythmia [RSA] and heartrate) measures were compared across conditions, and also related to individual alexithymic traits.

RESULTS

Participants with higher levels of alexithymia performed less accurately than participants with lower levels, in both conditions. High-alexithymia participants showed a smaller reduction in heartrate over the course of the ExoBuilding condition than low-alexithymia participants, although there were no differences in RSA between conditions or participants.

CONCLUSION

Alexithymia extends beyond conscious interoceptive activities and is also observed in immersive contexts that usually exert psychophysiological effects on typical occupants. These initial findings highlight the importance of considering both conscious and implicit measures of interoception, and we suggest ways in which theories of alexithymia might benefit from capturing this distinction.

Alexithymic traits and parental postpartum bonding: Findings from the FinnBrain Birth Cohort Study

In the postpartum period, some parents experience problems in bonding with the infant, which can lead to difficulties in adjusting to the parental caregiving role. Alexithymia, through deficits in emotional processing, could potentially be associated with problems in parental postpartum bonding. In the current study, this association has been explored in a large population-based sample of mothers and fathers, and to our knowledge, this is the first study to investigate this association. The study population (n = 2,671) was part of the FinnBrain Birth Cohort study and included 1,766 mothers and 905 fathers who returned The Postpartum Bonding Questionnaire (PBQ) at three months postpartum and the 20-item Toronto Alexithymia Scale (TAS-20) at six months postpartum. Correlation analyses and hierarchical regression modeling, adjusted for selected background factors, were performed separately for mothers and fathers. The alexithymia dimension "Difficulty Identifying Feelings" (DIF) in mothers and fathers, and additionally dimensions of "Difficulty Describing Feelings" (DDF) and "Externally Oriented Thinking" (EOT) in fathers were associated with weaker postpartum bonding, when related background factors were controlled for. To our knowledge this was the first study to investigate the relationship between parents' alexithymic traits and postpartum bonding within a large birth cohort study population. The main finding was that especially higher levels of maternal DIF and paternal EOT were associated with weaker postpartum bonding. Longitudinal studies are needed to establish the potential causality of this relationship.

Alexithymia and Parental Bonding in Women with Genitopelvic Pain/Penetration Disorder

OBJECTIVE

The role of emotion regulation and alexithymia in the pathophysiology of genitopelvic pain/penetration disorder (GPPPD) is emphasized. Parental bonding is linked to emotion regulation and alexithymia. This study aimed to examine the relationships between parental bonding, alexithymia, and GPPPD.

PATIENTS AND METHODS

Sixty-four patients with GPPPD were enrolled in the study, and 60 controls were matched for demographic features. Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia, the Bonding to Parents Scale (BPS) was used to assess parental bonding, and sexual functions were assessed via Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The rate of alexithymic traits was statistically higher in the GPPPD group than in the controls (p = 0.005). Patients with GPPPD obtained higher scores on the maternal care/control (p = 0.003) and maternal overprotection (p = 0.008) compared to controls. Difficulty describing feelings factor of alexithymia (p = 0.012) emerged as a predictor of group membership (GPPPD vs controls). To test whether alexithymia was significantly associated with parental bonding, all subjects were divided into two subgroups, alexithymic and non-alexithymic. When the subgroups were compared in terms of parental attitudes, maternal (p = 0.034) and paternal (p = 0.006) overprotection subscale scores were higher in the alexithymic group than in the non-alexithymic group.

DISCUSSION

According to the results, alexithymic traits are characteristic of patients with GPPPD; however, although patients with GPPPD may experience difficulties with perceived parental bonding, this factor does not appear to be a predictor of GPPPD.

Direct and indirect effects of alexithymia on disordered eating in a non-clinical female sample: Determining the role of negative affect

BACKGROUND

Alexithymia is an independent predictor of symptoms of eating disorders, but also influences disordered eating in clinical samples indirectly via negative affect (depression and anxiety). The aim of the current work was to establish if alexithymia predicts disordered eating in a non-clinical sample directly and indirectly (via negative affect).

METHODS

A sample of healthy females (n = 248) completed measures of depression, anxiety, alexithymia, and disordered eating (drive for thinness, bulimia, and body dissatisfaction). Bias-corrected bootstrapping was used to conduct parallel mediation analyses to determine if negative affect (depression and anxiety) mediated the influence of alexithymia on disordered eating.

RESULTS

The relationship between alexithymia (difficulty identifying feelings) and drive for thinness was mediated by depression but not anxiety. The link between difficulty identifying feelings and bulimia was mediated by anxiety but not depression. The correlation between alexithymia (difficulty describing feelings) and body dissatisfaction was mediated by both depression and anxiety. However, after controlling for negative affect, difficulty identifying feelings remained an independent predictor of drive for thinness, and difficulty describing feelings remained an independent predictor of body dissatisfaction.

CONCLUSION

Facets of alexithymia (DIF and DDF) directly predict disordered eating in healthy participants as well as indirectly via depression and anxiety. These findings suggest that targeted interventions to improve the ability of individuals to identify and describe their feelings could be beneficial in reducing disordered eating, particularly in those "at risk" of developing eating disorders.

Is alexithymia associated with sleep problems? A systematic review and meta-analysis

Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N = 26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES = 0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES = 0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition.

Alexithymia and facial emotion recognition in patients with craniofacial pain and association of alexithymia with anxiety and depression: a systematic review with meta-analysis

Background

We aimed to determine the presence of alexithymia in patients with craniofacial pain (CFP) compared with asymptomatic individuals. Our secondary aims were to assess the relationship of alexithymia with anxiety and depression levels, as well as to assess the presence of facial emotion recognition deficit.

Methods

Medline, Scielo and Google Scholar were searched, with the last search performed in 8 September 2021. Standardized mean differences (SMDs) and 95% CIs were calculated for relevant outcomes and were pooled in a meta-analysis using the random effects model. In addition, meta-analyses of correlations and a meta-regression of alexithymia with depression and anxiety were performed.

Results

Regarding alexithymia, assessed through the Toronto Alexithymia Scale (TAS), the results showed significant differences, with higher values in patients compared with asymptomatic individuals, with a large clinical effect (SMD 0.46; 95% CI [0.22–0.71]; heterogeneity-Q 66.86; p < 0.001; inconsistency (I²) = 81%). We found statistically significant correlations with a small clinical effect of alexithymia with anxiety and depression. The meta-regression showed no significant association between the TAS and anxiety or depression. With respect to facial emotion recognition, the results showed statistically significant differences, with greater recognition difficulty in patients compared with asymptomatic individuals, with a large clinical effect (SMD −1.17; 95% CI [−2.01 to −0.33]; heterogeneity-Q 2.97; p = 0.080; I² = 66%).

Conclusions

Patients with CFP showed alexithymia with moderate evidence. There was also moderate evidence indicating that these patients had significant deficits in facial emotion recognition compared with asymptomatic individuals. Furthermore, alexithymia showed statistically significant correlations with anxiety and depression levels.