Is it the Taste or the Buzz? Alexithymia, Caffeine, and Emotional Eating

Breadth of substance use is associated with the selection of a larger food portion size via elevated impulsivity

Substance use is associated with altered or elevated food consumption and disordered eating. In the present study we examined whether breadth (variety) of drug use was associated with elevated portion size in a general population sample as it was in persons in recovery from substance use disorder. Furthermore, measures of emotional eating, impulsivity, food misuse, food craving were taken as possible mediators and reward responsiveness was examined as a potential moderator of this association. 444 adults (48.6 % women, mean age of 47.8 years) completed an online study in which they were asked to make judgements of ideal portion size for 6 different foods using a validated online tool that allowed participants to adjust the portion size of images of foods. Ideal portion size has been identified as a strong predictor of actual consumption. Participants were also asked to report the number of substances used in the past and provide anthropometric information. The results confirmed that breadth of drug use was associated with selection of higher portion size. Reward responsiveness was not a moderator of this relationship. Of the tested mediators, only impulsivity mediated the association between breadth of drug use and portion size. The results show that impulsivity may underlie the association between eating and substance use.

A systematic review of the relationship between alexithymia and emotional eating in adults

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20^th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

Association between alexithymia and substance use: A systematic review and meta-analysis

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.

Parsing the link between reinforcement sensitivity theory and eating behavior: A systematic review

The Reinforcement Sensitivity Theory (RST) is a widely studied psychobiological model of personality. RST factors seem to influence eating behavior, but how these personality traits are associated with distinct features of eating behavior is still unclear. In the present systematic review, we analyzed the relationship between RST personality factors and eating behavior using a parsing approach in which BMI-related results, self-reported results, and behavioral results were distinguished. Our analysis revealed that reward and punishment sensitivity seem to correlate and influence distinct features of eating behavior. The association between BMI and RST factors was uncertain, but nonlinear associations between reward sensitivity and weight need further testing. Reward sensitivity was linked to most eating behavior phenotypes (e.g., emotional eating and restrained eating), but only punishment sensitivity was primarily correlated with eating pathology. Reward sensitivity was the main factor linked with reactivity to food stimuli on many behavioral measures. The neurobiological personality factors of RST offer parsimonious concepts to understand eating behavior outcomes and the differential relationships observed are useful to translational research.

Alexithymia disrupts emotion regulation processes and is associated with greater negative affect and alcohol problems

OBJECTIVE

Alexithymia is common among people who abuse alcohol, yet the mechanisms by which alexithymia exerts its influence remain unclear. This analysis tested a model whereby the three subscales of the Toronto Alexithymia Scale exert an indirect effect on alcohol problems through difficulties with emotion regulation and psychological distress.

METHOD

Men and women (n = 141) seeking alcohol use disorder (AUD) treatment completed the Toronto Alexithymia Scale, the Difficulties with Emotion Regulation Scale, the Brief Symptom Inventory, the Short Inventory of Problems, and the Alcohol Dependence Scale.

RESULTS

The Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale was positively associated with alcohol problems through emotion dysregulation and psychological distress. The other two subscales, Difficulty Describing Feelings and Externally oriented Thinking, were not associated with any other variables.

CONCLUSION

People with alexithymia may consume alcohol to help regulate undifferentiated states of emotional arousal. Given the prevalence of alexithymia among people who abuse alcohol, treatment supplements that enhance the identification of emotions are needed.

Alexithymia and Adult Attachment: Investigating the Mediating Role of Fear of Intimacy and Negative Mood Regulation Expectancies

Literature suggests an association between alexithymia and insecure adult attachment, but the mediation factors involved in this relationship are under-investigated. The study was carried out to test the possible mediation roles of the fear of intimacy and negative mood regulation expectancies in explaining this relationship. A convenience sample of 258 Polish adults (mean age: 30; 45% male), completed self-reporting measures related to adult attachment (RAAS), alexithymia (TAS-20), fear of intimacy (FIS) and negative mood regulation expectancies (NMRE). The results showed that alexithymia directly and indirectly predicts insecure adult attachment. Alexithymia positively predicts the fear of intimacy, which, in turn, positively predicts insecure adult attachment. Finally, alexithymia negatively predicts NMRE which, in turn, predict insecure adult attachment. It emerges from our data that the fear of intimacy and NMRE may be mediating factors in the relationship between alexithymia and adult attachment. Limitations, future directions of research and guidance for intervention are discussed.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.

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One quarter of participants reported eating more than usual during COVID-19.

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One third of participants reported eating less healthfully than usual.

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Difficulty identifying feelings influences emotional eating via emotion dysregulation.

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Difficulty describing feelings influences emotional eating via emotion dysregulation.

The Great Disrupter: Relationship of Alexithymia to Emotion Regulation Processes and Smoking among Pregnant Women

Background: Many women continue to smoke during pregnancy, despite known risks, often in response to negative affect. Recent scholarship has begun to examine factors that decrease the success of behavioral treatments for smoking cessation in pregnancy, which are the preferred interventions. Alexithymia is one factor that may interfere with smoking cessation interventions. Alexithymia restricts access to emotional information and increases propensity toward maladaptive behaviors, including smoking. However, mechanisms underlying such effects are largely unknown. Objectives: Using data from a longitudinal treatment study, the present research examined difficulties with emotion regulation as a potential mechanism linking alexithymia and smoking. Pregnant smokers (n = 73; mean age = 24.78; SD = 4.50) completed measures related to alexithymia, smoking, emotion regulation, depression, anxiety, and anger at baseline and then again following eight sessions of Cognitive-Behavioral Smoking Cessation Treatment. Results: Nearly 40% of the sample met the criteria for alexithymia. The alexithymia group reported higher depression, anxiety, and anger. They also reported more difficulties with emotion regulation. In a path analysis, baseline alexithymia had a significant positive indirect effect on number of cigarettes smoked at the end of treatment through difficulties with emotion regulation. Conclusions/Importance: Similar to other studies, alexithymia limits the understanding of emotional information necessary for selection and implementation of adaptive coping responses. Our results extend the literature by suggesting that smoking may be an attempt to manage undifferentiated and unpleasant sensations created by alexithymia.

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.