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Fang J, Qiu C, Sun Z, Zhou J, He P, Conti A, Lu Y, Huang X, Xu J, Tang W. A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress. Compr Psychiatry 2024; 133:152505. [PMID: 38852302 DOI: 10.1016/j.comppsych.2024.152505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/17/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism. METHODS A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis. RESULTS When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria. CONCLUSIONS The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.
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Affiliation(s)
- Jinbo Fang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Zeyuan Sun
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jing Zhou
- Department of Psychosomatic Medicine, Leshan People's Hospital, Leshan, China
| | - Ping He
- Department of Nursing, Jianyang People's Hospital, Jiangyang, China
| | - Aldo Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yi Lu
- School of Disaster Reconstruction and Disaster Management, Sichuan University, Chengdu, China; School of Business Administration, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuping Xu
- School of Business Administration, Sichuan University, Chengdu, China.
| | - Wanjie Tang
- West China of Public Health School, West China Fourth Hospital, Sichuan University, Chengdu, China.
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Yang J, Wang L, Jin C, Wu YW, Zhao K. The Bridge Between Childhood Trauma and Alexithymia Among Adolescents with Depressive and Bipolar Disorders: A Network Bridge Analysis. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01737-8. [PMID: 39012545 DOI: 10.1007/s10578-024-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
Childhood trauma and alexithymia are significant risk factors for adolescent mental health issues. Prior research has linked these factors to psychopathology, but the complexities of their interrelation remain underexplored. This study aims to elucidate the relationship between various forms of childhood trauma and alexithymia in adolescents with depressive and bipolar disorders. Structural Equation Modeling (SEM) and network analysis were utilized on data from 2343 Chinese adolescents (aged 12-18 years, 77.93% female) diagnosed with depression or bipolar disorder. Measures included the Childhood Trauma Questionnaire (CTQ) and the Toronto Alexithymia Scale (TAS-20). SEM demonstrated a significant correlation between childhood trauma and alexithymia. Network analysis identified emotional abuse and difficulty identifying feelings as central nodes. Emotional abuse emerged as a key factor for difficulty in emotional identification among adolescents. This study highlights the need for early intervention and the importance of emotional nurturing in childhood to prevent long-term socioemotional difficulties.
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Affiliation(s)
| | - Lijun Wang
- Wenzhou Medical University, Wenzhou, China
| | | | - Yu-Wei Wu
- Student Affairs Division, Wenzhou Business College, Wenzhou, 325035, China.
| | - Ke Zhao
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, 323060, China.
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Kick L, Schleicher D, Ecker A, Kandsperger S, Brunner R, Jarvers I. Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Front Psychiatry 2024; 15:1412229. [PMID: 39011338 PMCID: PMC11246998 DOI: 10.3389/fpsyt.2024.1412229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions. Methods In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated. Results The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse. Discussion These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.
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Affiliation(s)
- Lorenz Kick
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stephanie Kandsperger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Théorêt V, Hébert É, Hébert M. Investigating the role of alexithymia in the association between cumulative childhood maltreatment and teen dating violence victimization. J Psychiatr Res 2024; 173:192-199. [PMID: 38547741 DOI: 10.1016/j.jpsychires.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Childhood maltreatment is increasingly recognized as an important risk factor for teen dating violence (TDV) victimization. However, far too little research has studied the mechanisms that could explain this higher risk of revictimization. The present study investigated the role of alexithymia in the association between cumulative childhood maltreatment, TDV victimization occurrence and chronicity, and TDV-related post-traumatic stress disorder (PTSD) symptoms. METHODS A total of 2780 adolescents, aged 13 to 19, completed measures of childhood maltreatment and alexithymia at Time 1 and TDV victimization and TDV-related PTSD symptoms at Time 2 (6 months later). Two mediational models were tested to examine the role of alexithymia as a risk factor for revictimization. One model assessed TDV occurrence as an outcome, while the other explored TDV chronicity and TDV-related PTSD symptoms as outcomes. RESULTS Findings suggest that cumulative childhood maltreatment is associated with an increased probability of TDV occurrence through alexithymia. Cumulative childhood maltreatment and alexithymia are also associated with TDV chronicity and TDV-related PTSD symptoms. Notably, cumulative childhood maltreatment is associated with higher levels of alexithymia among adolescent victims of TDV, which, in turn, predicts higher TDV chronicity and TDV-related PTSD symptoms. LIMITATIONS This study relied on abbreviated measures and did not include all forms of child maltreatment (e.g., emotional and physical neglect). CONCLUSIONS Promoting emotional awareness and identification among youth victims of child maltreatment could reduce the risk of TDV occurrence, TDV chronicity, and TDV-related PTSD symptoms.
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Affiliation(s)
- Valérie Théorêt
- School of Criminology, Université de Montréal, Québec, Canada
| | - Élizabeth Hébert
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
| | - Martine Hébert
- Canada Research Chair in Interpersonal Traumas and Resilience, Canada; Department of Sexology, Université du Québec à Montréal, Québec, Canada.
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Hamel C, Rodrigue C, Clermont C, Hébert M, Paquette L, Dion J. Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence. Sci Rep 2024; 14:6359. [PMID: 38493260 PMCID: PMC10944459 DOI: 10.1038/s41598-024-56909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.
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Affiliation(s)
- Catherine Hamel
- Département de Psychologie, Université de Montréal, Montréal, H2V 2S9, Canada.
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada.
| | - Christopher Rodrigue
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- École de Psychologie, Université Laval, Québec, G1V 0A6, Canada
| | - Camille Clermont
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- École de Psychologie, Université Laval, Québec, G1V 0A6, Canada
| | - Martine Hébert
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- Département de Sexologie, Université du Québec À Montréal, Montréal, H2L 4Y2, Canada
| | - Linda Paquette
- Département Des Sciences de La Santé, Université du Québec À Chicoutimi, Chicoutimi, G7H 2B1, Canada
| | - Jacinthe Dion
- Research Centre On Intimate Relationship Problems and Sexual Abuse (CRIPCAS), Université de Montréal, Montréal, H2V 2S9, Canada
- Département de Psychologie, Université du Québec À Trois-Rivières, Trois-Rivières, G9A 5H7, Canada
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Jakobson LS, McQuarrie AM, Van Landeghem C, Smith SD. Traits linked to sensory processing sensitivity mediate the relationship between externally oriented thinking and fantasizing. Front Psychol 2024; 15:1354120. [PMID: 38533217 PMCID: PMC10963545 DOI: 10.3389/fpsyg.2024.1354120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction Alexithymia is characterized by difficulties identifying and describing feelings but expression of externally oriented thinking (EOT) and difficulty fantasizing is more variable. In two studies, we investigated whether links between EOT and fantasizing are mediated by sensory processing sensitivity (SPS). Methods University students completed measures of alexithymia, SPS, and fantasizing. Results In Study 1 (N = 700) we identified two clusters of SPS traits: a positive facet (sensitivity to subtle stimuli) and a negative facet (sensitivity to uncomfortable stimuli). In the 499 participants who completed the fantasy measure, low EOT scores predicted stronger SPS positive and negative traits, which predicted a stronger tendency to mentally project oneself into the lives of characters in books, movies, and plays. In Study 2 (N = 600), the link between EOT and this same fantasizing tendency was again mediated by features of SPS-in this case fantasy proneness and emotional reactivity. Discussion We suggest that, whereas individuals who score high on EOT have an impoverished fantasy life, those who score relatively low on EOT and turn their attention inward are able to maintain stronger representations of imagined events in working memory (enhancing the likelihood that they will be recalled) and react more strongly to these events (enhancing their salience). Stronger expression of these features of SPS, in turn, increases the likelihood that one will develop a cognitive style that involves the application of imagery-based strategies to support deep processing of the thoughts and feelings of characters depicted in narratives.
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Affiliation(s)
- Lorna S. Jakobson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Stephen D. Smith
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Winnipeg, Winnipeg, MB, Canada
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Li M, Yuan Y, Cheng X, Wang Y, Xu Z. Childhood maltreatment and insomnia in college students: The role of alexithymia and psychological distress. Acta Psychol (Amst) 2024; 243:104149. [PMID: 38245937 DOI: 10.1016/j.actpsy.2024.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
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.
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Affiliation(s)
- Man Li
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China; Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin 300387, China
| | - Yidan Yuan
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Xinyue Cheng
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Yurou Wang
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Zhansheng Xu
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China; Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China; Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin 300387, China.
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Yang L, Huang M. Childhood maltreatment and mentalizing capacity: A meta-analysis. CHILD ABUSE & NEGLECT 2024; 149:106623. [PMID: 38245975 DOI: 10.1016/j.chiabu.2023.106623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/02/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The protective role of mentalizing capacity against the adverse effects of childhood maltreatment (CM) is acknowledged; however, empirical studies have yielded diverse conclusions regarding the relationship between childhood maltreatment and mentalizing capacity. OBJECTIVE This meta-analytic review aims to comprehensively summarize and quantify the association between childhood maltreatment and mentalizing capacity. PARTICIPANTS AND SETTING A total of 23 studies involving 3910 participants were included in the analysis. METHODS Systematic searches across eight bibliographic databases identified peer-reviewed publications describing empirical studies on the interplay between CM and mentalizing capacity. Effect sizes (r) were synthesized using random-effects models. A moderated effects analysis was conducted on five variables: participant gender, age group, mental health status, mentalizing capacity measurement, and childhood maltreatment measurement. RESULTS The findings showed a significant moderate negative correlation between childhood maltreatment and mentalizing capacity (r = -0.21, 95 % CI = [-0.26, -0.15]). This suggests that heightened severity of childhood maltreatment corresponds to lower mentalizing capacity. Moreover, the strength of this correlation was influenced by participant gender, age group, mental health status, mentalizing capacity measurement, and CM measurement. CONCLUSIONS The controversy surrounding the link between CM and mentalizing capacity gains clarity when considering significant moderating variables. The pooled effect provides a preliminary definition of the magnitude and direction of this correlation.
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Affiliation(s)
- Linhua Yang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China
| | - Manxia Huang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China.
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Putica A, Van Dam NT, Felmingham K, Lawrence-Wood E, McFarlane A, O'Donnell M. Interactive relationship between alexithymia, psychological distress and posttraumatic stress disorder symptomology across time. Cogn Emot 2024; 38:232-244. [PMID: 37987839 DOI: 10.1080/02699931.2023.2283934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3-4 years following the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology.
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Affiliation(s)
- Andrea Putica
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nicholas T Van Dam
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kim Felmingham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Alexander McFarlane
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Van Landeghem C, Jakobson LS. Isolating unique variance in mental health outcomes attributable to personality variables and childhood emotional abuse. Front Psychol 2024; 15:1330483. [PMID: 38318082 PMCID: PMC10838979 DOI: 10.3389/fpsyg.2024.1330483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction University students are at high risk for anxiety and depression. Our main objective was to tease apart variance in symptom severity that was uniquely attributable to four associated variables that are frequently confounded: exposure to childhood emotional abuse, alexithymia, sensory processing sensitivity (SPS), and anxiety sensitivity (AS). Methods University students (N = 410) completed an online survey designed to measure our four key study variables along with several other potentially relevant variables including sex, physical activity levels, and perceived COVID-19 impacts. Results Over half of the participants reported moderate to extremely severe symptoms of anxiety and depression. Females reported stronger signs of SPS and AS and were more likely than males to have increased their moderate/vigorous exercise since the pandemic began. After controlling for the other variables, the best predictors of perceived COVID-19 impacts were SPS, childhood emotional abuse, and current levels of physical activity. Whereas all three personality variables and childhood emotional abuse emerged as significant predictors of both depression and anxiety, neither COVID-19 impacts nor physical activity levels accounted for unique variance in either model. Unexpectedly, male sex emerged as an additional risk factor for depression, raising the possibility that males experience unique stressors and societal pressures that increase their risk of depression. Discussion These findings help to clarify the links between childhood emotional abuse, personality traits implicated in emotional awareness and self-regulation, and mental health. They may have important implications for the development and implementation of individualized treatments for common mental disorders.
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Affiliation(s)
| | - Lorna S. Jakobson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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van Sleeuwen C, van Zuiden M, Koch SBJ, Frijling JL, Veltman DJ, Olff M, Nawijn L. How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD. Eur J Psychotraumatol 2023; 14:2281187. [PMID: 38154073 PMCID: PMC10990451 DOI: 10.1080/20008066.2023.2281187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
Background: Alexithymia, an inability to recognise one's emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation.Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample.Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer.Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = -0.107, p = .355), oxytocin levels (β = -0.164, p = .161), insula (β = -0.170, p = .158) or amygdala (β = -0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations.Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia's relevance in the clinical phenotype of PTSD.
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Affiliation(s)
- Cindy van Sleeuwen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia B. J. Koch
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Jessie L. Frijling
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, the Netherlands
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Arq National Psychotrauma Centre, Diemen, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Pei C, Fan C, Luo H, Bai A, Ni S, Luo M, Huang J, Zhou Y, Huo L. Sleep problems in adolescents with depression: Role of childhood trauma, alexithymia, rumination, and self-esteem. J Affect Disord 2023; 338:83-91. [PMID: 37269886 DOI: 10.1016/j.jad.2023.05.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND While sleep problems are common in adolescents with depression, the exact prevalence has not been reported. Although previous studies have shown that childhood trauma, alexithymia, rumination, and self-esteem are related to sleep problems, the interactions between these factors remain unclear. METHODS This study, conducted from March 1, 2021 to January 20, 2022, employed a cross-sectional design. The participants were 2192 adolescents with depression with a mean age of 15 years. The Chinese version of the Pittsburgh Sleep Quality Index, Childhood Trauma Questionnaire, Toronto Alexithymia Scale-20, Ruminative Response Scale, and Rosenberg Self-Esteem Scale were used to measure sleep problems, childhood trauma, alexithymia, rumination, and self-esteem, respectively. We used PROCESS 3.3 for SPSS to determine the chain mediating effect of alexithymia and rumination and the moderating effect of self-esteem in the relationship between childhood trauma and sleep problems. RESULTS Up to 70.71 % of adolescents with depression had sleep problems. Furthermore, alexithymia and rumination played a chain mediation role in the relationship between childhood trauma and sleep problems. Finally, self-esteem moderated the relationships between alexithymia and sleep problems and rumination and sleep problems. LIMITATIONS Owing to the study design, we cannot derive causal relationships between variables. Further, the self-reported data may have been influenced by subjective participant factors. CONCLUSIONS This study reveals potential ways of how childhood trauma influences sleep problems in adolescents with depression. These findings suggest that interventions targeting alexithymia, rumination, and self-esteem in adolescents with depression may be effective in reducing their sleep problems.
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Affiliation(s)
- Chenran Pei
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Changhe Fan
- Department of Psychiatry, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Haocheng Luo
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ayu Bai
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Shengmiao Ni
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Min Luo
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Junxuan Huang
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.
| | - Lijuan Huo
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education; Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
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13
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Weiss NH, Goncharenko S, Forkus SR, Ferguson JJ, Yang M. Longitudinal Investigation of Bidirectional Relations Between Childhood Trauma and Emotion-Driven Impulsivity in the Adolescent Brain Cognitive Development Study. J Adolesc Health 2023; 73:731-738. [PMID: 37410001 PMCID: PMC10529354 DOI: 10.1016/j.jadohealth.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/01/2023] [Accepted: 05/27/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Exposure to childhood trauma is associated with numerous adverse mental health consequences. Addressing important gaps in the existing research, the proposed study clarifies the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity. METHOD This study utilized a sample of 11,872 9- to 10-years-olds recruited from 21 research sites across the United States from the Adolescent Brain Cognitive Ddevelopment (ABCD) Study. Childhood trauma was assessed at one- and two-year follow-ups. Negative and positive urgency were assessed at baseline and two-year follow-up. Cross-lagged panel models evaluated the longitudinal and bidirectional associations between childhood trauma and both negative and positive emotion-driven impulsivity. RESULTS Findings showed that earlier childhood trauma was associated with higher levels of later negative (β = 0.133, p < .001) and positive (β = 0.125, p < .001) emotion-driven impulsivity. Further, higher levels of earlier positive (β = 0.033, p < .006), but not negative (β = 0.010, p = .405), emotion-driven impulsivity were associated with later childhood trauma. Finally, the strength of the relations between childhood trauma and emotion-driven impulsivity did not differ by sex (ΔX2 = 10.228, p > .05). DISCUSSION Identification of both negative and positive emotion-driven impulsivity among children exposed to trauma may serve as a point of intervention to reduce subsequent risk for deleterious health outcomes.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island.
| | | | - Shannon R Forkus
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island; Medical University of South Carolina, Charleston, South Carolina
| | - Jewelia J Ferguson
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
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14
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Muzi S, Pace CS. Attachment and alexithymia predict emotional-behavioural problems of institutionalized, late-adopted and community adolescents: An explorative multi-informant mixed-method study. Clin Psychol Psychother 2023; 30:1130-1145. [PMID: 37259169 DOI: 10.1002/cpp.2862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Compared to community adolescents (COM), adolescents placed in residential care (RC) or late adopted (LA) appear to show more emotional-behavioural problems. They also appear vulnerable in variables linked to emotional-behavioural problems, such as insecure-disorganized attachment and alexithymia. This study employs a mixed-method multi-informant approach to (1) compare adolescents placed in RC, LA and COM in emotional-behavioural problems, attachment and alexithymia and (2) investigate relationships and interplay of attachment and alexithymia concerning emotional-behavioural problems in these three groups. METHOD Participants were 174 adolescents (50 RC, 33 LA and 91 COM; Mage = 15, 53% boys and 47% girls). Adolescents' internalizing and externalizing problems were assessed through both caregiver-reported and self-reported questionnaires, while attachment and alexithymia were assessed with a mixed method, using interviews and self-report questionnaires. RESULTS The results showed RC adolescents as more vulnerable in all variables, while LA and COM did not differ. Accounting for the group, attachment and alexithymia cumulatively predicted 25-43% of internalizing problems, and 19-43% of externalizing problems depending on the method of assessment or problems' informant (all p < 0.01). Alexithymia was both an independent predictor and interacted with preoccupied attachment in predicting internalizing problems, while no predictors were isolated for externalizing ones, and the group never indicate an effect on problems' rates. CONCLUSIONS The authors discuss the utility to maintain a research focus on attachment and alexithymia, also suggesting future directions of research. A need to determine potential distortions of results because of problems' informant and method of assessment is also highlighted.
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Affiliation(s)
- Stefania Muzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Serena Pace
- Department of Educational Sciences, University of Genoa, Genoa, Italy
- Centro Italiano Aiuti all'Infanzia (CIAI), Genoa, Italy
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15
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Elwyn R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 2023; 11:2. [PMID: 36604749 PMCID: PMC9815687 DOI: 10.1186/s40337-022-00729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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16
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Wilkinson S, Evans S, DeJong M. Assessing autism spectrum disorder in children with a background of maltreatment: challenges and guidance. Arch Dis Child 2022:archdischild-2022-323986. [PMID: 36385007 DOI: 10.1136/archdischild-2022-323986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 10/22/2022] [Indexed: 11/17/2022]
Abstract
There may be some similarities in the presentation of children who have autism spectrum disorder (ASD) and those exposed to maltreatment affecting assessment and diagnosis. Overlapping characteristics include difficulties understanding and maintaining relationships, sensitivity to routine and hyper-reactivity to sensory inputs. Children who have been maltreated are at increased risk of various developmental vulnerabilities with both environmental and genetic factors being relevant. The existing epidemiological evidence has found that looked-after children are more likely to screen positively for neurodevelopmental disorders and there are smaller scale studies in adoptive children finding higher rates of ASD than would be expected in the general population. Other research suggests a predominantly genetic basis for this increased risk in keeping with what is generally understood about the aetiology of autism. Children exposed to profound deprivation in Romanian orphanages were found to be at higher risk of a pattern of traits termed 'quasi autistic' which tended to reduce following adoption, but these findings have not been replicated in children experiencing maltreatment in birth families. Reactive attachment disorder (RAD) has some overlapping criteria with ASD, but its prevalence is unknown and children with RAD should be more socially reciprocal and not have the same repetitive and restricted behaviours and interests. We recommend experienced multidisciplinary assessment that considers both the possibility of maltreatment in children with ASD and neurodevelopmental vulnerabilities in children who have been maltreated and advise on assessment and management strategies.
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Affiliation(s)
- Simon Wilkinson
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sacha Evans
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Margaret DeJong
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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17
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Kyranides MN, Christofides D, Çetin M. Difficulties in facial emotion recognition: taking psychopathic and alexithymic traits into account. BMC Psychol 2022; 10:239. [PMID: 36303236 PMCID: PMC9615175 DOI: 10.1186/s40359-022-00946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alexithymic and psychopathic traits are closely associated, but distinct constructs. Both have been associated with facial emotion processing deficits reflecting empathy deficits, however the underlying mechanism contributing to these deficits is not well-understood. METHODS This study investigated facial emotion recognition performance in a non-clinical sample (N = 110) including both male and female participants, with varying levels of psychopathic and alexithymic traits. Facial emotion recognition was assessed using a computerized task, that presented different expressions depicting five emotional states (pain, fear, sadness, anger, happiness) and neutral expressions. RESULTS Results suggest that the high psychopathic traits group reported lower accuracy compared to the low psychopathic traits group, indicating a more generalized deficit in facial affect recognition, across all emotions. The alexithymic groups (high vs. low) on the other hand did not differ in their performance on the task for any of the emotions presented. CONCLUSION These findings add to the current body of research regarding face processing categorization deficits in relation to psychopathic and alexithymic traits and can inform prevention and intervention efforts that aim to facilitate facial emotion recognition in individuals with these personality traits.
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Affiliation(s)
| | - Demetris Christofides
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK.,Mind Mental Health Care, London, UK
| | - Melis Çetin
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK
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