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Sperry SH, Eckland NS, Kwapil TR. Emotional awareness, affective dysregulation, and bipolar spectrum psychopathology: A path analysis. Psychiatry Res 2021; 297:113739. [PMID: 33513486 DOI: 10.1016/j.psychres.2021.113739] [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: 04/25/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Affective dysregulation is present in those with subsyndromal symptoms of hypomania and mania and prospectively predicts the development of bipolar spectrum disorders. A crucial, understudied area related to the experience and regulation of emotion in this population is emotional awareness - emotional clarity (Clarity) and attention to emotion (Attention). We examined whether scores on the Hypomanic Personality Scale (HPS) were associated with deficits in emotional awareness and whether these deficits were associated with heightened intensity and instability of negative (NA) and positive affect (PA). Young adults (n=233), oversampled for high HPS scores completed self-reports and 14 days of experience sampling assessing high and low arousal NA and PA. HPS scores were associated with low Clarity and unassociated with Attention. High HPS scores were associated with greater high and low arousal NA intensity and instability only for those at low and mean levels of Attention. In contrast, there was a significant indirect association between HPS scores and intensity of high and low arousal NA and PA, as well as instability of high arousal NA, through low Clarity. Results highlighted that individual differences exist in the extent to which facets of emotional awareness differentially link scores on the HPS to emotional outcomes.
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Affiliation(s)
- Sarah H Sperry
- University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | | | - Thomas R Kwapil
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Visted E, Vøllestad J, Nielsen MB, Schanche E. Emotion Regulation in Current and Remitted Depression: A Systematic Review and Meta-Analysis. Front Psychol 2018; 9:756. [PMID: 29867700 PMCID: PMC5968125 DOI: 10.3389/fpsyg.2018.00756] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/30/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD. Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties. Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation. Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions.
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Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Solli District Psychiatric Centre (DPS), Bergen, Norway
| | - Morten Birkeland Nielsen
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Neural activation during cognitive reappraisal in girls at high risk for depression. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:49-56. [PMID: 28372994 DOI: 10.1016/j.pnpbp.2017.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although emotion dysregulation, one of the core features of depression, has long been thought to be a vulnerability factor for major depressive disorder (MDD), surprisingly few functional magnetic resonance imaging (fMRI) studies have investigated neural correlates of emotion regulation strategies in unaffected high risk individuals. METHOD Sixteen high risk (RSK) young women and fifteen matched low risk controls (CTL) were scanned using fMRI while performing an emotion regulation task. During this task, participants were instructed to reappraise their negative emotions elicited by International Affective Picture System images (IAPS). In addition, Difficulties in Emotion Regulation Strategies Scale (DERS) was used to assess participants' emotion dysregulation levels. RESULTS Both RSK and CTL individuals show increased amygdala activation in response to negative emotional stimuli, however no difference was found between groups in using cognitive reappraisal strategies and functions of brain regions implicated in cognitive reappraisal. Interestingly, our psychometric test results indicate that high risk individuals are characterised by lower perceived emotional clarity (EC). CONCLUSION Results of the current study suggest depression vulnerability may not be linked to the effectiveness of cognitive reappraisal. Alternatively, lower EC may be a vulnerability factor for depression.
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Loas G, Dalleau E, Lecointe H, Yon V. Relationships between anhedonia, alexithymia, impulsivity, suicidal ideation, recent suicide attempt, C-reactive protein and serum lipid levels among 122 inpatients with mood or anxious disorders. Psychiatry Res 2016; 246:296-302. [PMID: 27744231 DOI: 10.1016/j.psychres.2016.09.056] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
Several studies have explored the relationship between C-reactive protein (CRP), serum lipid levels, risk of suicide and alexithymia or impulsivity in mood or anxiety disorders. However, to date, no study has evaluated the effects of anhedonia on these parameters. The aim of the study was to evaluate the relationship between anhedonia, alexithymia, impulsivity, suicidal ideation, recent suicide attempt, C-reactive protein (CRP) and lipid levels in patients with mood or anxiety disorders. One hundred and twenty-two inpatients with mood or anxiety disorders were recruited. Alexithymia and impulsivity were rated by the 20-item Toronto Alexithymia Scale (TAS-20) and the Barratt impulsivity scale (BIS-10), respectively. Anhedonia and depression were rated by the Temporal Experience Pleasure Scale (TEPS) and the Beck Depression inventory (BDI-II). The TEPS contained two subscales rating anticipatory and consummatory anhedonia. From the BDI-II an anhedonia subscale was extracted rating anhedonia-state. Trait consummatory anhedonia and state anhedonia were associated with low levels of total cholesterol or HDL and low levels of triglycerides respectively. Trait anticipatory anhedonia and state anhedonia were associated with suicidal ideations. The difficulty of identifying feelings component of alexithymia was associated with low levels of total cholesterol and LDL. A high level of suicidal ideation was associated with low levels of HDL. Higher levels of CRP were found in inpatients having recently attempted suicide compared with inpatients who had not attempted suicide. In mood and anxiety disorders, anhedonia and the "difficulty of identifying feelings" component of alexithymia (which has previously been found to be associated with suicide risk) could explain the relationship between serum lipid levels and higher suicide risk.
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Affiliation(s)
- Gwenolé Loas
- University Department of Psychiatry, Hôpital Nord, CHU d'Amiens, France; Department of Psychiatry, Hôpital Erasme, ULB, Bruxelles, Belgium.
| | - Elodie Dalleau
- University Department of Psychiatry, Hôpital Nord, CHU d'Amiens, France
| | - Héloïse Lecointe
- University Department of Psychiatry, Hôpital Nord, CHU d'Amiens, France
| | - Valérie Yon
- University Department of Psychiatry, Hôpital Nord, CHU d'Amiens, France
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Thompson RJ, Kuppens P, Mata J, Jaeggi SM, Buschkuehl M, Jonides J, Gotlib IH. Emotional clarity as a function of neuroticism and major depressive disorder. Emotion 2015; 15:615-24. [PMID: 25844973 PMCID: PMC4586306 DOI: 10.1037/emo0000067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Investigators have begun to document links between emotional clarity and forms of negative emotionality, including neuroticism and major depressive disorder (MDD). Researchers to date have relied almost exclusively on global self-reports of emotional clarity; moreover, no studies have examined emotional clarity as a function of valence, although this may prove to be crucial in understanding the relation of emotional clarity to maladjustment. In 2 studies, we used experience-sampling methodology and multilevel modeling to examine the associations between emotional clarity and 2 constructs that have been linked theoretically with emotional clarity: neuroticism and depression. In Study 1 we assessed 95 college students who completed a self-report measure of neuroticism. In Study 2 we examined 53 adults diagnosed with MDD and 53 healthy adults. Reaction times to negative and positive emotion ratings during the experience-sampling protocols were used as an indirect measure of emotional clarity. Neuroticism was related to lower clarity of negative, but not of positive, emotion. Similarly, compared with the healthy controls, individuals with MDD had lower clarity of negative, but not of positive, emotion. It is important to note, findings from both studies held after controlling for baseline RTs and current levels of negative and positive emotion. These findings highlight the importance of assessing valence when examining emotional clarity and increase our understanding of the nature of the emotional disturbances that characterize neuroticism and MDD.
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Affiliation(s)
| | - Peter Kuppens
- Department of Psychology, KU Leuven - University of Leuven
| | - Jutta Mata
- Department of Psychology, Stanford University
| | | | | | - John Jonides
- Department of Psychology, University of Michigan
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Marchesi C, Ossola P, Scagnelli F, Mellini L, Tonna M, Ardissino D, De Panfilis C. The role of alexithymia in predicting incident depression in patients at first acute coronary syndrome. Compr Psychiatry 2015; 62:86-92. [PMID: 26343471 DOI: 10.1016/j.comppsych.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Alexithymia has been considered both to predispose to depression and to worsen cardiac prognosis after an acute coronary syndrome. Nonetheless, no studies have evaluated its role as a risk factor for incident depression, in patients with acute coronary syndrome. METHODS In 251 consecutive patients, the presence of a first-ever depressive episode was evaluated with the Primary Care Evaluation of Mental Disorders at baseline and 1, 2, 4, 6, 9, 12 and 24 months after their first acute coronary syndrome. At baseline, patients completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale. RESULTS Out of 251 subjects (80.9% males), a first-ever depressive episode was diagnosed in 66 patients. Depressed and never-depressed patients differed in female gender, living status, alexithymic scores at TAS-20 and depressive symptoms. Nonetheless, nor the TAS-20 factors nor its total score were predictive of developing a depressive episode in a Cox regression. Moreover, baseline differences in TAS-20 scores between the two groups, disappeared after controlling for anhedonic symptoms. CONCLUSION Our results do not support the hypothesis that alexithymia at TAS-20 is a risk factor for incident depression after acute coronary syndrome.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Francesca Scagnelli
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy.
| | - Lorenzo Mellini
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy.
| | | | - Diego Ardissino
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
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Thompson RJ, Boden MT, Gotlib IH. Emotional variability and clarity in depression and social anxiety. Cogn Emot 2015; 31:98-108. [PMID: 26371579 DOI: 10.1080/02699931.2015.1084908] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent research has underscored the importance of elucidating specific patterns of emotion that characterise mental disorders. We examined two emotion traits, emotional variability and emotional clarity, in relation to both categorical (diagnostic interview) and dimensional (self-report) measures of major depressive disorder (MDD) and social anxiety disorder (SAD) in women diagnosed with MDD only (n = 35), SAD only (n = 31), MDD and SAD (n = 26) or no psychiatric disorder (n = 38). Results of the categorical analyses suggest that elevated emotional variability and diminished emotional clarity are transdiagnostic of MDD and SAD. More specifically, emotional variability was elevated for MDD and SAD diagnoses compared to no diagnosis, showing an additive effect for co-occurring MDD and SAD. Similarly diminished levels of emotional clarity characterised all three clinical groups compared to the healthy control group. Dimensional findings suggest that although emotional variability is associated more consistently with depression than with social anxiety, emotional clarity is associated more consistently with social anxiety than with depression. Results are interpreted using a threshold and dose-response framework.
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Affiliation(s)
- Renee J Thompson
- a Department of Psychology , Washington University in St. Louis , 1 Brookings Drive, Campus Box 1125, St. Louis , MO 63130 , USA
| | - Matthew Tyler Boden
- b Center for Innovation to Implementation, VA Palo Alto Health Care System , 795 Willow Rd., Menlo Park , CA 94025 , USA
| | - Ian H Gotlib
- c Department of Psychology , Stanford University , 450 Serra Mall, Stanford , CA 94305 , USA
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Torres S, Guerra MP, Lencastre L, Miller K, Vieira FM, Roma-Torres A, Brandão I, Costa P. Alexithymia in anorexia nervosa: the mediating role of depression. Psychiatry Res 2015; 225:99-107. [PMID: 25467697 DOI: 10.1016/j.psychres.2014.10.023] [Citation(s) in RCA: 36] [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: 02/19/2014] [Revised: 07/03/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal.
| | | | - Leonor Lencastre
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Kylee Miller
- Carolina Institute for Developmental Disabilities, School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Filipa Mucha Vieira
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - António Roma-Torres
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B׳s, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Faculty of Psychology and Educational Sciences, University of Porto, Portugal
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Huang S, Berenbaum H, Chow PI. Distinguishing voluntary from involuntary attention to emotion. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2012.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leroy M, Loas G, Perez-Diaz F. Is impulsivity a risk factor of clinical events in acute coronary syndrome? A three-year follow-up study. Prog Neuropsychopharmacol Biol Psychiatry 2013; 40:149-52. [PMID: 23063652 DOI: 10.1016/j.pnpbp.2012.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Several depressive symptoms increase the risk of adverse clinical events after acute coronary syndrome (ACS) but the potential effect of impulsivity has not been explored. The aim of the study was to investigate the effects of impulsivity on prognosis at 3-year follow-up in patients hospitalised for ACS. METHODS Consecutively admitted ACS patients (n=277) completed the tenth version of the Barratt Impulsivity Scale (BIS 10) and the Hospital Anxiety and Depression Scale depression subscale (HAD-D) at baseline (1-4 days after their admission). The three subscales of the BIS 10 rating motor impulsivity (motor-BIS 10), attentional impulsivity (atten-BIS 10) and nonplanning impulsivity (nonplan-BIS 10) were taken into account. Patients were followed during 3 years for adverse clinical events divided into severe cardiac events (mortality or myocardial infarction (MI)), and clinical events (mortality, MI, recurrence of ACS, hospital readmission and onset or deterioration of heart failure (HF)). RESULTS At follow-up, there were 135 clinical events including 40 severe cardiac events. Low motor impulsivity and high depression were associated with poor prognosis, but high levels of motor impulsivity were the only predictors of lower frequency of severe cardiac events after adjusting for demographic and clinical variables. LIMITATIONS The patients were recruited from only one hospital and lack of structured interview for assessment of depression. CONCLUSIONS Motor impulsivity predicted low incidence of severe cardiac events following ACS and the BIS can be used clinically.
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Affiliation(s)
- Michel Leroy
- The University Department of Psychiatry, CHU d'Amiens, University of Picardie, Amiens, France
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Thompson RJ, Berenbaum H, Bredemeier K. Cross-sectional and longitudinal relations between affective instability and depression. J Affect Disord 2011; 130:53-9. [PMID: 20951438 PMCID: PMC3035756 DOI: 10.1016/j.jad.2010.09.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 09/13/2010] [Accepted: 09/18/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a growing recognition that emotional traits are important for understanding many mental health disorders, including major depressive disorder (MDD). The present research examined (a) the relation between MDD and the emotional trait of affective instability, and (b) whether individual facets of affective instability, affect intensity and affect variability, exhibited unique relations with anhedonic depression. METHODS In Study 1, affective instability and MDD were both assessed via clinical interviews in an adult community sample (n=288). In Studies 2 and 3, the relations between anhedonic depression and affect variability and affect intensity were assessed cross-sectionally using self-report measures in a college student sample (n=142; Study 2) and a female community sample (n=101; Study 3). Study 3 also prospectively examined whether affect variability and/or intensity predicted changes in anhedonic depression over two months. RESULTS In Study 1, affective instability and MDD were significantly associated, even after excluding individuals experiencing a current major depressive episode. In Studies 2 and 3, affect variability but not affect intensity was significantly, positively associated with anhedonic depression. In Study 3, affect variability but not affect intensity prospectively predicted increases in anhedonic depression. LIMITATIONS Future studies should assess the entire Bipolar Disorder spectrum and utilize event sampling, permitting the examination of other facets of affective instability (e.g., temporal dependency) and address other limitations of retrospective measures (e.g., recall bias). CONCLUSIONS These findings suggest that affective instability and particularly affect variability are associated with MDD and anhedonic depression. The tendency to experience frequent fluctuations in mood may constitute an important risk factor for depression.
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Affiliation(s)
- Renee J. Thompson
- Correspondence concerning this article should be addressed to Renee J. Thompson, Department of Psychology, Jordan Hall, Bldg 420; Stanford, CA 94305.
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Pollatos O, Gramann K. Electrophysiological evidence of early processing deficits in alexithymia. Biol Psychol 2011; 87:113-21. [DOI: 10.1016/j.biopsycho.2011.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 02/20/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
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Edel MA, Rudel A, Hubert C, Scheele D, Brüne M, Juckel G, Assion HJ. Alexithymia, emotion processing and social anxiety in adults with ADHD. Eur J Med Res 2010; 15:403-9. [PMID: 20952350 PMCID: PMC3351908 DOI: 10.1186/2047-783x-15-9-403] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective Given sparse research on the issue, this study sought to shed light upon the interactions of alexithymia, emotion processing, and social anxiety in adults with attention-deficit hyperactivity disorder (ADHD). Subjects and methods 73 German adults with ADHD according to DSM-IV diagnostic criteria participated. We used the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) to assess different features of social anxiety, and we applied the German 'Experience of Emotions Scale' (SEE) to measure emotion processing. Results 40% of the sample were found to meet the DSM-IV criteria of social anxiety disorder, and about 22% were highly alexithymic according to a TAS-20 total score ≥ 61; however, the mean TAS-20 total score of 50.94 ± 9.3 was not much higher than in community samples. Alexithymic traits emerged to be closely linked to emotion processing problems, particularly 'difficulty accepting own emotions', and to social anxiety features. Discussion/conclusion Our findings suggest interactions of alexithymia, emotion processing dysfunction, and social anxiety in adults with ADHD, which may entail the therapeutic implication to thoroughly instruct these patients to identify, accept, communicate, and regulate their emotions to aid reducing interaction anxiety.
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Affiliation(s)
- M-A Edel
- Depart. of Psychiatry, Rurh University, LWL, Hospital Bouchum, Germany
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Berenbaum H, Bredemeier K, Thompson RJ, Boden MT. Worry, Anhedonic Depression, and Emotional Styles. COGNITIVE THERAPY AND RESEARCH 2010. [DOI: 10.1007/s10608-010-9329-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marechal V, Loas G, Legrand A, Corcos M. Alexithymia in Severely Obese Patients Seeking Surgical Treatment. Psychol Rep 2009; 105:935-44. [DOI: 10.2466/pr0.105.3.935-944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of the study was to examine the rate of alexithymia as measured by the Toronto Alexithymia Scale in a sample of severely obese subjects, as well as the relationships between this dimension and five other dimensions found in obesity: depression, anhedonia, external locus of control, impulsivity, and interpersonal dependency. A second purpose was to test the hypothesis that alexithymia could be a prognosis factor in severely obese subjects seeking bariatric surgery. 49 severely obese and 40 psychiatric patients presenting mood, neurotic, or personality disorders participated. Analyses showed a significantly lower rate of alexithymia in severely obese (42.9%) than in psychiatric patients (67.5%). Interpersonal dependency was the main predictor of alexithymia in the two samples and impulsivity as well as anhedonia were independent predictors of alexithymia only in the severely obese sample. Preoperative Body Mass Index was the sole predictor of 1-yr. postoperative Body Mass Index in severely obese subjects receiving surgical treatment.
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Affiliation(s)
- Virginie Marechal
- University Department of Psychiatry, Centre Hospitalo-Universitaire and Hǒpital Pinel, Amiens, France
| | - Gwenolé Loas
- University Department of Psychiatry, Centre Hospitalo-Universitaire and Hǒpital Pinel, Amiens, France
| | - Alain Legrand
- University Department of Psychiatry, Centre Hospitalo-Universitaire and Hǒpital Pinel, Amiens, France
| | - Maurice Corcos
- Department of Adolescent Psychiatry, The Institut Mutualiste Montsouris, Paris, France
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Etain B, Roy I, Henry C, Rousseva A, Schürhoff F, Leboyer M, Bellivier F. No evidence for physical anhedonia as a candidate symptom or an endophenotype in bipolar affective disorder. Bipolar Disord 2007; 9:706-12. [PMID: 17988360 DOI: 10.1111/j.1399-5618.2007.00413.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bipolar affective disorder (BPAD) is clinically and genetically heterogeneous and the affected phenotype is poorly defined, hampering studies of its genetic basis. Studies of specific, familial, clinical indicators of BPAD may be useful for identifying heritable forms. Homogeneous forms of the disease may be identified in patients (candidate symptom approach) and some vulnerability markers may be sought in unaffected relatives of patients (intermediate traits or endophenotypes). Physical anhedonia (PA) is considered a possible candidate symptom and endophenotype in schizophrenia, but has never been specifically investigated in BPAD. METHODS Physical anhedonia scores (measured using Chapman's Physical Anhedonia Scale) were compared in 351 euthymic bipolar patients, 130 of their first-degree relatives and 170 healthy controls with no personal or familial history of schizophrenia, mood disorders or suicidal behavior. We investigated intrafamilial resemblance of PA and compared the progressive and clinical characteristics of hedonic and anhedonic bipolar probands. RESULTS Physical anhedonia was a stable trait in normothymic bipolar patients and significant intrafamilial correlation of PA scores was observed in bipolar families. However, PA scores were similar in unaffected relatives and controls and the clinical characteristics of anhedonic and hedonic patients did not differ significantly. Physical anhedonia was not associated with an increased familial risk for bipolar disorder. CONCLUSIONS Physical anhedonia is a stable, familial dimension in BPAD families. It cannot be considered an endophenotype because unaffected relatives of bipolar patients and healthy controls have similar PA scores. It also cannot be considered a candidate symptom because it does not identify a homogeneous clinical and familial sub-group of bipolar patients. Given the results of previous studies, PA might be a specific candidate symptom (and endophenotype) to schizophrenia. However, the validation of this hypothesis requires replication studies in bipolar disorder and schizophrenia and further investigations in other psychiatric diseases (in particular across the mood disorder spectrum).
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Affiliation(s)
- Bruno Etain
- AP-HP, Hôpital Albert Chenevier, Département Hospitalo-Universitaire de Psychiatrie, Université Paris XII, France.
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Tull MT, Medaglia E, Roemer L. An investigation of the construct validity of the 20-Item Toronto Alexithymia Scale through the use of a verbalization task. J Psychosom Res 2005; 59:77-84. [PMID: 16186002 DOI: 10.1016/j.jpsychores.2005.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 02/02/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The construct validity of the 20-Item Toronto Alexithymia Scale (TAS-20) was examined through a verbalization task requiring participants to discuss a past distressing event. METHODS Verbalizations were transcribed and coded for the frequency and number of different negative and positive emotion words used. Relationships between the TAS-20 and these variables were examined. RESULTS Controlling for negative affect (NA), the difficulty identifying feelings (DIF) subscale was positively associated with the frequency of negative emotion words used and negatively associated with the frequency and number of different positive emotion words used during the verbalization task. High, compared with low, scoring TAS-20 participants used a lower frequency of and fewer different positive emotion words. CONCLUSION The TAS-20 may be measuring negative emotional expressivity separate from negative affectivity, as well as a reduced capacity to access and elaborate upon positive emotion. Findings are discussed in regard to improving the conceptualization and measurement of emotional deficits in alexithymia.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Massachusetts Boston, 02125, USA.
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Rossier J, Rigozzi C, Berthoud S. Validation de la version française de l’échelle de contrôle de Levenson (IPC), influence de variables démographiques et de la personnalité. ANNALES MEDICO-PSYCHOLOGIQUES 2002. [DOI: 10.1016/s0003-4487(01)00111-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Honkalampi K, Hintikka J, Antikainen R, Lehtonen J, Viinamäki H. Alexithymia in patients with major depressive disorder and comorbid cluster C personality disorders: a 6-month follow-up study. J Pers Disord 2001; 15:245-54. [PMID: 11406996 DOI: 10.1521/pedi.15.3.245.19211] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors examined the association between alexithymia, cluster C personality disorders (CPD), and severity of depression among 121 outpatients with major depressive disorder (MDD) in a 6-month, follow-up study. Diagnosis of depression and CPD was confirmed by means of the Structured Clinical Interviews for DSM-III-R (SCID I and SCID II). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale and severity of depression was assessed using the 21-item Beck Depression Inventory. Results indicated that alexithymic features are common in patients with MDD but often alleviated during recovery from depression. Moreover, comorbid CPD and severity of depression seemed to be associated with poorer recovery from alexithymia. The implications of these findings are discussed.
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Affiliation(s)
- K Honkalampi
- Department of Psychiatry, Research and Development Unit, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
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Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H. Alexithymia and Depression: A Prospective Study of Patients With Major Depressive Disorder. PSYCHOSOMATICS 2001; 42:229-34. [PMID: 11351111 DOI: 10.1176/appi.psy.42.3.229] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors conducted a 12-month follow-up study to determine the association between alexithymia and depression in 116 outpatients with major depressive disorder (MDD) and 540 control subjects from the general population. Alexithymia was screened using the Toronto Alexithymia Scale (TAS-20), and depression was assessed using the Beck Depression Inventory (BDI). The results show that the severity of depression was significantly associated with alexithymia. In addition, the BDI scores increased or decreased proportionately with the change in TAS-20 score in both groups. These results lend further support to the idea that alexithymia may be a state-dependent phenomenon.
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Affiliation(s)
- K Honkalampi
- Department of Psychiatry, Kuopio University Hospital, Finland.
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Bankier B, Aigner M, Bach M. Alexithymia in DSM-IV Disorder: Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression. PSYCHOSOMATICS 2001; 42:235-40. [PMID: 11351112 DOI: 10.1176/appi.psy.42.3.235] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.
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Affiliation(s)
- B Bankier
- Department of Psychiatry, University of Vienna, Austria.
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Abstract
The Toronto Alexithymia Scale (TAS-26) was administered to patients with sexual disorders (n = 112) and to healthy control subjects (n = 94). The clinic sample was divided into three subgroups according to DSM-III-R criteria: patients with hypoactive sexual desire disorder (n = 41), patients with orgasm disorders (n = 51) and patients with male erectile disorder (n = 20). TAS scores were significantly higher for male and female patients with hypoactive sexual desire disorder, and with male erectile disorder than controls. The TAS scores in the orgasm disorder patients were not significantly different from those of controls. These results are interesting because they show an association betweeen alexithymia and some sexual symptoms.
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Affiliation(s)
- F Madioni
- Department of Psychiatry, University of Geneva, Switzerland.
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Davis C, Scott-Robertson L. A psychological comparison of females with anorexia nervosa and competitive male bodybuilders: body shape ideals in the extreme. Eat Behav 2000; 1:33-46. [PMID: 15001065 DOI: 10.1016/s1471-0153(00)00007-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is accumulating evidence that young men have become as concerned with their physical appearance as young women. However, different from women who want to achieve an ultra-slender body shape, most men want to increase their muscle mass and body size. Women with anorexia nervosa (AN) and competitive male bodybuilders are those who have taken the cultural standards of bodily perfection to the extreme, and both use unhealthy behaviours such as severe food restriction, excessive exercise, and steroids in pursuit of their goals. Findings of this study confirmed our prediction that the psychological profile of bodybuilders would be very similar to that found in women with AN. Both groups were significantly more obsessional, perfectionistic, anhedonic, and pathologically narcissistic than the general population. However, the bodybuilders reported very positive perceptions of their self-worth while the AN patients had very negative perceptions. Results are interpreted in the framework of a speculative developmental model of AN and bodybuilding, which focuses on the role of personality in the initiation and maintenance of excessive behaviours.
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Affiliation(s)
- C Davis
- Kinesiology and Health Sciences, York University, 343 Bethune College, 4700 Keele Street, Toronto, ON, Canada M3J 1P3.
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