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Guo X, Wu S, Dong W, Zhang Y, Su Y, Chen C. The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem. Psychol Res Behav Manag 2024; 17:783-797. [PMID: 38444719 PMCID: PMC10911978 DOI: 10.2147/prbm.s450195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Background & Aim Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents. Methods A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects. Results The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect. Conclusion These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.
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Affiliation(s)
- Xiajun Guo
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Sijia Wu
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Wanglin Dong
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yiqiu Zhang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yue Su
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Chaoran Chen
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
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Wu B, Zhang H, Chen J, Chen J, Liu Z, Cheng Y, Yuan T, Peng D. Potential mechanisms of non-suicidal self-injury (NSSI) in major depressive disorder: a systematic review. Gen Psychiatr 2023; 36:e100946. [PMID: 37655114 PMCID: PMC10465892 DOI: 10.1136/gpsych-2022-100946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a frequent and prominent phenomenon in major depressive disorder (MDD). Even though its prevalence and risk factors are relatively well understood, the potential mechanisms of NSSI in MDD remain elusive. Aims To review present evidence related to the potential mechanisms of NSSI in MDD. Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, articles for this systematic review were searched on Medline (through PubMed), Embase (through Elsevier), PsycINFO (through OVID) and Web of Science databases for English articles, as well as China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang Data, and the Chongqing VIP Chinese Science and Technology Periodical (VIP) Databases for Chinese articles published from the date of inception to 2 August 2022. Two researchers (BW, HZ) independently screened studies based on inclusion and exclusion criteria and assessed their quality. Results A total of 25 157 studies were searched. Only 25 of them were ultimately included, containing 3336 subjects (1535 patients with MDD and NSSI, 1403 patients with MDD without NSSI and 398 HCs). Included studies were divided into 6 categories: psychosocial factors (11 studies), neuroimaging (8 studies), stress and hypothalamic-pituitary-adrenal (HPA) axis (2 studies), pain perception (1 study), electroencephalogram (EEG) (2 studies) and epigenetics (1 study). Conclusions This systematic review indicates that patients with MDD and NSSI might have specific psychosocial factors, aberrant brain functions and neurochemical metabolisms, HPA axis dysfunctions, abnormal pain perceptions and epigenetic alterations.
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Affiliation(s)
- Baichuan Wu
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifeng Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghong Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- General Psychiatry Editorial Office, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaye Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhang B, Zhang W, Sun L, Jiang C, Zhou Y, He K. Relationship between alexithymia, loneliness, resilience and non-suicidal self-injury in adolescents with depression: a multi-center study. BMC Psychiatry 2023; 23:445. [PMID: 37337144 DOI: 10.1186/s12888-023-04938-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) behaviors are prevalent in adolescents and have adverse effects on physical and mental health. However, little is known about the relationship between NSSI and alexithymia, or the underlying mechanisms that could explain this relationship. This study aimed to elucidate the current status of NSSI in adolescent depression, and analyze the relationship between alexithymia, loneliness, resilience, and adolescent depression with NSSI, so as to provide a theoretical basis for psychotherapeutic interventions. METHOD The study sample involved inpatients and outpatients from 12 hospitals across China and adolescents with depression who met the DSM-5 diagnostic criteria for depression episode. The following scales were used: The Functional Assessment of Self-Mutilation, Toronto Alexithymia Scale, UCLA Loneliness Scale, and Connor Davidson Resilience Scale. RESULTS The detection rate of NSSI in adolescents with depression from 2021.01.01-2022.01.01 was 76.06% (1782/2343). Spearman's correlation analysis revealed a significant correlation between alexithymia, loneliness, resilience and NSSI in depressed adolescents, and the results of the non-parametric test showed that the differences between the two groups for each factor were statistically significant. Binary logistic regression results showed that alexithymia (B = 0.023, p = 0.003, OR = 1.023, 95% CI: 1.008-1.038) and depression (B = 0.045, p < 0.001, OR = 1.046, 95% CI: 1.026-1.066) are risk factors for NSSI, resilience (B = - 0.052, p < 0.001, OR = 0.949, 95% CI: 0.935 - 0.964) is a protective factor for NSSI. Alexithymia directly predicted NSSI and also indirectly influenced NSSI through the mediated effect of resilience. Loneliness moderates the first half of the path of this mediated model. CONCLUSION The present study confirms a moderated mediation effect: Alexithymia can have an impact on NSSI behaviors in depressed adolescents through the mediating role of resilience. Loneliness, as a moderating variable, moderated the first half of the pathway of the mediating model. We discuss perspectives for future research and interventions based on the findings of the study.
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Affiliation(s)
- Bing Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Wei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Lingmin Sun
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China
- Anhui Mental Health Center, 230022, Hefei, China
- Hefei Fourth People's Hospital, Hefei, China
| | - Cheng Jiang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China
| | - Yongjie Zhou
- Shenzhen Kangning Hospital, Shenzhen, China.
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
| | - Kongliang He
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230022, China.
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, 230022, China.
- Anhui Mental Health Center, 230022, Hefei, China.
- Hefei Fourth People's Hospital, Hefei, China.
- Psychological counseling department, Hefei Fourth People's Hospital, Anhui, 230000, China.
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Dong Z, Zhou J, Conti A, Westwood SJ, Fu X, Liu Q, Yuan Y, Huang X, Qiu C, Zhang X, Tang W. Association between alexithymia and non-suicidal self-injury in psychiatric patients: the mediating role of self-esteem and the moderating role of emotional intelligence. J Psychiatr Res 2023; 162:57-64. [PMID: 37088044 DOI: 10.1016/j.jpsychires.2023.04.006] [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: 10/05/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Raffagnato's theory claims that if people have no words to express their emotions (alexithymia), they express themselves by venting or through non-suicidal self-injury (NSSI). However, these associations have not been confirmed in psychiatric patients. This study explored the relationship between alexithymia and NSSI in psychiatric patients and the potential underlying psychological mechanisms. METHODS This retrospective study involved face-to-face interviews with 449 outpatients consecutively recruited from West China Hospital. Alexithymia, self-esteem, NSSI, and emotional intelligence (EI) were measured. The moderating role of EI and the mediating role of self-esteem between alexithymia and NSSI were also explored. Logistic regressions were used to examine whether sociodemographic, clinical variables and alexithymia were independently associated with NSSI. RESULTS The DSM-5 NSSI disorder and alexithymia prevalences were found to be 32.5% and 45.2%. When the other covariables were controlled for, the alexithymic patients were found to be at increased odds (OR 2.76) of engaging in NSSI behaviors. These results confirmed the strong associations between alexithymia, low self-esteem, and NSSI risk. Lower EI was found to be related to the connections between alexithymia and NSSI. Except for the lower risk in anxiety patients, the risk of NSSI was similar for patients with other mental disorders, CONCLUSION: This study revealed the psychological mechanisms through which alexithymia increases the risk of NSSI. Therefore, to reduce NSSI risk, screening for alexithymia should be emphasized. Self-esteem as a targeted psychological intervention could also assist in mitigating the process from alexithymia to NSSI behaviors, and EI training for psychiatric patients could weaken the relationship between alexithymia and NSSI.
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Affiliation(s)
- Zaiquan Dong
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhou
- Department of Psychosomatic Medicine, Leshan People's Hospital, Leshan, Sichuan, China
| | - Aldo Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, UK
| | - Xia Fu
- Out-patient Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Liu
- Out-patient Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanling Yuan
- Department of Pharmacy of West China Hospital, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wanjie Tang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Gatta M, Raffagnato A, Angelico C, Benini E, Medda E, Fasolato R, Miscioscia M. Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality. CLINICAL NEUROPSYCHIATRY 2023; 20:17-28. [PMID: 36936619 PMCID: PMC10016105 DOI: 10.36131/cnfioritieditore20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Objective suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework. Method we conducted a retrospective study with 190 adolescents (M= 14.5, SD age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires. Results the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20. Conclusions the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.
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Affiliation(s)
- Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Elena Benini
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Erica Medda
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Rachele Fasolato
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (A.R); (C.A.); elena. (E.B.); (E.M.); (R.F.); (M.M.)
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padua, Italy
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Raffagnato A, Iannattone S, Fasolato R, Parolin E, Ravaglia B, Biscalchin G, Traverso A, Zanato S, Miscioscia M, Gatta M. A Pre-Adolescent and Adolescent Clinical Sample Study about Suicidal Ideation, Suicide Attempt, and Self-Harming. Eur J Investig Health Psychol Educ 2022; 12:1441-1462. [PMID: 36286085 PMCID: PMC9600697 DOI: 10.3390/ejihpe12100100] [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: 06/29/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (Mage = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal-Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.
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Affiliation(s)
- Alessia Raffagnato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Sara Iannattone
- Department of General Psychology, University of Padua, 35131 Padua, Italy
- Correspondence: ; Tel.: +39-049-827-6918
| | - Rachele Fasolato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Elisa Parolin
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Benedetta Ravaglia
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Gaia Biscalchin
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Annalisa Traverso
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Silvia Zanato
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
| | - Marina Miscioscia
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Michela Gatta
- Department of Woman and Child’s Health, Padua University Hospital, 35128 Padua, Italy
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Tang WC, Lin MP, Wu JYW, Lee YT, You J. Mediating role of depression in the association between alexithymia and nonsuicidal self-injury in a representative sample of adolescents in Taiwan. Child Adolesc Psychiatry Ment Health 2022; 16:43. [PMID: 35705987 PMCID: PMC9202208 DOI: 10.1186/s13034-022-00477-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nock's (2009) integrated theoretical model suggests that specific intrapersonal vulnerability factors caused by distal risk factors contribute to the development of nonsuicidal self-injury (NSSI). Alexithymia and depression have been found to predict NSSI. Based on Nock's model, alexithymia plays a distal risk factor role to increase the risk of depression-an intrapersonal vulnerability factor-and further increase the risk of NSSI. However, small or unrepresentative samples in past studies limit the generalizability of the results. This study examined the roles of depression and alexithymia in predicting NSSI, as well as the mediating effect of depression in the relation between alexithymia and NSSI in a large representative sample of adolescents in Taiwan. METHODS Using a cross-sectional study design, a large representative sample of 2,170 senior high school students in Taiwan was assessed by self-report measures of alexithymia, depression, and NSSI. Mediation analyses were performed to examine whether the relation between alexithymia and NSSI was mediated by depression. The questionnaires were administered in classrooms. RESULTS Results showed that alexithymia positively predicted NSSI (β = 0.23, p < .001) and depression can also positively predict NSSI (β = 0.41, p < .001). Additionally, the association between alexithymia and NSSI was fully mediated by depression. CONCLUSIONS This study data provided evidence for the mediating role of depression between alexithymia and NSSI, which can be explained by Nock's (2009) integrated theoretical model. The implications of the findings for future research and intervention were discussed.
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Affiliation(s)
- Wen-Ching Tang
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, 106, Taipei City, Taiwan
| | - Min-Pei Lin
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, 106, Taipei City, Taiwan.
| | - Jo Yung-Wei Wu
- Good-Day Psychology Clinic, 5F., No. 167, Xialin Rd., South District, 702, Tainan City, Taiwan
| | - Yueh-Ting Lee
- Department of Counseling and Guidance, National University of Tainan, No.33, Sec. 2, Shu- Lin St, 700, Tainan, Taiwan
| | - Jianing You
- Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), & School of Psychology, Ministry of Education, South China Normal University, 510631, Guangzhou, People's Republic of China
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8
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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9
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Gatta M, Angelico C, Rigoni F, Raffagnato A, Miscioscia M. Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm. J Clin Med 2022; 11:jcm11082220. [PMID: 35456311 PMCID: PMC9026923 DOI: 10.3390/jcm11082220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11–18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.
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Affiliation(s)
- Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (F.R.); (A.R.)
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (F.R.); (A.R.)
- Correspondence: (C.A.); (M.M.)
| | - Francesca Rigoni
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (F.R.); (A.R.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (F.R.); (A.R.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (M.G.); (F.R.); (A.R.)
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padua, Italy
- Correspondence: (C.A.); (M.M.)
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Bordalo F, Carvalho IP. The role of alexithymia as a risk factor for self-harm among adolescents in depression - A systematic review. J Affect Disord 2022; 297:130-144. [PMID: 34695502 DOI: 10.1016/j.jad.2021.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Considering the suggested role of alexithymia in increasing the risk of self-harm, especially when depression is also present, and that rates of self-harm tend to peak in adolescence, the aim of this systematic review was to synthetize the most relevant research studies on this topic and provide an understanding on whether alexithymia can be considered as an important risk factor for non-suicidal self-harm among adolescents with depression. METHODS Searches were conducted in PubMed, Web of Science, and PsycINFO, resulting in 290 records. After removal of duplicates, 273 records were left and after reading the titles and abstracts, 231 articles were excluded, leaving 42 articles that were read in full. Of these 42, nine articles were included in this review. RESULTS The sample of this review consists of eight case-control studies and one cross-sectional and longitudinal survey. All nine studies concluded that the most important variables associated with self-harming behavior were depression and alexithymia, among all other variables assessed. The self-harming groups showed significantly higher scores on alexithymia (overall and particularly Factor 1- difficulties identifying feelings and differentiating them from bodily sensations), when compared to the control (no self-harming) groups, and the mean depression scores for self-harming groups were significantly higher than those for non-harming groups. All nine studies included in this review shared the limitation of self-reported information. CONCLUSION These results indicate that alexithymia is a risk factor for non-suicidal self-harm among adolescents with depression, even when other variables were also inspected, and may be a prevention and therapeutic target in the future.
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Affiliation(s)
- Felícia Bordalo
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.
| | - Irene P Carvalho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; Medical Psychology Unit, Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; CINTESIS, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
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11
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Iannattone S, Raffagnato A, Zanato S, Traverso A, Tascini B, Del Col L, Miscioscia M, Gatta M. Children with Psychopathology and Their Parents Facing the Covid-19 Pandemic: A Case-Control Study. CLINICAL NEUROPSYCHIATRY 2021; 18:324-333. [PMID: 35096079 PMCID: PMC8785424 DOI: 10.36131/cnfioritieditore20210606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective This case-control study aimed to explore the effects of the COVID-19 outbreak on the mental well-being of pediatric psychiatric outpatients and their families, comparing them with children/adolescents and their parents from the general population. Method The case group consisted of 168 subjects: 56 patients (6-18 years old) with psychiatric disorders, and their 112 parents. The healthy control group included 189 subjects: 63 children and adolescents with no psychopathologies, and their 126 parents. Both groups were assessed during the first COVID-19 lockdown in Italy (T0) and 4 months later (T1), by administering the CBCL6-18 and DASS-21. Results Patients showed a good adaptation to the pandemic situation, while the children/adolescents in the healthy sample showed a greater variation in their general habits and a higher prevalence of stress symptoms during the lockdown. The patients’ parents likewise had fewer stress-related symptoms than caregivers in the healthy control group, both during the lockdown and 4 months later. At T0, patients’ mothers reported higher anxiety levels than mothers in the healthy group, while at T1 fathers of healthy children scored higher on the DASS-21 anxiety and stress scales than patients’ fathers. As concerns changes over time (T0-T1) in the parents’ psychological well-being, a general improvement was detected in both groups. Conclusions The pandemic and quarantine measures were confirmed as significant stressors for all children and adolescents, and negatively affected their parents’ adaptation. The findings of this study point to the need for preventive interventions to support the mental health of all parents and their children in uncertain and stressful times.
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Affiliation(s)
- Sara Iannattone
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.), Department of General Psychology, University of Padua, 35131 Padua, Italy,Corresponding author Sara Iannattone Department of General Psychology – University of Padua Via Venezia, 8 35131, Padua (PD), Italy E-mail:
| | - Alessia Raffagnato
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
| | - Silvia Zanato
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
| | - Annalisa Traverso
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
| | - Benedetta Tascini
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
| | - Lara Del Col
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
| | - Marina Miscioscia
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.), Department of General Psychology, University of Padua, 35131 Padua, Italy, Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Michela Gatta
- Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy; (S.I.); (A.R.); (S.Z.); (A.T.); (B.T.); (L.D.C); (M.M.); (M.G.)
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12
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Mancinelli E, Sharka O, Lai T, Sgaravatti E, Salcuni S. Self-injury and Smartphone Addiction: Age and gender differences in a community sample of adolescents presenting self-injurious behavior. Health Psychol Open 2021; 8:20551029211038811. [PMID: 34659789 PMCID: PMC8512283 DOI: 10.1177/20551029211038811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to identify the variables (i.e., internalizing, and externalizing problems, self-control, emotion dysregulation, and alexithymia) relevant for Smartphone Addiction and non-suicidal self-injury (NSSI), conceptualized as emotion-regulation strategies, also assessing age and gender differences. Based on power analysis, N = 78 Italian adolescents (11-19 years; Mage = 14.24; SD = 1.56; 73.1% females) were considered. Step-wise multivariate linear regressions evidence a mutual association between NSSI and Smartphone Addiction, particularly relevant in pre-adolescence. Low self-control is significantly associated with the Smartphone Addiction, while emotion dysregulation and alexithymia with NSSI. This study supports NSSI and Smartphone Addiction conceptualization as emotion-regulation strategies and the importance of prevention interventions.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Ona Sharka
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | | | - Eleonora Sgaravatti
- The Net-ONLUS, Padua, Italy.,Complex Psychology Unit - Infancy, Adolescence and Family, USSL3, Via Piazzetta Unità d'Italia, Padua, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
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13
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Tambelli R, Cimino S, Marzilli E, Ballarotto G, Cerniglia L. Late Adolescents' Attachment to Parents and Peers and Psychological Distress Resulting from COVID-19. A Study on the Mediation Role of Alexithymia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10649. [PMID: 34682393 PMCID: PMC8535909 DOI: 10.3390/ijerph182010649] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022]
Abstract
The scientific literature has shown the key role played by attachment to parents and peers and difficulties in recognizing, processing, and regulating emotions (i.e., alexithymia) in the (mal-)adaptive psychological response to the COVID-19 pandemic during late adolescence. No study has yet explored the complex interplay between these variables. We recruited a sample of 454 late adolescents (Mage = 22.79, SD = 2.27) and assessed attachment to parents and peers, alexithymia, and peritraumatic distress due to COVID-19 through self-report instruments. Attachment to fathers and peers, but not to mothers, and alexithymia significantly predicted levels of peritraumatic distress. Alexithymia fully and partially mediated the effect of, respectively, attachment to mothers and attachment to peers on peritraumatic distress due to COVID-19. These findings suggested that intervention programs focused on the promotion of peer social relationships, supportive parent-adolescent relationships, and the ability to recognize and discriminate one's own and others' emotions are needed in helping late adolescents to face the current health emergency and preventing short- and long-term psychopathological consequences related to the COVID-19 pandemic.
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Affiliation(s)
- Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00186 Rome, Italy; (R.T.); (E.M.); (G.B.)
| | - Silvia Cimino
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00186 Rome, Italy; (R.T.); (E.M.); (G.B.)
| | - Eleonora Marzilli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00186 Rome, Italy; (R.T.); (E.M.); (G.B.)
| | - Giulia Ballarotto
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00186 Rome, Italy; (R.T.); (E.M.); (G.B.)
| | - Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, 00186 Rome, Italy;
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14
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The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae for Children and Adolescents with Neuropsychiatric Disorders and Their Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189880. [PMID: 34574803 PMCID: PMC8471939 DOI: 10.3390/ijerph18189880] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to investigate the immediate and short-term impact of the pandemic on the psychological well-being of Italian children and adolescents with psychiatric disorders and their families. Overall, 56 patients aged 6-18 (M = 13.4 years, SD = 2.77) and their parents were evaluated during the COVID-19 lockdown (T0) and after 4 months (T1). An ad hoc data sheet, Youth Self-Report 11-18 (YSR), Child Behavior Checklist 6-18 (CBCL), and Depression Anxiety Stress Scale-21 (DASS-21) were administered. Patients, mainly suffering from internalizing disorders, overall demonstrated a good adaptation to the pandemic context. Moreover, patients with behavioral disorders showed a greater psychological discomfort at both T0 and T1 compared to patients with internalizing disorders. Over time, patients presented an improvement on the emotional side, as proven by a significant decrease in internalizing and post-traumatic stress problems. Finally, no significant differences were found in the emotional-behavioral profile of patients according to the means of conducting neuropsychiatric interventions during the lockdown (i.e., in person/remotely/interrupted), thus allowing us to exclude important negative effects caused by the transition to remote therapy. Concerning parents, an inverse relationship emerged between the DASS-21 scores and the level of resilience, which therefore represents a protective factor against psychological maladjustment. Over time, an improvement in the psychological well-being of parents was observed, as shown by a significant decrease in mothers' anxiety and fathers' stress.
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15
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Tang WC, Lin MP, You J, Wu JYW, Chen KC. Prevalence and psychosocial risk factors of nonsuicidal self-injury among adolescents during the COVID-19 outbreak. CURRENT PSYCHOLOGY 2021; 42:1-10. [PMID: 34092987 PMCID: PMC8167308 DOI: 10.1007/s12144-021-01931-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
The research investigated the prevalence of nonsuicidal self-injury (NSSI) during the COVID-19 outbreak and identified the psychosocial risk factors among junior high school students in Taiwan. Cross-sectional design was applied and 1,060 participants (Mage = 14.66, SD = 0.86 years) were recruited into the study. The prevalence of NSSI was found to be 40.9% (95% confidence interval, 37.9%-43.9%) during the COVID-19 outbreak. The results suggested that the self-injurers group were mostly female, and scored significantly higher in neuroticism, depression, impulsivity, alexithymia, virtual social support, dissatisfaction with academic performance, and lower in subjective wellbeing, self-esteem, actual social support, and family function than the non-injurers group. In addition, high neuroticism, low self-esteem, high virtual social support, high impulsivity, and high alexithymia were independently predictive in the logistic regression analysis. The principal results of this study suggested that NSSI was extremely prevalent among adolescents during the COVID-19 outbreak, and in particularly, personality and virtual environment risk factors and enhancing self-esteem should be the focus of NSSI preventive strategies when targeting this age population. Our results provide a reference towards designing NSSI prevention programs geared toward the high school population during the COVID-19 pandemic.
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Affiliation(s)
- Wen-Ching Tang
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106 Taiwan
| | - Min-Pei Lin
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106 Taiwan
| | - Jianing You
- Center for Studies of Psychological Application & School of Psychology, South China Normal University, No. 155 Zhongshan W. Rd, Tianhe District, Guangzhou, China
| | - Jo Yung-Wei Wu
- Good-Day Psychology Clinic, 5F., No. 167, Xialin Rd., South District, Tainan City, 702 Taiwan
| | - Kuan-Chu Chen
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106 Taiwan
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16
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Fynn DM, Gignac GE, Becerra R, Pestell CF, Weinborn M. The Prevalence and Characteristics of Alexithymia in Adults Following Brain Injury: A Meta-Analysis. Neuropsychol Rev 2021; 31:722-738. [PMID: 33624197 DOI: 10.1007/s11065-021-09484-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/07/2021] [Indexed: 01/06/2023]
Abstract
Alexithymia is the inability to identify and describe one's own emotions. Some research suggests that organic alexithymia may occur after acquired brain injury (ABI). However, the results in the literature are inconsistent, when comparisons are made against healthy controls. Furthermore, a precise estimate of alexithymia prevalence in the ABI population has not yet been reported. Consequently, this meta-analysis aimed to estimate the prevalence and characteristics of alexithymia in ABI, as measured by the Toronto Alexithymia Scale-20 (TAS-20). Based on 22 unique ABI samples, a series of random-effects meta-analyses estimated moderate to large positive effect sizes (i.e., greater alexithymia in ABI samples) for the TAS-20 total scale (Hedges' g = 1.00, 95% CI [0.75, 1.35]), as well as the subscales: difficulty identifying feelings (Hedges' g = 0.92, 95% CI [0.66, 1.17]), difficulty describing feelings (Hedges' g = 0.69, 95% CI [0.50, 0.87]) and externally oriented thinking (Hedges' g = 0.75, 95% CI [0.64, 0.85]). Furthermore, a meta-regression identified a larger effect size (TAS-20 total scale score) for traumatic brain injury (TBI) samples, in comparison to non-TBI samples. Finally, the prevalence of clinically significant levels of alexithymia (TAS-20 total scale ≥ 68.4; i.e., two SDs above the general population mean) in ABI patients was estimated at 15.2%. We interpreted the results to suggest that ABI may have a substantial negative impact on affective processing abilities and, thus, comprehensive assessment of emotional functioning deficits following ABI should be considered by practitioners.
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Affiliation(s)
- Danielle M Fynn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gilles E Gignac
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Rodrigo Becerra
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Carmela F Pestell
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Michael Weinborn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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17
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The Role of Alexithymia in Social Withdrawal during Adolescence: A Case-Control Study. CHILDREN-BASEL 2021; 8:children8020165. [PMID: 33671559 PMCID: PMC7926933 DOI: 10.3390/children8020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
Although social withdrawal is becoming increasingly common among adolescents, there is still no consensus on its definition from the diagnostic and psychopathological standpoints. So far, research has focused mainly on social withdrawal as a symptom of specific diagnostic categories, such as depression, social phobia, or anxiety disorders, or in the setting of dependence or personality disorders. Few studies have dealt with social withdrawal in terms of its syndromic significance, also considering aspects of emotion control, such as alexithymia. The present case-control study aimed to further investigate the issue of social withdrawal, and try to clarify the part played by alexithymia in a sample of Italian adolescents diagnosed with psychological disorders (n = 80; Average Ageg = 15.2 years, SD = 1.49). Our patients with social withdrawal (cases) scored significantly higher than those without this type of behavior (controls) in every domain of alexithymia investigated, using the Toronto Alexithymia Scale (TAS-20) and with the scales in the Youth Self-Report (YSR) regarding internalizing problems, anxiety-depression, social problems, and total problems. Internalizing problems and total levels of alexithymia also emerged as predictors of social withdrawal. These variables may therefore precede and predispose adolescents to social withdrawal, while social problems may develop as a consequence of the latter.
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18
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Tatnell R, Hasking P, Newman L. Multiple mediation modelling exploring relationships between specific aspects of attachment, emotion regulation, and non‐suicidal self‐injury. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth Tatnell
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia,
| | - Penelope Hasking
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia,
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia,
| | - Louise Newman
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia,
- Department of Psychiatry, Centre for Women's Mental Health, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia,
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19
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Gatta M, Balottin L, Mannarini S, Chesani G, Del col L, Spoto A, Battistella PA. Familial factors relating to alexithymic traits in adolescents with psychiatric disorders. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12098] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michela Gatta
- Childhood Adolescence Family Unit, ULSS 16 Padova, Woman and Child Health Department, University of Padova, Padova, Italy,
| | - Laura Balottin
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy,
| | - Stefania Mannarini
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy,
| | - Giulia Chesani
- Childhood Adolescence Family Unit, ULSS 16 Padova, Woman and Child Health Department, University of Padova, Padova, Italy,
| | - Lara Del col
- Childhood Adolescence Family Unit, ULSS 16 Padova, Woman and Child Health Department, University of Padova, Padova, Italy,
| | - Andrea Spoto
- General Psychology Department, University of Padova, Padova, Italy,
| | - Pier Antonio Battistella
- Childhood Adolescence Family Unit, ULSS 16 Padova, Woman and Child Health Department, University of Padova, Padova, Italy,
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Sellami R, Bouattour W, Baati I, Feki I, Masmoudi J. Relation entre alexithymie et impulsivité dans un échantillon d’adolescents scolarisés de la région de Sfax, Tunisie. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Lockwood J, Townsend E, Daley D, Sayal K. Impulsivity as a predictor of self-harm onset and maintenance in young adolescents: a longitudinal prospective study. J Affect Disord 2020; 274:583-592. [PMID: 32663991 DOI: 10.1016/j.jad.2020.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/30/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rates of self-harm in young adolescents are increasing and self-harm typically emerges at this developmental stage. Greater specificity of impulsivity as a multifaceted construct is enabling investigation of links between individual impulsivity facets and self-harm outcomes. However, studies have yet to adequately explore these associations in young adolescents, and prospective relationships between multidimensional impulsivity and self-harm in younger adolescents remain untested. This study investigates unidimensional facets of impulsivity as risk-factors for the emergence and maintenance of self-harm, specifically within young community-based adolescents. METHODS A school-based sample of 594 adolescents (aged 13-15 years) provided data at two time points, 12 weeks apart. Logistic regression analyses determined associations between impulsivity-related facets (as delineated by the UPPS-P scale) and self-harm outcomes over time. RESULTS Overall, 23.6% of young people reported lifetime self-harm. A higher tendency towards Sensation Seeking was associated with self-harm onset over the study-period (OR 1.19, 95% CI 1.017-1.401). Deficits in Premeditation predicted maintained (versus remitted) self-harm behaviour during this time (OR 1.16, 95% CI 1.013-1.328). Negative Urgency was a significant cross-sectional correlate, but did not offer prospective predictive utility. LIMITATIONS The study relied on self-report. Interpretations are cautious given low incidence of self-harm outcomes over the course of the study. CONCLUSIONS Separate pathways to impulsive behaviour describe the psychological context in which self-harm starts and develops in young people. Findings support differential treatment targets and developmentally-focused early intervention. The predictive utility of impulsivity was inconsistent between cross-sectional and longitudinal analyses, underlining the role for temporality in the establishment of risk of self-harm.
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Affiliation(s)
- Joanna Lockwood
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK.
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
| | - David Daley
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; Centre for Mood Disorders, Institute of Mental Health, University of Nottingham, UK
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Norman H, Oskis A, Marzano L, Coulson M. The relationship between self‐harm and alexithymia: A systematic review and meta‐analysis. Scand J Psychol 2020; 61:855-876. [DOI: 10.1111/sjop.12668] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Hilary Norman
- Faculty of Science and Technology Middlesex University London UK
| | - Andrea Oskis
- Faculty of Science and Technology Middlesex University London UK
| | - Lisa Marzano
- Faculty of Science and Technology Middlesex University London UK
| | - Mark Coulson
- School of Psychology University of East Anglia Norwich UK
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Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res 2020; 288:112920. [PMID: 32279008 DOI: 10.1016/j.psychres.2020.112920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). METHODS A literature search was conducted for original articles examining the general and psychiatric populations. RESULTS There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. CONCLUSION The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.
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Ulloa Flores RE, Mayer Villa PA, de la Peña Olvera F, Palacios Cruz L, Victoria Figueroa G. DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:39-43. [PMID: 32081207 DOI: 10.1016/j.rcp.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.
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Affiliation(s)
- Rosa Elena Ulloa Flores
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México.
| | - Pablo Adolfo Mayer Villa
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México
| | | | - Lino Palacios Cruz
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Moseley RL, Gregory NJ, Smith P, Allison C, Baron-Cohen S. Links between self-injury and suicidality in autism. Mol Autism 2020; 11:14. [PMID: 32039740 PMCID: PMC7008575 DOI: 10.1186/s13229-020-0319-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autistic individuals without intellectual disability are at heightened risk of self-injury, and appear to engage in it for similar reasons as non-autistic people. A wide divergence of autistic perspectives on self-injury, including those who frame it as a helpful coping mechanism, motivate investigating the link between self-injury, suicide ideation, and attempts which has been reported in typically developing individuals. METHOD One hundred three autistic participants completed the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the Suicide Behaviors Questionnaire (SBQ-R), and the Interpersonal Social Evaluation List (ISEL-12) across two online studies. Logistic regression was conducted to predict self-harming status via responses to questions on suicidality, and to predict whether certain self-injurious behaviors, including cutting, were especially associated with suicide ideation and attempts. Non-parametric correlation analysis examined relationships between suicide ideation/attempts and other variables that might characterize self-harmers especially at risk of suicidality. These included perceived access to social support, purposes or reasons for self-injury, the number of different self-injurious behaviors engaged in, the duration and lifetime incidence of self-injury, and the individual's feelings about their self-injury. RESULTS While self-injuring status was significantly predicted by responses to a question on suicide ideation and attempts, there was no relationship between suicide ideation/attempts and a participant's personal feelings about their self-injury. The method of cutting was also predicted by suicide ideation and attempts, though other methods common in autistic people were at borderline significance. Use of self-injury for the regulation of low-energy emotional states like depression, for self-punishment or deterrence from suicide, and for sensory stimulation, was associated with suicide ideation and attempts, as was the number of self-injurious behaviors engaged in. There was no significant relationship between suicide ideation/attempts and the duration and lifetime incidence of self-injury or social support. CONCLUSIONS These preliminary data suggest that while individuals might frame their self-injury as a positive or neutral thing, there remains a concerning relationship between self-injury and suicidality which exists regardless of individual feelings on self-injury. This is consistent with the theoretical perspective that self-injury can be a "gateway" through which individuals acquire capability for lethal suicidal behaviors. The data highlight that particular methods (cutting) and reasons for self-injury may be of significant concern, but this information, which might be of extreme value for clinicians, requires further investigation and validation.
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Affiliation(s)
- R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
| | - N. J. Gregory
- Department of Psychology, Bournemouth University, Poole, UK
| | - P. Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - C. Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S. Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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Raffagnato A, Angelico C, Valentini P, Miscioscia M, Gatta M. Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents. Front Psychiatry 2020; 11:262. [PMID: 32322222 PMCID: PMC7158949 DOI: 10.3389/fpsyt.2020.00262] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11-18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.
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Affiliation(s)
- Alessia Raffagnato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Perla Valentini
- Department of Communication Sciences, Humanistic and International Studies: History, Culture, Languages, Literature, Arts, Media, University of Urbino 'Carlo Bo', Urbino, Italy
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy.,Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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Greene D, Boyes M, Hasking P. The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis. J Affect Disord 2020; 260:140-166. [PMID: 31494366 DOI: 10.1016/j.jad.2019.08.088] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI; direct harm to the body without suicidal intent) and risky drinking are two behaviours that serve emotion regulatory functions. When underlying emotional problems are untreated, individuals may shift between NSSI and risky drinking. Both behaviours are associated with alexithymia, difficulties identifying and describing emotions and retaining an externally orientated thinking style. However, it is unknown to what extent the associations are similar and under what circumstances (e.g. sex, age) they may differ. METHOD To compare both associations we conducted an extensive review using several databases. Overall, 20 NSSI-related articles and 33 risky drinking-related articles met the inclusion criteria. RESULTS A meta-analysis revealed significant positive associations between total alexithymia scores, difficulties identifying feelings, difficulties describing feelings and both NSSI and risky drinking. However, these associations appear stronger for NSSI. Further, externally orientated thinking was associated with risky drinking but not NSSI. Age had opposing moderating effects on the relationships, with the association between alexithymia and NSSI being stronger in younger samples and the association between alexithymia and risky drinking being stronger in older samples. Further, the association between alexithymia and NSSI was stronger for female only samples compared to male only samples. LIMITATIONS The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional. CONCLUSION These results imply that NSSI and risky drinking may have both shared and distinguishable correlates. Alexithymia can be targeted in treatment to potentially reduce the likelihood of individuals shifting between behaviours to regulate their emotions.
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Affiliation(s)
- Danyelle Greene
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia
| | - Mark Boyes
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia
| | - Penelope Hasking
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia.
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Demers LA, Schreiner MW, Hunt RH, Mueller BA, Klimes-Dougan B, Thomas KM, Cullen KR. Alexithymia is associated with neural reactivity to masked emotional faces in adolescents who self-harm. J Affect Disord 2019; 249:253-261. [PMID: 30780118 PMCID: PMC6724702 DOI: 10.1016/j.jad.2019.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a major, trans-diagnostic mental health problem among adolescents. Alexithymia has been identified as a developmental risk factor for NSSI. Research on how alexithymia relates to the neurobiology of automatic emotion processing is only beginning to emerge. This study evaluates the relationship between alexithymic features and neural responses to automatic processing of emotional content in adolescents with NSSI. METHODS 25 female adolescents (ages 13-21) with a history of repeated engagement in NSSI completed the Toronto Alexithymia Scale and the Difficulties with Emotion Regulation Scale and underwent functional magnetic resonance imaging (fMRI) during a task in which participants were exposed to masked emotions. RESULTS One facet of alexithymia, limited internal emotion awareness or externally-oriented thinking (EOT), was related to differential reactivity to masked emotional faces in clusters in the right supramarginal gyrus and right inferior frontal gyrus. Follow-up assessment of regional reactivity revealed that greater EOT is associated with lower activation to masked happy faces but higher activation to masked fearful faces. Other facets of alexithymia did not show relationships with reactivity to masked emotional faces. LIMITATIONS This is a cross-sectional and small sample that only includes females, which may attenuate generalizability of findings. CONCLUSIONS We report neural correlates of multiple facets of alexithymia in adolescents with NSSI. Among adolescents who self-harm, those with higher levels of EOT may be less alert to subtle positively-valenced emotion cues. For this subset of adolescents with NSSI, interventions designed to enhance mental representation of emotional responses and attention to positive emotions may be appropriate.
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Affiliation(s)
- Lauren A Demers
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA.
| | | | - Ruskin H Hunt
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota College of Liberal Arts, Minneapolis, MN 55455, USA
| | - Kathleen M Thomas
- Institute of Child Development, University of Minnesota College of Education and Human Development, Minneapolis, MN 55455, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Zinchuk MS, Avedisova AS, Guekht AB. Nonsuicidal self-injury behavior in non-psychotic disorders: epidemiology, social and clinical risk factors. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:108-119. [DOI: 10.17116/jnevro2019119031108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wester KL, King K. Family Communication Patterns and the Mediating Role of Communication Competence and Alexithymia in Relation to Nonsuicidal Self-Injury. ACTA ACUST UNITED AC 2018. [DOI: 10.17744/mehc.40.3.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nonsuicidal self-injury (NSSI) affects a growing number of youth and transitional-aged youth. Nock's (2009) comprehensive model of NSSI engagement points to a range of factors that combine to predict who is at a heightened risk for self-injury. The present study examined the impact of specific interpersonal factors, family communication patterns (i.e., conversation and conformity orientations), and communication competence on five supported measures of self-injurious behaviors. We further tested whether alexithymia, or a person's inability to identify and describe their emotions, mediated family communication patterns and communication competence in predicting NSSI behavior. Family communication patterns, specifically conversation orientation, had a positive impact on lifetime NSSI behaviors. While communication competence positively related to both lifetime and current NSSI behaviors, alexithymia mediated these relationships. Implications for treatment are provided.
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Parolin M, Miscioscia M, De Carli P, Cristofalo P, Gatta M, Simonelli A. Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity. Front Psychol 2018; 9:645. [PMID: 29872408 PMCID: PMC5972315 DOI: 10.3389/fpsyg.2018.00645] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.
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Affiliation(s)
- Micol Parolin
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Pietro De Carli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | | | - Michela Gatta
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Childhood Adolescence Family Unit, Ulss6 Veneto, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
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Cerutti R, Zuffianò A, Spensieri V. The Role of Difficulty in Identifying and Describing Feelings in Non-Suicidal Self-Injury Behavior (NSSI): Associations With Perceived Attachment Quality, Stressful Life Events, and Suicidal Ideation. Front Psychol 2018; 9:318. [PMID: 29593617 PMCID: PMC5859383 DOI: 10.3389/fpsyg.2018.00318] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: Core alexithymic features, such as the difficulty in identifying and describing feelings, are associated with poor attachment styles and emotional trauma, which influence the capacity to regulate affect. Additionally, emotional regulation has been found to be the most commonly identified function associated with non-suicidal self-injury behavior (NSSI) in adolescents as they attempt to modulate strong emotions. However, few studies have examined the link between difficulty in identifying and describing feelings (core components of alexithymia), NSSI behaviors, quality of attachment, life stressors and suicidal ideation in healthy early adolescents. Consequently, this study aims to investigate these constructs and the relationship among them in a large non-clinical sample of adolescents. Methods: Seven hundred and nine middle school students (50.4% males), aged 10–15 years (M = 12.6; SD = 1.06) were involved in this study. In order to investigate the variables considered in the study, the following measures were administered: the Deliberate Self-Harm Inventory exploring non-suicidal self-injurious behaviors; the Alexithymia Questionnaire for Children examining difficulty in identifying and describing feelings; the Inventory of Parent and Peer Attachment assessing the quality of parental and peer attachment; the Life Stressor Checklist-Revised outlining stressful/traumatic events and the Children’s Depression Inventory evaluating suicidal ideation. Results: We found significantly positive relationships among difficulty in identifying and describing feelings, NSSI behaviors, stressful events, and suicidal ideation. Data indicated a significant negative association of difficulty in identifying and describing feelings with quality of attachment to parents and peers. Further findings highlighted that difficulty in identifying and describing feelings significantly mediated the effect of quality of attachment (parent and peer) on NSSI and suicidal ideation. Conclusion: The ability to identify and describing feelings is important to managing emotional expression and understanding the feelings of others, both crucial in attaining successful interpersonal relationships. Our data revealed that, while controlling for stressful life events, low levels of attachment may increase adolescents’ difficulty in identifying and describing their own feelings, which in turn may increase the risk of both NSSI and suicidal ideation.
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Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonio Zuffianò
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom
| | - Valentina Spensieri
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
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Lin MP, You J, Ren Y, Wu JYW, Hu WH, Yen CF, Zhang X. Prevalence of nonsuicidal self-injury and its risk and protective factors among adolescents in Taiwan. Psychiatry Res 2017; 255:119-127. [PMID: 28544943 DOI: 10.1016/j.psychres.2017.05.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
Abstract
The present study aimed to investigate the prevalence of nonsuicidal self-injury (NSSI) in a large representative sample of secondary school students and identified the psychosocial risk and protective factors. Using a cross-sectional design, 2170 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling. The one-year prevalence of NSSI was found to be 20.1%. Results suggested that compared to non-injurers, episodic self-injurers reported higher levels of neuroticism and openness, while repetitive self-injurers reported higher levels of neuroticism, openness, avoidance/emotion-focused coping, and virtual social support, and lower levels of self-esteem and cognitive reconstruction/problem-focused coping. Compared to episodic self-injurers, repetitive self-injurers reported a higher level of avoidance/ emotion-focused coping. Additionally, compared to non-injurers, mild self-injurers reported higher levels of neuroticism and openness, while severe self-injurers reported higher levels of neuroticism, openness, avoidance/emotion-focused coping, and virtual social support, and lower levels of self-esteem and cognitive reconstruction/problem-focused coping. Our study found that NSSI is fairly prevalent among secondary school students in Taiwan. Psychosocial risk factors, especially maladaptive coping strategies, should be given special attention when examining adolescents with NSSI. Regarding protective factors, enhancing self-esteem should be the focus of formulating effective intervention strategies for NSSI.
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Affiliation(s)
- Min-Pei Lin
- Department of Educational Psychology and Counseling, National Taiwan Normal University, No.162, Section 1, Heping E. Rd., Da-an District, Taipei City 106, Taiwan.
| | - Jianing You
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, and School of Psychology, South China Normal University, No. 155 Zhongshan W. Rd, Tianhe District, Guangzhou, China
| | - Yaxuan Ren
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, and School of Psychology, South China Normal University, No. 155 Zhongshan W. Rd, Tianhe District, Guangzhou, China
| | - Jo Yung-Wei Wu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, University Rd, Tainan 701, Taiwan
| | - Wei-Hsuan Hu
- Department of Counseling and Guidance, National University of Tainan, No.33, Section 2, Shu-Lin St., Tainan 700, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan; Department of Psychiatry, Tainan Municipal Hospital, No.670, Chongde Road, East District, Tainan 701, Taiwan
| | - Xu Zhang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, and School of Psychology, South China Normal University, No. 155 Zhongshan W. Rd, Tianhe District, Guangzhou, China
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Meszaros G, Horvath LO, Balazs J. Self-injury and externalizing pathology: a systematic literature review. BMC Psychiatry 2017; 17:160. [PMID: 28468644 PMCID: PMC5415783 DOI: 10.1186/s12888-017-1326-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/24/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. METHODS A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). RESULTS Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. CONCLUSIONS Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.
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Affiliation(s)
- Gergely Meszaros
- Semmelweis University, Mental Health Sciences School Of Ph.D., Üllői út 26, Budapest, 1085, Hungary. .,Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021, Hungary.
| | - Lili Olga Horvath
- 0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021 Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
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Gatta M, Miscioscia M, Sisti M, Comis I, Battistella PA. Interactive Family Dynamics and Non-suicidal Self-Injury in Psychiatric Adolescent Patients: A Single Case Study. Front Psychol 2017; 8:46. [PMID: 28220084 PMCID: PMC5292625 DOI: 10.3389/fpsyg.2017.00046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
Non-Suicidal Self-Injury (NSSI) is a common, multifaceted phenomenon among adolescents. Recent researchers have shown that a number of psychological and psychiatric correlates are implicated in the onset/repetition of NSSI, but those previous studies did not directly observe the family interaction patterns of this clinical population. In this paper, the quality of family interactions was observed using the Lausanne Trilogue Play procedure to deepen the specific interactive dimensions associated with NSSI in adolescents. The results of a single case study showed a lack of positive emotional exchanges, a parenting style expressing hostility, a high level of control and difficulties in triangulation. Through this method, the authors show that a better understanding of the role of family interactions is crucial and could improve the assessment and treatment of Non-Suicidal Self-Injurious behaviors. Research and clinical implications are discussed.
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Affiliation(s)
- Michela Gatta
- Childhood Adolescence Family Unit, ULSS 16 - University of PaduaPadua, Italy; Department of Women's and Children's Health, University of PaduaPadua, Italy
| | - Marina Miscioscia
- Department of Women's and Children's Health, University of PaduaPadua, Italy; Department of Developmental and Social Psychology, University of PaduaPadua, Italy
| | - Marta Sisti
- Childhood Adolescence Family Unit, ULSS 16 - University of Padua Padua, Italy
| | - Ilaria Comis
- Childhood Adolescence Family Unit, ULSS 16 - University of Padua Padua, Italy
| | - Pier Antonio Battistella
- Childhood Adolescence Family Unit, ULSS 16 - University of PaduaPadua, Italy; Department of Women's and Children's Health, University of PaduaPadua, Italy
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Mannarini S, Balottin L, Toldo I, Gatta M. Alexithymia and psychosocial problems among Italian preadolescents. A latent class analysis approach. Scand J Psychol 2016; 57:473-81. [PMID: 27376760 DOI: 10.1111/sjop.12300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/29/2016] [Indexed: 12/13/2022]
Abstract
The study, conducted on Italian preadolscents aged 11 to 13 belonging to the general population, aims to investigate the relationship between the emotional functioning, namely, alexithymia, and the risk of developing behavioral and emotional problems measured using the Strength and Difficulty Questionnaire. The latent class analysis approach allowed to identify two latent variables, accounting for the internalizing (emotional symptoms and difficulties in emotional awareness) and for the externalizing problems (conduct problems and hyperactivity, problematic relationships with peers, poor prosocial behaviors and externally oriented thinking). The two latent variables featured two latent classes: the difficulty in dealing with problems and the strength to face problems that was representative of most of the healthy participants with specific gender differences. Along with the analysis of psychopathological behaviors, the study of resilience and strengths can prove to be a key step in order to develop valuable preventive approaches to tackle psychiatric disorders.
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Affiliation(s)
- Stefania Mannarini
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
| | - Laura Balottin
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
| | - Irene Toldo
- Child Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Michela Gatta
- Childhood, Adolescence and Family Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
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