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Fernández-Fernández R, Ibias J, Del Toro-Pérez C, Lahera G, Gasca-Salas C. Alexithymia in Parkinson's Disease: A Meta-analysis. Am J Geriatr Psychiatry 2025; 33:638-653. [PMID: 39732593 DOI: 10.1016/j.jagp.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/26/2024] [Accepted: 11/04/2024] [Indexed: 12/30/2024]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor manifestations, including alexithymia. This condition is defined by difficulty in recognizing, articulating, and expressing one's emotional states. In this study, we conducted a systematic review and meta-analysis to compare the prevalence of alexithymia in PD patients and a healthy population, and to identify associated demographic and clinical factors. We identified 16 observational studies through Pubmed, EMBASE, PsycINFO, and SCOPUS, selecting articles published since 2002. Data were analyzed using a random-effects model. We conducted additional prevalence meta-analyses and correlation meta-analyses. We found that PD patients exhibit higher levels of alexithymia compared to the general population (combined effect size 0.65 [95% CI = 0.49-0.81; P <0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, P <0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, P <0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, P<0.05]), after adjusting for covariates. The additional meta-analysis reported higher prevalence of alexithymia in PD and a pooled correlation coefficient of 0.496 (95% CI = 0.40-0.59, P <0.05) when we analyzed alexithymia and depression scores. To our knowledge, there are no previous meta-analysis applied to alexithymia in PD patients. Even though we could not determine whether alexithymia is a primary characteristic of PD, we found an association of higher levels of alexithymia with depression and higher levodopa equivalent daily dose. Furthermore, there are not enough studies to draw clear conclusions about the influence of cognitive status.
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Affiliation(s)
- Roberto Fernández-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain; Hospital Universitario Infanta Cristina (RFF), Madrid. Spain; PhD Program in Health Sciences (RFF), University of Alcalá de Henares, Madrid, Spain
| | - Javier Ibias
- Department of Behavioral Sciences and Methodology (JI), Faculty of Psychology, National Distance Education University (UNED), Madrid, Spain
| | - Cristina Del Toro-Pérez
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities (GL), University of Alcala, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS) (GL), Madrid, Spain; Psychiatry Service (GL, CGS), Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Carmen Gasca-Salas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) (RFF, CDTP, CGS), Hospital Universitario HM Puerta del Sur, HM Hospitales. Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales (RFF, CDTP, CGS), Madrid, Spain; Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED) (CGS), Instituto Carlos III, Madrid, Spain; University CEU-San Pablo (CGS), Madrid, Spain.
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Li T, Meng C, Cheng Y, Wang J, Zhang Y. The relationship between core self-evaluation and cognitive failure in Chinese adolescents: the sequential mediating role of alexithymia and depression. BMC Psychol 2025; 13:328. [PMID: 40181384 PMCID: PMC11966809 DOI: 10.1186/s40359-025-02613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 03/13/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND The difficulties that cognitive failure can pose for individuals in the conduct of their everyday life have been documented in many studies. However, there is still limited understanding of the factors that influence cognitive failure and the mediating processes involved. This study uses cognitive resource theory to develop a chain mediation model in order to explore the relationship between core self-evaluation (CSE), alexithymia, depression, and cognitive failure. METHODS Chinese middle school students (aged 14-18 years, 15.39 ± 0.58) were recruited as participants, and a total of 1,400 participants completed the Core Self-Evaluation Scale (CSES), Cognitive Failures Scale (CFS), Toronto Alexithymia Scale (TAS-20), and Depression Self-Rating Scale (SDS). SPSS 27.0 was used for common method bias testing, descriptive statistical analysis, correlation analysis, and sequence mediation analysis. RESULTS Core self-evaluation (r = -0.52), alexithymia (r = 0.65), and depression (r = 0.57) were significantly correlated with cognitive failure, and core self-evaluation could significantly negatively predict cognitive failure (β = -0.06, p < 0.05). Alexithymia and depression played a partial mediating role between core self-evaluation and cognitive failure (CI = [-0.43, -0.33], effect = -0.38), specifically including three pathways: firstly, the independent mediating role of alexithymia (CI = [-0.28, -0.20], effect = -0.24); secondly, the independent mediating role of depression (CI = [-0.14, -0.07], effect = -0.10); thirdly, the sequential mediating role of alexithymia and depression (CI = [-0.05, -0.02], effect = -0.04). CONCLUSION Core self-evaluation was significantly negatively correlated with cognitive failure. Alexithymia and depression played a partial mediating role between core self-evaluation and cognitive failure. The results indicate that raising core self-evaluation, addressing depression, and reducing alexithymia are crucial for reducing cognitive failure issues among adolescents. Therefore, schools and families can take some measures to provide more positive support for teenagers, help them form positive self-awareness, and reduce the occurrence of negative emotions and cognitive errors.
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Affiliation(s)
- Taolin Li
- Mental Health Guidance Center, Qianjiang Senior High School, Chongqing, 409000, China
| | - Chunyan Meng
- Nanchong Vocational College of Science and Technology, Nanchong, 637200, China
| | - Yanghuan Cheng
- School of Psychology, Shanghai Normal University, Shanghai, 200233, China
| | - Jing Wang
- Nanchong Vocational College of Science and Technology, Nanchong, 637200, China
| | - Youxue Zhang
- School of Education Science, Chengdu Normal University, Chengdu, 611130, China.
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Kurihara K, Enoki H, Shinzato H, Takaesu Y, Kondo T. Cluster analysis of patients with alcohol use disorder featuring alexithymia, depression, and diverse drinking behavior. Neuropsychopharmacol Rep 2024; 44:512-520. [PMID: 38773706 PMCID: PMC11544455 DOI: 10.1002/npr2.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
AIM This study aimed to identify subgroups of alcohol use disorder (AUD) based on a multidimensional combination of alexithymia, depression, and diverse drinking behavior. METHOD We recruited 176 patients with AUD, which were initially divided into non-alexithymic (n = 130) and alexithymic (n = 46) groups using a cutoff score of 61 on the Toronto Alexithymia Scale (TAS-20). Subsequently, the profiles of the two groups were compared. Thereafter, a two-stage cluster analysis using hierarchical and K-means methods was performed with the Z-scores from the TAS-20, the Quick Inventory of Depressive Symptomatology Self-Report Japanese Version, the 12-item questionnaire for quantitative assessment of depressive mixed state, and the 20-item questionnaire for drinking behavior pattern. RESULTS In the first analysis, Alexithymic patients with AUD showed greater depressive symptoms and more pathological drinking behavior patterns than those without alexithymia. Cluster analysis featuring alexithymia, depression, and drinking behavior identified three subtypes: Cluster 1 (core AUD type) manifesting pathological drinking behavior highlighting automaticity; Cluster 2 (late-onset type) showing relatively late-onset alcohol use and fewer depressive symptoms or pathological drinking behavior; and Cluster 3 (alexithymic type) characterized by alexithymia, depression, and pathological drinking behavior featuring greater coping with negative affect. CONCLUSION The multidimensional model with alexithymia, depression, and diverse drinking behavior provided possible practical classification of AUD. The alexithymic subtype may require more caution, and additional support for negative affect may be necessary due to accompanying mood problems and various maladaptive drinking behaviors.
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Affiliation(s)
- Kazuhiro Kurihara
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Hiroyuki Enoki
- Major in Clinical Psychology, Graduate School of Psychological SciencesHiroshima International UniversityHiroshimaJapan
| | - Hotaka Shinzato
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
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Telli B, Bilge AR. Literally or prosodically? Recognising emotional discourse in alexithymia. Cogn Emot 2024:1-15. [PMID: 39039748 DOI: 10.1080/02699931.2024.2380762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
Alexithymia is characterised by difficulties in identifying, recognising, and describing emotions. We studied alexithymia in the context of speech comprehension, specifically investigating the incongruent condition between prosody and the literal meaning of words in emotion-based discourse. In two experiments, participants were categorised as having high or low alexithymia scores based on the TAS-20 scale and listened to three-sentence narratives where the emotional prosody of a key phrase or a keyword was congruent or incongruent with its literal meaning. The incongruent condition resulted in slower reaction times and lower accuracy in recognition of emotions. This incongruence effect was also evident for individuals with high alexithymia, except for anger. They recognised anger as accurately in both congruent and incongruent conditions. Contrary to our hypothesis, however, individuals with high alexithymia did not show an overall difference in emotion recognition compared to the low alexithymia group. These findings highlight the nuanced relationship between emotional prosody and literal meaning, offering insights into how individuals with varying levels of alexithymia process emotional discourse. Understanding these dynamics has implications for both cognitive research and clinical practice, providing valuable perspectives on speech comprehension, especially in situations involving incongruence between prosody and word meaning.
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Affiliation(s)
| | - A Reyyan Bilge
- Department of Psychology, Northeastern University, Boston, MA, USA
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Kenangil G, Demir M, Tur E, Domac F. Alexithymia, depression, and cognition in patients with Parkinson's disease. Acta Neurol Belg 2023; 123:85-91. [PMID: 33453039 DOI: 10.1007/s13760-020-01581-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Basal ganglia are connected to dorsal prefrontal and orbitofrontal structures, which have an important role in emotional experience. Alexithymia is defined as the inability to recognize and verbalize emotions. There is little known about alexithymia and cognitive dysfunction and its relationship with depression. In this study, we examined the relation of alexithymia with cognition and depression in non-demented patients with Parkinson's disease (PD). MATERIALS AND METHODS Fort-two consecutive non-demented patients PD and 40 healthy controls were enrolled in the study. The Turkish version of the Montreal Cognitive Assessment scale (MOCA-TR), 20-item Toronto Alexithymia Scale (TAS-20) (F1, F2, F3 subgroups), and Beck Depression Inventory (BDI-I) were used to evaluate cognitive functions, alexithymia, and depression, respectively, in both groups. RESULTS The total TAS-20 score was 55.71 ± 19 in the PD group and 46.33 ± 8.21 in the control group. There was a statistically significant difference in the total TAS-20 scores between the groups (p < 0.001). In subgroups of alexithymia, all mean scores of F1, F2, and F3 were higher in the PD group (p = 0.019, p < 0.001, and p = 0.005, respectively). In the MOCA-TR test, the mean scores in visuospatial and delayed recall of patients with PD were statistically lower than in the control group (p = 0.044 and p = 0.04, respectively). The MOCA-TR and BDI total scores were significantly correlated with TAS-20 total scores. In subgroup analysis, we only found an association between the visuospatial domain of MOCA-TR and the F3 subgroup of TAS-20 (r = - 0.22, p = 0.03). There was no relation between alexithymia and disease duration or total levodopa dose (p < 0.05). CONCLUSION Alexithymia is not a rare symptom in PD. It should be accepted as an independent non-motor symptom, and patients should be interrogated accordingly.
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Affiliation(s)
- Gulay Kenangil
- Department of Neurology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.
| | - Mehmet Demir
- Department of Neurology, Agri Dr. Yasar Eryılmaz Dogubeyazıt State Hospital, Agri, Turkey
| | - Esma Tur
- Department of Neurology, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Fusun Domac
- Department of Neurology, Istanbul Erenkoy Mental Health and Neurological Disorders Training and Research Hospital, Istanbul, Turkey
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Isaksson M, Holmbom Goh M, Ramklint M, Wolf-Arehult M. The Social Safeness and Pleasure Scale (SSPS): a psychometric evaluation of the Swedish version in a non-clinical sample and two clinical samples with eating disorders or borderline personality disorder. BMC Psychol 2022; 10:311. [PMID: 36527142 PMCID: PMC9756562 DOI: 10.1186/s40359-022-01020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social safeness and pleasure refer to the extent to which people experience their world as safe, warm, and soothing. Difficulties in achieving social safeness have been identified as a transdiagnostic vulnerability factor for developing and maintaining psychopathology and for feeling less contentment and self-compassion. The study aim was to evaluate the psychometric properties of the Swedish version of the Social Safeness and Pleasure Scale (SSPS). METHODS The SSPS was evaluated in a non-clinical sample of 407 participants. The internal consistency and test-retest reliability of the SSPS were explored and a confirmatory factor analysis was performed. Convergent validity was studied based on the assumption of negative correlations with the personality traits detachment and mistrust, derived from the Swedish Universities Scale of Personality. Divergent validity was studied based on the assumption of no or small correlations with impulsiveness and adventure-seeking-personality traits not assumed to be related to social safeness. Validity was also investigated by comparing the SSPS results in the non-clinical sample with those in two clinical groups of patients diagnosed with either borderline personality disorder (BPD; n = 58) or eating disorders (n = 103), recruited from two psychiatric outpatient clinics. RESULTS Confirmatory factor analysis confirmed a one-factor structure. Cronbach's alpha was 0.95 and test-retest reliability was 0.92. Validity was supported by moderate to strong negative correlations between the SSPS and the detachment and mistrust scales and no or small correlations with the impulsiveness and adventure-seeking scales in a personality questionnaire. Finally, we found significantly lower mean values on the SSPS in the clinical groups compared with the non-clinical group, with the lowest mean in the BPD sample. CONCLUSIONS The results showed good to excellent psychometric properties for the Swedish version of the SSPS, supporting its use in both clinical practice and research. Future research could use the SSPS when evaluating interventions aimed at improving the ability to develop social safeness, such as compassion-focused therapy or radically open dialectical behavior therapy, interventions that may be particularly important in BPD patients.
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Affiliation(s)
- Martina Isaksson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85 Uppsala, Sweden
| | - Maria Holmbom Goh
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85 Uppsala, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85 Uppsala, Sweden
| | - Martina Wolf-Arehult
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85 Uppsala, Sweden ,grid.425979.40000 0001 2326 2191Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Lee KS, Murphy J, Catmur C, Bird G, Hobson H. Furthering the language hypothesis of alexithymia: An integrated review and meta-analysis. Neurosci Biobehav Rev 2022; 141:104864. [PMID: 36087760 DOI: 10.1016/j.neubiorev.2022.104864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/26/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
Alexithymia, including the inability to identify and express one's own feelings, is a subclinical condition responsible for some of the socioemotional symptoms seen across a range of psychiatric conditions. The language hypothesis of alexithymia posits a language-mediated disruption in the development of discrete emotion concepts from ambiguous affective states, exacerbating the risk of developing alexithymia in language-impaired individuals. To provide a critical evaluation, a systematic review and meta-analysis of 29 empirical studies of language functioning in alexithymia was performed. A modest association was found between alexithymia and multi-domain language deficits (r = -0.14), including structural language, pragmatics, and propensity to use emotional language. A more theoretically-relevant subsample analysis comparing alexithymia levels in language-impaired and typical individuals revealed larger effects, but a limited number of studies adopted this approach. A synthesis of 11 emotional granularity studies also found an association between alexithymia and reduced emotional granularity (r = -0.10). Language impairments seem to increase the risk of alexithymia. Heterogeneous samples and methods suggest the need for studies with improved alexithymia assessments.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, United Kingdom; Yale Child Study Center, Yale School of Medicine, United States.
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Geoffrey Bird
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, United Kingdom
| | - Hannah Hobson
- Department of Psychology, University of York, United Kingdom
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Association between Alexithymia and Depression among King Khalid University Medical Students: An Analytical Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10091703. [PMID: 36141315 PMCID: PMC9498473 DOI: 10.3390/healthcare10091703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Alexithymia is a condition in which a person is unable to explain his/her emotions, bodily sensations, or discuss sentiments. This study aims to determine the prevalence of alexithymia and its relationships with socio-demographics and depression among medical students. A cross-sectional survey was conducted among medical students at King Khalid University (KKU), Saudi Arabia. A stratified random sampling technique was utilized for data collection using the Toronto Alexithymia Scale (TAS-20) and the Patient Health Questionnaire-9 (PHQ-9). A multiple logistic regression model was used to identify the factors associated with alexithymia. A total of 333 students participated in this study, almost two-thirds (64.6%) were from clinical years, and 51.4% were females. The prevalence of alexithymia and depression was 47.4% and 88.9%, respectively. Regression analysis showed females had a doubled risk (OR = 2.09), and students with high-income status showed less probability of having alexithymia (OR = 0.39), whereas people with chronic health problems showed a doubled risk for alexithymia (OR = 2.04). Moreover, depression was significantly associated with alexithymia (OR = 1.91). Our study revealed that the prevalence of alexithymia was high along with depression among studied samples. This raises attention towards finding measures to reduce it for the better performance of students and to avoid psychological problems in the future.
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Fynn DM, Preece DA, Gignac GE, Pestell CF, Allan A, Kraats CV, Green SL, Weinborn M, Becerra R. Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire. J Affect Disord 2022; 302:224-233. [PMID: 35092756 DOI: 10.1016/j.jad.2022.01.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community. METHODS The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored. RESULTS Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established. LIMITATIONS The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI. CONCLUSION Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.
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Affiliation(s)
- Danielle M Fynn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | - Gilles E Gignac
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Carmela F Pestell
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | | | - Sarah L Green
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Michael Weinborn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Rodrigo Becerra
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Scarpazza C, Zangrossi A, Huang YC, Sartori G, Massaro S. Disentangling interoceptive abilities in alexithymia. PSYCHOLOGICAL RESEARCH 2021; 86:844-857. [PMID: 34097132 PMCID: PMC8182733 DOI: 10.1007/s00426-021-01538-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia—a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience—remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants’ level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R2 = 0.29 and R2 = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R2 = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy.
| | - Andrea Zangrossi
- Department of Neuroscience, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy.,Padova Neuroscience Center (PCN), University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Yu-Chun Huang
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Giuseppe Sartori
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy
| | - Sebastiano Massaro
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Surrey Business School, University of Surrey, Guildford, Rik Medlik Building (MS), Guildford, GU2 7XH, UK
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Hawkins LG, Mullet N, Tuliao AP, Gudenrath T, Holyoak D, Landoy BVN, Klanecky AK, McChargue DE. Alexithymia, Prior Trauma, Alcohol Use, and Sexual Aggression Perpetration: A Cross-Cultural Comparison of a Moderated Mediation Model. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2021; 33:455-474. [PMID: 32248750 DOI: 10.1177/1079063220912451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this study, we examined the relationships between prior trauma, alexithymia, and sexual aggression perpetration among 610 U.S. college students and 107 college students from the Philippines utilizing a cross-sectional retrospective design. We tested a moderated mediation model with alexithymia as the mediator between prior trauma and sexual aggression perpetration, and alcohol use as a moderator of the alexithymia-sexual aggression link. Moreover, given that cultural norms may influence these relationships, we also examined the structural invariance of the proposed moderated mediation model. Path analyses and multiple group analysis were used to examine the moderated mediation model, and examine model differences between samples. We did not find evidence for alexithymia as a mediator, but there was a significant interaction between alcohol use severity and alexithymia on sexual aggression perpetration across both samples. Alexithymia is a key variable in understanding the alcohol use-sexual aggression perpetration relationship. Clinical implications and recommendations for future research are also discussed.
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Adult attachment styles and emotional regulation: The role of interoceptive awareness and alexithymia. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Sagar R, Talwar S, Desai G, Chaturvedi SK. Relationship between alexithymia and depression: A narrative review. Indian J Psychiatry 2021; 63:127-133. [PMID: 34194055 PMCID: PMC8214133 DOI: 10.4103/psychiatry.indianjpsychiatry_738_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/10/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Shivangi Talwar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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14
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Hemming L, Shaw J, Haddock G, Carter LA, Pratt D. A Cross-Sectional Study Investigating the Relationship Between Alexithymia and Suicide, Violence, and Dual Harm in Male Prisoners. Front Psychiatry 2021; 12:670863. [PMID: 33995152 PMCID: PMC8116549 DOI: 10.3389/fpsyt.2021.670863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Suicide and violence are common within male prisoners. One suggested risk factor for both behaviors is alexithymia. Alexithymia describes a deficit in identifying and describing feelings and is also related to externally oriented thinking. This study aimed to explore the relationship between alexithymia, suicide, violence and dual harm in male prisoners. Methods: Eighty male prisoners were recruited from three prisons. Participants were asked to complete a battery of questionnaires including measures of alexithymia (TAS-20), suicide ideation (ASIQ), suicide behavior, violence ideation (SIV), violence behavior, depression (BDI-II), hopelessness (BHS), impulsivity (DII) and anger (NAS-PI). Regression analyses and ANOVAS were conducted to assess the association between alexithymia (and its subcomponents) with six outcomes; suicide ideation, suicide behavior, violence ideation, violence behavior, dual harm ideation and dual harm behavior. Results: Alexithymia was a univariate predictor of suicide ideation, though was not a significant predictor when considered in a multivariate model. Alexithymia was a significant multivariate predictor of suicide behavior. Alexithymia was not a significant multivariate predictor of violence ideation or behavior. There were no significant differences in alexithymia or subscales between those with suicide ideation/behavior alone, violence ideation/behavior alone and those with dual harm ideation/behavior. Conclusion: In male prisoners, alexithymia appears an important univariate predictor of suicide and violence, though the current study suggests no significant contribution above other well-known correlates of suicide and violence.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Lesley-Anne Carter
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Science, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
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15
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Arroyo-Anlló EM, Souchaud C, Ingrand P, Chamorro Sánchez J, Melero Ventola A, Gil R. Alexithymia in Alzheimer's Disease. J Clin Med 2020; 10:jcm10010044. [PMID: 33375608 PMCID: PMC7795069 DOI: 10.3390/jcm10010044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Alexithymia is widely recognized as the inability to identify and express emotions. It is a construct which consists of four cognitive traits such as difficulty in identifying feelings, describing feelings to others, externally oriented thinking, and limited imaginative capacity. Several studies have linked alexithymia to cognitive functioning, observing greater alexithymia scores associated with poorer cognitive abilities. Despite Alzheimer's disease (AD) being a neurodegenerative pathology characterized by cognitive troubles from the early stages, associated to behavioral and emotional disturbances, very few investigations have studied the alexithymia in AD. These studies have shown that alexithymia scores-assessed with Toronto Alexithymia Scale (TAS)-were greater in AD patients than healthy participants. The objective of the study was to investigate if the alexithymia was present in patients with mild AD. We hypothesized that the AD group would show more alexithymia features than the control group. We evaluated 54 subjects, including 27 patients diagnosed with mild AD and 27 normal healthy controls, using the Shalling Sifneos Psychosomatic Scale (SSPS-R) and a neuropsychological test battery. Using non-parametric statistical analyses-Wilcoxon and Mann-Whitney U tests-we observed that the SSPS-R scores were similar in the AD and control groups. All participants showed SSPS-R scores below to 10 points, which means no-alexithymia. We did not find significant correlations between SSPS-R scores and cognitive variables in both groups (p > 0.22), but we observed a negative association between name abilities and alexithymia, but it does not reach to significance (p = 0.07). However, a significant correlation between SSPS-R score and mood state, assessed using Zerssen Rating Scale, was found in both groups (p = 0.01). Because we did not find a significant difference in the alexithymia assessment between both subject groups, pot hoc analyses were computed for each item of the SSPS-R. We made comparisons of alexithymic responses percentages in each SSPS-R item between AD and control groups, using Fisher's test. We observed that AD patients produced more alexithymic responses in some items of SSPS-R test than the control group, particularly about difficulties to find the words to describe feelings, as well as difficulties of imagination capacity and externally oriented thinking. The present results do not confirm our hypothesis and they do not support the results of previous studies revealing great alexithymia in AD.
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Affiliation(s)
- Eva Mª Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-629460944
| | - Corinne Souchaud
- Department of Neurology and Neuropsychology, University Hospital, CHU La Milétrie, 86000 Poitiers, France;
| | - Pierre Ingrand
- Department of Biostatistics, University of Poitiers, 86000 Poitiers, France;
| | - Jorge Chamorro Sánchez
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Alejandra Melero Ventola
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Roger Gil
- Department of Neurology, University Hospital, 86000 Poitiers, France;
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16
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Porreca A, De Carli P, Filippi B, Parolin M, Simonelli A. Mothers' alexithymia in the context of parental Substance Use Disorder: Which implications for parenting behaviors? CHILD ABUSE & NEGLECT 2020; 108:104690. [PMID: 32890853 DOI: 10.1016/j.chiabu.2020.104690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Maternal substance use disorder (SUD) represents a severe risk for caregiving, affecting diverse domains of parenting behaviors, such as sensitivity, structuring, intrusiveness, and hostility. Various studies highlighted that difficulties in parenting behaviors in the context of SUD are exacerbated by the co-occurrence of psychopathological symptoms. A large body of research points out the presence of high rates of alexithymia in individuals with SUD, and some studies provide evidence of an association between this psychopathological aspect and parenting. Nevertheless, no prior research has explored how alexithymic traits could affect quality of parenting behaviors in mothers with SUD. OBJECTIVE To investigate the impact of maternal alexithymia on parenting behaviors in mothers with SUD. METHODS Sixty women in residential treatment for SUD and their children participated in the study. The participants were assessed with respect to alexithymia, quality of parenting behaviors, and depressive symptoms. RESULTS Forty-three percent of the mothers reported the presence of alexithymia. These mothers presented with significantly low scores on sensitivity (β = -.25, p < .05) and structuring (β = -.32, p < .05). After controlling for depressive symptomatology, the effect of alexithymia on parenting behaviors remained only for structuring (β=.35, p < .05). CONCLUSIONS In the context of SUD, maternal alexithymia significantly impacts the quality of parenting behaviors, specifically structuring, indicating that difficulties in becoming aware of one's own feelings jeopardize the ability to scaffold interactions and set age-appropriate limits in an emotionally attuned way. Clinical implications of the findings are discussed.
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Affiliation(s)
- Alessio Porreca
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy.
| | - Pietro De Carli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy.
| | - Bianca Filippi
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy.
| | - Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy.
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy.
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17
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Sfeir E, Geara C, Hallit S, Obeid S. Alexithymia, aggressive behavior and depression among Lebanese adolescents: A cross-sectional study. Child Adolesc Psychiatry Ment Health 2020; 14:32. [PMID: 32939221 PMCID: PMC7487493 DOI: 10.1186/s13034-020-00338-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For a long time, Lebanon has been considered an unstable country. This can have a negative impact on Lebanese adolescents that consequently face secondary emotional stress, leading to more mental health problems such as anxiety, depression, and alexithymia. The objective of this study was to assess the association between alexithymia, depression and aggressive behavior in a sample of Lebanese adolescents. METHODS This is a cross-sectional study, conducted between September 2018 and February 2019, which enrolled 568 young adolescents aged between 15 and 18 years using a proportionate sample from two Lebanese governorates. Out of 750 questionnaires distributed, 568 (75.73%) were completed and collected back. RESULTS The mean age was 15.87 ± 0.82 years, with 302 (53.2%) females; 180 (31.7%) were alexithymic, 193 (34.0%) and 181 (31.9%) had moderate (scores between (89 and 111) and high (scores ≥ 112) aggression respectively, whereas 176 (31.0%) and 149 (26.2%) had moderate (scores between 3 and 4) and high (scores ≥ 5) depression respectively. Higher levels of alexithymia were significantly associated with higher depression (Beta = 0.44), higher total aggression (Beta = 0.78), higher physical aggression (Beta = 0.24), higher verbal aggression (Beta = 0.14), higher anger (Beta = 0.22), and higher hostility (Beta = 0.19). CONCLUSION The prevalence of alexithymic behaviors, as well as aggression and depression in Lebanese students appears to be very high in comparison with students worldwide. Alexithymia was significantly associated with higher depression, physical and verbal aggression, anger and hostility among adolescents. Factors underlying the high level of alexithymia remain not fully elucidated.
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Affiliation(s)
- Elsa Sfeir
- grid.444434.70000 0001 2106 3658Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,Department of Pediatrics, Notre-Dame des Secours University Hospital (CHU-NDS), Byblos, Lebanon
| | - Claudine Geara
- grid.444434.70000 0001 2106 3658Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- grid.444434.70000 0001 2106 3658Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,INSPECT-LB, Institut National de Santé Publique, Epidemiologie Clinique Et Toxicologie- Liban, Beirut, Lebanon
| | - Sahar Obeid
- grid.444434.70000 0001 2106 3658Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,INSPECT-LB, Institut National de Santé Publique, Epidemiologie Clinique Et Toxicologie- Liban, Beirut, Lebanon ,Research and Psychology Departments, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon
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18
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Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals. J Affect Disord 2020; 263:428-436. [PMID: 31969274 DOI: 10.1016/j.jad.2019.10.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature. METHODS The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants. RESULTS Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = <.001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005). LIMITATIONS The study is limited by the small sample size and its cross-sectional nature. CONCLUSIONS Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.
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19
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Bagby RM, Parker JDA, Taylor GJ. Twenty-five years with the 20-item Toronto Alexithymia Scale. J Psychosom Res 2020; 131:109940. [PMID: 32007790 DOI: 10.1016/j.jpsychores.2020.109940] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Twenty-five years ago, this journal published two articles reporting the development and initial validation of the 20-Item Toronto Alexithymia Scale (TAS-20). Since then the literature on alexithymia has burgeoned with the vast majority of this research using the TAS-20, including multiple language translations of the scale. METHOD In this article we review the psychometric literature evaluating various aspects of the reliability and validity of the TAS-20 and examine some of the controversies surrounding the scale and the construct it assesses. We reflect on the ways in which the TAS-20 has advanced the measurement of the construct and theory of alexithymia. We also discuss recent developments and some future directions for the measurement of alexithymia. RESULTS Although not without some controversy, the preponderance of the accumulated evidence over a 25-year period supports various aspects of the reliability and validity of the TAS-20, including findings from confirmatory factor analytic and convergent and discriminant validity studies which are consistent with Nemiah et al.'s (Nemiah et al., 1976 [3]) and Taylor and colleagues (Taylor et al., 1997 [9]) theoretical formulations and definition of the alexithymia construct. CONCLUSIONS Based on the accumulated empirical evidence of 25 years, we conclude that the TAS-20 is a reliable and valid instrument and accurately reflects and measures the construct as it was originally defined by Nemiah et al. Nemiah et al. (1976) [3] as composed of deficits in affect awareness and expression and pensée opératoire (operational thinking). Clinicians and researchers can use the TAS-20 to confidently measure alexithymia, the roots of which have foundations in psychosomatic medicine.
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Affiliation(s)
- R Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - James D A Parker
- Department of Psychology, Trent University, Peterborough, Ontario, Canada
| | - Graeme J Taylor
- Department of Psychiatry (Emeritus), University of Toronto, Toronto, Ontario, Canada
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20
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Hemming L, Haddock G, Shaw J, Pratt D. Alexithymia and Its Associations With Depression, Suicidality, and Aggression: An Overview of the Literature. Front Psychiatry 2019; 10:203. [PMID: 31031655 PMCID: PMC6470633 DOI: 10.3389/fpsyt.2019.00203] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/20/2019] [Indexed: 11/21/2022] Open
Abstract
Depression affects around 4-10% of the general population in England. Depression can often lead to behaviors and thoughts related to suicide and aggression, which have a social and economic burden to the United Kingdom. One construct that has been theorized as having an association with these behaviors is alexithymia. People with alexithymia have difficulties identifying and describing their emotional experiences. To date, there is no consensus on types or causes of alexithymia. Whilst the literature evidences a strong relationship between alexithymia and suicidality and aggression, little is known about the nature of this relationship. The present article will attempt to describe the extant literature on this relationship, drawing out some of the contentions and unanswered questions.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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21
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22
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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: 22] [Impact Index Per Article: 3.1] [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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23
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McIntosh RC, Ironson G, Antoni M, Lai B, Kumar M, Fletcher MA, Schneiderman N. Psychological Distress Mediates the Effect of Alexithymia on 2-Year Change in HIV Viral Load. Int J Behav Med 2017; 24:294-304. [PMID: 27882489 DOI: 10.1007/s12529-016-9602-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Individuals with trait alexithymia (AL) display poor cognitive assimilation of thoughts, feelings, and emotions. This may result in the persistence of stress, anxiety, and depressive disorders. The cumulative effect of this psychological distress is also linked clinical markers of human immunodeficiency virus (HIV) disease progression. This study examines the indirect effect of AL on HIV viral load as a function of baseline levels and change in psychological distress. METHODS N = 123 HIV positive adults aged 37.9 ± 9.2 years provided blood samples for HIV-1 viral RNA and CD4 T lymphocytes along with self-reported stress, anxiety, and depression every 6 months for 2 years. A second-order conditional latent growth model was used to represent baseline and 2-year change in cumulative levels of psychological distress and to test the indirect effect of baseline levels of trait AL on change in HIV-1 viral load through this latent measure. RESULTS AL was associated with baseline and latent change in psychological distress. Furthermore, baseline psychological distress predicted 2-year change in HIV-1 viral RNA after controlling for viral load at baseline. Altogether, trait AL had a significant indirect effect on change in viral load (β = 0.16, p = 0.03) as a function of baseline levels of distress. CONCLUSION Identification and communication of thoughts, feelings, and emotions are important for long-term psychological adaptation in HIV. Greater psychological distress, in turn, allows for persistence of peripheral viral replication.
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Affiliation(s)
- Roger C McIntosh
- Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
| | - Gail Ironson
- Department of Health Psychology, University of Miami, Miami, FL, 33124, USA
| | - Michael Antoni
- Department of Health Psychology, University of Miami, Miami, FL, 33124, USA
| | - Betty Lai
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Mahendra Kumar
- Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary Ann Fletcher
- Department of Clinical Immunology, Institute of Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA
| | - Neil Schneiderman
- Department of Health Psychology, University of Miami, Miami, FL, 33124, USA
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24
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Loas G, Braun S, Delhaye M, Linkowski P. The measurement of alexithymia in children and adolescents: Psychometric properties of the Alexithymia Questionnaire for Children and the twenty-item Toronto Alexithymia Scale in different non-clinical and clinical samples of children and adolescents. PLoS One 2017; 12:e0177982. [PMID: 28542508 PMCID: PMC5444663 DOI: 10.1371/journal.pone.0177982] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/05/2017] [Indexed: 01/17/2023] Open
Abstract
This study had two aims. Firstly, the psychometric properties of the 20-item Toronto Alexithymia Scale (TAS-20) and the Alexithymia Questionnaire for Children (AQC) that measure the three dimensions of alexithymia (DIF, difficulty identifying feelings; DDF, difficulty describing feelings; EOT, externally-oriented thinking) were explored in various samples of children, adolescents or young adults to detect the best factor-structure and to examine if the Externally-Oriented Thinking (EOT) factor must be deleted or not. Secondly, the capacity for adolescents to distinguish between alexithymia and depression was studied using factorial analyses of items of self-report of alexithymia and depression scales. Four groups were examined (80 healthy children, 105 adolescents with various psychiatric disorders, 333 healthy older adolescents and 505 young adults recruited from universities). The first two groups filled out the AQC and the latter two the TAS-20. Confirmatory factorial analyses (CFA) showed that the two-factor model (DIF, DDF) provided acceptable fits and had significant advantages over the three-factor model (DIF, DDF, EOT). Low alpha coefficients for the EOT subscale were reported (range from 0.18–0.61). Except for the children sample, exploratory factorial analyses (EFA) were performed on the items of the TAS-20 or AQC without the EOT items and the Beck depression inventory-II (BDI-II) or the Zung Self-Rating Depression Scale (SDS). The items of the AQC and BDI-II or items of the TAS-20 and SDS loaded on separate factors with only a minor overlap suggesting that adolescents were able to differentiate alexithymia and depression when self-assessments were used. Alexithymia can be reliably assessed in adolescents using the TAS-20 or AQC without the eight items rating the EOT dimension.
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Affiliation(s)
- Gwenolé Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
- * E-mail:
| | - Stéphanie Braun
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Marie Delhaye
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Paul Linkowski
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Dorard G, Bungener C, Phan O, Edel Y, Corcos M, Berthoz S. Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers. J Psychosom Res 2017; 95:74-80. [PMID: 28314553 DOI: 10.1016/j.jpsychores.2017.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In recent decades, alexithymia has been considered a risk factor for multiple somatic and psychiatric conditions. Yet, whereas alexithymia has been extensively studied in adults with a substance misuse, only one study has reported data on cannabis abusers from the general population. Hence, our main objective was to explore alexithymia in a clinical sample of treatment-seeking young outpatients with a DSM-IV cannabis dependence or abuse diagnosis compared to controls. METHODS 120 young patients (95 males - mean age 17.9years (SD=2.8; 14 to 25)) with a cannabis dependence or abuse (DSM-IV-TR criteria evaluated with the MINI), seeking treatment in an addiction unit, and 110 healthy control subjects (77 males - mean age 18.2years (SD=3.4; 14 to 25)) participated in the study. They completed a battery of self-reports measuring alexithymia (TAS-20; BVAQ-B), depression (BDI-13) and state and trait anxiety (STAI). RESULTS 35.3% of cannabis users were alexithymic, and logistic regression analysis showed that the alexithymic components of difficulties identifying and describing feelings combined with trait anxiety predicted group membership. CONCLUSION This first study on young cannabis abusers and dependent subjects further emphasizes the importance of considering the affective style, and particularly the anxious temperament and alexithymia features, as factors associated with substance misuse during late adolescence.
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Affiliation(s)
- Géraldine Dorard
- Laboratoire de Psychopathologie et Processus de Santé EA 4057, Institut Universitaire Paris Descartes de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, 71 avenue Édouard Vaillant, 92100 Boulogne-Billancourt, France.
| | - Catherine Bungener
- Laboratoire de Psychopathologie et Processus de Santé EA 4057, Institut Universitaire Paris Descartes de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, 71 avenue Édouard Vaillant, 92100 Boulogne-Billancourt, France.
| | - Olivier Phan
- Clinique Dupré, FSEF, 30 avenue Franklin Roosevelt, BP 101, 92333 Sceaux cedex, France; CJC Pierre Nicole, Croix-Rouge Française, 27 rue Pierre Nicole, 75005 Paris, France; CESP, Université Paris-Sud, Cochin-Maison des Adolescents, 97 Boulevard Port Royal, 75014 Paris, France..
| | - Yves Edel
- Equipe d'addictologie hospitalière de liaison et de soins (ELSA), Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.
| | - Maurice Corcos
- Département de psychiatrie de l'adolescent et du jeune adulte, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France.
| | - Sylvie Berthoz
- CESP, Université Paris-Sud, Cochin-Maison des Adolescents, 97 Boulevard Port Royal, 75014 Paris, France.; Département de psychiatrie de l'adolescent et du jeune adulte, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France.
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Probst T, Sattel H, Gündel H, Henningsen P, Kruse J, Schneider G, Lahmann C. Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder. Front Psychiatry 2017; 8:261. [PMID: 29255429 PMCID: PMC5722801 DOI: 10.3389/fpsyt.2017.00261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/14/2017] [Indexed: 12/22/2022] Open
Abstract
This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients' alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists' alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p < 0.05): a stronger alliance in the therapists' perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists' view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.
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Affiliation(s)
- Thomas Probst
- Georg-Elias-Müller Institute for Psychology, Georg-August University of Göttingen, Göttingen, Germany.,Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Marburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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Ready RE, Mather MA, Santorelli GD, Santospago BP. Apathy, alexithymia, and depressive symptoms: Points of convergence and divergence. Psychiatry Res 2016; 244:306-11. [PMID: 27512920 DOI: 10.1016/j.psychres.2016.07.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/04/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022]
Abstract
This study determined convergence and divergence in the constructs of alexithymia, apathy, and depressive symptoms. Understanding of similarities and differences between these constructs will improve diagnostic accuracy for clinical and research purposes. Community-dwelling participants (N=622, M age=35.6 years, SD=13.1) completed online measures of alexithymia, depression, and apathy; 12.2% were alexithymic, 37.8% reported significant depressive symptoms, and 24.9% reported significant apathy. Exploratory Factor Analyses (EFAs) determined the best factor structure for the apathy, alexithymia, and depressive symptoms was comprised of three factors and accounted for 45.1% of item variance. The Depression, Apathy, and Alexithymia factors were defined most strongly by item content that is at the core of each construct. Depression was defined most highly by items assessing sadness, low self-esteem, and loneliness. The strongest item loadings for Alexithymia were difficulty identifying and describing feelings. Apathy was characterized by poor motivation, low interest, and lack of initiative. However, each of these core and defining features had significant cross-loadings on one of the other two factors. Negative affect shared variance with Apathy, low motivation shared variance with Depression, and difficulty describing and identify feelings shared variance with Depression and Apathy. Clinical and research implications are discussed.
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Affiliation(s)
- Rebecca E Ready
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA.
| | - Molly A Mather
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA
| | | | - Breanna P Santospago
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA
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Error monitoring is related to processing internal affective states. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2016; 16:1050-1062. [DOI: 10.3758/s13415-016-0452-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Saariaho AS, Saariaho TH, Mattila AK, Joukamaa MI, Karukivi M. The role of alexithymia: An 8-year follow-up study of chronic pain patients. Compr Psychiatry 2016; 69:145-54. [PMID: 27423355 DOI: 10.1016/j.comppsych.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome. METHODS Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability. RESULTS In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period. CONCLUSION Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.
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Affiliation(s)
- Anita S Saariaho
- Pain Clinic, Raahe Hospital, P.O. BOXs 25, 92101, Raahe, Finland.
| | - Tom H Saariaho
- Pain Clinic, Oulu University Hospital, P.O. BOX 21, FIN-OUH, Oulu, Finland.
| | - Aino K Mattila
- Department of Psychiatry, Tampere University Hospital, P.O. BOXs 2000, 33521 Tampere, Finland.
| | - Matti I Joukamaa
- School of Health Sciences, Tampere University, 33014 Tampere, Finland.
| | - Max Karukivi
- Unit of Adolescent Psychiatry, Satakunta, Hospital District, Antinkatu 15A, 28100 Pori, Finland.
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Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. CURRENT ADDICTION REPORTS 2016; 3:239-248. [PMID: 27695665 DOI: 10.1007/s40429-016-0097-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alexithymia, characterized by impairments in emotional awareness, is common among individuals with substance use disorders. Research on alexithymia suggests that it is a trait that may contribute to substance dependence. This paper will review alexithymia as it relates to substance use and substance use disorders, considering its potential role in the maintenance and treatment of these disorders. We will then describe how neural correlates associated with alexithymia may shed light on how alexithymia relates to addiction. Finally, we present preliminary fMRI data that examines how alexithymia may relate to the neurobiological correlates of reward/loss processing in individuals with cocaine dependence. While preliminary, these findings suggest a role of alexithymia in reward anticipation in cocaine-dependent individuals.
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Ling Y, Zeng Y, Yuan H, Zhong M. Cross-cultural validation of the 20-item Toronto Alexithymia Scale in Chinese adolescents. J Psychiatr Ment Health Nurs 2016; 23:179-87. [PMID: 27028136 DOI: 10.1111/jpm.12298] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The TAS-20 is the most widely used self-reported questionnaire to assess the level of alexithymia in students and community and clinical samples. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The TAS-20-C exhibited high levels of reliability and validity, indicating that it is appropriate for the assessment of alexithymia in Chinese adolescents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Screening adolescents who are at risk of alexithymia through the TAS-20 could help to perform necessary and effective precautions to decrease the adverse effects of alexithymia, such as the risks of developing depressive mood and behavioral problems. ABSTRACT Purpose The aim of this study was to examine the psychometric properties of the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20-C) in a sample of Chinese adolescents. Method Adolescents (n = 1260) recruited from three schools in mainland China completed the TAS-20-C, the somatization subscale of the Symptom Checklist 90 (SCL-90) and Center for Epidemiological Studies Depression Scale (CES-D). Five different factorial models of the TAS-20 were tested using confirmatory factor analysis (CFA). Cronbach's α, mean inter-item correlations and predictive validity were also evaluated. Results Among those five different factorial models, the four-factor structure model was suitable and invariant across gender and age in this sample. The TAS-20-C demonstrated adequate internal reliability. Gender and age accounted for insignificant amounts of variability in total TAS-20-C and factor scores. TAS-20-C total and subscale scores were correlated significantly with SCL-90 somatization subscale and CES-D. Girls scored higher than boys on difficulty identifying feelings (DIF) and pragmatic thinking (PR) subscales. DIF and lack of subjective significance or importance of emotions (IMs) subscale scores were higher among younger than among middle and older adolescents. Implications for Practice Validating the TAS-20 in adolescents is quite important to use it in evaluating adolescents' alexithymia, and screen those at risk of alexithymia.
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Affiliation(s)
- Y Ling
- College of Education, Hunan Agriculture University, Changsha, Hunan, China
| | - Y Zeng
- College of Education, Hunan Agriculture University, Changsha, Hunan, China
| | - H Yuan
- Students Affairs Department, Central South University of Forestry and Technology, Changsha, Hunan, China
| | - M Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
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Ho NSP, Wong MMC, Lee TMC. Neural connectivity of alexithymia: Specific association with major depressive disorder. J Affect Disord 2016; 193:362-72. [PMID: 26796237 DOI: 10.1016/j.jad.2015.12.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 12/19/2015] [Accepted: 12/26/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Alexithymia has been frequently associated with major depression disorders (MDD). Yet little is known about the exact relationship of alexithymia and MDD. In order to explore this subject matter, the neural connectivity associated with alexithymia in people with MDD and matched nonclinical controls were compared. METHODS Twenty-two females diagnosed with first-episode MDD and twenty-one matched nonclinical controls were MRI brain-scanned with diffusion-tensor-imaging and resting-state-functional-imaging methods, and self-reported the Chinese 20-item Toronto Alexithymia Scale. RESULTS Voxel-wise multiple regression analysis showed a group interaction effect regarding the correlation between white-matter-connectivity and alexithymia. Significant correlations were observed at the corpus-callosum in MDDs and at the right superior-longitudinal-fasciculus in the controls. These findings were then used to derive seeds for analyzing resting-state-functional-connectivity in each group separately. The results further revealed that alexithymia in MDDs were associated with reduced functional-connectivity in the right precentral-gyrus and several regions of the brain on the right which are associated with cognitive regulation in the default-mode-network. In contrast, among the control subjects, alexithymia was correlated with increased functional-connectivity between the right inferior-frontal-gyrus-triangularis and the right superior-occipital-lobe, which is associated with emotional response to external stimuli. LIMITATIONS Better participant selection, especially recruitment of medication-free samples, and the engagement of additional alexithymia assessments, should be considered in future investigations. CONCLUSIONS These findings supported our a priori hypothesis that MDDs and controls have distinct white-matter correlates of alexithymia, and these corresponded to the existing proposed neural correlates for the cognitive and affective characteristics of alexithymia respectively. Extended impacts of these microstructural changes on remote functional networks might help explain the distinct behavioral characteristics of alexithymia for these groups, as well as implications for therapeutic intervention of MDD.
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Affiliation(s)
- Nerissa S P Ho
- Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam Road, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong
| | | | - Tatia M C Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam Road, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong; Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Borhani K, Borgomaneri S, Làdavas E, Bertini C. The effect of alexithymia on early visual processing of emotional body postures. Biol Psychol 2016; 115:1-8. [DOI: 10.1016/j.biopsycho.2015.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/23/2015] [Accepted: 12/27/2015] [Indexed: 12/30/2022]
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Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity. AIDS Behav 2016; 20:325-38. [PMID: 26143246 DOI: 10.1007/s10461-015-1126-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.
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Colligan SM, Koven NS. Interference Resolution in Emotional Working Memory as a Function of Alexithymia. AMERICAN JOURNAL OF PSYCHOLOGY 2015; 128:337-45. [PMID: 26442340 DOI: 10.5406/amerjpsyc.128.3.0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although alexithymia is recognized as a set of traitlike deficits in emotion processing, research suggests there are concomitant cognitive issues as well, including what appears to be an unusual pattern of enhanced working memory (WM) despite broader executive dysfunction. It is unknown whether this enhancement includes the executive elements of WM and whether executive control of WM in alexithymia differs for emotional and neutral stimuli. This study examined how alexithymia moderates patterns of interference resolution in WM with valenced and nonvalenced stimuli. Participants (N = 93) completed the Toronto Alexithymia Scale and a recency probes WM task containing positive, negative, and neutral stimuli, with some trials containing proactive interference from previous trials. The reaction time difference between interference and noninterference trials indexed degree of interference resolution. Toronto Alexithymia Scale score moderated a within-subject effect such that, when valenced probes were used, there was less proactive interference in the positive relative to negative valence condition; this valence-based interference discrepancy was significant for a subset of highly alexithymic participants. Alexithymia did not moderate proactive interference to negative or neutral stimuli or accuracy of responses. These results suggest that, although alexithymia does not influence executive control in WM for nonemotional items, alexithymic people demonstrate an idiosyncratic response to positive stimuli that might indicate blunted reactivity.
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Scarpazza C, Làdavas E, di Pellegrino G. Dissociation between Emotional Remapping of Fear and Disgust in Alexithymia. PLoS One 2015; 10:e0140229. [PMID: 26462241 PMCID: PMC4604077 DOI: 10.1371/journal.pone.0140229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023] Open
Abstract
There is growing evidence that individuals are able to understand others' emotions because they "embody" them, i.e., re-experience them by activating a representation of the observed emotion within their own body. One way to study emotion embodiment is provided by a multisensory stimulation paradigm called emotional visual remapping of touch (eVRT), in which the degree of embodiment/remapping of emotions is measured as enhanced detection of near-threshold tactile stimuli on one's own face while viewing different emotional facial expressions. Here, we measured remapping of fear and disgust in participants with low (LA) and high (HA) levels of alexithymia, a personality trait characterized by a difficulty in recognizing emotions. The results showed that fear is remapped in LA but not in HA participants, while disgust is remapped in HA but not in LA participants. To investigate the hypothesis that HA might exhibit increased responses to emotional stimuli producing a heightened physical and visceral sensations, i.e., disgust, in a second experiment we investigated participants' interoceptive abilities and the link between interoception and emotional modulations of VRT. The results showed that participants' disgust modulations of VRT correlated with their ability to perceive bodily signals. We suggest that the emotional profile of HA individuals on the eVRT task could be related to their abnormal tendency to be focalized on their internal bodily signals, and to experience emotions in a "physical" way. Finally, we speculated that these results in HA could be due to a enhancement of insular activity during the perception of disgusted faces.
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Affiliation(s)
- Cristina Scarpazza
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
| | - Elisabetta Làdavas
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
| | - Giuseppe di Pellegrino
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
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Terock J, Janowitz D, Spitzer C, Miertsch M, Freyberger HJ, Grabe HJ. Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome. Compr Psychiatry 2015; 62:34-41. [PMID: 26343465 DOI: 10.1016/j.comppsych.2015.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/28/2015] [Accepted: 06/06/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alexithymia, a common personality style of patients seeking psychotherapeutic help, is associated with illness severity and negative treatment outcome in various mental disorders. Still, it remains unclear how alexithymia influences psychopathology and the therapeutic processes. In previous studies, a strong association of alexithymia with self-directedness (SD), a dimension of Cloninger's Temperament and Character Inventory (TCI) has been shown. In this study, we investigated the interaction of alexithymia and SD, and their impact on general psychopathology and on treatment outcome. METHOD 716 consecutively admitted day-clinic outpatients were examined at admission (t0) and discharge (t1). The Toronto Alexithymia Scale 20 (TAS-20), the SD subscale of the TCI and the Symptom Checklist 90 (SCL-90-R) were administered. Linear regression analyses were performed to calculate associations and the predictive power of TAS-20 and SD on psychopathology at admission and treatment outcome. ANOVA was used to calculate interactions of TAS-20 and SD on treatment outcome. A general linear model was applied to compare the outcome of four subgroups, defined by high/low TAS-20 and SD scores. RESULTS Regression analyses revealed significant prediction of the baseline General Severity Index (GSIt0) by TAS-20 (df=4, 711; Beta: 0.385; p<0.001) and SD (Beta: -0.365; p<0.001). The whole model accounted for 41% of the explained variance. On subscale level, the 'Difficulties in identifying feelings' facet (DIF) of TAS-20 was the strongest predictor of GSIt0 (Beta: 0.478, P<0.001) and GSIt1 (Beta: 0.072, p=0.049). Therapeutic outcome measured by GSIt1 was significantly predicted by SD (df=5, 710; Beta: -0.065; p=0.041), but not by TAS-20 (Beta: 0.042; p=0.179). Change scores (∆) of TAS-20 and SD predicted GSIt1 (df=5, 710; TAS-20∆ Beta: -0.268; p<0.001; SD∆ Beta: 0.191; p<0.001) as well as GSI∆ (df=5, 710; TAS∆ Beta: 0.384; p<0.001; SD∆: -0.274; p<0.001) significantly. ANOVA revealed no significant interactions of TAS-20 and SD at admission on the treatment outcome (p>0.05). CONCLUSION Low SD was shown to be a common problem of alexithymic patients and both, alexithymia and SD were highly associated with general symptom severity. SD was found to have a greater impact on treatment outcome while adjusting for baseline GSI. Alexithymia and SD act as independent factors with no significant interaction in their impact on psychopathology at admission and discharge. As different interventions were shown to improve SD scores in previous studies, SD may represent a relevant psychotherapeutic target, worthy to be addressed especially in alexithymic patients. Future studies should investigate other dimensions of the TCI, especially harm avoidance and reward dependence.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany.
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | | | - Martin Miertsch
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Germany
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Marchesi C, Ossola P, Scagnelli F, Mellini L, Tonna M, Ardissino D, De Panfilis C. The role of alexithymia in predicting incident depression in patients at first acute coronary syndrome. Compr Psychiatry 2015; 62:86-92. [PMID: 26343471 DOI: 10.1016/j.comppsych.2015.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Alexithymia has been considered both to predispose to depression and to worsen cardiac prognosis after an acute coronary syndrome. Nonetheless, no studies have evaluated its role as a risk factor for incident depression, in patients with acute coronary syndrome. METHODS In 251 consecutive patients, the presence of a first-ever depressive episode was evaluated with the Primary Care Evaluation of Mental Disorders at baseline and 1, 2, 4, 6, 9, 12 and 24 months after their first acute coronary syndrome. At baseline, patients completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale. RESULTS Out of 251 subjects (80.9% males), a first-ever depressive episode was diagnosed in 66 patients. Depressed and never-depressed patients differed in female gender, living status, alexithymic scores at TAS-20 and depressive symptoms. Nonetheless, nor the TAS-20 factors nor its total score were predictive of developing a depressive episode in a Cox regression. Moreover, baseline differences in TAS-20 scores between the two groups, disappeared after controlling for anhedonic symptoms. CONCLUSION Our results do not support the hypothesis that alexithymia at TAS-20 is a risk factor for incident depression after acute coronary syndrome.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Francesca Scagnelli
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy.
| | - Lorenzo Mellini
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy.
| | | | - Diego Ardissino
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, Università degli Studi di Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
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Babaei S, Gharechahi M, Hatami Z, Ranjbar Varandi S. Metacognition and Body Image in Predicting Alexithymia in Substance Abusers. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2015; 4:e25775. [PMID: 26495262 PMCID: PMC4609502 DOI: 10.5812/ijhrba.25775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/27/2015] [Accepted: 02/26/2015] [Indexed: 11/16/2022]
Abstract
Background: Substance dependency is one of the biggest problems and worries of the world. It stunts the growth of society and causes various problems such as reduction in public health, increase in mortality, rise in social and domestic traumas, loss of educational and occupational opportunities, involvement with the judicial system, and development of the substance-abuse cycle. Objectives: The aim of this study was to determine the role of metacognition and body image in predicting alexithymia in substance abusers. Patients and Methods: The research sample included addicts (males and females aged 10 to 70 years) who referred to the addiction treatment and counseling centers of three Iranian cities of Zahedan, Sari, and Neyriz. Participants were selected by random sampling. The metacognitive strategy questionnaire (MCQ-30), physical self-description questionnaire (PSDQ), and Toronto alexithymia scale (TAS-20) were used for data collection. The hypotheses were tested using the Pearson’s correlation method and regression analysis. Results: According to the results of the current study, the highest correlation was between alexithymia and the cognitive awareness subscale (r = 0.305; P < 0.01).There was no significant correlation between alexithymia and body image. Based on the multiple regression analysis, the three predictors explained 11% of the variance (R2 = 0. 11, F = 3.981; P < 0.01). Cognitive awareness significantly predicted 9% of the variance (β = 0.305; P < 0.01), and the other subscales predicted about 2%. Conclusions: These findings demonstrated that metacognition had an important role in predicting alexithymia in the substance abusers, which underscores the necessity of precautionary measures.
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Affiliation(s)
- Samaneh Babaei
- Deputy of Research and Technology, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | | | - Zohreh Hatami
- Training and Education Organization of Daregaz, Daregaz, IR Iran
| | - Shahryar Ranjbar Varandi
- Training and Education Organization of Sari, Sari, IR Iran ; Department of Clinical Psychology, Sari Branch, Islamic Azad University, Sari, IR Iran
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Morie KP, Nich C, Hunkele K, Potenza MN, Carroll KM. Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone maintained individuals. Drug Alcohol Depend 2015; 152:157-63. [PMID: 25982006 PMCID: PMC4458169 DOI: 10.1016/j.drugalcdep.2015.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alexithymia, a characteristic marked by poor ability to identify, define and communicate emotions, has been associated with poorer treatment outcome, including traditional clinician delivered CBT. Computerized cognitive behavioral therapy (CBT4CBT), an effective adjunct to treatment, may provide a means of conveying skills without requiring interaction with a clinician. METHODS Seventy-three methadone maintained, cocaine dependent individuals participating in an 8-week randomized clinical trial comparing standard methadone maintenance to methadone maintenance plus CBT4CBT completed the Toronto Alexithymia Scale (TAS-20) at pretreatment, post-treatment, and follow-ups conducted one, two, and 6 months after treatment. RESULTS There were no statistically significant differences on baseline TAS-20 scores by multiple demographic and substance use variables including gender and substance use severity. Higher TAS-20 scores were associated with somewhat higher levels of distress as measured by the Beck Depression Inventory and multiple Brief Severity Index scales. TAS-20 scores remained relatively stable throughout the duration of treatment and follow-up. Indicators of treatment process, including treatment retention, adherence and therapeutic alliance, were not significantly correlated with TAS-20 scores. There was a significant interaction of alexithymia and treatment condition, such that individuals with higher baseline scores on the TAS-20 submitted significantly higher percentages of cocaine-negative urine toxicology specimens and reported a higher percentage of abstinence days, and longer periods of consecutive abstinence within treatment when assigned to CBT4CBT compared with treatment as usual. CONCLUSIONS These findings suggest that individuals with increased alexithymia may benefit from computerized CBT; possibly via reduced demands on interpersonal skills and interactions associated with computerized therapies.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Karen Hunkele
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
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Babaei S, Ranjbar Varandi S, Hatami Z, Gharechahi M. Metacognition Beliefs and General Health in Predicting Alexithymia in Students. Glob J Health Sci 2015; 8:117-25. [PMID: 26383206 PMCID: PMC4804023 DOI: 10.5539/gjhs.v8n2p117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/31/2015] [Indexed: 01/04/2023] Open
Abstract
Objectives: The present study was conducted to investigate the role of metacognition beliefs and general health in alexithymia in Iranian students. Methods: This descriptive and correlational study included 200 participants of high schools students, selected randomly from students of two cities (Sari and Dargaz), Iran. Metacognitive Strategies Questionnaire (MCQ-30); the General Health Questionnaire (GHQ) and Farsi Version of the Toronto Alexithymia Scale (TAS-20) were used for gathering the data. Using the Pearson’s correlation method and regression, the data were analyzed. Results: The findings indicated significant positive relationships between alexithymia and all subscales of general health. The highest correlation was between alexithymia and anxiety subscale (r=0.36, P<0.01). Also, there was a significant negative relationship between alexithymia and some metacognitive strategies. The highest significant negative relationship was seen between alexithymia and the sub-scale of risk uncontrollability (r=-0.359, P < 0.01). Based on the results of multiple regressions, three predictors explained 21% of the variance (R2=0. 21, F=7.238, P<0.01). It was found that anxiety subscale of General Health significantly predicted 13% of the variance of alexithymia (β=0.36, P<0.01) and risk uncontrollability subscale of Metacognition beliefs predicted about 8% of the variance of alexithymia (β=-0.028, P<0.01). Conclusions: The findings demonstrated that metacognition beliefs and general health had important role in predicting of alexithymia in students.
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Affiliation(s)
- Samaneh Babaei
- Zahedan University of Medical Sciences, Zahedan, IR Iran..
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Norman H, Borrill J. The relationship between self-harm and alexithymia. Scand J Psychol 2015; 56:405-19. [DOI: 10.1111/sjop.12217] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/24/2015] [Indexed: 11/26/2022]
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Loas G, Baelde O, Verrier A. Relationship between alexithymia and dependent personality disorder: a dimensional analysis. Psychiatry Res 2015; 225:484-8. [PMID: 25529260 DOI: 10.1016/j.psychres.2014.11.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/07/2014] [Accepted: 11/30/2014] [Indexed: 01/30/2023]
Abstract
The present study had two aims and used two different samples. The first aim was to determine if alexithymia and dependent personality disorder (DPD) are distinct or overlapping constructs. The second aim was to determine the specificity and the stability of the relationship between alexithymia and DPD. The first study used exploratory principal components analysis (PCA) in a sample of 477 non-clinical subjects who completed three questionnaires measuring alexithymia (Twenty item Toronto Alexithymia Scale, i.e. TAS-20), dependent personality disorder (Dependent Personality Questionnaire, i.e. DPQ) and depression (Beck Depression Inventory-II, i.e. BDI-II). The second study used a sample of 305 subjects consecutively admitted to an outpatient department of legal medicine. The subjects completed (at admission and 3 months later) the Structured Clinical Interview for DSM-IV, screen questionnaire (SCID-II-SQ), the TAS-20 and the BDI. Multiple regressions were done. For the first study, the PCA yielded a four-factor solution with no overlap of the significant factor loadings for the items from each scale and with the factors corresponding to their respective construct. For the second study, multiple regressions showed that only avoidant personality disorder was an independent predictor of the TAS-20 scores. Alexithymia is a construct that is distinct and separate from DPD and depression. Alexithymia is not a stable feature of DPD while it is a core feature of avoidant personality disorder.
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Affiliation(s)
- Gwenolé Loas
- Department of Psychiatry, Hôpital Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - Olympe Baelde
- Department of Psychiatry, Hôpital Pinel, Amiens, France
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Lee HJ, Joo Y, Youngstrom EA, Yum SY, Findling RL, Kim HW. Diagnostic validity and reliability of a Korean version of the Parent and Adolescent General Behavior Inventories. Compr Psychiatry 2014; 55:1730-7. [PMID: 24962447 DOI: 10.1016/j.comppsych.2014.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the validity and reliability of a Korean version of the Parent General Behavior Inventory-10-item Mania Scale (P-GBI-10M) and the Adolescent General Behavior Inventory (A-GBI) for bipolar and depressive disorder in youths. METHODS Ninety-two subjects with mood disorder and their parents were recruited from September 2011 to June 2013 through the Department of Psychiatry at the Asan Medical Center, Seoul, Korea. In addition, 125 community participants were recruited through two middle schools and one high school in Seoul. The parents of subjects completed the Parent-version Mood Disorder Questionnaire (P-MDQ), P-GBI-10M and Attention-deficit/hyperactivity disorder Rating Scale (ARS). Adolescents complete the 76-item A-GBI, Beck Depression Inventory (BDI), and Adolescent version of the Mood Disorder Questionnaire (A-MDQ). RESULTS Different profiles were evident between the clinic-referred group and the community control, including different P-GBI-10M (t=3.07, p=0.003), A-GBI Depressive (t=4.99, p<0.001), Hypomanic/Biphasic subscales (t=3.17, p=0.002), and BDI (t=4.76, p<0.001) scores. The A-GBI Depressive subscale score (t=3.02, p=0.003), BDI score (t=2.12, p=0.037) and A-GBI Hypomanic/Biphasic subscale score (t=2.71, p=0.008) were significantly different between patients with bipolar disorder and those with depressive disorder. Of the 73 items of the Depressive and Hypomanic/Biphasic subscales of the A-GBI, eight discriminated between bipolar and depressive disorder. Furthermore, A-GBI Depressive subscale scores were significantly correlated with BDI (r=0.81, p<0.001), A-GBI Hypomanic/Biphasic subscale (r=0.88, p<0.001), A-MDQ (r=0.58, p<0.001), P-MDQ (r=0.22, p=0.005), and ARS (r=0.26, p<0.001) scores. Cronbach's α of the A-GBI was 0.98. CONCLUSION The Korean version of the Parent and Adolescent General Behavior Inventories showed excellent internal consistency, fair-to-good construct, and discriminant validity.
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Affiliation(s)
- Hyun-Jeong Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yeonho Joo
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Eric A Youngstrom
- Department of Psychology and Psychiatry, University of NC at Chapel Hill, Chapel Hill, NC
| | - Sun Young Yum
- Department of Psychiatry, The Commonwealth Medical College of Pennsylvania, Scranton, PA
| | - Robert L Findling
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Johns Hopkins University, Baltimore, MD
| | - Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Marchesi C, Ossola P, Tonna M, De Panfilis C. The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders. Compr Psychiatry 2014; 55:972-8. [PMID: 24439561 DOI: 10.1016/j.comppsych.2013.12.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. METHODS Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). RESULTS The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. CONCLUSIONS Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.
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Affiliation(s)
- Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | | | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
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Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav Immun 2014; 36:165-75. [PMID: 24184475 DOI: 10.1016/j.bbi.2013.10.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 12/30/2022] Open
Abstract
The neuropathological changes resulting from Human Immunodeficiency Virus (HIV) infection may manifest in alexithymia (AL), a multidimensional trait characterized by impairments in the cognitive assimilation of feelings and emotions. A sample of 93 HIV survivors scoring high, i.e., ⩾74 on the 26-item Toronto Alexithymia Scale (TAS-26), were compared to 79 low AL (TAS-26⩽54) survivors on measures of neurocognitive, psychological, neuroendocrine and immune function. Neurocognitive function was evinced by a standardized test of psychomotor speed, cognitive flexibility and task switching ability, HIV Dementia and general cognitive status. Patients were also screened for levels of depression, anxiety and psychological stress. A 24-h urinary norepinephrine (NE) and cortisol (CORT) collection was taken; blood was drawn for T lymphocyte subset counts (CD4+CD3+) and HIV-1 viral load. Alexithymic patients exhibited higher levels of executive dysfunction, psychological distress, norepinephrine-to-cortisol (NE/CORT) ratio and viral load. Linear regression models accounting for sociodemographic and disease-related variables revealed two AL subscales, difficulties identifying and describing feelings, predicted and explained a significant proportion of variance in the outcome measures. Specifically, poorer executive task-switching/cognitive flexibility was associated with greater difficulty describing feelings; dysregulated autonomic response (high NE/CORT ratio) and depressive symptoms were predicted by difficulty identifying feelings; higher levels of anxiety and psychological stress were both predicted by greater difficulty describing and identifying feelings. Overall, the psychoneuroimmunological profile of alexithymia in HIV positive persons at mid-stage of infection suggests a greater vulnerability for disease progression.
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Marchesi C, Giaracuni G, Paraggio C, Ossola P, Tonna M, De Panfilis C. Pre-morbid alexithymia in panic disorder: a cohort study. Psychiatry Res 2014; 215:141-5. [PMID: 24230995 DOI: 10.1016/j.psychres.2013.10.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 01/12/2023]
Abstract
Whether alexithymia is a personality trait which increases the risk of Panic Disorder (PD) is still debated. In this prospective study, alexithymic levels were evaluated before, during and after an anxious episode. Therefore, the alexithymic levels, the presence of PD and the severity of anxious-depressive symptoms were evaluated, at intervals of about 1 month, in pregnant women, attending the Centers for Prenatal Care, using the Toronto Alexithymia Scale (TAS-20), the Primary Care Evaluation of Mental Disorders and the Hospital Anxiety and Depression Scale (HADS). Twenty-one women affected by PD and 256 healthy women (controls) were included in the study. Women who developed PD, compared to controls, showed similar TAS-20 and HADS scores during the pre-morbid phase, a significant increase of them during PD and a significant decrease after symptoms improvement, whereas no change was observed in controls. Our data suggest that in pregnant women alexithymia does not represent a personality trait that increases the risk of developing PD, and they support the hypothesis that alexithymia is a state dependent phenomenon in PD pregnant women.
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Affiliation(s)
- Carlo Marchesi
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy.
| | - Giovanna Giaracuni
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy
| | - Cecilia Paraggio
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy
| | - Paolo Ossola
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy
| | - Matteo Tonna
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy
| | - Chiara De Panfilis
- Department of Neurosciences, Psychiatric Section, University of Parma and Mental Health Department, Local Health Service, Parma, Italy
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Gilbert P, McEwan K, Catarino F, Baião R, Palmeira L. Fears of happiness and compassion in relationship with depression, alexithymia, and attachment security in a depressed sample. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 53:228-44. [DOI: 10.1111/bjc.12037] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/01/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Paul Gilbert
- Mental Health Research Unit; Derbyshire Healthcare NHS Foundation Trust; Derby UK
| | - Kirsten McEwan
- Mental Health Research Unit; Derbyshire Healthcare NHS Foundation Trust; Derby UK
| | - Francisca Catarino
- Mental Health Research Unit; Derbyshire Healthcare NHS Foundation Trust; Derby UK
- Faculty of Psychology and Education Sciences; University of Coimbra; Portugal
| | - Rita Baião
- Faculty of Psychology and Education Sciences; University of Coimbra; Portugal
| | - Lara Palmeira
- Cognitive and Behavioural Research Centre (CINEICC); University of Coimbra; Portugal
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