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Psychological Medicine Jun 2022Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general...
BACKGROUND
Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood.
METHODS
In total, 337 adolescents and adults (autism = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms.
RESULTS
Autistic individuals reported significantly higher alexithymia than comparison individuals ( < 0.001, effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in feelings were particularly associated with current self-reported social-communication difficulties [ < 0.001, = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties ( = 0.02, = 0.43, 95% CI 0.07-0.82). Difficulties in feelings were particularly associated with current anxiety symptom severity ( < 0.001, = 0.54, 95% CI 0.41-0.77) and predicted later anxiety ( = 0.01; = 0.31, 95% CI 0.08-0.62).
CONCLUSIONS
Our findings suggest that difficulties in identifying . describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.
Topics: Adolescent; Adult; Affective Symptoms; Anxiety; Autistic Disorder; Communication; Cross-Sectional Studies; Depression; Female; Humans; Male
PubMed: 33028432
DOI: 10.1017/S0033291720003244 -
Developmental Cognitive Neuroscience Feb 2017Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that... (Review)
Review
Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one's own emotion), underscoring the link between bodily and emotional awareness. Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding. This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood. Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception. Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology. We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.
Topics: Adolescent; Affective Symptoms; Awareness; Cognition; Emotions; Heart Rate; Humans; Interoception; Mental Disorders; Neurosciences; Perception; Psychopathology
PubMed: 28081519
DOI: 10.1016/j.dcn.2016.12.006 -
Rehabilitation Psychology Nov 2019Alexithymia refers to reduced emotional awareness and is associated with higher levels of burden and disability in adults with chronic pain. Limited research has...
PURPOSE/OBJECTIVE
Alexithymia refers to reduced emotional awareness and is associated with higher levels of burden and disability in adults with chronic pain. Limited research has examined alexithymia in adolescents with chronic pain. The current study aimed to (a) determine whether alexithymia was higher in adolescents with (vs. without) chronic pain and (b) examine the relationship between alexithymia and pain experiences in youth. Research Method/Design: We assessed alexithymia in 22 adolescents with chronic pain and in 22 adolescents without chronic pain (otherwise healthy), and its relation to pain experiences (i.e., self-reported pain intensity, pain bothersomeness, and pain interference), while controlling for the concomitant effects of psychological distress (i.e., depressive and anxiety symptoms).
RESULTS
After controlling for psychological distress, adolescents with versus without chronic pain had higher total alexithymia scores (p = .042; η2 = .10), and specifically, greater difficulty identifying feelings (p = .001; η2 = .23). Difficulty identifying feelings was related to worse pain interference (r = .55; p = .015) and pain bothersomeness (r = .55; p = .015).
CONCLUSIONS/IMPLICATIONS
These preliminary findings suggest that adolescents with chronic pain may have greater difficulty identifying their emotions, and that this might be related to increased pain interference and pain bothersomeness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Topics: Adolescent; Affective Symptoms; Chronic Pain; Female; Humans; Male; Severity of Illness Index
PubMed: 31393153
DOI: 10.1037/rep0000287 -
BMC Neuroscience May 2020Alexithymia is a personality trait characterized by difficulties identifying and describing feelings, an externally oriented style of thinking, and a reduced inclination...
BACKGROUND
Alexithymia is a personality trait characterized by difficulties identifying and describing feelings, an externally oriented style of thinking, and a reduced inclination to imagination. Previous research has shown deficits in the recognition of emotional facial expressions in alexithymia and reductions of brain responsivity to emotional stimuli. Using an affective priming paradigm, we investigated automatic perception of facial emotions as a function of alexithymia at the behavioral and neural level. In addition to self-report scales, we applied an interview to assess alexithymic tendencies.
RESULTS
During 3 T fMRI scanning, 49 healthy individuals judged valence of neutral faces preceded by briefly shown happy, angry, fearful, and neutral facial expressions. Alexithymia was assessed using the 20-Item Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and the Toronto Structured Interview for Alexithymia (TSIA). As expected, only negative correlations were found between alexithymic features and affective priming. The global level of self-reported alexithymia (as assessed by the TAS-20 and the BVAQ) was found to be related to less affective priming owing to angry faces. At the facet level, difficulties identifying feelings, difficulties analyzing feelings, and impoverished fantasy (as measured by the BVAQ) were correlated with reduced affective priming due to angry faces. Difficulties identifying feelings (BVAQ) correlated also with reduced affective priming due to fearful faces and reduced imagination (TSIA) was related to decreased affective priming due to happy faces. There was only one significant correlation between alexithymia dimensions and automatic brain response to masked facial emotions: TAS-20 alexithymia correlated with heightened brain response to masked happy faces in superior and medial frontal areas.
CONCLUSIONS
Our behavioral results provide evidence that alexithymic features are related in particular to less sensitivity for covert facial expressions of anger. The perceptual alterations could reflect impaired automatic recognition or integration of social anger signals into judgemental processes and might contribute to the problems in interpersonal relationships associated with alexithymia. Our findings suggest that self-report measures of alexithymia may have an advantage over interview-based tests as research tools in the field of emotion perception at least in samples of healthy individuals characterized by rather low levels of alexithymia.
Topics: Adolescent; Adult; Affective Symptoms; Behavior; Brain; Brain Mapping; Emotions; Face; Facial Expression; Female; Humans; Male; Neuropsychological Tests; Young Adult
PubMed: 32471365
DOI: 10.1186/s12868-020-00572-6 -
Social Cognitive and Affective... Oct 2022Alexithymia is characterized by impairments in emotion processing, frequently linked to facial expressions of emotion. The eye-region conveys information necessary for...
Alexithymia is characterized by impairments in emotion processing, frequently linked to facial expressions of emotion. The eye-region conveys information necessary for emotion processing. It has been demonstrated that alexithymia is associated with reduced attention to the eyes, but little is known regarding the cognitive and electrophysiological mechanisms underlying emotive eye-region processing in alexithymia. Here, we recorded behavioral and electrophysiological responses of individuals with alexithymia (ALEX; n = 25) and individuals without alexithymia (NonALEX; n = 23) while they viewed intact and eyeless faces with angry and sad expressions during a dual-target rapid serial visual presentation task. Results showed different eye-region focuses and differentiating N1 responses between intact and eyeless faces to anger and sadness in NonALEX, but not in ALEX, suggesting deficient perceptual processing of the eye-region in alexithymia. Reduced eye-region focus and smaller differences in frontal alpha asymmetry in response to sadness between intact and eyeless faces were observed in ALEX than NonALEX, indicative of impaired affective processing of the eye-region in alexithymia. These findings highlight perceptual and affective abnormalities of emotive eye-region processing in alexithymia. Our results contribute to understanding the neuropsychopathology of alexithymia and alexithymia-related disorders.
Topics: Affective Symptoms; Anger; Emotions; Eye; Facial Expression; Humans
PubMed: 35277722
DOI: 10.1093/scan/nsac013 -
Turk Psikiyatri Dergisi = Turkish... 2021It has been emphasised recently that emotion regulation problems may be the core symptoms of attention deficit hyperactivity disorder (ADHD). In this study, we aimed to...
OBJECTIVE
It has been emphasised recently that emotion regulation problems may be the core symptoms of attention deficit hyperactivity disorder (ADHD). In this study, we aimed to determine the incidence of alexithymia, the relationship between alexithymia and impulsiveness, the severity of ADHD, depression and anxiety semptoms in adult ADHD.
METHOD
All participants were assessed with the Structured Clinical Interview For DSM IV Axis I Disorders (SCID-I); and completed the Toronto Alexithymia Scale (TAS), the Impulsive Behavior Scale (UPPS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), Adult Attention Deficit and Hyperactivity Disorder Self Reporting Scale (ASRS) and the Wender Utah Rating Scale (WURS). The ADHD patients were also assessed with the Diagnostic Interview for ADHD (DIVA) for DSM-5 criteria.
RESULTS
The study included 101 ADHD patients with a mean age of 23.06 ± 4.24 years with 47.5% females, and 100 healthy control individuals with a mean age of 22.76 ± 5.68 years with 50% female participants. Alexithymia incidence was 41.5% in the ADHD group. The increase in the levels of impulsiveness, depression and anxiety correlated with the severity of ADHD symptoms; and impulsiveness predicted alexithymia in the ADHD group.
CONCLUSION
Alexithymia incidence was higher in the ADHD group. When ADHD and control participants were combined, alexithymic individuals was more associated with impulsivity with frequent display of anxiety symptoms.
Topics: Adolescent; Adult; Affective Symptoms; Anxiety; Attention Deficit Disorder with Hyperactivity; Female; Humans; Impulsive Behavior; Male; Psychiatric Status Rating Scales; Young Adult
PubMed: 34392507
DOI: 10.5080/u23775 -
PloS One 2021The long-standing hypothesis that emotions rely on bodily states is back in the spotlight. This has led some researchers to suggest that alexithymia, a personality...
The long-standing hypothesis that emotions rely on bodily states is back in the spotlight. This has led some researchers to suggest that alexithymia, a personality construct characterized by altered emotional awareness, reflects a general deficit in interoception. However, tests of this hypothesis have relied on heterogeneous assessment methods, leading to inconsistent results. To shed some light on this issue, we administered a battery of self-report questionnaires of interoception and alexithymia to three samples from Italy, the U.S., and Singapore (N = 814). Correlation and machine learning analyses showed that alexithymia was associated with deficits in both subjective interoceptive accuracy and attention. Alexithymics' interoceptive deficits were primarily related to difficulty identifying and describing feelings. Interoception showed a weaker association with externally-oriented thinking as operationalized by the Toronto Alexithymia Scale (TAS-20) and no association with the affective dimension of alexithymia later introduced by the Bermond-Vorst Alexithymia Questionnaire (BVAQ). We discuss our results with reference to the theoretical and psychometric differences between these two measures of alexithymia and their shortcomings. Overall, our results support the view that interoceptive deficits are a core component of alexithymia, although the latter cannot be reduced to the former.
Topics: Adolescent; Adult; Affective Symptoms; Correlation of Data; Female; Humans; Interoception; Machine Learning; Male; Middle Aged; Self Report; Surveys and Questionnaires; Young Adult
PubMed: 34898643
DOI: 10.1371/journal.pone.0261126 -
Clinical Psychology Review Aug 2014Many individuals with schizophrenia are reported to have maladaptive expression and processing of emotion. This may take the form of conscious and implicit processes.... (Meta-Analysis)
Meta-Analysis Review
AIMS
Many individuals with schizophrenia are reported to have maladaptive expression and processing of emotion. This may take the form of conscious and implicit processes. Potential regulatory processes underlying schizophrenia are reviewed. We aimed to estimate effect sizes, potential heterogeneity and publication bias across three areas of measurement: a range of cognitive emotion regulation strategies(1) (CERS), alexithymia and dissociation.
METHOD
Data were pooled from 47 case-control studies involving measures of experiential avoidance, attentional deployment, cognitive reappraisal, emotion management, dissociation and alexithymia. All studies were rated for quality, risk of bias and publication bias.
RESULTS
The following effect sizes (g) were observed: emotion management: 0.96 [0.77, 1.14] and cognitive reappraisal: 0.49 [0.32, 0.66] were negatively associated with schizophrenia. Experiential avoidance: -0.44 [-0.59, -0.29], attentional deployment -0.96 [-1.18, -0.75], dissociation: -0.86 [-1.13, -0.60] and alexithymia: -1.05 [-1.45, -0.65] were positively associated with schizophrenia. Subgroups of dissociation and attentional deployment were also analysed. Meta-analyses revealed potential publication bias and heterogeneity in the study of CERS in schizophrenia.
CONCLUSIONS
A marked difference in the implementation of CERS is associated with schizophrenia compared to controls. Dissociation variables and alexithymia are also indicated and may be implicated in adaptive cognitive emotional regulation. Theoretical and research implications are discussed.
Topics: Affective Symptoms; Dissociative Disorders; Humans; Schizophrenia
PubMed: 25105273
DOI: 10.1016/j.cpr.2014.07.002 -
Neuroscience and Biobehavioral Reviews Apr 2018Alexithymia refers to deficiencies in identifying and expressing emotions. This might be related to changes in structural brain volumes, but its neuroanatomical basis... (Meta-Analysis)
Meta-Analysis Review
Alexithymia refers to deficiencies in identifying and expressing emotions. This might be related to changes in structural brain volumes, but its neuroanatomical basis remains uncertain as studies have shown heterogeneous findings. Therefore, we conducted a parametric coordinate-based meta-analysis. We identified seventeen structural neuroimaging studies (including a total of 2586 individuals with different levels of alexithymia) investigating the association between gray matter volume and alexithymia. Volumes of the left insula, left amygdala, orbital frontal cortex and striatum were consistently smaller in people with high levels of alexithymia. These areas are important for emotion perception and emotional experience. Smaller volumes in these areas might lead to deficiencies in appropriately identifying and expressing emotions. These findings provide the first quantitative integration of results pertaining to the structural neuroanatomical basis of alexithymia.
Topics: Affective Symptoms; Brain; Gray Matter; Humans; Magnetic Resonance Imaging; Neuroimaging
PubMed: 29360475
DOI: 10.1016/j.neubiorev.2018.01.004 -
Journal of Psychiatric Research Apr 2022Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions.... (Review)
Review
Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.
Topics: Affect; Affective Symptoms; Emotions; Humans; Mental Disorders
PubMed: 35151218
DOI: 10.1016/j.jpsychires.2022.01.053