Emotion Ideology Mediates Effects of Risk Factors on Alexithymia Development

Despite its connection to mental and behavioral health complications, elevated alexithymia tends to be associated with low responsiveness and high resistance to psychological intervention. To further understanding of potential treatment targets for clients with alexithymic traits, the present study explored the (a) independent contributions of various risk factors to statistical predictions of alexithymic trait severity, (b) generalizability of risk factor contributions across two culturally distinct samples, and (c) potential for emotion ideology (i.e., beliefs about emotion and emotional experience) to mediate such contributions. Preliminary results suggest emotion socialization and child abuse may be salient contributors to alexithymia severity, whereas effects of trauma exposure may be limited to samples with high overall exposure to alexithymia risk-factors. Moreover, emotion ideology mediates the relation between risk-factor exposure and alexithymia severity. Thus, psychotherapeutic interventions targeting emotion ideology may be beneficial when working with clients with elevated alexithymia.     

The Preoedipal Development of the Critical Superego and Its Manifestations in Psychoanalytic Group Psychotherapy

Alexithymia is a psychic dysfunction in which symbolic thinking and fantasy are reduced, somatization is common, feelings are poorly communicated, empathy is impaired, and intimate interpersonal relations are difficult to maintain. Individuals with significant alexithymia may have a variety of psychiatric disorders but their psychotherapy should always be informed by an awareness of their alexithymia. This paper reviews the concept and details the most efficient means of psychotherapy for alexithymic patients. Ideal treatment for such patients maximizes their opportunities to learn while protecting their self-esteem and minimizing nonproductive stress. Such treatment involves concurrent individual and group psychotherapy. Clinical material is presented and specific therapeutic maneuvers are explored.     

Finding words for feelings: The relationship between personality disorders and alexithymia

This study examined whether personality disorders (PDs) are associated with alexithymic features at varying levels of comorbid psychopathology distress. 167 psychiatric outpatients completed the Toronto Alexithymia Scale (TAS) and the General Severity Index (GSI) of the SCL90-revised. Bootstrapping analyses were performed to test whether the PD/alexithymia relationship was moderated by psychopathology distress (GSI). The overall number of PD criteria was associated with cognitive aspects of alexithymia (i.e., Externally Oriented Thinking, EOT) only at low/moderate levels of distress. Borderline criteria predicted EOT only when distress was low, while avoidant and dependent criteria were independently related with EOT. No association was found between other PDs and alexithymia facets. Thus, within clinical samples the alexithymia/PD association is mainly explained by comorbid psychopathology; however, individuals with avoidant, dependent and borderline features might have a specific difficulty with focusing on internal reality, even when their current symptom distress is low.     

Association of emotional intelligence with alexithymic characteristics

We examined the association of emotional intelligence and alexithymic characteristics as the personality trait in cohorts of 267 college students and 398 psychiatric outpatients. Score on the Toronto Alexithymia Scale were significantly correlated with those on the Emotional Intelligence Scale, suggesting that alexithymic characteristics are related to lower emotional intelligence. In conclusion, these data suggest that emotional intelligence overlaps with alexithymia.     

Processing of facial expressions of negative emotion in alexithymia: the influence of temporal constraint

Alexithymia, a characteristic involving a limited affective vocabulary appears to involve three components: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. There is evidence that alexithymic characteristics are associated with differences in emotion information-processing. We examined the role of temporal factors in alexithymic emotion-processing deficits, taking into account the confound between alexithymic characteristics and positive and negative affectivity. One hundred forty-six participants completed the 20-item Toronto Alexithymia Scale and the Positive and Negative Affect Schedule. In a signal-detection paradigm, participants judged facial expressions depicting neutral or negative emotions under slow and rapid presentation conditions. The alexithymia component of difficulty in describing feelings was inversely related to the ability to detect expressions of negative emotion in the speeded condition. This relationship was independent of positive and negative affectivity. Alexithymic components positive and negative affectivity were unrelated to response bias. The results emphasize the influence of difficulty describing feelings within the alexithymia construct and its difference from positive and negative affectivity. They suggest that an alexithymic deficit in describing feelings is associated with a deficit in processing negative emotions that is most apparent when processing capacity is challenged. Theoretical and methodological implications are discussed.     

The Construct Validity of the MMPI Alexithymia Scale With Psychiatric Inpatients

Relatively few studies have addressed the issue of the Minnesota Multiphasic Personality Inventory (MMPI) alexithymia scale's construct validity. In this study, the validity of the scale is supported by the finding of a significantly lower percentage of alexithymic individuals in a large sample of psychiatric inpatients than in samples of patients with a variety of physical disorders (i.e., migraine headaches, asthma bronchitis/emphysema, and hypertension). Validity of the scale is further supported through a comparison of the alexithymic and nonalexithymic psychiatric inpatients on a series of Rorschach and MMPI variables. As predicted, alexithymics were less verbally productive, displayed less ability to fantasize, and demonstrated greater defensive pseudonormality. Results suggest the measure may be of value in studies of psychiatric patients as well as those with physical disorders.     

The construct validity of the MMPI alexithymia scale with psychiatric inpatients

Relatively few studies have addressed the issue of the Minnesota Multiphasic Personality Inventory (MMPI) alexithymia scale's construct validity. In this study, the validity of the scale is supported by the finding of a significantly lower percentage of alexithymic individuals in a large sample of psychiatric inpatients than in samples of patients with a variety of physical disorders (i.e., migraine headaches, asthma bronchitis/emphysema, and hypertension). Validity of the scale is further supported through a comparison of the alexithymic and nonalexithymic psychiatric inpatients on a series of Rorschach and MMPI variables. As predicted, alexithymics were less verbally productive, displayed less ability to fantasize, and demonstrated greater defensive pseudonormality. Results suggest the measure may be of value in studies of psychiatric patients as well as those with physical disorders.     

Alexithymia in chronic urticaria patients

Alexithymia has been described as an important dimension in several medical and psychiatric diseases. Chronic urticaria (CU) is a chronic condition, in which treatment is difficult. Our aim is to determine the prevalence of alexithymia traits in patients with CU, and to identify the relationships between alexithymia and psychological variables and quality-of-life dimensions. Fifty-five sequential CU patients in a faculty ambulatory specialized consultation, with an average age of 44.92, were compared with 31 healthy volunteers. Both groups were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale [TAS-20]), attachment (Adult Attachment Scale-R [AAS-R]), psychopathology (Brief Symptom Inventory [BSI]), personality dimensions (The NEO Five-Factor inventory [NEO-FFI]) and quality of life (Short Form-36 [SF-36]). The classification of CU reactions was obtained from the patient's history, physical examination, laboratory assessment and histopathologic findings. All the patients were under treatment with sedating H1-antihistamines, non-sedating H1-antihistamines combination of H1 and H2 blocker, 2 H1-antihistamines and 3 H1-antihistamines. High traits of alexithymia were found on CU patients (56.9%) as well as high symptom rates of anxiety. Alexithymia traits were significantly positively correlated with insecure attachment styles, with psychopathological symptoms, and with the defense mechanism turn against self. We also reported a significant negative correlation between alexithymia traits and the dimensions of quality of life. Insecure attachment styles were positively correlated with psychopathological symptoms and negatively correlated with quality of life. We did not find significant statistical correlations between alexithymia and clinical variables. CU patients present serious difficulty in dealing with emotion arousal. There is strong evidence of a psychosomatic specificity in CU, with marked alexithymic traits.     

Alexithymia and hypersensitivity to touch and palpation

Alexithymia appears to be directly related to the process of somatization of psychological distress that has not found verbal expression. The lack of a meaningful dialogue between mother and child in early infancy may predispose the development of an alexithymic strategy in expressing psychic and psychosocial stress. This can occur in the form of unpleasant bodily sensations or pain. The human skin is, in addition to the oral and gastrointestinal organs, the earliest contact sphere between the young infant and the environment. In a group of 312 randomly chosen patients at an outpatient primary health care clinic a significant relationship was found between palpational hypersensitivity to touch on the one hand and somatization proneness and the degree of alexithymia on the other hand.     

Cognitive Alexithymia Mediates the Association Between Avoidant Attachment and Interpersonal Problems in Patients With Somatoform Disorder

Patients with somatoform disorder (SFD) are characterized by the presence of chronic physical complaints that are not fully explained by a general medical condition or another mental disorder. Insecure attachment patterns are common in this patient group, which are often associated with interpersonal difficulties. In the present study, the mediational role of two types of alexithymia and negative affectivity (NA) was examined in the association between attachment styles and interpersonal problems in a group of 120 patients with SFD. Patients were requested to fill out several self-report questionnaires for the assessment of attachment strategies, alexithymia, NA, and interpersonal problems. Cognitive alexithymia (i.e., the inability to identify and verbalize emotions) mediated the relationship between avoidant attachment patterns and interpersonal problems, even after controlling for NA. Preliminary findings also suggested that NA acted as a moderator of the mediator cognitive alexithymia. These results have important implications for clinical practice, as this study clearly shows that interpersonal problems do not automatically follow from insecure attachment strategies, but are contingent upon alexithymic features. It is recommended to target alexithymic features in patients with SFD, particularly in the context of negative emotions. Therefore, cognitive alexithymia may be an important therapeutic focus, specifically in the treatment of avoidant ptients with SFD.     

Alexithymie et élaboration verbale de l’affect chez des adultes souffrant d’une pathologie respiratoire

Alexithymia is a deficit in the cognitive processing of emotion. From a psychoanalytic perspective, alexithymia can be conceived as a disorder of affect mentalization. The present study proposes an original angle for the study of alexithymia by using an innovative method for the evaluation of affect mentalization through the analysis of discourse: the grille de l’élaboration verbale des affects (GÉVA). The GÉVA was applied to the discourse of 62 participants suffering from a respiratory disorder and whose level of alexithymia was previously assessed with the Beth Israel Hospital Psychosomatic Questionnaire (BIQ). Results show that the alexithymic participants’ discourse presents lower levels of verbal elaboration of affect as well as a lower proportion of emotional content compared to the non alexithymic participants’ discourse.     

Non-verbal expressivity in alexithymia: A study on emoji use in text messaging across varying levels of alexithymia

The present study examined whether emoji use would be quantitatively and/or qualitatively altered in alexithymia. 646 individuals (Mean Age = 23.11, SD = 7.03; 424 Female) with varying levels of alexithymia took part in a series of vignettes where they were positioned as senders of hypothetical text messages. Participants were tasked to opt in or out of tagging an emoji onto positive and negative text messages. Emoji use frequency was diminished at the high end of the alexithymic continuum, relative to the middle and low spectrums. However, emoji for positive and negative text messages were used with similar patterns of frequency across alexithymic groups of varying severity, suggesting that emoji use is quantitatively but not qualitatively altered in alexithymia.     

Alexithymia and Affect Intensity of Fine Artists

Research on creative artists has examined mainly their personality traits or cognitive abilities. However, it seems important to explore also their emotional traits to complete the profile. This study examines two emotional characteristics: alexithymia and affect intensity. Even if most research suggests that artists are less alexithymic and experience more intensively their emotions, Botella, M., Zenasni, F., and Lubart, T. (Psychology of Aesthetics, Creativity, and the Arts, 5 , 251, 2011) observed that art students were as alexithymic as psychology students and more alexithymic than a normative population. The aim of this study was to examine these issues with artists and non‐artists and to compare artists to art students. Results indicate that artists are less alexithymic and present higher affect intensity than non‐artists. Moreover, results show that art students present more difficulties processing their emotions than artists.     

Alexithymia, emotional disclosure, and health: a program of research

This article reviews a program of research on alexithymia, emotional disclosure, and health. The article first describes two lines of research and then outlines current work attempting to integrate these lines. The first research line involves basic correlational studies on alexithymia's link to health problems; these studies suggest that alexithymia is a potential risk factor for symptoms and illness behavior, although not necessarily organic disease. The second research line involves experimental studies of the health effects of emotional disclosure via expressive writing or talking; these studies suggest that disclosure improves health on average, but that the effects are not that robust and that various moderators likely are involved. The next section of the article describes recent attempts to integrate the two research lines by examining how baseline levels of alexithymia influence the effects of emotional disclosure; these analyses suggest that alexithymia interferes with or attenuates the health benefits of disclosure. Finally, the article describes initial forays into research on interventions with the alexithymic patients. This evolving program of research demonstrates the value of integrating emotion, personality, and health, and highlights the bidirectional relationship between clinical problems and basic research.     

Understanding alexithymia in female adolescents: The role of attachment style

Adults with alexithymia retrospectively report emotional difficulties with caregivers during childhood. However, the association between attachment style and alexithymic traits may be evident at an earlier stage than adulthood, i.e. during adolescence. Sixty school-based healthy females aged 9–18 years (mean 14.08, SD 2.71 years) participated in an Attachment Style Interview (ASI) and completed the Toronto Alexithymia Scale (TAS-20). Greater levels of alexithymia were exhibited by both anxious and avoidant insecurely attached groups compared to securely attached participants. Fear of separation (characteristic of anxious attachment style) predicted both overall alexithymia scores and the specific alexithymic trait of ‘difficulty identifying feelings’ (DIF). Constraints on closeness (an avoidant attachment attitude) predicted ‘difficulty describing feelings’ (DDF). Low felt attachment to primary caregiver was a predictor of ‘externally oriented thinking’ (EOT). These findings indicate that features of anxious and avoidant insecure attachment styles are differentially related to the separate facets of alexithymia in female adolescents. Specifically, the findings concerning fear of separation may reflect the adolescent struggle for autonomy and the resulting effects on the affect regulation system. Our results also suggest that the normative differentiation of the emotional and cognitive aspects of alexithymia may occur on a developmental trajectory.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

Intergenerational association of alexithymic characteristics for college students and their mothers.

The intergenerational association of alexithymic characteristics of mothers and their children were examined in a sample of 232 pairs of college students and their mothers. Scores on the Toronto Alexithymia Scale, Parental Bonding Inventory, and the Family Environmental Scale of college students were significantly correlated with their mothers' memories of when they were also 20 years old. College students' scores were significantly correlated with their mothers' scores on each questionnaire. The student-mother pairs were further divided into two family types, nuclear and extended families. Correlations were higher for scores of the nuclear family than for those of the extended family. Such results suggest there may be intergenerational transmission of alexithymia and related factors from mothers to children.     

The stability of alexithymia during work in a high‐stress environment: A prospective study of Swedish peacekeepers serving in Kosovo

Larsson, M. R., Bäckström, M., Michel, P.‐O. & Lundh, L.‐G. (2010). The stability of alexithymia during work in a high‐stress environment: A prospective study of Swedish peacekeepers serving in Kosovo. Scandinavian Journal of Psychology. We applied a prospective design to reinvestigate the issue whether the sub‐domains of alexithymia could be considered stable traits or distress‐related states. Assessments of alexithymia and subjective distress were conducted before deployment to Kosovo in a sample of male peacekeepers. A second assessment was conducted approximately six months later during the final phase of service. The results showed evidence of moderate to high relative stability in all alexithymic sub‐domains. It was also found that a relative change in subjective distress predicted a relative change in difficulty identifying feelings and difficulty describing feelings but not in externally oriented thinking. We suggest therefore that the alexithymic sub‐domains could be considered relatively stable traits but that the level of difficulty identifying and describing feeling varies with the level of subjective distress.     

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM ) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self‐awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem‐focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally‐oriented thinking factor of alexithymia significantly explained both problem‐ and emotion‐focused coping, while the difficulty‐describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.