The prevalence of non-suicidal self-injury (NSSI) among adolescents underscores the importance of understanding the complex factors that drive this behaviour. Framed within broader constructs of emotional regulation theories, alexithymia and peer victimisation are thought to interact to influence NSSI behaviours.

This research addresses whether alexithymia and peer victimisation serve as risk factors for NSSI and, if so, how these factors interact with each other.

This quantitative study analysed data from 605 adolescents, using a range of validated self-report measures including the Toronto Alexithymia Scale. Statistical analyses including one-way analysis of variance, multiple regression and structural equation modelling were employed to scrutinise the relationships among the variables.

Alexithymia and peer victimisation significantly predicted NSSI behaviours. Specifically, the ‘difficulty in identifying feelings’ subscale of alexithymia emerged as a noteworthy predictor of NSSI (P < 0.001). Peer victimisation mediated the relationship between alexithymia and NSSI, explaining approximately 24.50% of alexithymia's total effect on NSSI. In addition, age was a significant predictor of NSSI, but gender and education years were not (P > 0.05). These relationships were found to be invariant across genders.

This study enriches our understanding of the interplay between alexithymia, peer victimisation and NSSI, particularly within the Chinese context. Its findings have significant implications for a rethinking of alexithymia's theoretical construct and interventions targeting emotional literacy and peer dynamics among adolescents. Future research could benefit from a longitudinal design to establish causality.

Alexithymia is considered a personality trait characterized by difficulties in identifying and expressing emotions, impoverished fantasy life and tendency toward action-oriented or ‘operational’ Thinking. There are alterations in cognitive processing and regulation of emotions, and tendency to somatization.

The authors examine literature regarding the concept of alexithymia, exploring the current definition and role in the clinic, research findings and proposed management.

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

Alexithymia is not a discrete psychiatric diagnosis. It has been reported in 9-10% of the general population. It is related to numerous psychiatric disorders (substance use disorders, anxiety disorders, depression and eating disorders), but also to somatic illnesses (essential hypertension, functional gastrointestinal disorders, diabetes mellitus, psoriasis, fibromyalgia and cancer pain). Neuroimaging and neurobiological studies found evidence for morphological and functional brain alterations that integrate the classification introduced by Bermond. Affective type I is characterized by the absence of emotional experience and, consequently, by the absence of cognition accompanying the emotion (associated to right unilateral cortical lesions). Cognitive Type II is characterized by a selective deficit of emotional cognition with sparing of emotional experience (associated to a right-to-left unidirectional deficit in interhemispheric transfer).

There is little consensus on the subject. Clarification of the mechanisms underlying alexithymia can improve our management of these individuals. Identification of effective strategies could improve the patients’ capacities for adaptive emotional processing and enhance other aspects of functioning.

No significant relationships.

Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients.

To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression.

We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10-3).

According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients.

No significant relationships.

Alexithymia is a construct which has been described in persons under the autistic spectrum. Besides Autistic Spectrum Disorders, alexithymia nowadays is highly correlated with several psychiatric disorders, among them being Eating Disorders. Several studies suggested a “cognitive-affective” division in the inner experience of patients with Anorexia Nervosa, because of their difficulty in describing, identifying and recognising their own emotions as well as others

This study aims to identify how many adolescents diagnosed with Anorexia Nervosa meet the characteristics of alexithymic personality traits and in which domain of these traits they had the most struggles with.

The study lot includes 34 adolescents diagnosed with Anorexia Nervosa evaluated by a self report survey: Online Alexithymia Questionnaire-G2 (OAQ-G2). The cut-off scores are: 113 and above - correlated with alexithymia, 95-112 - correlated with possible alexithymia and under 94 - insignificant clinical score. We analyzed the result of every subcategory of the questionnaire in order to determine whether there is an area affected more than others.

The sample included 34 patients, female to male ratio 31:3, evaluated in the Department of Child and Adolescent Psychiatry, “Prof. Dr. Alexandru Obregia” Psychiatry Hospital. 29,41% had clinically semnificative scores for alexithymic traits, while 52,94% scored for possibile alexithymia according to the OAQ-G2.

In 82,35% of patients from the lot we identified alexithymic personality traits. The F1 subcategory (difficulty identifying feelings) and F5a (problematic interpersonal process) were the ones that distinguished the alexithymic group from the possible alexithymic one.

No significant relationships.

Eating disorders and borderline personality disorder can coexist with high frequency in people with alexithymia. At the same time, it has been described that alexithymia can be present in patients suffering from depression, anxiety, obsessive-compulsive disorders, PTSD and eating disorders, among others. In this sense, it has been described that alexithymia could help maintain eating disorder.

To review the existing literature on the relationship between alexithymia, emotional instability and a family history of autism spectrum traits with the development of eating disorders. To expose, through the clinical case of a patient with eating disorders, the diagnostic complexity and evolution after the beginning of a comprehensive and multidisciplinary therapeutic plan with different mental health devices.

To review the personal and family psychopathological aspects and the clinical evolution of a patient with a diagnosis of restrictive subtype anorexia nervosa since its inclusion in a therapeutic program.

This is a longitudinal study through personal biographical reconstruction and family history and subsequent follow-up of a clinical case based on the implementation of an individualized therapeutic program and the results obtained.

Currently there is evidence in the literature that finds a high correlation between alexithymia and eating disorders. However, these findings are believed to be influenced by other comorbid symptoms such as depression or anxiety. Furthermore, the diagnosis of ASD in people with AN is a complex process that requires a thorough clinical evaluation over time. Detailed studies are needed to determine the importance of these factors in the development of an eating disorder.

No significant relationships.

Patients with “personality disorder”, has history of traumatic life events and are predisposed to develop alexithymia and dissociation, considered as risk factor for severity.

The aim of the research is to analyze alexithymia relating to dissociative symptoms, and investigate their associations, in 34 patients with personality disorder.

Outpatients with personality disorder relating to Mental Health Centre have been identified and tested with the Dissociative Experiences Scale, the Parma Scale for Personality Functioning and the Toronto Alexithymia Scale.

There was no significant association between age of patients and presence of alexithymia (r=-0.16) and dissociation (r=-0.19); most patients with alexithymia and dissociation were female (67%; 0.67%). 71% of alexithymic subjects had attended lower secondary school, 50% upper secondary school and 43% had a university degree. Substance use is higher in alexithymic patients (73%). 69% of subjects who do not undergo any individual or group psychotherapy are alexithymic; for dissociative symptoms it is significant to undergo both psychotherapies. Alexithymia and dissociation are more frequent in histrionic personality disorder (80%; 60%) and borderline personality disorder (55%; 54%). There is a potential correlation between alexithymia and the presence of dissociative symptoms (r=0.64).

This study found that alexithymia and dissociative symptoms are frequent within personality disorders, particularly in histrionic and borderline personality disorder. We found that the two phenomena were associated. Furthermore we found alexithymia is more influenced by external factors than dissociative symptoms.

No significant relationships.

Primary Headache, including Tension-Type Headache (TTH), represents one of the most common somatic disorders in children and adolescents with a strong impact on quality of life. Several risk factors, as environmental, familiar, and psychological features, including personality traits, are related to the development of Primary Headache. However, studies on specific subgroups of TTH are relatively few in early adolescents.

Therefore, this cross-sectional pilot study aims at exploring the role of anxiety and alexithymia in early adolescents with and without TTH.

A sample of 70 early adolescents (Mage=14.59, SD=1.85; 71% females) consisting of a clinical group (31 with TTH) enrolled in an Italian Child Neuropsychiatry Clinic and a comparison group (38 without TTH) enrolled in schools, matched on gender and age, completed: 1) Multidimensional Anxiety Scale for Children (MASC) to detect the Total levels of Anxiety, also in their factor of Physical Symptoms, Social Anxiety, Harm Avoidance, and Separation Anxiety; 2) the Toronto Alexithymia Scale (TAS-20) to detect the Total levels of Alexithymia, also in their factor of Difficulty to Identifying and to Describing Feelings and Externally Oriented Thinking.

TTH outcome positively correlated with Harm Avoidance (rho=.68, p<.001) and Total Alexithymia (rho=.72, p<.001). In a logistic regression, Harm Avoidance and Total Alexithymia predicted 69% of the variance in TTH outcome (p<.032).

This disorder may be a maladaptive strategy to cope with problems and feeling emotions, then early adolescents could be fostered in the acquisition of more adaptive emotion regulation abilities.

No significant relationships.

Emotion processing deficits have been identified as a critical transdiagnostic factor that facilitates distress after trauma exposure. Limited skills in identifying and labelling emotional states (i.e. alexithymia) may present on the more automated (less conscious) end of the spectrum of emotional awareness and clarity. Individuals with alexithymia tend to exhibit a disconcordance between subjective experience and autonomic activity (e.g. where high levels of subjective emotional intensity are associated with low physiological arousal), which may exacerbate distress. Although there is a robust link between alexithymia and trauma exposure, no work to date has explored whether alexithymia is associated with emotional response disconcordance among trauma-exposed adults.

Using a validated trauma script paradigm, the present study explored the impact of alexithymia on emotion response concordance [skin conductance (Galvanic Skin Response, GSR) and Total Mood Disturbance (TMD)] among 74 trauma-exposed adults recruited via a posttraumatic stress disorder (PTSD) treatment clinic and student research programme.

Unlike posttraumatic symptom severity, age, sex, participant type and mood (which showed no effect on emotion response concordance), alexithymia was associated with heightened emotion response disconcordance between GSR and TMD [F(1, 37) = 8.93, p = 0.006], with low GSR being associated with high TMD. Observed effects of the trauma script were entirely accounted for by the interaction with alexithymia, such that those with alexithymia showed a negligible association between subjective and physiological states.

This finding is paramount as it shows that a large proportion of trauma-exposed adults have a divergent emotion engagement profile.

Professional burnout syndrome (PBS) is currently considered from the perspective of value-oriented sense –of underlying psychological factors contributing to PBS development promotes the relevance of this study.

The study population included 81 medical professionals from out-patient polyclinic healthcare institution, among which 47(58%) healthcare professionals showed symptoms of burnout (mean age – 38,5±11,4 years old).

‘Attitude to Work and Professional Burnout’ by V.A. Vinokur, ‘Coping Strategies’ by S. Folkman and R. Lazarus Р., Spielberg’s Questionnaire; TAS-26; Emotional Response Scale by A. Megrabyan and N. Epstein.

The correlation analysis revealed certain interdependencies between the professional burnout symptoms and personal qualities of subjects. Thus, the higher burnout level correlated with increased emotional burnout (r=0,871; p=0,016), reduced professional satisfaction (r=0,624; p=0,031), poorer health and adaptation (r=0,872; p=0,023), increased state anxiety (r=0,551; p=0,000), increased alexithymia scores (r=0,823; p=0,017); reduced empathy scores as emotional response to others’ emotional experience (r=0,466; p=0,000) and reduced willingness to involve into other people’s issues (r=0,564; p=0,032). No statistically significant correlations between TAS total alexithymia score and empathy score were demonstrated.

The healthcare professionals employed at the out-patient polyclinic units belong to the at-risk population group of professional burnout syndrome development. The individuals with higher burnout levels show typical specific correlations of empathy forms: in particular, decreased ability to differentiate one’s feelings from feelings of others, increased emotional sensitivity and reduced willingness to involve into other people’s issues are usually observed.

Studies indicated that breast cancer cause alexithymia that having adverse effect on resilience. Recognizing and expressing emotions are very crucial to cope with the difficulties.

This study aimed to examine the role of alexithymia on psychological resilience and related variables in women with breast cancer.

In this descriptive study, 70 women with breast cancer who apply to a medical oncology outpatient between June 2019-February 2020 were included. 9-questions questionnaire was used to determine the sociodemographic and cancer related characteristics of the participants. The Multidimensional Scale of Perceived Social Support (MSPSS), Toronto Alexithymia Scale (TAS-20), Psychological Resilience Scale (PRS) were used to determine perceived social support, alexithymia and psychological resilience levels. Descriptive statistics, correlations, ANOVA and t-test were used for data analysis.

The MSPSS (20.07 ± 10.54) and TAS-20 were found low (47.71 ± 11.96) and PRS were high (132.24 ± 16.47). A negative, weak, significant relationship was found between the alexithymia (r=-0.370, p=0.02) and perceived social support (r=-0.496, p=0.01) with psychological resilience. There was no significant difference between the psychological resilience and age, education level, marital status, having children, profession, employment status, duration of illness, type of treatment, having metastases, and becoming caregiver (p> 0.05).

The psychological resilience of women with breast cancer was negatively related to their alexithymia and perceived social support levels. It indicates that being able to recognize the emotions and having social support systems would positively affect the recovery process.

No significant relationships.

The problem of specificity of psychological adaptation mechanisms at the patients with Type 2 Diabetes Mellitus (T2DM) is extremely actual. The aim is to investigate gender psychological characteristics associated with T2DM

In the comparative study 62 patients (28 male, 34 female; mean age 56,8±2,3 and 55,4±2,7 yrs.) with T2DM (HbA1c 7,3±1,3%) and visceral obesity (Grade 2) were included.

Research methods: the Depression Scale of Zung, the Spielberger trait scale anxiety, Toronto Alexithymia Scale and MMPI test

T2DM-female-patients in comparison with T2DM-male showed significantly higher personal anxiety scores (51,2+7,6 and 44,1+10,6 respectively; р<0,05), depression scores (44,2+7,6 and 36,7+8,4 respectively; р<0,05), while alexithymia scores were higher at T2DM-males (68,2+9,6 and 71,7+6,4 respectively; p<0,05). In MMPI test (after correction by K-scale) 46,8% of patients demonstrated profiles with elevated scale 1 score (above 70 Т-scores, but below 80 Т-scores) regardless of gender differences. However, the T-scores for T2DM-male patients were on the average by 1,07 higher than for T2DM-female (58,4 vs 54,4 respectively, р˃0,05), that indicated more higher concern related to own physical health condition. The female T2DM-patients significantly more often demonstrated profiles with scale 6 peak (exceeding 65 Т-scores): 79,4% vs. 21,4%, which indicated the more higher accentuation of personality traits (concealed hostility; protest; rigidity, desire to blame the others for one’s failure, et cetera)

The patient’s gender has to be taken into consideration at development of clinical, diagnostic and prevention activities of patients with T2DM and visceral obesity.

Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.

To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.

This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.

Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.

SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.

Alexithymia, that is the inability to recognize and describe one’s own emotions, is a transdiagnostic feature across eating disorders (EDs) and it has been associated to a prolonged stress exposure.

Therefore, we evaluated whether alexithymia affects the hypothalamus-pituitary-adrenal (HPA) axis functioning in patients with anorexia nervosa (AN) or bulimia nervosa (BN).

Twenty-six women with AN and 26 with BN participated in the study. Alexithymia was evaluated by the Toronto Alexithymia Scale–20 and eating-related psychopathology was measured by the Eating Disorder Inventory-2. The activity of the HPA axis was assessed by the salivary cortisol awakening response (CAR). Group differences in saliva CAR were tested by repeated measures 3-way ANOVA with diagnosis and alexithymia as between-subject factors.

The prevalence of alexithymia did not differ significantly between the two diagnostic groups (c2=1.24, p=0.26). Alexithymia was associated with more severe eating-related psychopathology in AN women but not in BN women. A significant reduction in the magnitude of CAR occurred in alexithymic patients with BN compared to non-alexithymic patients with BN (t = 3.39, p = 0.008), but not in alexithymic women with AN (t = 0.67, p = 0.54).

These results confirm the presence of a more severe eating-related psychopathology in alexithymic individuals with AN and show, for the first time, an association between alexithymia and a dampened basal activity of the HPA axis in BN.

No significant relationships.

Some research suggests that mental health problems can be brought on by the stress of having unexplained symptom. In non-western cultures especially, psychological distress is often communicated through multiple somatic complaints. The biopsychosocial model takes into consideration all factors affecting health and disease, supporting the integration of biological, psychological and social factors in the assessment and treatment.

In our study we assess prevalence of alexithymia as a potential psychopathological attribute manifesting as unexplained somatic symptoms

196 patients aged 18 to 60 with unexplained physical symptoms for at least three months, after collection of demographic data, medical and psychiatric history, were subject to Arabic version of the following scales : patient health questionnaire PHQ-15 to assess severity of somatic symptoms, patient health questionnaire PHQ-9 to assess depressive symptoms, generalized anaxiety disorder GAD-7 to assess general anxiety disorder symptoms and Toronto Alexithymia scale TAS to assess alexithymia

90% of ours ample were female patients, 49,5% showed alexithymia, 27,6% were borderline alexithymic and 23% had no alexithymia. Patients with unexplained physical symptoms showed moderate to high depressive symptoms in 81,1% of the sample, moderate to severe anxiety symptoms in 73,5%. Severity of somatic symptoms as assessed by PHQ-15 were significantly highly correlated to scores for Alexithymia (TAS), depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) p<0,001

Alexithymia is prevalent among patients with unexplained physical symptoms. This later population has high prevalence of depressive and anxiety symptoms that go with the severity of somatic manifestations

The relationship of alexithymia with gambling addiction is not obvious, but it is present, as evidenced by the results of many studies. Alexithymia is likely to associate with gambling as a coping behavior to increase emotional arousal and avoid negative emotions, according to the affect dysregulation model. Alexithymic individuals experience the same spectrum of emotions as ordinary people, however, from the standpoint of psychology, psychiatry, unexpressed emotions are repressed into the subconscious, and their bodily manifestations accumulate.

We plan to conduct research to improve the medical and psychological support of patients with pathological gambling due to the presence of alexithymia.

A systematic search of the literature was run in the major reference databases including PubMed, Cochrane Database for Systematic Review, Web of Science, Scopus until 2019. All studies assessed alexithymia with the Toronto Alexithymia Scale while gambling problems were assessed mostly with the South Oaks Gambling Screen.

We assume that for pathological gamblers, specific psychotherapeutic techniques like body-centered psychotherapy could help them to differentiate feelings from bodily sensations.

The results highlight the importance of taking in the relationship between alexithymia and pathological gambling. Further studies are needed to widen the knowledge of this association.

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.

In total, 337 adolescents and adults (autism N = 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 N = 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.

Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r 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 describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44–0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07–0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41–0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08–0.62).

Our findings suggest that difficulties in identifying v. 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.

This study examined how alexithymia subscales, depression and obsessive-compulsive personality(OCP) relate to eating disorder tendency (EDT) in non-clinical Japanese female adolescents.

A self-report questionnaire survey was conducted on 393 Japanese female adolescents (273 undergraduates and 120 college students, mean age=19.9yrs, SD=1.4).

A stepwise multiple regression analysis was conducted, indicating that “difficulty in identifying feelings”(DIF) (β=.17, p< .01) and “difficulty in describing feelings” (DDF) (β=−.15, p< .01), which are factors of alexithymia, depression (β=.30, p< .001) and OCP (β=.14, p< .05) predicted EDT. Depression had the strongest effect on EDT, with DIF the second strongest. Surprisingly, DDT had a significantly negative effect on EDT.

First, prevention and therapy of eating disorder should focus on depression, difficulty in identifying feelings, and obsessive-compulsive personality. Second, one aspect of discontinuity between clinical and non-clinical females with high risk of eating disorder was implied: Non-clinical females with high risk of eating disorder may tend to describe at least superficial feelings frequently, if not deep or real feelings with introspection. Further, the possibility of describing may work as a preventive factor for non-clinical females with high risk of eating disorder against suffering from clinical eating disorder.

Table 1:

Results of stepwise multiple regression analysis predicting EDT