Alexithymia and temperament and character model of personality in alcohol-dependent Turkish men

Aims:  Alexithymia, a personality trait characterized as having problems identifying, describing, and working with one's own feelings, often marked by a lack of understanding of the feelings of others, is only partly described within the context of personality. The aim of the present study was therefore to study the prevalence of alexithymia among male alcohol-dependent inpatients and investigate the relationship between alexithymia and the dimensions of Cloninger's psychobiological model of personality.
Methods:  The Turkish version of the Toronto Alexithymia Scale (TAS-20) and the Turkish version of the Temperament and Character Inventory (TCI) were administered to 111 male alcohol-dependent inpatients.
Results:  TAS-20 scores correlated positively with harm avoidance and self-transcendence and negatively with self-directedness and cooperativeness. Regression analysis identified high harm avoidance and self-transcendence and low self-directedness as independent predictors of alexithymia. Also harm avoidance and self-transcendence predicted alexithymia in a logistic regression model.
Conclusions:  Alexithymia can be explained by specific dimensions within Cloninger's psychobiological model of personality in alcohol-dependent Turkish men.     

Personality and Alexithymic Disparity in Obsessive-Compulsive Disorder Based on Washing and Checking

The aim of this study was to investigate pathway relationship of personality characteristics and alexithymic traits in OCD symptoms of obsession, and compulsive behavior of washing and checking. Two-hundred and seventy patients diagnosed with OCD were consecutively recruited from the psychiatric outpatient department of a teaching hospital. Structural equation modeling showed those more neurotic, less extraverted and with higher levels of alexithymia difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT) were more likely to develop obsessive thoughts. Those less extraverted was more prone to develop washing compulsions, and those more neurotic were more likely to develop checking compulsions. EOT was the only alexithymic trait to have no gender difference within this group of patients with OCDs. The different personality and alexithymic trait pathways found between OCD obsession, washing and checking symptoms provide support that they may be different subtypes within the OCD diagnosis. Obsession was associated with washing, but not checking. Furthermore, no gender difference was found between the obsession and compulsive symptoms. Extraversion and neuroticism can be used to differentiate washing and checking, and alexithymia to differentiate washing and obsessions. This should be taken into consideration for intervention targeting patients with different OCD symptoms.     

The relationship of suicide attempt history with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality in substance dependents

The aim of this study was to evaluate the prevalence of suicide in Turkish male substance dependents, and to investigate the relationship of suicide attempt history with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Participants were 154 consecutively admitted male substance dependents. Patients were investigated with the Childhood Abuse and Neglect Questionnaire, Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Among substance-dependent patients, 28.6% was considered a group with suicide attempt history (SAH). Current age was lower and rate of being single was higher in the group with SAH. There were no significant differences between groups in terms of employment, educational status and duration of education. Rates of physical, emotional abuse and neglect, self-mutilation and being alexithymic were higher and ages at first substance use and regular substance use were lower in the group with SAH. Mean scores of "difficulty in identifying feelings" (DIF) and "difficulty in describing feelings" (DDF) subscale EOT of the TAS-20 were higher in the SAH group. Among temperament and character dimensions of the TCI, only "Self-directedness" and "Cooperativeness" were lower in SAH and there were no significant differences between groups in terms of other subscales. Age and Self-directedness score of TCI were determinants for suicide attempt. In particular, young drug users with low Self-directedness scores could be the target population in order to prevent suicidal behavior. This study also suggests that in substance-dependent patients, in the background of all suicidal behavior, childhood abuse and neglect must be evaluated.     

The relationship of alexithymia characteristics to dreaming

Objective: In two studies, we tested two hypotheses about the relationship of alexithymia to dreaming; that dreams of alexithymic people are barren and rarely recalled, and that the dreams are unregulated and nightmarish.Methods: Study 1 was a retrospective survey of dreaming among several hundred young adults, and Study 2 was a 1-week, prospective diary study of 153 young adults in which recall, content, and length of dreams were assessed.Results: Across both studies, the externally oriented thinking (EOT) facet of the Toronto Alexithymia Scale (TAS)-20 correlated with different dream characteristics than the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) facets, even after statistically controlling for the other facets. Greater EOT was related to an increased frequency of nights without dream recall, having shorter dreams, having dreams rated as boring and lacking vividness, and not believing in the importance of dreams. In contrast, greater DIF or DDF was related to an increased frequency of nights with disturbing dreams, and having dreams rated as bizarre and aggressive.Conclusion: We find support for both hypotheses, but different facets of the multidimensional alexithymia construct account for the two types of dream reports.     

Alexithymia in somatoform and depressive disorders

OBJECTIVE: Alexithymia and its association with attribution styles, amplification and illness attitudes was studied among subjects with somatoform disorders, depressive disorders and normal subjects. METHODS: Two groups of 30 subjects each, bearing diagnoses of somatoform disorder and depressive disorder respectively (ICD-10 DCR), and one group of 30 normal controls were recruited. The study subjects were assessed using the Toronto Alexithymia Scale and scales for assessing attribution styles, amplification and illness attitudes. RESULTS: Mean alexithymia scores in the somatoform (60.4) and depressive disorder groups (62.5) were higher than in normal subjects (54.2). In the somatoform disorder group, total alexithymia and 'difficulty describing feelings' scores positively correlated with psychological attribution (the latter correlation was also noted in the depressive disorder group), but not with the illness attitudes, amplification, somatic attribution scores or any of the sociodemographic variables. Compared with normal subjects, those with somatoform and depressive disorder had greater difficulty in identifying bodily sensations and feelings. Subjects with depressive disorder had more difficulty in expressing feelings compared to somatoform disorder subjects. CONCLUSIONS: While total alexithymia scores do not differentiate somatoform from depressive disorders, the two diagnostic groups do differ in that depressed subjects have greater difficulty in expressing feelings. However, all three groups had mean scores within the non-alexithymic range. Alexithymia and difficulty in expressing feelings were associated with psychological attribution of innocuous bodily sensations in the somatoform disorder group suggesting that alexithymic subjects are more able to psychologize bodily symptoms than non-alexithymic subjects. Somatoform and depressive disorder subjects and normals differ from each other in certain alexithymic characteristics, which could have potential therapeutic implications.     

Alexithymia—an independent risk factor for impulsive‐compulsive disorders in Parkinson's disease

Impulsive‐compulsive disorders (ICDs) are frequent side effects of dopaminergic medication in Parkinson's disease (PD). Alexithymia, a personality trait characterized by difficulties identifying and describing feelings and an externally oriented thinking style, has been linked to various impulse‐control problems in the general population. In PD, the prevalence of alexithymia is approximately twice as high as in the general population. However, whether alexithymia is associated with ICDs in PD is currently unknown. We examined the relationship between self‐reported ICDs and alexithymia in a sample of 91 PD patients (89 on dopaminergic medication). Additional self‐report measures assessed impulsivity, depression, anxiety, behavioral inhibition/approach, and emotion‐regulation strategies. We observed that alexithymia, and particularly difficulty identifying feelings and difficulty describing feelings, was significantly correlated with ICDs, even when controlling for impulsivity, anxiety, and depression. In addition, a group analysis revealed that PD patients with clinical and moderate levels of alexithymia had significantly more ICDs than non‐alexithymic patients, suggesting that even moderately high alexithymia levels increase the risk for ICDs in PD. Our results identify alexithymia as an independent risk factor for ICDs in PD. Thus, the inclusion of alexithymia in the neuropsychiatric assessment of patients with PD may help identify patients at risk for ICDs. © 2013 International Parkinson and Movement Disorder Society     

Alexithymia and temperament and character model of personality in patients with major depressive disorder

Alexithymia is thought to be a stable personality trait and a predisposing risk factor for depression. In this study, we aimed to identify the prevalence of alexithymia in a depressed and nondepressed sample and examined the relationship between Cloninger's psychobiological model of personality with alexithymia. The Turkish version of the 20-item Toronto Alexithymia Scale (TAS-20), the Turkish version of the Temperament and Character Inventory, and the 21-item Beck Depression Inventory (BDI) were administered to 81 depressed patients and 51 controls. The mean age of the groups was 30.5 ± 7.7 and 32.75 ± 8.73, respectively. Depression severity was evaluated with the BDI. In the depressed group, 33.3% were alexithymic, and alexithymic subjects had significantly higher BDI scores. Depressed individuals were significantly more alexithymic than the controls on the total and all the 3 subscales of TAS-20. The TAS-20 total score was negatively correlated with the temperament dimension of Reward Dependence (RD) and the character dimension of Self-Directedness (SD). In the TAS-20 subscale, difficulties in identifying feelings was positively correlated with Self-Transcendence and negatively correlated with SD. The difficulties in expressing feelings subscale was negatively correlated with RD and SD. In the depressed patient group, the temperament dimension of RD was significantly lower in the alexithymic group. The rate of alexithymia is found high among this sample of Turkish depressed patients, and the results suggested a strong connection between alexithymia and depression. Alexithymia is explained by specific dimensions and subscale within Cloninger's psychobiological model of personality in this sample of depressed Turkish patients.     

Alexithymia and affective expression in endogenous and non-endogenous depression

Clinical observations and psychopathological reports on patients with endogenous depression suggested a high frequency of alexithymic characteristics in these patients. 21 inpatients with unipolar endogenous depression and 21 inpatients with neurotic-reactive depression, classified according to ICD-9 and DSM-III criteria, were assessed with the content analysis method of Gottschalk-Gleser and the Beth Israel Alexithymia Questionnaire (BIAQ) as well as other questionnaires at two points of time. The gorup with unipolar endogenous depression showed significantly less separation anxiety, diffuse anxiety, total anxiety, hostility directed inward, total hostility and depressivity at both points of time. The endogenous depression group showed significantly higher scores in the BIAQ than the group with neurotic depression. The specifity of alexithymia in psychosomatic patients, its high frequency and the significance of this phenomenon in endogenous depression are discussed.     

Alexithymia and Self-Esteem in a Sample of Opioid Dependent Males: a Controlled Study

The aim of this study was to evaluate the prevalence of alexithymia in opioid dependents compared to the controls and to examine the relationship between alexithymia and depression, anxiety, and self-esteem in opioid dependents. Fifty male heroin-dependent outpatients who completed the detoxification process according to DSM-IV TR diagnostic criteria and 50 control subjects matched for age, gender, and education status who do not abuse heroin or any other substances were included in the study. Subjects were interviewed by using the Structured Clinical Interview for DSM-IV (SCID-I). Variables of interest were assessed according to Toronto Alexithymia Scale-20 (TAS-20), Rosenberg Self-Esteem Scale (RSES), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Forty-two percent of the opioid dependents were estimated as alexithymic according to the cut-off scores of TAS-20 (> 61), while this ratio was 10% for the control group. The mean TAS-20 score in the dependent group was significantly higher than in the control group. BDI, BAI, and RSES scores were also found to be significantly higher in the dependent group, particularly in the alexithymic opioid dependent group. There were significant positive correlations between TAS-20 and BDI, BAI, and RSES scores. Further studies are needed to understand the negative effects of alexithymia and lower self-esteem on opioid dependence.

     

Relationship of alexithymia and temperament and character dimensions with lifetime post‐traumatic stress disorder in male alcohol‐dependent inpatients

Aims: The purpose of the present study was to evaluate the prevalence of lifetime post‐traumatic stress disorder (PTSD) in male alcohol‐dependent inpatients and to investigate the relationship of PTSD with alexithymia and temperament and character dimensions. Methods: Participants were 156 consecutively admitted male alcohol‐dependent subjects. Patients were investigated using the Clinician‐Administered PTSD Scale (CAPS), the Toronto Alexithymia Scale (TAS‐20) and the Temperament and Character Inventory (TCI). Results: Among alcohol‐dependent inpatients 32.1% were considered as having lifetime PTSD. Mean scores of alexithymia, novelty seeking (NS), harm avoidance (HA) and self‐transcendence (ST) were higher in the PTSD group, whereas age and self‐directedness (S) were lower. Among age and other factors of TAS‐20, ‘difficulty in identifying feelings (DIF)’ predicted PTSD in a logistic regression model. When age and personality dimensions of TCI were taken as independent variables, S predicted PTSD in the logistic regression model. Finally, among subscales of TCI, ‘impulsiveness versus reflection’ (NS2) and ‘congruent second nature versus bad habits’ (S5) predicted PTSD. Conclusions: Alexithymia and personality traits, particularly high DIF and S scores are related with lifetime PTSD diagnosis, even when controlling for age among alcohol‐dependent inpatients. Causal relationships between alexithymia, personality dimensions and PTSD, and their implications on treatment are not clear and should be evaluated in longitudinal studies.     

Are alexithymia, depression, and anxiety distinct constructs in affective disorders?

OBJECTIVE: the present study was undertaken to gain a better insight into the relationship between alexithymia, anxiety, and depression. Two hypotheses were tested: (1) whether a depressive or anxiety disorder is associated with an elevation of one or more dimensions of alexithymia; and (2) whether alexithymia is an independent construct from depression and anxiety in patients with depressive or anxiety disorders. METHOD: a total of 113 patients with depressive or anxiety disorders (DSM-IV) and 113 control subjects completed the 20-item version of the Toronto alexithymia scale (TAS-20) and the hospital anxiety and depression scale (HADS). RESULTS: the TAS-20 total score was higher in depressed and anxious patients than in controls. This finding mainly depended on an increased score for "difficulty identifying feelings"(DIF), and (only in depressed patients) on an increased score for "difficulty communicating feelings" (DCF). The factor analysis of the TAS-20 and HADS items showed that depression is a construct different from alexithymia, whereas some overlap exists between anxiety and DIF dimension. CONCLUSION: our results suggest that in depressive and anxiety disorders, alexithymia and depression are separate constructs that may be closely related; in contrast, there are some overlaps between the DIF dimension and anxiety.     

The 20-item Toronto alexithymia scale: structural validity, internal consistency and prevalence of alexithymia in a Swiss adolescent sample

BACKGROUND: The alexithymia construct is mainly characterized by a difficulty in identifying and expressing feelings that is thought to reflect a deficit in cognitive processing and regulation of emotional states. During the last decade, alexithymia has been associated with a large variety of medical and psychiatric disorders in the adult population. Although adolescence is probably an opportune time to explore processes of emotion regulation, alexithymia has been rarely examined during this period. The 20-item Toronto alexithymia scale (TAS-20) is the most widely used self-report measure of alexithymia. For this scale, a three-factor structure was proposed: difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT). Research has yielded considerable evidence that the TAS-20 is a reliable and valid measure of alexithymia in normal and clinical adult samples. To date, no psychometric data concerning the use of the TAS-20 with adolescent samples are available. OBJECTIVES: The aim of the study is to provide psychometric data concerning the TAS-20 when administered to healthy adolescents. Furthermore, in a developmental perspective, this study explores the evolution of alexithymia across age groups in adolescence. METHOD: The TAS-20 was administered to a sample of 264 adolescents aged from 14 to 19 years. In order to compare alexithymia across age groups, the sample was divided into three groups: group 1 (<16 years old), group 2 (16-17 years old) and group 3 (>17 years old). RESULTS: Results of a confirmatory factor analysis (CFA) confirmed that the data fitted well to the three-factor model of the TAS-20 (chi(2)/df=2.22, GFI=0.88, AGFI=0.84 and RMSEA=0.068). The internal reliability coefficients and mean interitem correlations are acceptable for DIF (alpha>0.60; mean interitem correlation=0.22) and good for DDF (alpha>0.70, mean interitem correlation=0.33). As often reported in most translations of the TAS-20, the internal reliability of EOT is poor. Results of a one-way Anova showed a significant linear trend indicating that, with age, the level of alexithymia (TAS-20 total score), the difficulty in identifying feelings and the externally oriented thinking decreased. DISCUSSION: This study demonstrated that the TAS-20 has sufficient construct validity in a non-clinical sample of adolescents. Our results support the idea that adolescence period is associated with the development of the ability to regulate emotions.     

Defense styles, impulsivity and suicide attempts in major depression

BACKGROUND: The aim of our study was to identify if defense mechanisms are associated with impulsivity and lifetime suicide attempts in depressed patients. SAMPLING AND METHODS: The Defense Style Questionnaire, the Impulsivity Rating Scale and the Impulse Control Scale were used in 77 depressed inpatients. RESULTS: Impulsivity was correlated positively with immature and neurotic styles and negatively with mature style. Some but not all defense mechanisms were relevant in this respect. The number of lifetime suicide attempts was positively correlated not only with impulsivity, but also with immature style and to a lesser extent with neurotic style. Several defense mechanisms were involved in these correlations: undoing, projection, passive aggression, acting out, splitting and somatization. CONCLUSIONS: Like impulsivity, defense styles may be relevant to discriminate recurrent suicide attempters in depression. Prospective assessment of defense styles and suicide attempts in depression is needed.     

Sympathetic activity in alexithymics with mother’s low care

This study examines the relationships between alexithymic characteristics and their psychological factors (i.e., maternal closeness) and the sympathetic system in a sample of male college students. At the resting period, low frequency (LF)/ high frequency (HF) ratio, as an index of sympathetic activity, was significantly higher for students with high scores on global alexithymia or its alexithymia factor (difficulty describing feelings) than those with low scores, suggesting that alexithymic students tend to indicate high sympathetic activity during the resting period. During stress, the increase of LF/HF ratio was higher for students with low scores on alexithymia than those with high scores. Although no significant differences were noted, one may speculate that the differences in stress-related activation of LF/HF are due to higher levels of LH/HF in high alexithymics prior to stress. Our findings indicate that significant association between alexithymia and sympathetic activity during the resting period was controlled for the level of mother’s care, suggesting that maternal attachment in infancy and/or childhood may play an important role in the development of alexithymic characteristics and/or sympathetic activity during the resting period.     

The determination of defense style by questionnaire

The Defense Style Questionnaire was relabeled in terms of DSM-III-R defenses and administered to three groups: a normal population, family practice patients, and patients with anxiety disorders. The preferred factor structure identified mature defenses (sublimation, humor, anticipation, and suppression), neurotic defenses (undoing, altruism, idealization, and reaction formation), and immature defenses (projection, passive aggression, acting out, etc). Factor scores varied systematically with group membership and with measures of total symptoms. In this cross-sectional study, the vulnerability factors of neuroticism, locus of control, and defense style were all correlated with neurotic symptoms, but defense style added little to the variance explained by the other two. Within the patient group, however, neuroticism and locus of control did not distinguish among panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder, while defense style showed patterns characteristic of each disorder.     

Dissociation and alexithymia among men with alcoholism

Aim:  The aim of the present study was to evaluate the relationship between alexithymia and dissociation among men with alcoholism.
Methods:  Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State–Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants.
Results:  Fifty-three patients were considered as having alexithymia. The alexithymic group had a significantly higher rate of dissociative taxon members (patients with pathological dissociation; 62.3%) according to Bayesian probability. Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis. A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well.
Conclusion:  Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism. The relevance of this triad for prevention and treatment of alcoholism deserves interest in further research.     

Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking). but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.     

Alexithymia and Emotional Intelligence in Patients with Panic Disorder, Generalized Anxiety Disorder and Major Depressive Disorder

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.     

Do alexithymic traits predict illness?

The common theoretical speculation that alexithymic personality characteristics (impoverished fantasy life and difficulty expressing feelings verbally) lead to psychosomatic disease was tested in a sample of 181 men. Unlike previous investigations, this study used a measure of alexithymic characteristics taken at least 1 year before any of the men became ill. Comparisons were made of the premorbid MMPI alexithymia scale scores of groups of men who remained well for 10 years or within 10 years developed either physical illness (cancer or benign tumors), "classical" psychosomatic disease (hypertension or gastrointestinal ulcers), or psychiatric disorder (schizophrenia). Results did not support the notion that alexithymia leads to illness onset. There were no significant differences among the groups in their premorbid alexithymia scores. Furthermore, the groups did not differ in the percentage of individuals labeled alexithymic with the use of previously established cut-off points. Although the findings cast doubt on alexithymia as a cause of illness, they do not conflict with the idea that alexithymia can result from the stress of disease or that this type of personality configuration may lead to a decreased response to treatment and a prolonged course of illness.