Are alexithymia and depression distinct or overlapping constructs?: a study in a general population

The aim of this study was to investigate the relationship between alexithymia and depression in a general population sample (N = 1,888), as measured by the 20-item Toronto Alexithymia Scale (TAS-20) and the 21-item Beck Depression Inventory (BDI-21), using factor analysis. The items of the TAS-20 and the BDI-21 loaded on separate factors with only a minor overlap concerning physical worries. However, in a subset of subjects, who were both alexithymic and depressed, loadings were highly overlapping. These findings suggest that alexithymia and depression may be highly associated. Another conclusion might be that psychometric properties of the TAS should be further developed to make differentiation between alexithymia and depression possible.     

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.     

Coping and experiential avoidance: unique or overlapping constructs?

The present study examined associations between coping as measured by the Brief COPE and experiential avoidance as measured by the AAQ-II and the role of both constructs in predicting psychological distress and well-being. Specifically, associations between experiential avoidance and other types of coping were examined, and factor analysis addressed the question of whether experiential avoidance is part of coping or a related but independent construct. Results showed that experiential avoidance loads on the same factor as other emotion-focused and avoidant types of coping. The higher people are in experiential avoidance, the more they tend to utilize these types of coping strategies. Both experiential avoidance and coping predicted psychological distress and well-being, with most variance explained by coping but some additional variance explained by experiential avoidance. ANOVAS also showed gender differences in experiential avoidance and coping approaches. Results are discussed in light of previous relevant findings and future treatment relevant implications.     

Are typically-developing siblings of children with an autism spectrum disorder at risk for behavioral, emotional, and social maladjustment?

Existing literature regarding the adjustment of siblings of children with an autism spectrum disorder (ASD) remains inconclusive, with some studies showing positive adjustment, others showing negative adjustment, and others showing no difference when compared to siblings of typically-developing children. For the current study, 42 parents of a child with an ASD and a typically-developing sibling (ASD group) and 42 parents of two typically-developing siblings (control group) provided data via online questionnaires. Both diagnostic category and autism symptom severity were tested as possible moderators, but neither produced significant interactions with either externalizing behaviors or internalizing symptoms in the target child when predicting externalizing behaviors, internalizing symptoms, or social problems in the sibling. However, across the overall sample (ASD and control groups), maladjustment - particularly internalizing symptoms - in the target children significantly related to maladjustment in their siblings. Thus, these findings suggest that having a sibling with an ASD is neither a risk nor protective factor for maladjustment among typically-developing siblings above and beyond the relation between maladjustment among siblings in general. Given some of the mixed findings in the literature, other possible moderators that may put siblings of a child with an ASD at specific risk should be considered in future research.     

Are trail making and color trails tests of equivalent constructs?

The Color Trails Test (CTT) was developed as a culturally fair analogue of the Trail Making Test (TMT). This study examined the equivalence of these two tests for Chinese individuals in Hong Kong. One hundred and eight Chinese people volunteered for this study, and were classified into four groups according to their age and level of education. Their performance on these two tests was compared. The findings suggested that age and level of education indeed played significant roles in their performance on these two tests. Strong correlations (r = 0.72) were only observed between scores on Part B of the TMT and Part 2 of the CTT when the participants were older and had higher levels of education. This suggests that the equivalent construct of the Trail Making and Color Trails Tests can only be examined and established within specific age and education parameters.     

Traditional bullying and cyberbullying: Differences in emotional problems,and personality. Are cyberbullies more Machiavellians?

Few studies have examined differences in emotional problems and personality of traditional bullies and cyberbullies. The present study aimed to determine whether those engaged in cyberbullying differ in emotional problems, and personality from those engage in traditional bullying perpetration. An Argentinean sample of 898 high school students was recruited (56% female; mean age = 15.2 SD = 1.6). Adolescents completed measures of traditional bullying, cyberbullying, self-esteem, anxiety, depression, and personality. A 6% were traditional bullies; 8%, cyberbullies; and 4% were involved in both forms; the remainders were non involved. Results indicated that cyberbullies showed less depression and anxiety than traditional bullies. Also, cyberbullies scored low in neuroticism and high in agreeableness compared to traditional bullies. The results suggest that cyberbullies are characterized by an emotional and personality profile different from traditional bullies. In the discussion we analyze the implications of these results.     

Neuroimaging in disorders of social and emotional functioning: what is the question?

Social and emotional processing uses neural systems involving structures ranging from the brain stem to the associational cortex. Neuroimaging research has attempted to identify abnormalities in components of these systems that would underlie the behavioral abnormalities seen in disorders of social and emotional processing, notably autism spectrum disorders, the focus of this review. However, the findings have been variable. The most replicated anatomic finding (a tendency toward large brains) is not modular, and metabolic imaging and functional imaging (although showing substantial atypicality in activation) are not consistent regarding specific anatomic sites. Moreover, autism spectrum disorder demonstrates substantial heterogeneity on multiple levels. Here evidence is marshaled from a review of neuroimaging data to support the claim that abnormalities in social and emotional processing on the autism spectrum are a consequence of systems disruptions in which the behaviors are a final common pathway and the focal findings can be variable, downstream of other pathogenetic mechanisms, and downstream of more pervasive abnormalities.     

Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?

To investigate associations between social anxiety and smoking behaviour in order to explore whether social anxiety predicts the first onset of cigarette smoking, regular smoking and the development of nicotine dependence. Baseline and four-year follow-up data from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of 3,021 adolescents and young adults, are used. Smoking behaviour and psychopathology were assessed with the M-CIDI and its DSM-IV algorithms. At baseline, 35.7% of the sample were regular smokers, and 18.7% fulfilled criteria for DSM-IV nicotine dependence. Twenty-seven point two percent reported at least one social fear, and 7.2% met criteria for DSM-IV social phobia, most of whom reported first onset of social fear problems clearly prior to smoking initiation. Cross-sectional retrospective baseline analyses based on retrospective reports revealed that social fears and DSM-IV social phobia were both significantly associated with higher rates of nicotine dependence. Prospective-longitudinal analyses that were conducted in an attempt to confirm cross-sectional retrospective results showed that baseline non-users with social fears (OR = 3.85) and baseline non-dependent users with social fears (OR = 1.5) had an increased risk of onset of nicotine dependence during the follow-up period of four years. These findings remained significant even when controlling for co-morbid depressive disorders. Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. It is suggested that social fears could lead to heavy tobacco use as smoking is a socially acceptable behaviour that relieves anxiety in social situations. Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social fear symptoms and the development of tobacco consumption and nicotine dependence in adolescence.     

Alcoholism and obesity: overlapping neuropeptide pathways?

Ethanol is a caloric compound, and ethanol drinking and food intake are both appetitive and consummatory behaviors. Furthermore, both ethanol and food have rewarding properties. It is therefore possible that overlapping central pathways are involved with uncontrolled eating and excessive ethanol consumption. A growing list of peptides has been shown to regulate food intake and/or energy homeostasis. Peptides such as the melanocortins, corticotropin releasing factor, and cholecystokinin promote reductions of food intake while others such as galanin and neuropeptide Y stimulate feeding. The present review highlights research aimed at determining if ingestive peptides also regulate voluntary ethanol intake, with an emphasis on the melanocortins and neuropeptide Y. It is suggested that research directed at ingestive peptides may expand our understanding of the neurobiological mechanisms that drive ethanol self-administration, and may reveal new therapeutic candidates for treating alcohol abuse and alcoholism.     

Visual event-related potentials in subjects with alexithymia: modified processing of emotional aversive information?

OBJECTIVE: A modified autonomous response (e.g., electrodermal activity) in subjects with alexithymia (a reduced ability to identify and communicate emotions) while processing emotional information is well known. However, the functional and neurobiological bases of this impairment are unclear. Do subjects with alexithymia suffer from a primary lack of perception ("emotional blindness"), or is alexithymia based on incomplete information processing due to immature undifferentiated cognitive schemes? The study investigates if subjects with alexithymia show a modified central response as a correlate of classifying emotional aversive stimuli. METHOD: Twenty subjects with high alexithymia and 20 with low alexithymia (selected by the 20-item Toronto Alexithymia Scale) were investigated within a modified odd-ball paradigm. Three different stimulus categories were presented: aversive (probes) and affective neutral pictures (nontargets and instructed targets). Visual event-related EEG potentials and subjective data were recorded. RESULTS: All subjects showed elevated positive amplitudes or mean activity after probe presentation in the latency range: 150-260, 280-450, and 600-1500 msec. Subjects with alexithymia displayed increased positive components (especially P2) of visual event-related potentials after probe presentation than subjects without alexithymia. Subjects without alexithymia more frequently verbalized the emotional impact of these aversive pictures than subjects with alexithymia. CONCLUSIONS: These findings do not support the assumption of a primary lack of perception in alexithymia. Subjects with alexithymia show central correlates of perception and classification of aversive pictures. They may need more effort and cognitive recourses to process emotional information. Nevertheless, spontaneous verbal reference to emotional stimulus aspects is reduced.     

Are male and female responses to social phobia diagnostic criteria comparable?

Females typically report higher social phobia levels than males in community samples, and this may be due to sex bias in assessment measures. This study aims to establish whether patterns of responding to social phobia diagnostic criteria in the Composite International Diagnostic Interview (CIDI) are comparable across males and females. A subsample of participants in the Australian National Survey of Mental Health and Wellbeing (1997) reporting at least one social fear were selected (n = 1755). Analyses were conducted using a series of multi‐group confirmatory factor analyses for categorical data, with unique steps to model invariance of residual variances. Partial, but not full, invariance was established, as males and females differed in their responses to items assessing physical anxiety symptoms at low levels of social fear. Whilst these differences were statistically significant, they are likely not to affect clinical practice or rates of social phobia diagnosis. This supports differences on this measure being interpreted as genuine, and strengthens findings females are more vulnerable to social phobia than males. Copyright © 2012 John Wiley & Sons, Ltd.     

Psychopathy and depression: mutually exclusive constructs?

The present study was designed to evaluate the nature of the differences between psychopathy and depression. Based on previously articulated theoretical models, we hypothesized an inverse relationship between the two clinical constructs. Archival data were retrieved from 231 outpatient clients who had completed measures of depression and psychopathy. Correlational analyses and ANOVA's based on extreme groups supported the hypothesis. Implications for assessment, treatment, and research methodology are discussed.     

Impaired emotional facial expression recognition in alcoholics: are these deficits specific to emotional cues?

Previous studies have repeatedly linked alcoholism is to impairment in emotional facial expression decoding. The present study aimed at extending previous findings while controlling for exposure times of stimuli. Further, a control task was added on the decoding of non-emotional facial features. Twenty-five alcoholic participants were compared to 26 control participants matched for age, sex and educational level. Participants performed two computer tasks consisting of presentation of photographs of faces for either 250 or 1000 ms. The first task required "yes" or "no" responses as rapidly as possible to questions regarding non-emotional features of the face (gender, age range and cultural identity). The second task involved a different set of photographs implicating emotional facial expression decoding, with the same exposure times. Again, rapid "yes" or "no" responses to trials combining 32 emotional facial expressions by eight emotional labels (happiness, sadness, fear, anger, disgust, surprise, shame, and contempt) were required from participants. Reaction times were recorded for both tasks. Alcoholic and control participants showed similar results in both tasks in terms of response accuracy. Yet, in the emotional facial expression task, alcoholic participants' responses matched more negative emotional labels, especially sadness. Further, alcoholics were slower than control participants specifically to answer emotional questions on emotional facial expression. No differences appeared on reaction times in the control task. Contrary to expectations, no interaction of stimulus time exposure and group was observed. Overall, these findings replicate and extend previous results on emotional facial expression decoding ability: Alcoholics are specifically impaired on emotional non-verbal behavior information processing: They are slower to correctly identify an emotion.     

Exploring the relations between depression, somatization, dissociation and alexithymia--overlapping or independent constructs?

BACKGROUND: The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. SAMPLING AND METHODS: 924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. RESULTS: The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from -0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). CONCLUSIONS: This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.     

How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors

OBJECTIVE: The authors developed a methodological basis for investigating how risk factors work together. Better methods are needed for understanding the etiology of disorders, such as psychiatric syndromes, that presumably are the result of complex causal chains. METHOD: Approaches from psychology, epidemiology, clinical trials, and basic sciences were synthesized. RESULTS: The authors define conceptually and operationally five different clinically important ways in which two risk factors may work together to influence an outcome: as proxy, overlapping, and independent risk factors and as mediators and moderators. CONCLUSIONS: Classifying putative risk factors into these qualitatively different types can help identify high-risk individuals in need of preventive interventions and can help inform the content of such interventions. These methods may also help bridge the gaps between theory, the basic and clinical sciences, and clinical and policy applications and thus aid the search for early diagnoses and for highly effective preventive and treatment interventions.