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.     

Alexithymia,temperament and character as predictors of psychopathology in patients with major depression

The study investigated the capacity of alexithymic personality features, in combination with temperament and character traits, age and gender, to predict psychopathological symptoms in patients with major depression. Consecutive patients (n = 339) were investigated using the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory (TCI), the Symptom Checklist-90-R (SCL-90-R), and the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS). The amount of variance in SCL-90-R subscales and Hamilton scales predicted by TAS-20, TCI, age and gender was calculated by linear regression analyses. The ‘difficulties identifying feeling’ facet of alexithymia appeared to be a significant predictor of all dimensions of psychopathology. Among TCI scales harm avoidance was the strongest predictor for somatization, phobic anxiety, and anxiety (SCL-90-R, HARS); low self-directedness was the strongest predictor for obsessionality, depression (SCL-90-R, HDRS), interpersonal sensitivity and psychoticism; and low cooperativeness was the strongest predictor for hostility and paranoia. In conclusion, many psychopathological symptoms in major depression are associated with difficulties in the identification of emotions. Relative to alexithymia, Cloninger's psychobiological model of personality could predict psychopathological symptoms in a distinct and meaningful manner. The TAS-20 and the TCI are useful questionnaires for a better understanding of the relationship between psychopathology and personality in major depression.     

Alexithymia and brain gray matter volumes in a general population sample

Alexithymia is perceived as a personality construct involving deficits in the cognitive processing of emotion. Brain areas that process emotions might be structurally altered in affected people. Subjects from the Study of Health in Pomerania who underwent whole body magnetic resonance imaging were investigated. After quality control procedures 2,589 subjects with Toronto Alexithymia Scale 20 (TAS‐20) data and interview‐based information on major depressive disorder (MDD) were available. After exclusion of study participants who were older than 65 years or had MDD in their lifetime, 1,685 subjects were included in the voxel‐based morphometric (VBM 8) analyses. In whole‐brain analyses, the TAS‐20 total score was associated with less gray matter (GM) volumes of the bilateral dorsal anterior cingulate cortex (dACC). The TAS‐20 factor scale difficulty identifying feelings (DIF) was associated with less GM volume in three clusters: dACC, left middle and inferior temporal gyrus, left fusiform gyrus and cerebellum. The lower GM volume in the left fusiform gyrus was specific for females. Absolute GM volume analyses also revealed associations between the factor scales difficulty describing feelings, external orientated thinking and the dACC. Adjustment for current symptoms of anxiety and depression did not change the effects sizes substantially. In conclusion, lower GM volume in the dACC represents the major structural correlate of alexithymia. Associations with DIF suggest a prominent involvement of left temporal areas. These areas represent language and semantic processing and might be involved in the cognitive processing of emotions and the conscious identification of feelings. Hum Brain Mapp 35:5932–5945, 2014. © 2014 Wiley Periodicals, Inc.     

Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients

In the present study, the defense styles were assessed in alcohol-dependent patients to verify whether they used less adaptive defense mechanisms compared with healthy controls and to evaluate if immature defense styles (IDSs) are related with alexithymia, while controlling the effect of age, temperament, and character on this relationship in male alcohol-dependent inpatients. Participants were consecutively admitted 118 male alcohol-dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Toronto Alexithymia Scale, and the Temperament and Character Inventory. The alcohol-dependent patients were using neurotic defense style, some IDSs (projection, acting out, splitting, and somatization) more, and the mature defense style humor less than the control group. Together with higher age, IDS discriminated alcohol dependents from the control group (higher age, acting out, and splitting and lower humor in the second regression model). Immature defense style was positively correlated with novelty seeking, harm avoidance, self-transcendence, difficulty in identifying feelings (DIF), difficulty in describing feelings, external oriented thinking, and total alexithymia score in the present study, whereas it was negatively correlated with self-directedness and cooperativeness. Mean scores of neurotic and IDS were higher in the alexithymic group than the nonalexithymic group, and alexithymia was correlated with some IDSs. Higher difficulty in describing feelings predicted mature defense style, higher harm avoidance and DIF predicted neurotic defense style, and lower cooperativeness and self-transcendence and higher DIF predicted IDS. These suggest that alcohol dependents are using maladaptive IDS more, which can be taken into account in the development of therapeutic programs for these patients. In addition, IDS seems to be related with alexithymia, particularly DIF factor, whereas low cooperativeness and high self-transcendence are significant covariants. Thus, these results could indicate the use of specific strategies in the clinical and psychotherapeutic management of patients with alexithymic feature and IDS.     

Alexithymia and the five-factor model of personality.

The relationship between alexithymia assessed by the Toronto Alexithymia Scale (TAS) and the five-factor model of personality measured by the NEO Five-Factor Inventory (FFI) was investigated in a group of psychiatric outpatients (n = 114) and normal volunteers (n = 71). When controlling for depression, the domains of neuroticism, introversion, and low openness predicted alexithymia. These three dimensions accounted for 57.1% of the explained variance in the patient cohort and 38.1% in the volunteer group. In the patient cohort, neuroticism contributed the majority of explained variance, which may reflect the state effect of distress that elevates neuroticism. Introversion was the most significant predictor in the volunteer group. These data suggest alexithymia is a unique personality trait that is not fully explained by the five-factor model of personality.     

Secondary alexithymia: an empirical validation

Alexithymia is described as both a primary personality trait and a secondary state reaction to medical illness. To empirically study secondary alexithymia, a series of medically ill patients seen in psychiatric consultation were compared with a healthy control population. Measured by the Toronto Alexithymia Scale (TAS), the medically ill were more alexithymic than the healthy population. Alexithymia was best predicted by both depressed mood and lowered quality of life, rather than by the categorical ranking of the severity of the medical illness. Alexithymia did appear to be separate from self-reported mood. These data support the concept of secondary alexithymia.     

述情障碍与心理健康状况的相关性分析

目的 了解述情障碍与心理健康状况的关系。方法 对274名高中生进行TAS、SCL-90自我测试,对所获资料进行相关分析。结果 被试对象TAS总分与SCL-90总分及各因子分显著相关(P<0.01),同时SCL-90总分与TAS各因子分显著相关(P<0.01)。结论 心理健康水平在一定程度上取决于述情障碍的水平,述情障碍可能是心理健康水平的人格基础。     

长期住院精神分裂症患者述情障碍的研究

目的　探讨长期住院的精神分裂症患者的述情障碍问题。方法　对100例长期住院的精神分裂症患者采用多伦多述情障碍量表(TAS量表)评定,并根据年龄、文化程度、病程、住院时间、药物剂量的不同对患者进行分组对比。结果　长期住院的精神分裂症患者 TAS 均分及各因子分高于常模,且不同年龄、病程、住院时间的患者总均分及部分因子分存在明显的差异。结论　长期住院的精神分裂症患者存在一定的述情障碍。     

Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: relationship to depression and anxiety

To evaluate whether alexithymia in alcohol-dependent patients is a personality trait or a state-dependent phenomenon related to depression and anxiety, we evaluated absolute stability (the extent to which alexithymia scores change over time) and relative stability (the extent to which relative differences among individuals remain the same over time) of alexithymia during alcohol withdrawal. Seventy alcohol-dependent inpatients were assessed for alexithymia, depression and anxiety with the 20-item Toronto Alexithymia Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory at the onset of withdrawal, after 2 days and 2 weeks. Paired t-tests and correlational analyses were performed to evaluate absolute and relative stability of alexithymia and hierarchical regression analyses to assess whether alexithymia was related to anxiety and depression. Alexithymia decreased significantly from onset to end of withdrawal, but two of its three subfactors remained stable. Alexithymia scores at onset correlated significantly with scores at end, after partialling out the effects of depression and anxiety. In conclusion, the relative stability of alexithymia contrasting with large decreases in depression and anxiety during alcohol withdrawal supports the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon.     

Nightmares and alexithymia in traumatized North Korean refugees

BackgroundThe present study examined the association between nightmare distress and alexithymia in traumatized North Korean (NK) refugees resettled in South Korea and the effects of clinical or subclinical psychiatric symptoms on this association.MethodsThirty-eight NK refugees living in South Korea who had traumatic experiences (15 males, 23 females; 29.50 ± 13.11 years of age) were recruited. The Structured Clinical Interview for DSM-IV and the Clinician-Administered Post-Traumatic Stress Disorder (PTSD) Scale were conducted. All participants completed a series of questionnaires on the history of their previous traumatic experiences, the Beck Depression Inventory, the Nightmare Distress Questionnaire (NDQ), the Toronto Alexithymia Scale (TAS), and the Impact of Event Scale. In total, 18 refugees were classified as having nightmare distress based on NDQ scores, and 20 refugees were not.ResultsRefugees with nightmares reported significantly higher TAS total scores and Difficulty Identifying Feelings (DIF; a subscale of TAS) scores compared to those without nightmares. In addition, NDQ scores were positively correlated with TAS total scores (r = 0.43, p < 0.01) and DIF scores (r = 0.49, p < 0.01). These correlations remained significant after excluding refugees with current axis I psychiatric disorders or clinical or subclinical depressive symptoms. However, there was no significant correlation between nightmares and alexithymia after excluding refugees with clinical or subclinical trauma-related symptoms.ConclusionsNightmares in traumatized refugees were associated with alexithymia even in the absence of current psychiatric disorders or depressive symptoms. Trauma-related symptoms might be a mediating factor between nightmares and alexithymia in traumatized refugees.     

Alexithymia and personality in relation to social anxiety among university students

The aims of the present study were to investigate the relationship of social anxiety symptoms with alexithymia and personality dimensions in university students and to control the effects of depression and anxiety on this relationship. A total of 319 university students (85 males and 234 females) from two different universities in Ankara were investigated with the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Toronto Alexithymia Scale (TAS-20) and the Temperament and Character Inventory (TCI). We found that subscales of the LSAS (fear or anxiety and avoidance) were positively correlated with depression and alexithymia and “difficulty in identifying feelings” (DIF) and “difficulty in describing feelings” (DDF) subscales of the TAS-20. Harm avoidance (HA) showed positive correlations with subscales of the LSAS, whereas self-directedness (SD) showed negative correlations with these subscales. High TAS-20 DDFand HA and low SD predicted fear or anxiety LSAS subscale scores, whereas high TAS-20 DDF, HA and depression scores were predictors for LSAS avoidance subscale scores. Although our sample is not representative of the whole Turkish university student population, we conclude that both fear or anxiety and avoidance were mainly interrelated with DDF and HA, although the causal relationship is not clear.     

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.     

Temperament and character model of personality profile of alcohol- and drug-dependent inpatients

The aims of this study were to evaluate the differences in dimensions of temperament and character in Turkish alcohol- and drug-dependent inpatients, and to examine which dimensions would predict drug dependency. The subjects consisted of 111 alcohol-dependent and 93 drug-dependent inpatients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Subjects were tested using Cloninger's Temperament and Character Inventory (TCI). Among the temperament dimensions, novelty seeking score was higher and reward dependency score was lower in drug-dependent patients than in alcohol-dependent patients. Among the character dimensions, self-directedness and cooperativeness scores were lower in drug-dependent patients. Low age and novelty seeking predicted drug dependency in forward logistic regression model. Subscales that predicted drug dependency other than young age were lower scores on compassion vs revengefulness (C4) and helpfulness (C3), and higher score on spiritual acceptance vs rational materialism (ST3). As in previous studies, which indicate an association between personality and substance choice, in the present study, TCI was shown to be an efficient tool in discriminating alcohol and drug dependents; thus, it seems to be important to consider TCI dimensions in planning the treatment of substance dependency.     

Alexithymia and personality in relation to dimensions of psychopathology

OBJECTIVE: The authors examined the capacity of alexithymia to predict a broad range of psychiatric symptoms relative to that of other personality dimensions, age, and gender. METHOD: The Toronto Alexithymia Scale, the Temperament and Character Inventory, and the SCL-90-R were administered to 254 psychiatric patients. Multivariate linear regression analyses were performed. RESULTS: The difficulties identifying feelings factor of the Toronto Alexithymia Scale significantly predicted all SCL-90-R subscale scores and was particularly effective, relative to the personality dimensions of the Temperament and Character Inventory, in predicting somatization. The Temperament and Character Inventory dimensions emerged as distinct and conceptually meaningful predictors for the different SCL-90-R subscales. CONCLUSIONS: A broad range of current psychopathology is associated with difficulties in cognitively processing emotional perceptions. Further research needs to clarify whether alexithymia represents a risk factor for mental illness and poorer outcome.     

Alexithymia among Vietnam veterans with posttraumatic stress disorder

The authors studied 227 inpatients from a large Veterans Administration Medical Center to evaluate whether alexithymia is associated with posttraumatic stress disorder (PTSD) and to assess the validity of the Minnesota Multiphasic Personality Inventory (MMPI) alexithymia scale. Three groups--a carefully diagnosed PTSD group (N = 76), an alcohol abuse group (N = 76), and a general psychiatric group (N = 75)--were given a battery of psychological tests, including the MMPI, the Millon Clinical Multiaxial Inventory, and the Beck Depression Inventory, along with several cognitive measures. PTSD veterans were also evaluated on psychophysiologic indices (including a stressor) and on their subjective ratings to these indices. Results showed that alexithymia was more characteristic of PTSD patients than of the other groups. Also, alexithymia was inversely related to heart rate. Alexithymia was not significantly correlated with the subjective experience of stressors. The authors discuss the importance of the construct of alexithymia among PTSD patients and recommend the use of the alexithymia scale for these patients. The independence of this measure from the psychophysiologic condition of hyperarousal and the subjective experience of this state were also addressed.     

Multidimensionality and state dependency of alexithymia in recently sober alcoholics

In this study, we a) examined the appropriateness of using a single global score to represent alexithymia and b) constructed a model to examine the relationship between alexithymia and depression in recently sober alcoholics applying for inpatient care. To measure alexithymia, we used the Toronto Alexithymia Scale (TAS); to measure depression, we used the revised Beck Depression Inventory (BDI). Factor analyses identified three alexithymia factors (Feelings, Daydreaming, and External Thinking) and two depression factors (Somatic-Performance and Cognitive-Affective). The three TAS factors were not positively related to each other; the two BDI factors were. We used LISREL software to examine the relationships between the TAS factors and the BDI factors. The only two significant unidirectional coefficients were between the TAS-Feelings factor and the two BDI factors. Our results suggest that in recently sober alcoholics, alexithymia, as measured by the TAS, consists of three independent, unrelated dimensions. Moreover, only the dimension associated with an inability to identify feelings and to distinguish them from bodily sensations is related to depressive symptoms. To determine whether this alexithymia feelings dimension actually is dependent on situational depression and/or anxiety will require confirmation in additional samples, such as primary alexithymics and patients with major depressive disorders.     

医学生述情障碍与心理健康及人格特征的关系研究

目的探讨医学院学生述情障碍与心理健康状况及人格特征的关系。方法对医学院在校大学生310人进行多伦多述情障碍量表(TAS)、症状自评量表(SCL-90)、修订艾森克个性问卷(EPQ,其中205名学生完成)的测量,并进行相关和回归分析。结果TAS与SCL-90各因子相关均有统计学意义(P均=0.000),相关值在0.185-0.396,与强迫因子的相关系数最高;TAS各因子与EPQ中的内外向(E)、神经质维度(N)的相关具有统计学意义;回归分析发现强迫因子、E对TAS影响较强。结论医学生述情障碍与心理健康状况及人格特征中的部分量表存在有统计学意义的中度相关,其中与强迫因子、E相关较强。     

Validation of the alexithymia construct: a measurement-based approach

Alexithymia is a hypothetical personality construct that has been associated with a variety of medical and psychiatric disorders. This article reviews a program of research evaluating the validity of the construct using a measurement-based, construct validation approach. For this purpose the Toronto Alexithymia Scale (TAS) was developed. In a series of studies the TAS demonstrated internal consistency, good test-retest reliability, and a stable factor structure theoretically congruent with the alexithymia construct. In separate tests of construct validity, the TAS correlated in a theoretically meaningful fashion with measures of other constructs. Criterion validity was supported by a study in which the TAS was able to discriminate between behavioural medicine outpatients designated as alexithymic and those designated as nonalexithymic on the basis of objectively rated structured interviews. In a normal adult sample, TAS scores were not related to sociodemographic variables or intelligence. These results provide considerable empirical support for the validity of the alexithymia construct. In addition, the TAS appears to be a psychometrically sound measure of alexithymia that may prove useful in testing the construct with psychiatric and medical patient populations.     

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study

Objective

Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample.

Methods

The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25-64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998-2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed.

Results

BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores.

Conclusion

Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.     

Alexithymia,suicide ideation,affective temperaments and homocysteine levels in drug naïve patients with post-traumatic stress disorder: an exploratory study in the everyday ‘real world’ clinical practice

Objective: The present exploratory study aimed to investigate relationships between alexithymia, suicide ideation, affective temperaments and homocysteine levels among drug-naïve adult outpatients with Post-Traumatic Stress Disorder (PTSD) in an everyday ‘real world’ clinical setting.

Method: Sixty-four adult outpatients with PTSD were evaluated using the Davidson Trauma Scale (DTS), the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. As well, homocysteine levels were measured.

Results: Alexithymic subjects showed higher values on all scales but not homocysteine levels. Partial correlations showed that almost all studied variables were correlated with each other, except homocysteine levels. Regression analysis showed that higher disorder severity as measured by DTS and TAS-20 ‘Difficulty in Identifying Feelings’ dimension was associated with higher SSI scores.

Conclusions: In conclusion, alexithymic PTSD outpatients may be characterised by higher disorder severity and difficulty in identifying feelings that may be linked to increased suicide ideation, regardless of affective temperaments or homocysteine levels. Homocysteine levels were not related to any studied variable. However, study limitations are discussed and must be considered.

• Keypoints

• Patients with alexithymia showed increased PTSD severity, a higher score on TEMPS-A subscales, and more severe suicide ideation.

• The Difficulty in Identifying Feelings (DIF) dimension of TAS-20 was associated with suicide ideation in patients with PTSD.

• Homocysteine did not correlate with any studied variables.

• This study was exploratory and cross-sectional: further larger and prospective studies are needed.