De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.     

Déficits émotionnels chez des patients polytoxicomanes

Researches on troubles of emotional control in addictions have mainly focused their attention on alexithymia concept, defined by Sifneos in 1972. It was first characterized by a lack of words to express emotion (a: absence of; lexi: words; thymia: emotions, affects). Alexithymia's characteristics were described in patients with addictive behaviors by Wurmser in 1974 and Krystal in 1979. Since, many studies have shown there was a higher level of alexithymia in patients with addictive behaviour (alcoholism, drug addiction), when compared with normal controls. A recent large multicenter study (Jeammet, Corcos, Flamment, 2003) highlighted this assessment: 43,5% in drug addicts [N =124], 24,6% in normal controls [N =126]. Some authors think that alexithymia would be a risk factor for substances abuse, the patient using these ones in order to compensate a deficit in the ability to regulate and adjust one's emotions (primary or feature alexithymia). For others, alexithymia would develop following anxiety created by a somatic disease or a physical or psychological important trauma (secondary or state alexithymia). For Lane and Schwartz, alexithymia is linked to a deficit of emotional awareness. In 1987, the authors present a cognitive-developmental theory of emotional awareness that creates a bridge between normal and abnormal emotional states. Their primary thesis is that emotional awareness is a type of cognitive processing which undergoes five levels of structural transformation along a cognitive-developmental sequence derived from an integration of the theories of Piaget and Werner. The five levels of structural transformation are awareness of 1) bodily sensations; 2) the body in action; 3) individual feelings; 4) blends of feelings; and 5) blends of blends of feelings. The level of emotional awareness that an individual has reached can be assessed by the Levels of Emotional Awareness Scale (LEAS) which is an instrument presenting standardized emotion-evoking situations, asking the person how he or she would feel in each situation, and assigning a score to the responses based on the structural characteristics of the levels. The main objective of this research was to study the emotional treatment in 13 patients with multiple addictive behaviors according to DSM-IV criteria (drug addiction + alcoholism + smoking) and with a substitution treatment (methadone, Subutex^®). Those subjects were aged between 23 and 42 years. Our hypothesis was that subjects would present deficits in perception and regulation of emotions (alexithymia and low level of emotional awareness). Four rating scales were used to assess the emotional semiology and the possible presence of depression and/or anxiety: the Hamilton depression scale, 17 items version; the Tyrer's brief scale for anxiety; the Jouvent's rating scale of depressive mood and the Abrams-Taylor's scale of emotional blunting. Alexithymia was evaluated with the Toronto Alexithymia Scale, 20 items version (TAS-20), and the emotional awareness with the Levels of Emotional Awareness Scale (LEAS). Our results showed levels of alexithymia generally important. The prevalence of alexithymia in patients with addictive behaviors was 69% with a mean score to this scale of 57,8 ±11,5, which is above observed mean in the general population (46,2 ±10,52). The mean score to the LEAS was 49,6 ±6,5 and less than the one observed in patients with a depressive mood and normal controls by Berthoz in 2000, and same results were observed for scores « subject » and « other ». For eight patients, the total scores were between 51 and 59, showing a low level of emotional awareness corresponding to the second one, the sensorimotor enactive, in Lane and Schwartz's model. There was no significant correlation between intensity of depressive mood and anxiety (Hamilton's scale and Tyrer's scale) and the different scores of LEAS and TAS-20. On the other hand, there was a negative significant correlation between the score « subject » of LEAS and the intensity of emotional blunting assessed by the Abrams-Taylor's scale (R = -0.589, P <05). Furthermore, there was a tendency for significant correlation between the total score of LEAS and the intensity of emotional blunting (R =-0.543, P <0.10). The total score of TAS-20 was not related to the total score of LEAS. However, there was a positive significant correlation between the mean score of TAS-20 and the score « other » of LEAS (R =0.570, P <0.05). No significant correlation was observed between the three components of alexithymia and the different scores of LEAS. This study has shown troubles in emotions's treatment in a sample of patients with addictive behaviors. Levels of alexithymia were generally important (TAS-20), showing in these patients difficulties to identify and distinguish between feelings and bodily sensations, to describe feelings and presenting an externally-oriented thinking. Furthermore, subjects have a low level of emotional awareness, corresponding to the sensorimotor enactive level. At this level, emotion may be experienced as both a bodily sensation and an action tendency. Curiously, alexithymia is not related to LEAS scores: this may reflect different levels of emotional appraisal processes and consciousness in the two different instruments. However, the emotional deficit, when it is hetero-appraised by the clinician (Abrams-Taylor Scale), is related to weakness in the LEAS scores, in particular concerning awareness of one's own emotions.     

Joueurs de machines à sous dans une population française : étude de la dépression, de l’alexithymie et de la recherche de sensations

There are a multitude of factors implied in the acquisition, the development and the maintenance of gambling behavior. Among them, sensation seeking occupies an important place. Zuckerman originally suggested a relationship between sensation seeking and gambling. However, studies in this area have provided heterogeneous results. To explain these discrepancies, Zuckerman emphasized the fact that the type of gambling may be a crucial factor in the relationship with sensation seeking. Nevertheless, few studies have evaluated the link between the different types of gambling and problem behaviors. Furthermore, few studies were interested specifically on slot machines. While recent research has found high-levels of alexithymia in individuals with substance use and eating disorders only two studies have investigated the relationship between alexithymia and pathological gambling. Thus, these studies were focused on students. It is therefore important to study alexithymia in adult gamblers. Empirical data has shown that alexithymia levels may be influenced by negative mood states, especially depression. Some studies have found a positive correlation between alexithymia and depression scores, particularly in people with addictive behaviours. Nevertheless, studies found heterogeneous results. The main objective of this research was to evaluate scores on sensation seeking, alexithymia and depression (and the link between those variables) in gamblers of slot machines. Thus, slot machines gamblers were selected in the casino of Enghien-les-Bains, which is Paris nearest casino. Among them one distinguishes: regular gamblers (n = 45) from which were extracted pathological gamblers (n = 27), and occasional gamblers (n = 19). The South Oaks Gambling Screen and the criteria of the DSM-IV were used to measure the intensity of gambling behavior; sensation seeking was evaluated by the Sensation Seeking Scale form V; alexithymia by the Toronto Alexithymia Scale (TAS-20) and the depression by the Beck Depression Inventory. No differences appeared significant between the three groups of gamblers for the sensation seeking scores. Pathological gamblers obtained higher alexithymia scores than occasional gamblers. Nevertheless, these findings didn’t remain stable when controlling for the effect of depression. Among pathological gamblers, the BDI score is positively correlated to the ‘difficulty identifying feelings’ factor. This result is consistent with the literature, which shows that alexithymia is closely related to depression in addictive behaviors. Indeed, the ‘difficulty identifying feelings’ factor seems to be explained by depression severity. These results suggest that the emotional component of alexithymia would be thymo-dependent, whereas the cognitive component would be independent and constitute a stable clinical feature. Pathological gamblers who play slot machine are low sensation seekers who shun the more dramatic and extraverted form of sensation seeking. They play to reduce or avoid unpleasant emotional states like depression. Pathological gambling could therefore be in part a maladaptive coping strategy to deal with affective disturbances; the game may function as a self-medication to treat emotional states, which the gambler finds no other way of treating. According to previous studies, slot machine gambling is referred to as ‘escape’ gambling, where gamblers may dissociate.     

Profils de personnalité et fonctionnement émotionnel dans les sports extrêmes : à propos d’une étude exploratoire chez des BASE-jumpers

This study examines relations between emotional factors (anxiety and depression), normal and pathological personality, and risk-taking behavior in 11 BASE-jumpers comparing to a control group (n = 11).

Method

All the subjects have been evaluated with self-report questionnaires measuring their emotional states before and after the jump, their involvement in risk-taking behavior, sensation seeking, personality disorders, anxious and depressive symptomatology. Results show a significant effect of BASE-jump practice on emotional state. They have higher scores on the thrill and adventure seeking subscale, they show more drug consumption and more accidents than control group. We found also clinical elements of pathological personality solely from cluster B of the DSM-IV-TR classification among BASE-jumpers. Emotional factors are correlated with borderline personality in this same group.

Discussion

We analyzed those results depending on emotional and behavioral dysregulation, and their specifics involvement in borderline personality, risk-taking behaviors, and also addiction. Sensation seeking could be especially reinforced on the base of a borderline personality with the possibility of a build-up of risk which may put individuals addict to it.     

A family history of alcoholism relates to alexithymia in substance use disorder patients

Objectives

Previous research identified alexithymia as a potential risk factor for substance use disorders (SUD). More insight into the relation between alexithymia and SUD is needed in order to treat SUD effectively. Therefore, we investigated whether a familial vulnerability to alcoholism relates to the presence and severity of alexithymia in SUD patients.

Method

Hospitalized, abstinent SUD-patients (n = 187), were assessed with the Toronto Alexithymia Scale (TAS-20) and Addiction Severity Index (EuropASI). A maternal, paternal, and total continuous measure of the Family History of Alcohol (FHA) was developed. Kruskal-Wallis tests and Spearman correlations were used to relate the composite scores of FHA to alexithymia as a categorical and continuous measure. Multivariate regression models were performed to control for the effects of confounders on the relation between FHA and alexithymia.

Results

Compared to moderate (33%) and low (17%) alexithymic SUD-patients, high alexithymic (50%) patients were more likely to have fathers with alcohol problems (P = 0.004). Such a difference was not found for mothers with alcohol problems. The composite FHA-score was significantly associated with alexithymia (Rs = .19, P = 0.01). However, only a paternal FHA, independent from disturbed family functioning, related to the degree of alexithymia (β = .13, P = 0.06), especially to the Difficulty Identifying Feelings as measured by the TAS-20 (β = .16, P = 0.02).

Conclusions

The relation between a paternal FHA and a higher degree of alexithymia in SUD-patients suggests that alexithymia could mediate the familiality of alcoholism or SUD in the paternal line.     

Le questionnaire de fonctionnement ordalique (QFO) : premiers éléments de validation et résultats préliminaires chez des toxicomanes et des anorexiques

Risk-taking behaviours among adolescents have become a clinical reality and are related to a significant mortality and morbidity. Many of these behaviours are ordalique ones and consist in braving death with repetitive and deliberate risk-taking. Adolescents’ll leave their life to chance, fate, supernatural or divine powers in order to know if they must die or not. If subjects survive to fatal situations, they have a deep conviction that they’re protected and they feel therefore invincible. The ordalique behaviour is not equivalent to suicide. It’s a pathological way to restore a serious lack of narcissism and identity deficiencies. The ordalique functioning is a main characteristic of addictions, especially drug addiction. This article presents the construction of the ordalique functioning questionnaire (QFO) and initial validity studies. The QFO is composed of 71 items and four dimensions are evaluated : risk-taking, transgression, positive representation of risk-taking and believes. First dimension refers to the propensity of having dangerous activities (extreme sports, drugs use, risky sexuality, dangerous driving…). Second dimension refers to the subject’s relation to law, rules, prohibition and authorities and his tendency to have transgression behaviours. Third dimension refers to heroic representation of subjects who have risk-taking behaviours. This dimension mainly applies to narcissistic function of risk-taking. Fourth dimension refers to various believes (luck, fate, chance, god…) and the implication of these believes in risk-taking behaviours. In a first study, QFO was administrated to a population of 826 students from several universities of Toulouse. Four hundred and two of them were men and 424 were women. The age ranged from 18 to 37 with a mean of 21,13. The component analysis with varimax rotation allowed to find the four factors of construction. Alpha’s Cronbach are > 0.60 for the four factors (from 0.73 to 0.79) and therefore underline the internal consistency of the questionnaire. There’s a good inter-correlation between the factors (from 0.44 to 0.60) except for believes which is not significantly correlated with the other three factors. Each result shows that believes could be an independent dimension. A test-retest study after an interval of 15 days among 80 students indicates excellent temporal reliability (from 0.93 to 1). In a second study, QFO was administrated to 150 subjects (60 drugs addicts, 30 restrictive anorexics, 60 controls). The 60 drugs addicts (30 men and 30 women with a mean age of 27, 28) were in aftercare centers. They have a very strong dependence on drugs and alcohol according to the Addiction Severity Index (ASI, McLellan) and all of them are polyaddicted. The 30 women anorexics (mean age of 19,50) were restrictive type according to the anorexia and bulimia sections of the MINI (Mini International Neuropsychiatric Interview, Sheehan and al.). Twenty anorexics were hospitalized during the research, four anorexics were met in childhood guidance structures and five anorexics were having psychotherapy treatment. The mean weight is 37,12 kg and the mean body mass index (BMI) is 14,67. The 60 controls are composed of 30 men and 30 women with a mean age of 23,55. Thirty eight of them are students and 22 are working people. The controls don’t have any psychiatric troubles listed in DSM-IV (according to the 17 diagnostic sections of the MINI), don’t smoke more than 10 cigarettes per day, don’t suffer from eating disorders and don’t have present problems with drugs or alcohol. Anova analysis and Mann Whitney tests were used to compare means between the three groups. Results of drug addicts are significantly higher than controls on risk-taking (U = 0 ; P < 0.0000), transgression (U = 0 ; P < 0.0000), positive representation of risk-taking (U = 240 ; P < 0.0000) and believes (U = 15,5 ; P < .0000). Drug addicts also present results significantly higher than anorexics on risk-taking (U = 1 ; P < 0.0000), transgression (U = 0 ; P < 0.0000), positive representation of risk-taking (U = 0 ; P < 0.0000) and believes (U = 11 ; P < 0.0000). Anorexics have results significantly lower than controls on risk-taking (U = 216,5 ; P < 0.0000), transgression (U = 288 ; P < 0.0000), positive representation of risk-taking (U = 217 ; P < 0.0000) and believes (U = 118 ; P < 0.0000). These results underline in drug addicts an important psychic ordalique functioning that we can illustrate for example by the “russian roulette” with overdose, a risky sexuality and the share of syringes despite the threat of VIH. The very important differences between drugs addicts and anorexics indicate that anorexics would have a subjective relation to risk-taking different from drugs addicts. Indeed, unlike drug addicts, anorexics are not aware of the immediate and fatal risk of their behaviour. They don’t have a heroic representation of their risk-taking. They have not other risky activities apart from addiction. Anorexics don’t transgress laws and don’t have delinquent behaviours, they are rather conformist. They have few believes in chance, fate, destiny or god. Their results lower than controls on all dimensions of QFO showed that anorexics avoid sensations seeking and dangerous situations. The seeking of an ideal body is more important than braving death which is not even perceived. So, the subjective relation to risk-taking in anorexics wouldn’t be ordalique but “sacrificial”, that is to say focused on pathological self-control. These differences of functioning (ordalique versus sacrificial) between drug addicts and anorexics must be taken into account for therapeutic care. In this way, our results support the thesis of the existence of two types of addictions : those focused on sensations seeking, impulsivity, dangerous activities and those focused on sensations avoiding, pathological self-control, and no attraction for risk-taking. Moreover, this research shows that addictions could be classified according to a continuum from the more ordalique dependences (drug addiction) to the more accepted and passive ones (tobacco dependence) with at the other extremity the more sacrificial dependences (anorexia). In this second study, the Sensation Seeking Scale (SSS, Zuckerman) was also administrated. Correlations between SSS and QFO (from .70 to .87) indicated a very good concurrent validity. Moreover, there’s a very good inter-correlation between the four dimensions of QFO (from .76 to .90). These results, more satisfactory than in first study, can be due to the population which isn’t a run of the mill population but a pathological one with drugs addicts who have an important ordalique functioning. And notably, believes dimension, central in ordalique behaviours, is here strongly correlated with the three others dimensions of QFO. Therefore our thesis indicated above of an independent dimension can be excluded. In conclusion, QFO appears to be a promising tool for research in psychopathology.     

Interpersonal problem areas and alexithymia in adolescent girls with loss of control eating

This study investigated the links among interpersonal problem areas, depression, and alexithymia in adolescent girls at high risk for excessive weight gain and binge eating disorder. Participants were 56 girls (M_age = 14.30, SD = 1.56; 53% non-Hispanic White) with a body mass index (BMI, kg/m²) between the 75th and 97th percentiles (M_{BMI z} = 1.57, SD = 0.32). By design, all participants reported loss of control eating patterns in the past month. Adolescents were individually interviewed prior to participating in a group interpersonal psychotherapy obesity and eating disorder prevention program, termed IPT for the prevention of excessive weight gain (IPT-WG). Participants' interpersonal problem areas were coded by trained raters. Participants also completed questionnaires assessing depression and alexithymia. Primary interpersonal problem areas were categorized as interpersonal deficits [as defined in the eating disorders (ED) literature] (n = 29), role disputes (n = 22), or role transitions (n = 5). Girls with interpersonal deficits–ED had greater depressive symptoms and alexithymia than girls with role disputes (p's ≤ 0.01). However, girls with role transitions did not differ from girls with interpersonal deficits–ED or role disputes. Interpersonal problem area had an indirect association with depression via alexithymia; interpersonal deficits–ED were related to greater alexithymia, which in turn, was related to greater depressive symptoms (p = 0.01). Among girls at risk for excess weight gain and eating disorders, those with interpersonal deficits–ED appear to have greater distress as compared to girls with role disputes or role transitions. Future research is required to elucidate the impact of interpersonal problem areas on psychotherapy outcomes.     

Alexithymia and gastrointestinal-specific anxiety in moderate to severe irritable bowel syndrome

Objective

Gastrointestinal-specific anxiety (GSA) and alexithymia are two psychological constructs that may contribute to severity of irritable bowel syndrome (IBS). We aimed to investigate their independent contribution in predicting the level of severity in a group of patients with moderate to severe IBS.

Method

A sample of 177 consecutive IBS patients (49.2% with moderate and 50.8% with severe IBS), diagnosed with Rome III criteria, were evaluated for IBS symptoms, alexithymia, GSA, psychological distress, and psychosocial functioning with validated scales.

Results

IBS severity was highly associated to both alexithymia (r = 0.61) and GSA (r = 0.66), that were also associated to each other (r = 0.64). Severe IBS patients scored significantly different than moderate IBS patients to all scales in the expected direction. Multiple and hierarchical regression analyses showed that IBS severity was predicted at a similar degree by alexithymia and GSA, controlled for IBS symptoms, psychological distress, and psychosocial functioning. Effect sizes showed that the highest IBS severity scores were obtained by patients with high alexithymia alone (d = 1.16) or combined with higher GSA (d = 1.45).

Conclusion

Alexithymia and GSA were closely related to each other and associated to IBS severity, thus suggesting a common basis of emotional dysregulation. However, alexithymia (particularly the facets of difficulty identifying and describing feelings) resulted to be a stronger predictor of IBS severity than GSA, thus suggesting that impaired affective awareness may reflect on the clinical manifestations of IBS.     

Dépendance physiologique et fonctionnement émotionnel chez les jeunes adultes : affectivité, intensité émotionnelle et alexithymie dans la consommation de substances psychoactives

Objectives

The objective of this study is to describe the emotional functioning of individuals addicted to psychoactive substances, and verify that the dependent subjects are more sensitive to emotional dimensions and variables considered as non-dependent subjects.

Patients and methods

We recruited 268 subjects students. They filled out a protocol, first, a questionnaire assessment measuring dependencies (tobacco, alcohol, cannabis), and a second part consisting of four questionnaires: the Hospital Anxiety Depression (HAD) scale (anxiety and depression), the Émotionalité Positive et Négative (EPN-31) (affectivity), the Affect Intensity Measure (AIM) (affect intensity), and the Toronto Alexithymia Scale (TAS-20) (alexithymia). The 268 subjects were divided into: 69 subjects dependent (D) representing 25.7% of the sample, and 199 non-dependent (ND) subjects, representing 74.3%. It consisted of 224 women and 44 men, mean age was 22.23 years (standard deviation [S.D.]: 5.45, range: 18–56 years). There was no significant difference in gender (P > 0.05) between groups or in age (P < 0.05). The scores of anxiety and depression were significantly different between groups. We therefore conducted analysis of covariance (ANCOVA) including the total score of anxiety-depression as a covariate and as dependent variables, scores of emotions, emotional intensity and alexithymia with SPSS 11.5^®.

Results

The results show that dependent subjects have scores more important to the HAD than non-dependents, depression has been well regarded as a confounding factor. After controlling for this variable, they are more emotionally responsive, more sensitive to the emotional intensity, and alexithymia more than non-dependent. Activation and the emotional intensity appear to be dispositional variables may play a central role in emotional processing in the dependent subjects, associated with alexithymia. They could be located upstream of the processing of emotion, they would account for the gross apprehension felt by the subject, leading secondarily to the representation of emotion. The proportion of alexithymic subjects is 44.9% in this group of subjects, while only 13.6% among non-dependent subjects. They have greater difficulty in identifying emotions. This supports the idea of the existence of an emotional deficit in individuals addicted to psychoactive substances. This proportion is also larger than that found in general population.

Conclusions

The alexithymia seems to be a central variable emotional functioning dependent subjects, regardless of its relationship with depression, it could match the emotional processing mode preferred by the subjects dependent. Personality in this study seemed to reflect a vulnerability factor, which alexithymia represents a secondary dimension, even defensive. This could account for a mode of emotional regulation. The limitations of the study and possible openings will be discussed.     

Comparative study of the subjective emotional experience among adolescents showing depressive symptoms associated or not with risk-taking behavior

Introduction

Relationships between risk-taking behavior and depressive disorders in young people are considered as a complex psychopathological problem. Previous findings showed strong correlations between substance abuse, risk-taking behavior and depressive symptoms. Nevertheless, questions remain concerning potential common factors of depression and risk-taking behavior. Besides research focusing on personality dimensions, some others highlight the role played by emotions and their pathological aspects. In these studies, pathological emotional processing such as alexithymia or specific deficit in emotional intensity was linked to both risk-taking behavior and depressive disorders. The aim of this study was to investigate potential specific emotional profiles of adolescents engaged in pathological risk-taking or depressive symptomatology, versus adolescents presenting an association of both.

Method

Four hundred and eigty-eight adolescents (m_age = 14,93, SD = 1,44), with 257 boys (m_age = 15, SD = 1,51) and 231 girls (m_age = 14,52, SD = 1,23), were spread into four groups: adolescents engaged in high level risk-taking, adolescents showing both high risk-taking and high depressive symptoms, depressed adolescents, and a control group without any pathological aspects. The four groups completed a set of three assessments: Youth Risk Behavior Surveillance Scale (YRBSS), Level of Emotional Awareness Scale (LEAS) and Differential Emotional Scale (DES).

Results

Adolescents engaged in risk-taking have the lowest level of emotional awareness and subjective emotional intensity, while adolescents of the second group (depression with risk-taking behavior) have a higher level on both measures. Depressed adolescents present the highest score of emotional awareness within the pathological groups, lower than controls. Paradoxically, their ability to represent themselves others’ emotions were higher than the control group, just as the intensity of their subjective emotional experience in case of negative emotions.

Discussion

The results may be explained by a specific developmental hypothesis, in which emotional awareness growth from the early period of life to late childhood, allowing children to gradually experiment more and more complex subjective emotional experiences. However, early exposure to traumatic experiences or inadequate environment may lead to developmental arrests, in which emotional awareness is weak. In this case, a lack of emotional information caused by low emotional awareness may have pathological issues, in terms of depression and risk-taking behavior. Clinical implications of this interpretation are discussed.     

Alexithymia, depression and drug addiction

Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5%) compared to controls (24.6%). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients; 66.4% of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26% of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20% of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20% between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n=42) are not any more alexithymic than controls (n=114). Our results plead for a positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The Authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this study do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.     

Déficit émotionnel et intelligence machiavélique : étude des interrelations entre l'échelle d'alexithymie de Toronto (TAS-20) et l'inventaire mach-iv dans une population de 201 étudiants

The aim of the study was to explore the relationship between alexithymia and machiavellianism in a group of 201 university students. The subjects filled out the TAS-20 and the MACH-IV forms. The results showed firstly, a significant correlation between the two total scores (r = 0.35, P < 0.05), and secondly between the identification of feelings subscale of the TAS-20 and the opinions about human nature subscale of the Mach-IV (r = 0.44, P < 0.05). The results were discussed in light of the different factors (depression, dependency, psychoticism…) that could explain the relationship between the two concepts.     

Alexithymia in Parkinson's disease is related to severity of depressive symptoms

The authors investigated the possible relationship between depression and alexithymia in a population of hospitalized patients suffering from Parkinson's disease (PD). Fifty-eight PD patients without dementia participated in the study. Alexithymia was screened using the 20 item version of the Toronto Alexithymia Scale (TAS 20). Depression was diagnosed using a Structured Clinical Interview (SCID I) for DSM-IV. Severity of depression was evaluated with the Beck Depression Inventory (BDI). The prevalence of Alexithymia was about 21%. PD patients with major depression were significantly more alexithymic (TAS 20 average score = 61.4) than PD patients without depression (TAS 20 average score = 47.4) and, also, tended to be more alexithymic than PD patients with minor depression (MiD; TAS 20 average score =50.6), whereas no difference was found between PD patients with MiD and PD patients without depression. Moreover, high scores obtained on the BDI were found to strongly predict high level of alexithymia in these patients. These results extend to a cohort of PD patients previous data from the literature evidencing a strong association between alexithymia and severity of depressive symptoms.     

Religious involvement is associated with greater purpose,optimism, generosity and gratitude in persons with major depression and chronic medical illness

Objective

Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness.

Methods

129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures.

Results

Although religiosity was unrelated to depressive symptoms (F = 0.96, p = 0.43) and did not buffer the disability–depression relationship (B = − 1.56, SE 2.90, p = 0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F = 7.08, p < 0.0001).

Conclusions

Although unrelated to depressive symptoms in the setting of major depression and chronic medical illness, higher religious involvement is associated with positive emotions, a finding which may influence the course of depression over time.     

Traduction et validation française du questionnaire de répression de Weinberger

In a cognitive perspective, repression is defined as a coping strategy whose objective is to extinguish awareness of subjective emotional experience, leading to restriction of subjective experience. It is characterized by avoidance of threatening and distressing information, minimization of negative affects and low tendency to anxiety. Several measures of repressive coping style have been developed and the Weinberger Adjustment Inventory (WAI) appears to be the most psychometrically sound measure of repression.

Objectives

The main aim of this study was to translate and validate a French version of the WAI in non-clinical individuals on general population. The secondary objectives were to investigate its relationship to independent measures of anxiety, depression and alexithymia.

Materials and methods

Subjects (n = 159) were asked to complete the WAI questionnaire. A principal component analysis was carried out. The internal consistency was measured by the Cronbach alpha coefficients, and discriminant validity was assessed by examining correlations between the scales of the WAI. Because there is no other French validated instrument assessing repression, convergent validity was studied with alexithymia (Bermond-Vorst Alexithymia Questionnaire), anxiety and depression (Hospital Anxiety Depression Scale).

Results

Our factorial structure of the French WAI resembles the Weinberger's one. The “Consideration for Others” subscale does not belong to the Self-Restraint dimension: this is consistent with literature findings. The others results show solid metrological properties. Cronbach alpha reliabilities for principal and secondary factors were ranged from 0.80 to 0.93 (from 0.65 to 0.85 for the subscales) and the intercorrelations were low. Correlations were found between the WAI, the HAD and the Bvaq-b. Anxiety and Depression (HAD) are positively correlated to Distress and negatively correlated to Restraint, Defensiveness and Composite score. The repressive style, characterized by high scores on Defensiveness and Composite score, is positively correlated to affective component of alexithymia and negatively correlated to the cognitive score of alexithymia.

Conclusion

Globally, findings replicate earlier findings obtained in the Anglo-American context. The French version of the WAI thus appears to be valid and will help studying repression in France, especially in its complex relationships to alexithymia.     

Les idéations suicidaires chez les nouveaux arrivants en maison d’arrêt

Suicide in prison is in increase for several years and participates in a major problem of public health. The number of suicide in prison arises mainly during first moment of incarceration, in particular under fifteen days. Eighty percent of the subjects who attempt to commit suicide or commit suicide express such ideas months before. So the expression of suicidal ideations is a risk factor of suicide and their detection is crucial. This study has investigated suicidal risks in prisoners with the assessment of the rate of suicidal ideation as well as their link with risk factors such as depressive disorders, individual factors or life's event's life, etc. Participants were recruited from all-male adults, who just arrived in prison since one week in prison of Hauts-de-Seine, Nanterre, France. One hundred prisoners able to read and fill in the scales in autonomy way were evaluated from March to June 2007 using a structured interview, Beck Depression inventory (BDI), Scale of suicidal ideation by Beck (SSI) and a short version of Mini International Neuropsychiatric Interview (MINI). The SSI assesses precisely the presence of suicidal ideations and suicidal risk as well as its severity and the score gives some information on the severity of the suicidal risk. The BDI assesses the presence of depressive symptoms as well as the severity of depression according to a classification: Light, medium or severe depression. Eleven out of 100 prisoners have suicidal ideations in SSI. They are not connected significantly to the incarceration (χ² = 3.52, P = 0.05). The scores go from 3 to 27 (the maximum score for this scale is 36) and the medium score is 8.81: four people have scores around the medium score, four people have a score smaller than 5, three people have a score higher than 9. The group of prisoners who have suicidal ideations (n = 11) was compared with the group of prisoners without suicidal ideations (n = 89). Suicidal ideations are in link with the severity of depression in BDI (χ² = 12.53, P < 0.001) but not with its presence only: Prisoners who have suicidal ideations have a medium score of depression higher than prisoners who have not suicidal ideations (16.45 against 6.01, the maximum score for this scale is 39). Ninety-one percent of prisoners who have suicidal ideations suffer from medium or severe depression against 35 % of prisoners without suicidal ideations. Nevertheless, the difference is not significant if we compare the two groups with all types of depression-light, medium or severe (χ² = 2.74, P < 0.05). Moreover anxious and psychotics symptoms, in particular hallucinations in MINI are linked significantly with suicidal ideation (anxiety: χ² = 22.62, P = 0.00001; psychosis: χ² = 6.639, P = 0.01; hallucinations: χ² = 12.8, P = 0.001). Significant risk factors for suicidal ideation in prisoners are life's event such as personal suicidal attempt (χ² = 25.58, P < 0.000001) and substance use history (χ² = 7.76, P < 0.01) and the lack of family support (χ² = 8.7, P < 0.01). It is not the case for suicidal attempt in family (χ² = 1.663, P < 0.05) and a recent death (χ² = 1.24, P < 0.015). Prisoners, who are more than 35 years old, are married, have children and are in prison for murder(s) or rape(s) have significantly more suicidal ideations. Some prisoners who have not suicidal ideation in the SSI have a suicidal risk in the MINI. So we can think these ideas are under-expressed in the SSI because prisoners can feel uncomfortable to express such ideas. Moreover there is more than the half of prisoners who present some signs of depression in BDI for less than one third of prisoners in MINI: Depression can be over-expressed in BDI, what explain it is the severity of depression which is in link with suicidal ideations and no only its presence because a lot of prisoners (with or without suicidal ideations) seem to have a depression with the assessment of BDI. The results must be used with care because the population of the study is quite small, in particular for prisoners who have suicidal ideations. Furthermore it is very heterogeneous and judging origins of the link between suicidal ideations and risk factors is very difficult. In conclusion, these results cannot be generalised to the whole prison; they are specifics to this place of research. Symptoms of depression, anxiety and psychosis as well as personal history of suicidal attempt, substance use and a lack of family support are risk factors for suicidal ideations in prisoners. The precocious detection of suicidal ideation and risk factors would prevent from suicide and reduce the risks.     

Stratégies de coping, activités compensatoires et rechutes chez les alcooliques abstinents

Objectives

To be abstinent alcoholics must control their behaviour and adapt it. We may therefore consider that this stressful situation could involve the use of coping strategies. Several authors have established that avoidance or emotional coping strategies are dysfunctional while proactive strategies seem to increase the strength of abstinence behaviours. It has, however, been stated that the restriction of alcohol use is frequently complemented by the apparition of new addictive behaviours also considered as co-addictions or as overlaps. This statement was first based on observations concerning the frequently reported use of tobacco amongst alcoholic people. Since then other authors have reported that an increase of the consumption of coffee, candy and food could be observed when alcoholics try to reduce their use of alcohol. Drug uses have also been reported. Moreover, the co-addictions that appear amongst alcoholics do not only concern the use of other substances. These addictive overlaps sometimes take place with an increase of the involvement in activities such as sport practice, work or the use of the Internet. The objective of this research is first to study the addictive overlaps that can be observed amongst alcoholics, and their influence on the relapses. Then, the links between such behaviour with coping strategies will be tested.

Method

Twenty eight alcoholics (16 men, 12 women, average age: 47) were involved in the study. All of them were abstinent when answering the questionnaires. First, the participants were asked to fill a grid assessing the addictive overlaps and their frequency since the beginning of the cure. This grid was adapted from a questionnaire assessing the overlaps related to addictive behaviours amongst sportsmen. The overlaps are divided into two categories: addictive substance use overlaps and addictive activity overlaps. Then, coping strategies were measured with the use of the Ways of Coping Checklist (WCC). The questionnaire provides three scores referring to the three categories of coping strategies: proactive strategies, emotional strategies and social support seeking. Finally, referring to the medical files, the number of relapses since the beginning of the cure was reported for each of the participants.

Results

The number of relapses experienced by an alcoholic is related to two of the three coping strategies. The higher the number of relapses, the lower the score of proactive strategies (r = −0.719). Moreover, social support seems to be a useful strategy in order to maintain abstinence (r = −0.489). The three most frequently reported overlaps refer to substance use behaviours. These substances are: food, coffee and tobacco. Moreover, these overlaps are frequently associated: a strong link is observed for coffee and food (r = 0.668) and for coffee and tobacco (r = 0.464). However, there is no difference concerning the addictive overlaps between the alcoholics who have always maintained abstinence, and those who experienced one or several relapses. Finally, the results allow us to consider the hypothesis that addictive activity overlaps could be considered as sort of proactive coping strategies: this category of overlaps is negatively linked with social support seeking (r = −0.420).

Conclusions

The most frequently reported overlaps are those which seem to be similar to the behaviour that is supposed to be replaced: an oral dimension is observed in the overlaps of alcoholics. The terms of “addictive core” is proposed in order to describe the weakness of such people concerning addictive behaviours. However, other explicative psychological factors have been identified by several authors and may influence the results, such as alexithymia that is frequently related to addictive behaviours. In addition to this study, a longitudinal study of the addictive overlaps is relevant in order to examine their diachrony and their functional or dysfunctional role upon the relapses. Finally, the links between addictive overlaps and coping strategies should require further investigation in order to determine if these overlaps are part of the coping strategies.