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The Difficulties in Emotion Regulation Scale (DERS) comprising 36 items has been widely used across age, gender, psychopathology, language, and culture. Recently several alternative abridged forms have been introduced, namely, the DERS-16 (Bjureberg et al. 2016), the DERS-SF (Kaufman et al. 2016), and the DERS-18 (Victor and Klonsky, 2016), each composed of 16 or 18 items, to provide researchers and clinicians with a shorter measure of emotion dysregulation. However, no study to date has directly compared the psychometrics of these alternative forms. In the present study, using confirmatory factor analysis we first examined the factor structure of the four models of the DERS in two inpatient samples of 636 adolescents in the age-range of 12–17 years (M = 15.33, SD = 1.43), and 1807 adults in the age-range of 18–76 years (M = 34.86, SD = 14.63) with severe mental illness. Next, measurement invariance was tested comparing the two age groups across the four models of DERS. Only the DERS-SF established metric and scalar measurement invariance. Findings suggest that the factor structure of the original and the abridged models of DERS have acceptable fit, however only DERS-SF had equivalence of factor loadings and item intercepts across adolescents and adults.

The aim of this study is to investigate the relationship between alexithymia and Internet Gaming Disorder (IGD) (while controlling for depression and anxiety), explore the presence of gender differences, and the potential differences between MOBA and MMORPG gamers. A total of 429 young adults (mean age 20.7 years) recruited from different forums dedicated to video games took part in the study and filled a questionnaire including type of video game use, the Game Addiction Scale, the TAS-20 (evaluating alexithymia) and the HADS (evaluation anxiety and depression). In the whole sample, being alexithymic, depression scores, and anxiety scores were associated with IGD. Nevertheless, results differed depending on gender and type of games played. In male gamers, being alexithymic, being young, and having high anxiety and depression scores was associated with IGD. In female gamers, having less than a high school education and a high depression score was associated with IGD. In MOBA gamers, only the difficulty describing feelings factor was associated with IGD while in MMORPGs gamers, graduation from high school and anxiety scores were associated with IGD. Playing MOBA games could be a strategy to regulate emotions while playing MMORPG appears to be a maladaptive coping strategy to deal with negative affective disturbances. Gender and gaming type are important factors in the relationship between alexithymia, depression, anxiety and IGD. These results have some interesting clinical implications, which are discussed.

Schizophrenia is associated with an increased violence risk, particularly homicide. One possible, but scarcely explored, contributor to the increased violence risk is social cognitive impairment. Individuals with schizophrenia show impairments in social cognition that are associated with poor functional outcome. This study examined social cognition among homicide offenders with schizophrenia (HOS), applying validated measures of emotion perception and theory of mind (ToM). Two groups of individuals with schizophrenia were compared, one had committed homicide (HOS, n = 26), and the other had no violence history (non-HOS, n = 28). Healthy controls (HC, n = 71) were included as reference group for one measure. Emotion perception was indexed by the Emotion in Biological Motion (Emotion) and Pictures of Facial Affect (PFA) tests. ToM was assessed with the Hinting Task and Movie for the Assessment of Social Cognition (MASC). The results showed that HOS participants had significantly poorer performance than non-HOS in both emotion perception and ToM. For the MASC test, HOS participants showed large deficits compared to HC (-4 standard deviations). Particularly, HOS participants made a substantial number of undermentalizing errors. The results suggest that emotion perception deficits and a tendency to undermentalize may be important for understanding homicide in schizophrenia.

Previous studies that aimed to support emotion recognition deficits and alexithymia in B cluster personality disorders have mainly focused on borderline personality disorder (BPD), and resulted in mixed findings. In our study we examine emotion recognition and alexithymia in patients with histrionic (HPD), narcissistic (NPD) and borderline (BPD) personality disorders compared to each other and healthy controls. Furthermore, the possibility is investigated that it is not the type of PD but the severity of psychopathology which predicts the severity of emotion recognition deficits and alexithymia. Patients with HPD, NPD, BPD and healthy controls (N = 20 for each group) were examined by using the Ekman 60 Faces Test (FEEST) and the Toronto Alexithymia Scale (TAS-20). To measure the extent and severity of psychopathology, the Symptom-Checklist-90 Revised (SCL-90-R) was used. Patient groups performed significantly worse compared to healthy controls on the Ekman test and TAS-20, while we found no significant differences among patient groups in emotion recognition and alexithymia. Furthermore, higher scores on the SCL-90-R predicted poorer emotion recognition performance and higher alexithymic features. The empirical data supports the conclusion that the severity of psychopathology plays an important role in predicting emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders.

Schizotypy offers a useful construct for investigating the etiology, development, and expression of schizophrenia-spectrum psychopathology, as well as the comorbid expression of mood and anxiety disorders across the schizophrenia spectrum. The present study examined the associations of positive, negative, and disorganized schizotypy with affective symptoms and experiences in a sample of MTurk workers and college students (n = 575). Participants completed the Multidimensional Schizotypy Scale (MSS) and measures of depression, anxiety, social phobia, hypomanic traits, and state affect. As expected, positive schizotypy was significantly associated with hypomanic traits, whereas negative schizotypy was associated with reduced positive affect and reduced hypomanic traits. Although prior research has emphasized the association of positive schizotypy with depression and anxiety, the current results demonstrate that disorganized schizotypy is more strongly associated with elevated negative affect (over-and-above positive schizotypy). As such, these findings highlight the importance of examining disorganization of affect, in addition to the cognitive-behavioral deficits traditionally associated with disorganized schizotypy. Finally, the MSS and MSS-Brief demonstrated closely comparable findings. The present results provide further support for the construct validity of the MSS and the three-factor model of schizotypy.

Highlights • Prenatal anxiety and depression increase progressively throughout the pandemic. • Pandemic context differentially affects pregnant and non-pregnant women. • As the pandemic progresses, differences between groups intensify. • Being pregnant is a risk factor for the development of psychopathological indicators., Several studies have reported the susceptibility of pregnant women to emotional instability and stress. Thus, pregnancy may be a risk factor that could deepen the already negative effects of the current COVID-19 pandemic. Therefore, the aim of this study is to analyze longitudinally the psychopathological consequences of the pandemic in pregnant women, and to explore differences with non-pregnant women. The participants in this study were 102 pregnant women, and a control group of 102 non-pregnant women (most of them reported having university studies and little financial impact from the pandemic). They completed the Beck Depression Inventory-II, the State-Trait Anxiety Inventory, and the Positive and Negative Affect Schedule, in three different times (2, 14, and 47 days after the start of the lockdown). In a time range of 50 days of quarantine, all women showed a gradual increase in psychopathological indicators and a decrease in positive affect. Pregnant women showed a more pronounced increase in depression, anxiety and negative affect than the non-pregnant women did. In addition, pregnant women showed a more pronounced decrease in positive affect. It is important for institutions dedicated to perinatal health care to count on empirical information to optimize the provision of their services.

Highlights • The Covid-19 lockdown affect severity of emotional and mood behaviors in ADHD • Children and adolescents with low severity degree resulted more vulnerable to lockdown • Boredom and Little enjoyment/interest are the most affected dimensions during lockdown, The current study examined the impact of the lockdown due to the Covid-19 disease on mood state and behaviours of children and adolescents with ADHD. Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the degree of severity of six emotional and mood states (sadness, boredom, little enjoyment/interest, irritability, temper tantrums, anxiety) and five disrupted behaviours (verbal and physical aggression, argument, opposition, restlessness) based on their frequency/week (absent; low: 1-2 days/week; moderate: 3-4 days/week; severe: 5-7 days/week) before and during the lockdown. Important fluctuations were found in all dimensions during the lockdown independently by the severity degree. Subjects with previous low severity degree of these behaviors significantly worsened in almost all dimensions during the lockdown. On the contrary, ADHD patients with moderate and severe degree showed important improvement during the lockdown. Little enjoyment/interests and boredom resulted the dimensions more strongly affected by the condition of restriction, overall in children. Children vs. adolescents showed substantially similar trend but the former resulted significantly more vulnerable to emotive changes. The results provided both the individuation of domains affected, and the indirect benefits produced by restriction condition.

Postpartum depression (PPD), a female-specific disorder, is the most common medical complication associated with childbirth (10-20%). The pathological relevance of emotion processing, meta-cognition, alexithymia, and social cognition to PPD is unclear. We tested 25 mothers with PPD (mean age: 30.72 ± 5.76 years) and 25 healthy mothers (mean age: 32.03 ± 3.54 years) for alexithymia (Toronto Alexithymia Scale) and evaluated cognitive empathy (Faux Pas Test), affective empathy (Interpersonal Reactivity Index), meta-cognition (Meta-Cognitions Questionnaire), sociodemographic and clinical-psychometric characteristics and personality dimensions. Mothers with PPD showed higher levels of neuroticism and more anxiety-depressive characteristics. Their metacognitive abilities were significantly altered and they more often had alexithymia. Significant correlations between alexithymia and meta-cognition, trait anxiety, and neuroticism were found. Alexithymia, neurotic personality traits, and dysfunctional meta-cognition appear more frequently in PPD women than healthy women. Social cognition abilities were not significantly altered. Alexithymia and metacognitive distortions play important roles in the pathogenesis of PPD. Dysfunctional meta-cognition, neuroticism, and alexithymia may be risk factors that should be detected early in expectant mothers to prevent the development of PPD.

Four subtypes of the alexithymia construct have been proposed based on different response patterns to the Cognitive and Affective dimensions of the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Previous studies investigating whether alexithymia subtypes can be statistically estimated have not found complete support for these specific subtypes. These previous studies, however, contained several methodological limitations such as relatively small sample sizes, and considerations of only a limited number of proposed subtypes. In the current investigation, we examined whether the four proposed subtypes could be statistically detected in a large sample of undergraduate students (N = 612) who completed the BVAQ, using latent profile analysis (LPA). Based on observed responses to the five BVAQ subscales, consistent with previous studies, our results did not find support for the four proposed alexithymia subtypes. Rather, our results suggested LPA solutions that correspond to individuals with various degrees of alexithymia ‘severity’. Although further studies are needed, especially with clinical samples, these results question the idea of four alexithymia subtypes and suggest that the implementation of these subtypes into various research studies may be a premature endeavour.

Emotional dysfunctions have long been associated with psychopathy. Yet, the extent to which these dysfunctions include problems in emotion regulation (ER) has only recently become clearer. In this study, we first reviewed theoretical and empirical literature on psychopathy and ER, and then examined associations between ER and psychopathy in four diverse samples from two countries (MTurk, college, community, and offender samples from the United States and Italy; total N = 1940). We employed Structural Equation Modeling (SEM) to examine latent associations between ER and measures of psychopathy and the dark triad, respectively. Results revealed a consistent pattern of moderate associations between psychopathy and poorer ER. These patterns were replicated across samples and psychopathy assessment, and held when including Machiavellianism and narcissism in the models. Replicating and extending recent studies, these findings provide incremental evidence that the emotional dysfunctions associated with psychopathy include problems in ER. Thus, we contend that prevention efforts in the general community, as well as clinical risk assessment and treatment planning in clinical (forensic) populations should include an emphasis on ER, as it may represent an important factor explaining some of the maladaptive correlates of psychopathic personality.

This study investigated psychophysiological and subjective emotional responses to an affective startle modulation paradigm in first-presentation borderline personality disorder (BPD). Twenty BPD and 20 healthy control participants, aged 15-24 years, viewed a set of standardized pictures with pleasant, neutral, or unpleasant valence, and were instructed to either "maintain" or "suppress" their emotional response to the stimuli. Despite showing markedly higher levels of baseline distress on self-report questionnaires, BPD participants had significantly lower skin conductance responses and showed an absence of the fear potentiated startle response during early picture processing. Both groups showed similar startle responses later in picture processing, and when instructed to "maintain" or "suppress" their emotions. BPD participants were hypo-responsive to aversive stimuli during early processing, and did not react with more intense emotional responses to affective stimuli or show a diminished ability to regulate their responses. These results might be consistent with the finding that hypersensitivity of emotional response in BPD is specific to stimuli with themes of particular relevance to this disorder, such as rejection and abandonment.

Alexithymia is associated with increased risk for mental and physical health disorders but available assessments rely exclusively on self-report. The major aim of the current study was to develop and implement a performance-based task designed to characterize and quantify the relationship between one's description of emotional experience and self-reported alexithymia. Specifically, we examined performance-based measures of affect labeling of one's own emotions, emotional granularity and dialecticism. Healthy participants (N = 108) completed the Toronto Alexithymia Scale–20 Item Questionnaire. Participants viewed a series of film clips standardized to elicit discrete emotional states. After each clip, they indicated the emotion they experienced “the most” and rated a list of non-primary emotions, which formed indices of emotional granularity and dialecticism. Alexithymia was associated with increased tendency to report experiencing “no emotion” following evocative film clips, reduced negative emotional granularity and dialecticism of experienced emotions. TAS-20 subscales were each associated with a unique set of emotional correlates. In a healthy population, alexithymia is associated with reduced awareness of emotional states, and reduced dialecticism and granularity of negative (but not positive) emotions. Our performance-based assessment enriches understanding of the mechanisms underlying alexithymia by underscoring the central importance of emotion awareness, negative emotional granularity and dialecticism.

This study investigated the relationship between alexithymia and physical complaints among psychiatric outpatients, and whether sex moderated this relationship. Participants (N = 185) completed measures of physical complaints (bodily symptom burden, pain severity, pain interference), alexithymia, current symptom (depression, anxiety) distress, and somatosensory amplification (i.e., a person's tendency to be bothered by physical sensations). Hierarchical regression analyses were conducted, controlling for the influence of current psychiatric symptom distress and somatosensory amplification. Findings revealed differential relationships between alexithymia and physical complaints (pain interference) for women and men, in addition to main effects for sex and alexithymia. The findings suggest that the negative influence of alexithymia on bodily-related problems may not be universal.

Background Understanding factors influencing mental health of sexually abused teenagers is essential to orient treatment with this vulnerable population. The purpose of this study was to explore alexithymia as a mediator of the relationship between child sexual abuse and psychological distress using a representative sample of teenagers, while considering gender as a potential moderator. Methods Teenagers participating in the Quebec Youths’ Romantic Relationships Survey completed measures evaluating a history of child sexual abuse and alexithymia at baseline while psychological distress was evaluated 6 months later. Results A moderated mediated model revealed a partial mediation effect of alexithymia in the relationship between child sexual abuse and psychological distress. Gender acted as a moderator as the conditional indirect effects of child sexual abuse on mental health via alexithymia were stronger for boys. Conclusion Findings underscore the relevance of assessing and targeting sexually abused victims’ capacity to identify and communicate emotions to promote well-being.

Schizophrenia is associated with an elevated risk of aggression. Cognitive deficits have been associated with inpatient aggression and future violence. The relationship between cognitive deficits and violent behavior has however been inconsistent across studies. In addition, studies have failed to inform how cognitive deficits may contribute to aggression in schizophrenia. The current study examined the association of cognitive deficits with schizophrenia-related aggression and violent offending. It also explored the putative mediating role of negative emotionality on the impact of cognitive deficits on aggression. People with schizophrenia and schizoaffective disorder (N = 78) were recruited from a state hospital. Participants were classified based on their history of violent offending. Participants completed measures of cognition, symptoms, and aggression. Deficits in working memory, reasoning/problem-solving, and verbal learning were the most prioritized for the prediction of violent offender status. Violent offenders demonstrated greater impairments in most cognitive domains especially working memory and verbal learning. Offenders also demonstrated greater negative emotionality, excitement/agitation, and incidents of verbal and physical aggression. Negative emotionality and excitement/agitation fully transmitted the effect of cognitive deficits on impulsive aggression in meditational models. Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states.

Many individuals in the general population experience psychotic-like experiences in the absence of a psychotic disorder. The degree of psychological distress associated with these experiences is a key predictor of clinical outcomes. One factor that may influence the degree of distress from psychotic-like experiences is emotion regulation. Although it has been demonstrated that emotion regulation deficits are present in psychotic disorders, the association between emotion regulation and subclinical psychotic-like experiences is not well understood. Here, we examined the associations between frequency of and distress from psychotic-like experiences and several key components of emotion regulation: difficulties with emotion regulation; emotion regulation self-efficacy; and emotion regulation strategy use. Difficulties with emotion regulation and maladaptive patterns of emotion regulation strategy use were associated with the frequency of both positive and negative psychotic-like experiences. In addition, results suggest that habitual acceptance use and reappraisal self-efficacy may serve as protective factors against the distress associated with psychotic-like experiences.

Social dysfunction is a hallmark of schizophrenia that is associated with emotional disturbances. Researchers have employed ecological momentary assessment (EMA) to measure social and emotional functioning in people with schizophrenia. Yet, few studies have evaluated quality of real-world social interactions, and it is unclear how interactions impact emotional experiences in this population. Using novel EMA that passively collects audio data, we examined daily social behavior and emotion in schizophrenia (n = 38) and control (n = 36) groups. Contrary to hypotheses, both groups interacted with others at the same rate and exhibited similar levels of positive emotion. However, as expected, the schizophrenia group exhibited significantly less high-quality interactions and reported more negative emotion than controls. Social versus non-social context did not influence experienced emotion in either group. This is the first real-world study to passively assess quality of social interactions in schizophrenia. Although those with schizophrenia did not differ in their number of interactions, they were less likely to engage in substantive, personal conversations. Because high-quality interactions are linked with better social outcomes, this finding has important potential treatment implications. Future research should investigate quality of interactions across different types of social activities to gain a more nuanced understanding of social dysfunction in schizophrenia.

To fully understand the dimensionality of an instrument in a certain population, rival bi-factor models should be routinely examined and tested against oblique first-order and higher-order structures. The present study is among the very few studies that have carried out such a comparison in relation to the Symptom Checklist-90-R. In doing so, it utilized a sample comprising 2593 patients with substance use and impulse control disorders. The study also included a test of a one-dimensional model of general psychological distress. Oblique first-order factors were based on the original a priori 9-dimensional model advanced by Derogatis (1977); and on an 8-dimensional model proposed by Arrindell and Ettema (2003)—Agoraphobia, Anxiety, Depression, Somatization, Cognitive-performance deficits, Interpersonal sensitivity and mistrust, Acting-out hostility, and Sleep difficulties. Taking individual symptoms as input, three higher-order models were tested with at the second-order levels either (1) General psychological distress; (2) ‘Panic with agoraphobia’, ‘Depression’ and ‘Extra-punitive behavior’; or (3) ‘Irritable-hostile depression’ and ‘Panic with agoraphobia’. In line with previous studies, no support was found for the one-factor model. Bi-factor models were found to fit the dataset best relative to the oblique first-order and higher-order models. However, oblique first-order and higher-order factor models also fit the data fairly well in absolute terms. Higher-order solution (2) provided support for R.F. Krueger's empirical model of psychopathology which distinguishes between fear, distress, and externalizing factors (Krueger, 1999). The higher-order model (3), which combines externalizing and distress factors (Irritable-hostile depression), fit the data numerically equally well. Overall, findings were interpreted as supporting the hypothesis that the prevalent forms of symptomatology addressed have both important common and unique features. Proposals were made to improve the Depression subscale as its scores represent more of a very common construct as is measured with the severity (total) scale than of a specific measure that purports to measure what it should assess―symptoms of depression.

Adverse effects (AEs) are an important factor in antidepressant treatment decision-making, though common AE profiles from clinical trial research highlight physical AEs to the neglect of emotional and behavioral AEs. First-hand accounts of antidepressant users on the Internet can supplement AE profiles with information gained from real-world treatment experiences. We examined online user reviews of two older (escitalopram; duloxetine) and two newer (vilazodone; vortioxetine) antidepressants for differences in their AE profiles and determined which categories of AEs were associated with users' satisfaction. A codebook of 60 physical, emotional, and behavioral AEs was used for line-by-line coding of effects reported among 3243 user reviews from three popular health websites. Emotional and behavioral effects were commonly reported (41%), followed by sleep (31.9%) and gastrointestinal (25.0%) effects. Specific AEs statistically significantly varied across drugs, creating potentially meaningful differences in AE profiles. Users of newer drugs more often reported emotional instability, while users of older drugs reported more emotional blunting. Emotional and behavioral AEs demonstrated moderate to substantial relationships with users' satisfaction, whereas gastrointestinal, metabolic, or sexual AEs were minimally related. More specific and systematic assessment of a broader range of AEs is needed in both research and practice.

The aim of this study was to evaluate the potential contributing factors such as alexithymia, emotion regulation and difficulties in emotion regulation, positive/negative affects and clinical factors including severity of alcohol dependence and depression connected to high suicidality in alcohol-dependent outpatients. 205 alcohol-dependent outpatients and 100 normal controls completed the demographic questionnaire, the Persian version of the Toronto Alexithymia Scale (FTAS-20), the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), the Positive/Negative Affect Scales, the Alcohol Use Disorders Identification Test (AUDIT), and the Beck Depression Inventory-II (BDI-II). The suicidal risk was assessed using the Scale for Suicide Ideation (SSI) and history taking. Alcohol-dependent outpatients showed higher means in alexithymia, difficulties in emotion regulation, suppression subscale, negative affect, and suicide ideation than normal controls. Logistic regression analysis revealed that negative affect, duration of alcohol use, externally-oriented thinking, and severity of alcohol dependence explained lifetime suicide attempts. Depression, impulsivity, severity of alcohol dependence, reappraisal (reversely), externally-oriented thinking, difficulties engaging in goal-directed behaviors, and negative affect significantly predicted the suicidal risk. The findings may constitute useful evidence of the relevancies of alexithymia, emotion regulation, emotion regulation difficulties, and affects to suicidality in alcoholic patients.

Impulsivity has often been related to aggressive and self-mutilative behavior in Borderline Personality Disorder (BPD). Many authors focused on the key role of emotion dysregulation in explaining vulnerability to dysfunctional behavior in BPD in addition to trait impulsivity. Furthermore, recent works have shed light on a gap in empirical research concerning the specific mechanisms by which a lack of affective regulation produces aggression proneness. The purpose of the study was to investigate the role of impulsivity and emotion dysregulation in determining vulnerability to aggression and deliberate self-harm in a sample of BPD outpatients. Enrolled patients with BPD (N =79) completed a comprehensive assessment for personality disorder symptoms, trait impulsivity, emotional dysregulation, aggressive and self - mutilative behavior. Trait impulsivity significantly predicted both aggressive and self-mutilative proneness. Furthermore, emotion dysregulation was found significantly to account for the vulnerability to aggression and self-injury, in addition to the variance explained by impulsivity. In conclusion, these findings support evidence that emotion dysregulation plays an important role in increasing the risk of dysfunctional behavior in impulsive BPD individuals.

Suicidal behaviors are serious public health problems. The prominent association of mood disorders with suicide, along with the renaissance of the spectrum concept of psychiatric disorders in the recent decades, prioritizes the investigation of temperament variants in suicidal individuals. This study aimed to explore the relationship between affective temperaments and nonviolent suicide attempts. We administered Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A) to 141 (27 males and 114 females) consecutive self-poisoning non-lethal suicide attempters at a Medical Toxicology Center and a sex and age matched group of healthy individuals (28 males, 112 females). Female suicide attempters scored significantly higher in depressive, cyclothymic, irritable, and anxious temperaments compared with female controls, whereas male cases’ scores were significantly higher in depressive and anxious subscales compared with control males. Except for hyperthymic temperament which did not reveal any significant effects, depressive (OR: 11.5), cyclothymic (OR: 3.8), irritable (OR: 2.3), and anxious (OR: 8.8) temperaments were predictors for nonviolent suicide attempts. Therefore, this study replicated the evidence for the strong association of depressive temperament with suicide attempts. The hyperthymic temperament appeared to have neither protective nor predisposing influence. Further studies are needed to identify the role of this independent temperament.

Objective To identify emotion-associated risk factors for suicidality in patients with somatoform disorders. Methods A sample of 155 consecutive patients diagnosed with somatoform disorders at the Psychosomatic Ambulance of Bonn University Hospital filled in several questionnaires including the Symptom Checklist 90-Revised Version (SCL-90-R), the Toronto Alexithymia Scale (TAS-20), and the State Trait Anger Expression Inventory (STAXI). Our aim was to compare patients with suicide attempts to patients without suicide attempts via a MANCOVA (IV: Group; DV: SCL-90-R, TAS-20, STAXI; covariates: sex, age, depression, borderline personality disorder). Results Lifetime suicide attempts were documented in 20 patients (12.9%), current active suicidal ideation in 33.6%, and thoughts of death or dying in 55.9%. Patients with lifetime suicide attempts showed significantly more psychological distress, a significantly higher alexithymia sum score, a significantly higher score on trait anger, state anger, and a stronger tendency to express anger. Conclusion Somatoform disorder patients with lifetime suicide attempts might have greater difficulties in identifying and describing emotions, and a tendency to intensely experience and express anger. Future longitudinal studies should further investigate possible links between difficulties in coping with anger and suicidality to improve prophylaxis and treatment of suicidal behaviour in somatoform disorder patients.

Emotion dysregulation is commonly reported among adults with Attention-Deficit/Hyperactivity Disorder. This study examined whether inattention and/or hyperactivity/impulsivity directly affect functional impairment, or whether they do so indirectly by decreasing emotion regulation capabilities. An ethnically, racially and socioeconomically diverse sample of clients seeking treatment at a low-fee outpatient mental health clinic were recruited [N = 177, male n = 59, 33.3%, mean (SD) age = 28.54 (8.41) years]. Participants completed measures of inattention, hyperactivity/impulsivity, emotion regulation and impairment at intake. Inattention was more strongly related to emotion regulation and impairment than hyperactivity/impulsivity. Hayes’ PROCESS was used to test for significant indirect effects. More severe inattention was associated with less emotional clarity, which in turn was associated with worse Interpersonal Relationship difficulties; more severe inattention was associated with less access to emotion regulation strategies and poorer emotional clarity, which in turn were associated with greater Symptom Distress; and inattention was directly associated with impairment at school and work. In addition to treating inattention, clinicians should focus on emotion regulation deficits. Specifically, working with individuals to improve identification and labeling of emotions, develop strategies to reduce the intensity of their negative emotions, and feel more confident that they have these tools at their disposable may help to reduce impairment.

Research suggests that major depressive disorder (MDD) and bipolar disorder (BD) are both associated with unique emotional memory (EM) biases. To better elucidate the EM phenotypes of these disorders, we systematically reviewed the literature on non-autobiographical explicit EM biases in individuals with MDD and BD compared to healthy controls. The following databases were searched: Cochrane, Embase, HAPI, LILACs, Medline, PsycInfo and Web of Science. Grey literature and hand searches were also performed. Fourteen studies met full eligibility criteria. Eleven studies included data from an MDD sample (10 during acute depression, 1 during euthymia) and 3 studies included data from a BD sample (2 during acute mood episodes, 1 during euthymia). Only 3 of the studies in acute depression revealed a negative explicit EM bias. One study in MDD during euthymia revealed an EM deficit for negative stimuli. One of the two studies in BD (type I; BD-I) during an acute mood episode revealed a positive explicit EM bias, while the other showed no bias. One study in BD during euthymia showed an EM deficit for negative stimuli. Overall, this review concludes that current empirical evidence does not readily support the existence of an explicit EM bias in MDD during acute depression. The identification and implications of potential moderating factors on explicit EM performance in MDD and BD during both illness stages are discussed.

Alexithymia is a personality construct characterized by difficulties in identifying and describing emotions. Previous research has identified a positive association between alexithymia and aggression, and impulsivity may account for some of that association. This study tested a path model of associations between alexithymia, five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking), and verbal and physical aggression in a sample of 503 undergraduate students. Alexithymia had significant positive associations with all facets of impulsivity except for sensation seeking. Negative urgency and (lack of) premeditation mediated the relationship between alexithymia and verbal aggression. Positive urgency, negative urgency, and (lack of) premeditation mediated the relationship between alexithymia and physical aggression. Positive urgency also moderated the relationship between alexithymia and both forms of aggression, increasing the strength of those associations. These results highlight the role of emotion dysregulation in the context of aggression and support the use emotion regulation skills training in anger and aggression management programs.

From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.

This study investigated the interrelationship between alexithymia, defense style, emotional suppression, posttraumatic stress disorder (PTSD) following homicide and psychiatric co-morbidity. One hundred and fifty male homicide perpetrators and 156 male perpetrators of non-violent crime completed the Posttraumatic Stress Diagnostic Scale (except for non-violent perpetrators), the General Health Questionnaire-28, the Defense Styles Questionnaire, the Courtauld Emotional Control Scale and the Toronto Alexithymia Scale-20. The results showed that 44% of homicide perpetrators met the criteria for PTSD. No significant differences were found between groups in alexithymia, defense style and psychiatric co-morbidity. Homicide perpetrators suppressed depression significantly more than the non-violent group. PLS analyses showed that alexithymia was significantly correlated with defense style. Defense styles were significantly correlated with emotional suppression which, in turn, was associated with homicide-related PTSD and psychiatric co-morbidity. To conclude, perpetrators can experience PTSD reactions following the act of homicide. The severity of these reactions and other psychological problems were related to difficulty getting in touch with distressing emotions, the defenses they used to protect themselves psychologically and the way they suppressed their emotion.

Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.

Alexithymia has been frequently studied in the context of negative affect frequency but rarely in the context of positive affect frequency or in the context of affect intensity. However, affect intensity and frequency, even if they are independent, are generally confounded due to an overlap in items wording (tapping both dimensions). The aim of the study was to examine the incremental validity of alexithymia for predicting both affect intensity and frequency, regarding positive and negative valence. Two hundred and fifty five students fulfilled measurements for alexithymia, affect intensity and affect frequency. Results showed that the factor "Difficulty identifying feelings" is related to higher positive and negative affect intensity, as well as to negative affect frequency. Men were also more sensitive to positive affect intensity and frequency if they scored higher on alexithymia. They experienced less often positive affect, but the intensity of their affect was more intense. Conversely, alexithymia did not influence women's affect intensity or affect frequency. Thus, alexithymia factors are associated with specific patterns of affect intensity and frequency, highlighting an overall deficit in the processing of emotions with contrasting patterns regarding gender.

Dysregulation of the behavioral activation system (BAS) has been theorized to be a core factor underlying mood swings in bipolar disorder (BD). However, few studies have directly addressed BAS dysregulation and more research is needed to understand its dynamic expression in daily life. The aim of this study was to directly assess BAS dysregulation, and to examine its moderating effect on the relationship between life events and bipolar spectrum symptoms via multilevel modeling. Korean young adults (n = 100) were screened using the Hypomanic Personality Scale (HPS) from a large sample (N = 1,591). They completed online diaries for 7 consecutive days including the Daily Events Record as well as bipolar spectrum symptoms. BAS-activating and/or -deactivating scores were allocated to each reported life event by an expert consensus rating. Cross-level interaction analysis showed that the occurrence of BA life events contributed to a steeper increase in bipolar spectrum symptoms, particularly for individuals with high BAS dysregulation. The present study suggests that BAS dysregulation is a unique construct that deserves further exploration in BD.

Child maltreatment is known to be an etiological factor for developing alexithymia which refers to the difficulty to identify and express feelings. Yet, scarce data is available regarding the vulnerability in child victims of sexual abuse to develop alexithymia. The current study aimed to compare level of alexithymia among a sample of school-aged victims of child sexual abuse (CSA) and a comparison group of non-victimized children. Results also investigated the mediational role of alexithymia in the association between CSA and both internalized and externalized behavior problems. The sample involved 429 sexually abused and 98 non-abused children aged 6 to 12 years old and their parents. The Children's Alexithymia Measure (Way et al., 2010) and the Child Behavior Checklist (Achenbach and Rescorla, 2001) were completed by parents. Clinicians filled out an adapted version of the History of Victimization Form to assess CSA characteristics (Hebert and Cyr, 2010). Analyses revealed that victims of CSA presented significantly higher levels of alexithymia compared to their non-abused counterparts. Results also highlighted the role of alexithymia mediating the association between CSA and both internalized and externalized behavior problems. Focussing on alexithymia is a promising avenue to sustain resilience and prevent further difficulties in sexually abused children.

In everyday clinical work, psychiatrists encounter patients who present with symptoms spanning several diagnostic categories, e.g., showing signs of a psychosis, depression, and anxiety. This raises the critical question of which symptoms hold precedence over other and, by extension, which diagnosis is the right diagnosis. ICD-10 and DSM-5 do not provide unambiguous answers to this question and therefore psychiatry remains exposed to diagnostic disagreement with consequences for treatment and research. We explored symptom distribution in a sample of 98 first-admission psychiatric patients. We extracted and categorized singular symptoms into symptom domains: anxiety, mania, delusions, hallucinations, first-rank symptoms, and negative symptoms. Most symptoms were seen in most disorders. We found symptoms of depression and anxiety in almost all patients. Thus, just counting symptoms do not seem to be a valid way to make diagnoses. We elaborately discuss these issues in the context of the differential-diagnosis between schizophrenia and depression. Finally, we suggest that a combination of a criteria- and Gestalt-based approach to diagnosing mental disorders may contribute to counteract some of the current differential-diagnostic confusion.

Emotion dysregulation is implicated in both suicide attempts (SA) and non-suicidal self-injury (NSSI). However, little is known about how emotion dysregulation may differ between adolescents who have made an SA from those engaged in NSSI. We sought to address this gap by comparing emotion dysregulation profiles across three homogenous groups of adolescents (1) SA-only (2) NSSI-only (3) and typically developing controls (TDCs). Mean comparisons suggest that adolescents with a history of NSSI reported significantly lower distress tolerance and higher emotional reactivity when compared to adolescents who made an SA. After controlling for shared variance across emotion dysregulation measures, parent report of affective lability was the only scale to uniquely distinguish between NSSI and SA groups. Accurately distinguishing emotion dysregulation patterns across self-injurious groups has practical implications towards assessment, treatment, course of illness, and prevention.

Highlights • The COVID-19 pandemic has caused much of the populace to self-isolate. • Loneliness is significantly higher than normal during the COVID-19 pandemic. • Loneliness was associated with increased depression and suicidal ideation. • Public health efforts must address increased loneliness during the COVID-19 pandemic., In response to the COVID-19 pandemic, most communities in the United States imposed stay-at-home orders to mitigate the spread of the novel coronavirus, potentially leading to chronic social isolation. During the third week of shelter-in-place guidelines, 1,013 U.S. adults completed the UCLA Loneliness Scale-3 and Public Health Questionnaire (PHQ-9). Loneliness was elevated, with 43% of respondents scoring above published cutoffs, and was strongly associated with greater depression and suicidal ideation. Loneliness is a critical public health concern that must be considered during the social isolation efforts to combat the pandemic.

Alexithymia ("no words for feelings") is a personality construct characterized by an inability to identify, describe, and verbalize one's feelings, constricted imagination, and an externally oriented way of thinking. Alexithymia is commonly measured with self-report instruments. Data, in particular from Asian countries, regarding the epidemiology of alexithymia in adolescents are relatively limited. The objectives of this study were to examine the prevalence and explore the relationship between alexithymia, family emotional expressiveness, parental acceptance-rejection, and depression. A total of 1606 Chinese adolescents aged between 10 and 17 years old were recruited from 11 schools across the three major geographical regions of Hong Kong. A self-report questionnaire was administered. About 36% of adolescents were classified as alexithymic in the whole sample (males: 34.3%, females: 40.0%) and no gender differences were found. Adolescents with lower family emotional expressiveness and depression were more likely to report alexithymia. The alexithymia rate among Chinese adolescents was higher than in most of the existing studies. The association of alexithymia with diminished family emotional expressiveness underscores the relevance of targeting adolescents with low family emotional expressiveness, and depressive symptoms to increase their capacity to identify and communicate emotions in order to improve their psychological well-being.

Introduction Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). Methods A literature search was conducted for original articles examining the general and psychiatric populations. Results There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. Conclusion The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.

The present examination raises the question whether attrition in a longitudinal study leads to biased findings. The Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) originated in 1994 by following a sample of 1239 adolescents with follow-ups after three, six, and 22 years. The study collected data on life-events, self-esteem, and coping behavior as independent and mental problems as dependent variables. The baseline sample was partitioned according to follow-up status for the three subsequent waves of assessment. Baseline measures of associations between independent and dependent variables were compared for those retained in the study (group A) and those lost to follow-up (group B) at each phase of cross-sectional data collection by use of multiple linear regression analyses. There were significant differences for some baseline independent variables between the two groups with small effect sizes. Males and migrants dropped out more frequently. The main findings indicated that the strength of the associations between independent and dependent variables at baseline in the total sample and in each of the two groups as defined by sample sizes at the three follow-ups was close to equal. Thus, one may conclude from the current study that attrition in longitudinal studies rarely affects cross-sectional estimates of associations.

Alexithymia is common in patients with a substance use disorder (SUD) and is possibly a negative prognostic factor in their treatment. The aim of this study was twofold. First, we explored whether SUD patients with posttraumatic stress disorder (PTSD) are more alexithymic than SUD patients without PTSD. Next, we explored whether trait and state-related parts of alexithymia could be differentiated in these patients. This phenomenon was studied in 197 SUD patients with the Toronto Alexithymia Scale-20 (TAS-20); Clinician Administered PTSD Scale; Self-Report Inventory for PTSD; Traumatic Experiences Checklist; European Addiction Severity Index; and the Depression, Anxiety and Stress Scale in a cross-sectional design. SUD patients with current PTSD showed more alexithymic characteristics than patients without PTSD or with previous lifetime/not current PTSD. The severity of PTSD complaints; alcohol addiction; and the combination of depression, anxiety and stress symptoms, all of which are more related to alexithymia as a state, explained 38.1% of the TAS-20. In conclusion, we advise that SUD patients be assessed for alexithymia and that its degree is taken into account. We also tentatively assume that a considerable part of alexithymia is more state- than trait-related in these patients.

Previous evidence showed associations of alexithymia with altered declarative memory performance. However, these findings were not fully consistent and the underlying mechanism remains unclear. Alexithymic subjects may be at specific risk for chronic psychosocial stress, which in turn represents a predictor for poorer memory performance. We investigated independent and interaction effects of alexithymia and chronic perceived stress on declarative memory performance. Data were used from two independent general-population samples from the Study of Health in Pomerania (SHIP). In sample 1 (N = 1981), the Auditory Verbal Learning Test, the Toronto Alexithymia Scale (TAS-20) and the Screening Scale for Chronic Stress (SSCS) were applied. In sample 2 (N = 3799), the word list of the Nuremburg Age Inventory and TAS-20 were administered to replicate findings. Alexithymia was significantly associated with poorer immediate and delayed word recall. Chronic stress negatively predicted immediate, but not delayed recall. Alexithymia and particularly “Difficulties Identifying Feelings” showed significant associations with chronic perceived stress. Our findings provide clear evidence for an association of alexithymia with impaired declarative memory performance for words. The strong association of alexithymia with perceived chronic stress could contribute to explain the association of alexithymia with stress-related disorders.

The 20 item Toronto Alexithymia Scale (TAS-20) has been set as the golden standard in assessing alexithymia despite its limitation due to its self-report structure. Overcoming this bound is the main reason that in 2006 brought Bagby, Taylor and Parker to develop the Toronto Structured Interview for Alexithymia (TSIA): a structured interview composed of 24 questions with the purpose of assessing four dimensions of alexithymia: Identifying emotional feelings (DIF), Describing emotional feelings (DDF), Imaginal processes (IMP), and Externally oriented thinking (EOT). The present study aimed to confirm the validity of the TSIA in the assessment of alexithymia, using internal consistency (alpha) and convergent validity (comparing TSIA and TAS-20). Since it has been demonstrated an association between alexithymia, measured with the TAS-20, and negative affect, an additional goal was to evaluate the correlation of TSIA with two measures of depression and anxiety (BDI-II and STAI-Y2). Our results showed a significant capability of the TSIA in assessing alexithymia while clearing the limitation of the TAS-20 in keeping aside partially overlapping construct such as depression and anxiety. The final suggestion is that a reliable assessment of alexithymia might come from the application of both a self-report and an observer-rated instrument.

Alexithymia, or the inability to identify and describe one's emotions, is significantly higher in bipolar disorder (BD) and schizophrenia (SZ), compared to healthy controls (HC). Alexithymia has also been observed to predict psychosocial functioning in SZ. We investigated whether alexithymia predicted social and everyday functioning in BD, as well as transdiagnostically in HC, BD, and SZ patients. 56 BD, 45 SZ, and 50 HC were administered and compared on tests measuring neurocognition, social cognition, functioning and alexithymia. We conducted linear regressions assessing whether alexithymia predicted functional outcomes in BD. Next, we conducted hierarchical stepwise linear regressions investigating the predictive ability of neurocognition, social cognition and alexithymia on everyday and social functioning in our overall sample. BD and SZ patients were comparable on most demographics and demonstrated higher alexithymia compared to HCs. In BD, alexithymia predicted social functioning only. In the overall sample, difficulty identifying and describing feelings predicted everyday functioning; difficulty describing feelings predicted social functioning. Results suggest that aspects of alexithymia significantly predict functioning among these psychiatric groups, above and beyond the contributions of previously identified factors such as neurocognition and social cognition. Results may aid in developing proper interventions aimed at improving patients' ability to articulate their feelings.

Studies of gender cognitive differences in schizophrenia have reported mixed results. This study examined cognitive correlates including demographics, symptoms and functioning in men and women in a large sample of first-episode adult-onset psychosis patients. Detailed demographic, clinical and functioning data were collected from 360 first-episode patients upon admission into an early intervention service for psychotic disorders. They were also administered a comprehensive neurocognitive battery. Correlation analyses showed that memory and working memory were more significantly associated with onset age, negative symptoms and side effects in women. Processing speed correlated with antipsychotic dosage in men and side effects in women. Selective attention correlated with reality distortion and negative symptoms in women, and onset age and education in men. Executive function correlated with onset age and reality distortion in women. All cognitive domains significantly correlated with educational level and functioning in both genders. Negative symptoms explained significant variability in cognition in both genders, while reality distortion, side effects and affective symptoms were significant factors that differentiated between genders. Although there are similarities in cognitive deficits, considerable heterogeneity exists in associations of symptoms and cognition in men and women. Results facilitate individualised tailoring of interventions, including cognitive remediation therapy.

Alexithymia is an important but poorly understood emotional deficit in schizophrenia. We aimed at investigating the role of basic cognitive functions, cognitive biases, and symptom severity in alexithymia among patients with schizophrenia. Sixty patients (31 females) with schizophrenia were assessed with standardized clinical interviews for symptom severity. Cognitive functioning was assessed with neuropsychological tests. A self-report scale (Davos Assessment of Cognitive Biases, DACOBS), as well as two experimental tasks assessing jumping to conclusions (the Fish task) and source monitoring (Action memory task), were used to investigate cognitive biases. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Alexithymia was related to the severity of hallucinations but not delusions. Patients with a lifetime history of more psychotic symptoms had higher alexithymia. Alexithymia has broad relationships with different cognitive biases, especially in the self-reported measure. These relationships were not affected by neurocognition and symtpoms severity. In particular, difficulties in identification of feelings were related to various cognitive biases. Dysfunctional information processing can thus be considered as potential psychological correlates of alexithymia. The theoretical and clinical implications of our findings are discussed.

While social cognition (SC) is widely recognized as being impaired in schizophrenia, little is known about the potential heterogeneity in individuals' functioning. Using a wide range of SC measures and a cluster-analytic approach, we compared SC profiles in the general population and in people with schizophrenia. A total of 131 healthy controls and 101 participants with schizophrenia were included. Groups were compared on sociodemographic, neurocognition, anxiety and depressive mood variables. Three profiles were identified in healthy controls: one with good SC abilities (Homogeneous SC group) and two with specific weaknesses in complex Facial Emotion Recognition (Low FER group) or Affective Theory of Mind (Low AToM group). However, these patterns were not found in participants with schizophrenia, who were characterized rather by levels of SC functioning (i.e., Low, Medium and High SC groups). Importantly, while the High SC group (47.9% of the sample) exhibited normal performances, the two others were underpinned by different pathological processes (i.e., alexithymia for Medium SC group or neurocognition dysfunctioning for Low SC group). These results have important implications for future research as well as for clinical practice regarding assessment methodology and therapeutic interventions.