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Objective: To study the occurrence of alexithymia in obese adolescents. Methods: Cross-sectional study with 102 obese adolescents. Sociodemographic, clinical, and psychometric data (alexithymia and binge eating) were analyzed The Brazilian version of the Toronto Alexithymia Scale and Binge Eating Scale were used for psychometric data collection. Statistical analysis was performed using the Kolmogorov-Smirnov test, Student's t-test, ANOVA, chi-square, linear regression, and logistic regression. The study was approved by Research Ethics Committee. Results: A 22% occurrence of alexithymia was observed. Considering the category “possible alexithymia”, half of the participants presented some alexithymic behavior. Adolescents with alexithymia had higher binge eating scores (alexithymia 16,2 versus possible alexithymia 11,7 versus no alexithymia 8,5; ANOVA p < 0,0005) and three times more binge eating behavior than adolescents with no alexithymia or possible alexithymia (alexithymia 36.4% versus 17.2% possible alexithymia versus 11.8% no alexithymia; chi-square = 6,2, p = 0.04). In simple linear regression, alexithymia scores were positively associated with binge eating scores (r2 = 0,4; p = 0,002). Binary logistic regression showed a three times higher probability of an adolescent with severe obesity to meet the criteria for alexithymia. Conclusion: There was a 22% occurrence of alexithymia in obese adolescents. It was positively associated with obesity severity and higher binge eating scores, suggesting a relationship between severe obesity, alexithymia, and binge eating behavior.

Alexithymia has been characterized as an impaired ability of emotion processing and regulation. The definition of alexithymia does not include a social component. However, there is some evidence that social cognition may be compromised in individuals with alexithymia. Hence, emotional impairments associated with alexithymia may extend to socially relevant information. Here, we recorded electrophysiological responses of individuals meeting the clinically relevant cutoff for alexithymia (ALEX; n = 24) and individuals without alexithymia (NonALEX; n = 23) while they viewed affective scenes that varied on the dimensions of sociality and emotional valence during a rapid serial visual presentation task. We found that ALEX exhibited lower accuracy and larger N2 than NonALEX in the perception of social negative scenes. Source reconstruction revealed that the group difference in N2 was localized at the dorsal anterior cingulate cortex. Irrespective of emotional valence, ALEX showed stronger alpha power than NonALEX in social but not non-social conditions. Our findings support the hypothesis of social processing being selectively affected by alexithymia, especially for stimuli with negative valence. Electrophysiological evidence suggests altered deployment of attentional resources in the perception of social-specific emotional information in alexithymia. This work sheds light on the neuropsychopathology of alexithymia and alexithymia-related disorders.

OBJECTIVE Depression and apathy are common after traumatic brain injury (TBI), and different intervention strategies are recommended for each. However, a differential diagnosis can be difficult in clinical settings, especially given that apathy is considered to be a symptom of depression. In this study, the investigators aimed to isolate apathy from depression among patients with TBI and to examine whether apathy is exclusively associated with the amount of daily activity, as previously reported in the literature. METHODS Eighty-eight patients with chronic TBI completed the Japanese versions of the 21-item Beck Depression Inventory-II (BDI-II) and the Starkstein Apathy Scale (AS). Daily activity was measured with a 24-hour life log. A hierarchical cluster analysis was applied to divide the BDI-II data into separable components, and components' correlations with results of the AS and 24-hour life log scale were evaluated. RESULTS The BDI-II and AS revealed that 37 patients (42.0%) had both depression and apathy. BDI-II data were classified into four separate clusters (somatic symptoms, loss of self-worth, affective symptoms, and apathy symptoms). Loss of self-worth and apathy symptoms subscores were significantly positively correlated with total AS score (r=0.32, p=0.002, and r=0.52, p

Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC) among children with ADHD with and without Oppositional Defiant Disorder (ODD). Exploratory factor analysis (EFA) conducted in a sample of 328 youth (mean age = 6.08) with ADHD indicated a four-factor solution, comprised of the following factors: Negative Emotion Lability, Positive Emotion Lability, Socially Appropriate Affect, and Socially Incongruent Affect. The Negative and Positive Emotion Lability subscales assess the reactivity of negatively and positively valenced emotions, respectively. The Socially Appropriate and Socially Incongruent Affect subscales provide an assessment of social-emotional functioning. All subscales discriminated between children with ADHD only and ADHD with co-morbid ODD, such that children with ODD had greater emotional lability and social-emotional difficulties. This revised factor structure of the ERC facilitates a uniquely brief, yet multifaceted and specific, assessment of emotional difficulties in children with ADHD that can inform treatment planning and operationalize emotional reactivity and social-emotional functioning in future research efforts.

Background: Behavioral and psychological symptoms of dementia (BPSD) have a large impact on the quality of life of patients with Alzheimer’s disease (AD). Few studies have compared BPSD between early-onset (EOAD) and late-onset (LOAD) patients, finding conflicting results. Objective: The aims of this study were to: 1) characterize the presence, overall prevalence, and time of occurrence of BPSD in EOAD versus LOAD; 2) estimate the prevalence over time and severity of each BPSD in EOAD versus LOAD in three stages: pre-T0 (before the onset of the disease), T0 (from onset to 5 years), and T1 (from 5 years onwards); 3) track the manifestation of BPSD sub-syndromes (i.e., hyperactivity, psychosis, affective, and apathy) in EOAD versus LOAD at T0 and T1. Methods: The sample includes 1,538 LOAD and 387 EOAD diagnosed from 1996 to 2018. Comprehensive assessment batteries, including the Neuropsychiatric Inventory (NPI), were administered at the first medical assessment and at different follow-up period. Results: The overall prevalence for the most of BPSD was significantly higher in EOAD compared to LOAD whereas most BPSD appeared significantly later in EOAD patients. Between the two groups, from pre-T0 to T1 we recorded a different pattern of BPSD prevalence over time as well as for BPSD sub-syndromes at T0 and T1. Results on severity of BPSD did not show significant differences. Conclusion: EOAD and LOAD represent two different forms of a single entity not only from a neuropathological, cognitive, and functional level but also from a psychiatric point of view.

Affective traits, including extraversion and emotion regulation, are important considerations in clinical psychology due to their associations with the occurrence of affective disorders. Previously, emotional real-world scenes have been shown to influence visual search. However, it is currently unknown whether extraversion and emotion regulation can influence visual search towards neutral targets embedded within real-world scenes, or whether these traits can impact the effect of emotional stimuli on visual search. An opportunity sample of healthy individuals had trait levels of extraversion and emotion regulation recorded before completing a visual search task. Participants more accurately identified search targets in neutral images compared to positive images, whilst response times were slower in negative images. Importantly, individuals with higher trait levels of expressive suppression displayed faster identification of search targets regardless of the emotional valence of the stimuli. Extraversion and cognitive reappraisal did not influence visual search. These findings add to our understanding regarding the influence of extraversion, cognitive reappraisal, and expressive suppression on our ability to allocate attention during visual search when viewing real-world scenes.

Introduction Considering the suggested role of alexithymia in increasing the risk of self-harm, especially when depression is also present, and that rates of self-harm tend to peak in adolescence, the aim of this systematic review was to synthetize the most relevant research studies on this topic and provide an understanding on whether alexithymia can be considered as an important risk factor for non-suicidal self-harm among adolescents with depression. Methods Searches were conducted in PubMed, Web of Science, and PsycINFO, resulting in 290 records. After removal of duplicates, 273 records were left and after reading the titles and abstracts, 231 articles were excluded, leaving 42 articles that were read in full. Of these 42, nine articles were included in this review. Results The sample of this review consists of eight case-control studies and one cross-sectional and longitudinal survey. All nine studies concluded that the most important variables associated with self-harming behavior were depression and alexithymia, among all other variables assessed. The self-harming groups showed significantly higher scores on alexithymia (overall and particularly Factor 1- difficulties identifying feelings and differentiating them from bodily sensations), when compared to the control (no self-harming) groups, and the mean depression scores for self-harming groups were significantly higher than those for non-harming groups. All nine studies included in this review shared the limitation of self-reported information. Conclusion These results indicate that alexithymia is a risk factor for non-suicidal self-harm among adolescents with depression, even when other variables were also inspected, and may be a prevention and therapeutic target in the future.

Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one’s own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.

The concept of alexithymia has garnered much attention in an attempt to understand the psychological mechanisms underlying the experience of feeling an emotion. In this study, we aimed to understand how the interoceptive processing in an emotional context relates to problems of alexithymia in recognizing self-emotions. Therefore, we prepared experimental conditions to induce emotional awareness based on interoceptive information. As such, we asked participants to be aware of interoception under an anxiety-generating situation anticipating pain, having them evaluate their subjective anxiety levels in this context. High alexithymia participants showed attenuated functional connectivity within their 'interoception network', particularly between the insula and the somatosensory areas when they focused on interoception. In contrast, they had enhanced functional connectivity between these regions when they focused on their anxiety about pain. Although access to somatic information is supposed to be more strongly activated while attending to interoception in the context of primary sensory processing, high alexithymia individuals were biased as this process was activated when they felt emotions, suggesting they recognize primitive and unprocessed bodily sensations as emotions. The paradoxical somatic information processing may reflect their brain function pathology for feeling emotions and their difficulty with context-dependent emotional control.

OBJECTIVE: Alexithymia is common among people who abuse alcohol, yet the mechanisms by which alexithymia exerts its influence remain unclear. This analysis tested a model whereby the three subscales of the Toronto Alexithymia Scale exert an indirect effect on alcohol problems through difficulties with emotion regulation and psychological distress. METHOD: Men and women (n=141) seeking alcohol use disorder (AUD) treatment completed the Toronto Alexithymia Scale, the Difficulties with Emotion Regulation Scale, the Brief Symptom Inventory, the Short Inventory of Problems, and the Alcohol Dependence Scale. RESULTS: The Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale was positively associated with alcohol problems through emotion dysregulation and psychological distress. The other two subscales, Difficulty Describing Feelings and Externally-oriented Thinking, were not associated with any other variables. CONCLUSION: People with alexithymia may consume alcohol to help regulate undifferentiated states of emotional arousal. Given the prevalence of alexithymia among people who abuse alcohol, treatment supplements that enhance the identification of emotions are needed.

ObjectiveSocial inhibition may promote symptoms of depression and anxiety in adults from an outpatient hospital population. The current work builds on a previously corroborated construct of social inhibition and examines the psychometric properties of this assessment tool and its predictive validity in the adult outpatient hospital population. MethodsA total of 350 adult outpatients receiving treatment at the department of Medical Psychology or Psychiatry completed measures of social inhibition and symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire). Factor analyses, reliability estimates, and regression analyses were used to replicate the robustness of the model of social inhibition, and the 15-item Social Inhibition Questionnaire (SIQ15). ResultsIn the current sample (N =350; Mage =45 years; 67.4% women), factor analyses confirmed the previously suggested three-factor model of social inhibition as measured by the SIQ15. The subscales of behavioral inhibition, interpersonal sensitivity and social withdrawal proved to be internally consistent (Cronbach's α be-tween 0.87/0.95) and stable over time (test-retest reliability between r =0.76/0.83). At baseline, interpersonal sensitivity and social withdrawal were associated with anxiety and depressive symptoms. At three months follow-up, only interpersonal sensitivity was related to depressive symptoms. ConclusionsSocial inhibition is associated with anxiety and depression at baseline and can be reliably assessed with the SIQ15 in an outpatient hospital population. The association of interpersonal sensitivity with depressive symptoms at three-month follow-up suggests an important aim for future research on the development of preventive methods for affective symptoms in socially inhibited outpatients.

Background Smartphone-based monitoring constitutes a cost-effective instrument to assess and predict affective symptom trajectories. Large-scale transdiagnostic studies utilizing this methodology are yet lacking in psychiatric research. Thus, we introduce the Remote Monitoring Application in Psychiatry (ReMAP) and evaluate its feasibility and adherence in a large transdiagnostic sample. Methods The ReMAP app was distributed among n = 997 healthy control participants and psychiatric patients, including affective, anxiety, and psychotic disorders. Passive sensor data (acceleration, geolocation, walking distance, steps), optional standardized self-reports on mood and sleep, and voice samples were assessed. Feasibility and adherence were evaluated based on frequency of transferred data, and participation duration. Preliminary results are presented while data collection is ongoing. Results Retention rates of 90.25% for the minimum study duration of two weeks and 33.09% for one year were achieved (median participation 135 days, IQR=111). Participants transferred an average of 51.83 passive events per day. An average of 34.59 self-report events were transferred per user, with a considerable range across participants (0–552 events). Clinical and non-clinical subgroups did not differ in participation duration or rate of data transfer. The mean rate of days with passive data was higher and less heterogeneous in iOS (91.85%, SD=21.25) as compared to Android users (63.04%, SD=35.09). Limitations Subjective user experience was not assessed limiting conclusions about app acceptance. Conclusions ReMAP is a technically feasible tool to assess affective symptoms with high temporal resolution in large-scale transdiagnostic samples with good adherence. Future studies should account for differences between operating systems.

Studies on the theory of mind (TOM) and alexithymia in borderline personality disorder (BPD) have yielded inconsistent results. Also, the relationship between TOM abilities and alexithymia facets as two domains of social cognition has not been studied in BPD. This study aimed to fill this gap. Participants were 50 outpatients with BPD and 50 age and gender-matched healthy controls. Assessments performed using Reading the Mind in Eyes Task (RMET), Toronto Alexithymia Scale (TAS-20), Faux Pas Task (FPT), and Digit Span subtest of Wechsler Adult Intelligence Scale. Results showed that BPD patients scored lower on overall FPT (p .001) and its cognitive (p .001) and affective TOM (p .001) subtests but were comparable with healthy controls in emotion recognition ability assessed by RMET (p = .241). The BPD group also scored significantly lower in overall alexithymia (p .001) and subscales of difficulty identifying feelings (DIF; p .001) and difficulty describing emotions (DDF; p = .001). However, they performed similarly to the healthy control group in externally oriented thinking (EOT; p = .164). Correlation analysis revealed a significant negative correlation between EOT and RMET in the BPD group (r = -0.33, p .05). No association, however, was found between FPT and RMET. This study suggests that BPD patients are impaired in the complex TOM abilities and have lower self-awareness of emotions, but their recognition of others' emotions is intact. Also, the results demonstrate that a heightened level of EOT is associated with difficulties in facial emotion recognition in BPD patients.

Distress caused by sensory processing differences for autistic individuals may be reduced by repetitive behaviours (RRB), including repetitive motor (RMB) and insistence on sameness (ISB) behaviours. Intolerance of uncertainty (IU) and anxiety mediate the relationship between sensory processing and RRB in autistic children. We replicated this model in autistic adults, extending it to include alexithymia. Serial mediation, using data from 426 autistic adults, identified significant direct effects from sensory processing to RMB and ISB, and indirect effects through alexithymia-IU-anxiety for RMB, and IU alone, and alexithymia-IU for ISB. Different mechanisms may underpin RMB and ISB. Alexithymia alongside, IU and anxiety, should be considered when understanding the relationship between sensory processing and RRB, and when offering interventions to support autistic people.

Background Although suicidal ideation seems to be related with both burden of care and alexithymia, there is no study investigating the correlation between these factors and suicide probability in informal caregivers of psychiatric patients in the literature. Aim In this study, it was aimed to determine the suicide probability in psychiatric patients' primary caregivers, and to evaluate the effects of care burden, alexithymia and some risk factors on suicide probability. Methods This study was conducted with 262 caregivers between February 2019 and December 2019. Data were collected with the Personal Information Form, Suicide Probability Scale, Zarit Burden Interview, Toronto Alexithymia Scale. Results The mean score the caregivers obtained from the Suicide Probability Scale was 79.75 ± 59.29, and 17.9% of them were at risk for suicide. Also, caregivers' suicide probability was related to variables such as caregivers' sex, economic status, presence of any disease, duration of care, and patients' education level, psychiatric diagnosis, duration of illness, presence of physical illness, compliance with treatment. In addition, caregivers' burden and alexithymia levels were significantly associated with the participating caregivers' suicide probability. Conclusions This study demonstrates that approximately one out of every five caregivers was at risk for suicide. Therefore, hospital and community-based intervention strategies to support caregivers should be developed.

A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a ‘resource matching’ hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual (‘out-of-touch-with-reality’) behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational (‘in-touch-with-reality’) behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual ‘resource’ of the pain experience from its ‘feeding’ to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.

Objective Psychogenic nonepileptic seizures (PNES) are associated with high alexithymia, social cognition problems and low quality of life (QoL). Theory of Mind (ToM) has been studied in several conditions as a significant predictor of QoL. We aimed to assess the relationship between ToM abilities, alexithymia and subjective QoL in PNES patients and compare with generalised epilepsy (ES) patients and healthy controls. Method Patients with PNES (n = 28), ES (n = 28) and healthy volunteers (n = 28) were evaluated for alexithymia and quality of life (QoL) with Toronto Alexithymia Scale-20 (TAS-20) and Short Form-36 (SF-36). Reading the Mind in the Eyes test was used for assessment of affective ToM and Hinting Task and Strange Stories tests for cognitive ToM abilities. Results Analyses revealed lower SF-36 scores and poorer ToM performance in the PNES group compared to healthy group and poorer cognitive ToM performance than ES group. Cognitive ToM performance was inversely correlated with TAS-20 “difficulty identifying feelings” subscale and “physical functioning” subscale of SF-36 in the PNES group. Conclusion These results are consistent with previous research on PNES and other somatoform disorders and suggest that PNES is associated with impaired ToM task performance. ToM task performance might be related to specific aspects of alexithymia and QoL.

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

The psychological mechanisms connecting shame and anger among men remain underexplored. This study aimed to understand the potential roles of psychological distress and alexithymia in this pathway, both in the form of difficulty identifying and describing one's feelings. Self-report measures were completed by 1,000 men (age mean = 49.6 years; range = 19-86 years). Conditional process analysis investigated a moderated mediation effect to determine whether men's distress mediated the relationship between shame and anger, and whether this effect differed according to severity and type of alexithymia. Findings indicated moderated mediation, with psychological distress a significant mediator in the association between shame and anger. Furthermore, difficulties describing feelings (but not identifying feelings) moderated the relationship between shame and psychological distress. Men's shame can be expressed via anger when experiencing psychological distress, and the inability to express one's feelings exacerbates this pathway. Clinical and public health avenues to reduce the impact of alexithymia are discussed.Supplemental data for this article is available online at https://doi.org/10.1080/00223980.2021.1977598 .

Background Rates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population. Objective This study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour. Design This study used a cross-sectional, single-time-point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention. Setting and participants Community mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys. Main variables studied We examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two-step linear regression. Results The structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions. Discussion While there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions. Public contribution This study was designed and the results were interpreted as part of a larger, community-based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.

BACKGROUND AND OBJECTIVES Sleep problems are common among clients attending alcohol and drug services, yet the specific components of sleep disturbed by primary drug of concern (PDOC), and their relationships to affective disorder symptoms are unclear. METHODS We examined sleep problems in clients (n = 32) attending a specialist addiction clinic. RESULTS Global sleep quality was rated poor by >90% of participants (particularly disturbances, latency and efficiency components), with significant associations (p

Objectives Alexithymia is a risk factor associated with a wide array of mental health issues and has been linked to a history of trauma including child sexual abuse. Yet, few measures evaluating alexithymia in children have been validated. This study aimed to explore the psychometric properties of the French version of the Children's Alexithymia Measure (CAM; Way et al., 2010) in a sample of sexually abused children. Methods A sample of 418 non-offending caregivers of sexually abused children aged 6 to 12 completed the Children's Alexithymia Measure. They were also invited to complete a series of questionnaires used as validity indices including the Emotion Regulation Checklist, the Child Behavior Checklist and the Child Dissociative Checklist. Results Both exploratory and confirmatory factor analyses supported the unidimensional factor structure of the Children's Alexithymia Measure and the total score showed high internal consistency. As expected, the total score of the Children's Alexithymia Measure was positively correlated with emotion regulation difficulties. In addition, the total score of the Children's Alexithymia Measure was found to be correlated with dimensions of both internalizing and externalizing behavior problems as well as dissociative symptoms, with children displaying higher scores of alexithymia showing higher symptoms. Conclusions Findings provide initial support for the psychometric properties of the French version of the Children's Alexithymia Measure with a clinical sample of child victims of sexual abuse. The measure could be useful for future studies exploring the mediating role of alexithymia in the association between trauma and psychopathology. The measure could as well be a relevant tool in the clinical assessment of vulnerable children.

Background Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. Methods This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1–40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a “general alexithymia” factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. Results The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with “TAS” no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. Limitations Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. Conclusions These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia).

Severe irritability is common in youths with psychiatric disorders and results in significant dysfunction across domains (academic, social, and familial). Prior structural MRI studies in the pediatric population demonstrated that aberrations of cortical thickness (CT) and gray matter volume (GMV) in the fronto‐striatal‐temporal regions which have been associated with irritability. However, the directions of the correlations between structural alteration and irritability in the individual indices were not consistent. Thus, we aim to address this by implementing comprehensive assessments of CT, GMV, and local gyrification index (LGI) simultaneously in youths with severe levels of irritability by voxel‐based morphometry and surface‐based morphometry. One hundred and eight adolescents (46 youths with severe irritability and 62 healthy youths, average age = 14.08 years, standard deviation = 2.36) were scanned with a T1‐weighted MRI sequence. The severity of irritability was measured using the affective reactivity index. In youths with severe irritability, there was decreased CT, GMV, and LGI in the right superior frontal gyrus (SFG) compared to healthy youths, and negative correlations between these indices of the SFG and irritability. Our findings suggest that structural deficits in the SFG, potentially related to its role in inhibitory control, may be critical for the neurobiology of irritability., There was decreased CT, GMV, and LGI in the right superior frontal gyrus (SFG) compared to healthy youths, and negative correlations between these indices of the SFG and irritability. Our findings suggest that structural deficits in the SFG, potentially related to its role in inhibitory control, may be critical for the neurobiology of irritability.

The aim of this study was to investigate alexithymic traits in an adolescent clinical sample with internalizing and externalizing disorders. The study group consisted of 125 adolescents aged between 12 and 17 years who applied at our outpatient unit and diagnosed with an internalizing or externalizing disorder. The healthy control group consisted of 53 adolescents with no psychiatric disorder. All subjects fulfilled the Alexithymia Questionnaire for Children (AQC). Total AQC scores were higher in the study group than in the control group. When we divided the study group into two groups as internalizing and externalizing disorders, total AQC scores, AQC-difficulty identifying feelings, and AQC-difficulty describing feelings were significantly higher in the internalizing disorder group than in the externalizing disorder group. AQC-externally oriented thinking scores were significantly higher in the externalizing disorder group than in the internalizing disorder group. In future research, it would be useful to further increase understanding of alexithymia and its association with psychiatric disorders in adolescence.

While the rate of survival has increased in the past decade, the diagnosis of breast cancer is an extremely stressful experience for patients and it is associated with the manifestation of several psychological problems. To examine the effect of a group cognitive behavioral therapy (CBT) on the quality of life and emotional disturbance of women with breast cancer.The study was a randomized controlled clinical trial. Samples were 48 women who had been diagnosed with breast cancer and had undergone mastectomy and chemotherapy. Study variables were measured before and after the intervention and 1 month after the end of the intervention as a follow-up. Controls received nothing and were just followed-up. Repeated measure ANOVAs were used to compare the effectiveness of the intervention on the study variables.The results of 32 women were analyzed. The increase in quality of life scores was significantly higher in the intervention group compared to the control group (P 0.05). There were also significantly lower changes in the depression, anxiety, and stress scores of the intervention group (P 0.05). However, the changes in the score of death anxiety were not significantly lower in the intervention group in comparison to controls (P 0.05).Group cognitive behavioral therapy was effective in the improvement of quality of life and decreases some aspects of emotional disturbance. Findings of this study suggest that women with breast cancer can benefit from group CBT. Yet, some aspects of the mental health of these women may need more attention and individualized methods.ClinicalTrials.gov Identifier: IRCT20100911004728N4.

Intensive Home Based Treatment (IHBT) is a critical component of the continuum of community-based behavioral healthcare for youth with serious emotional disorder (SED) and their families. Yet despite being used nationwide at costs of over $100 million annually in some states, a well-vetted, research-based set of quality standards for IHBT has yet to be developed. The current project aimed to define program and practice standards for IHBT, drawing upon literature review, expert interviews, and a systematic Delphi process engaging over 80 participants, including IHBT developers, experts in evidence-based youth mental health, youth and family advocates, IHBT providers, and state policymakers. After two rounds of quantitative and qualitative input, adequate consensus was achieved on 32 IHBT Program Standards and 43 IHBT Practice Standards. These standards hold potential for informing efforts such as development of state regulations, provider contracts, memoranda of agreement, and training and workforce development initiatives. Translation of the quality standards into measurement strategies holds potential for providing a method of continuous quality improvement across multiple levels as well as use in research on IBHT.

The COVID-19 lockdown has drastically limited social interactions and brought about a climate of fear and uncertainty. These circumstances not only increased affective symptoms and social isolation among community dwelling older adults but also alter the dynamics between them. Using network analyses, we study the changes in these dynamics before and during the lockdown. Community-dwelling older adults (N = 419) completed questionnaires assessing depression, anxiety, and social isolation, before the COVID-19 pandemic, as part of a cohort study, and during the lockdown period. The total scores of these questionnaires were compared across time. For the network analyses, partial correlation networks were constructed using items in the questionnaires as nodes, separately at both timepoints. Changes in edges, as well as nodal and bridge centrality were examined across time. Depression and anxiety symptoms, and social isolation had significantly increased during the lockdown. Significant changes were observed across time on several edges. Greater connectivity between the affective and social isolation nodes at lockdown was observed. Depression symptoms have become more tightly coupled across individuals, and so were the anxiety symptoms. Depression symptoms have also become slightly decoupled from those of anxiety. These changing network dynamics reflect the greater influence of social isolation on affective symptoms across individuals and an increased vulnerability to affective disorders. These findings provide novel perspectives and translational implications on the changing mental health context amidst a COVID-19 pandemic situation. Published version This work was supported by Research Donations from Kwan Im Tong Hood Cho Temple and Lee Kim Tah Holdings Pte Ltd, under the Mind Science Centre, Department of Psychological Medicine, National University of Singapore.

Background Substance Use Disorder (SUD) causes a great deal of personal suffering for patients. Recent evidence highlights how defenses and emotion regulation may play a crucial part in the onset and development of this disorder. The aim of this study was to investigate potential differences in the defensive functioning between SUD patients and non-clinical controls. Secondly, we aimed at investigating the relationships between alexithymia and maladaptive/assimilation defenses. Methods The authors assessed defensive functioning (Response Evaluation Measure-71, REM-71), personality (MMPI-II), and alexithymia (TAS-20) of 171 SUD patients (17% female; mean age = 36.5), compared to 155 controls. Authors performed a series of ANOVAs to investigate the defensive array in SUD patients compared to that of non-clinical controls. Student t test for indipendent samples was used to compare clinical characteristics between the SUD group and the controls. To investigate the role of single defenses in explaining alexithimia’s subscores, stepwise multiple regression analysis were carried out on socio-demographic characteristics of participants (gender, age, and years of education), with REM-71 defenses as predictors. Results SUD patients presented a more maladaptive/assimilation (Factor 1) defensive array (p Projection (38% of variance explained, β = .270, p Conclusion The REM-71 and the TAS-20 might be useful screening instruments among SUD patients.

Background Severity of symptoms in patients with schizophrenia is a determinant of patient’s well-being, but evidence in low- and middle-income countries is limited. We aimed to measure the symptom severity using objective measurements, the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity scale (CGI-S), and their associations with well-being in patients with schizophrenia. Methods Patients with schizophrenia aged ≥18 years, without active psychosis including no history of hospitalization within the last 6 months, were included. Symptom severity was measured by the clinicians using BPRS and CGI-S. The patients’ well-being was assessed by self-report using the Subjective Well-being under Neuroleptic treatment scale (SWN) as continuous and binary outcomes (categorized into adequate or poor well-being). Correlations between symptom severity (BPRS and CGI-S scores) and well-being (SWN score) were analyzed using Pearson’s correlation. Association between well-being status and BPRS was analyzed using multivariate logistic regression. Results Of 150 patients, BPRS and CGI-S were inversely correlated with SWN score (r = − 0.47; p p r = − 0.51, p p = 0.006, and 4.01; 95%CI 1.38–11.7; p = 0.011, respectively). Conclusion Inverse relationships between symptom severity and well-being score were found. Higher BPRS Affect domain was significantly associated with lower patients’ well-being. The use of BPRS tool into routine clinical practice could serve as an adjunct to physician’s clinical evaluation of patients’ symptoms and may help improve patient’s well-being. Further research on negative symptoms associated with well-being is required.

Background The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results. Methods Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates. Results Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = − 6.0 – − 0.3) and the NPI-NH (95% CI = − 2.2 – − 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = − 2.7 – − 0.8) and the NPI-NH Affect sub-syndrome (95% CI = − 1.6 – − 0.2). No differences were found between conditions at weeks 8 or 24. Conclusion Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia. Trial registration ClinicalTrials.gov Identifier: NCT03357328. Retrospectively registered on November 29, 2017.

Objective: Affective symptoms are common in patients with head-and-neck cancer. This study determined the association between the presence of aspiration and symptoms of anxiety and depression, as well as patient characteristics in patients with head-and-neck cancer and dysphagia. Methods: Eighty-four patients with head-and-neck cancer and dysphagia completed the Hospital Anxiety and Depression Scale and underwent a standardized fiberoptic endoscopic evaluation of swallowing. Linear regression analysis was performed to explore the associations. Results:Fifty-two (61.9%) patients presented clinically relevant symptoms of anxiety or depression. Forty-eight (57.1%) patients presented with aspiration during fiberoptic endoscopic evaluation of swallowing. A significant negative association was found between the presence of aspiration and affective (anxiety and depression) symptoms (p = 0.04). Male patients presented significantly lower symptom scores of anxiety compared to females (p = 0.04). Conclusions: Clinically relevant affective symptoms were present in more than half of all patients with head-and-neck cancer and dysphagia. Surprisingly, a significant negative association was found between the presence of aspiration and these affective symptoms. Gender was also significantly associated with affective symptoms. These results suggest that there is a need for further investigation into the impact of psychological distress on patients with head-and-neck cancer and dysphagia.

The risk for developing stress-related disorders is elevated in individuals with high alexithymia, a personality trait characterized by impaired emotional awareness and interpersonal relating. However, it is still unclear how alexithymia alters perceived psychosocial stress and which neurobiological substrates are mechanistically involved. To address this question, we examined freshmen during transition to university, given that this period entails psychosocial stress and frequently initiates psychopathology. Specifically, we used a functional magnetic resonance imaging emotional face matching task to probe emotional processing in 54 participants (39 women) at the beginning of the first year at university and 6 months later. Furthermore, we assessed alexithymia and monitored perceived psychosocial stress and loneliness via questionnaires for six consecutive months. Perceived psychosocial stress significantly increased over time and initial alexithymia predicted subjective stress experiences via enhanced loneliness. On the neural level, alexithymia was associated with lowered amygdala responses to emotional faces, while loneliness correlated with diminished reactivity in the anterior insular and anterior cingulate cortex. Furthermore, insula activity mediated the association between alexithymia and loneliness that predicted perceived psychosocial stress. Our findings are consistent with the notion that alexithymia exacerbates subjective stress via blunted insula reactivity and increased perception of social isolation.

Social impairments are a core feature of autism-spectrum disorders. However, there is a considerable variability in these impairments. Most autistic individuals show large impairments in social functioning but some autistic individuals show small impairments in social functioning. The variability of these impairments has been attributed to the presence or absence of alexithymia. To address this issue, we capitalized on the fact that alexithymic and autistic traits are broadly distributed in the population. This allowed us to investigate how alexithymic and autistic traits affect social functioning in healthy individuals. Healthy individuals showed impairments on a resource-allocation task that were due to alexithymic but not autistic traits. These findings suggest that alexithymic rather than autistic traits impair prosocial behavior across the autism-spectrum.

COVID-19 has the potential to detrimentally impact HIV self-management in people living with HIV (PLHIV). Effective HIV-self management is critically important in managing symptoms as well as viral suppression. We examined the impact of the COVID-19 pandemic on HIV self-management, social support, social isolation, depressive symptoms, anxiety, and stress in PLHIV. 85 PLHIV were recruited from social media sites and completed an online survey. Data were collected between April 23 and 30, 2020. Participants reported increases in social isolation, depressive symptoms, anxiety, and stress and decreases in social support and overall HIV self-management from pre- to during the pandemic. Additionally, the Social Support domain and Chronic Nature of HIV domain of the HIV Self-Management Scale were also decreased from pre- to during the pandemic. The ability for PLHIV to maintain HIV self-management during this time is essential and HIV care providers should have plans in place to provide support. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03335-4.

Altered interoception has been consistently found in people with autism spectrum disorder (ASD), and this impairment may contribute to social cognitive dysfunctions. However, little is known regarding the intercorrelations between interoceptive sensibility, autistic, alexithymic, empathic, and self-related traits. We recruited 1360 non-clinical college students and adults to investigate the complex inter-relationship between these variables using network analysis. The resultant network revealed patterns connecting autistic traits to interoceptive sensibility, empathy, alexithymia, and self-awareness, with reasonable stability and test-retest consistency. The node of alexithymia exhibited the highest centrality and expected influence. As revealed by the network comparison test, networks constructed in high- and low-autistic subgroups were comparable in global strength and structure. Our findings suggested that alexithymia serves as an important node, bridging interoceptive deficits, self-awareness, and empathic impairments of autism spectrum disorder. The co-morbidity of alexithymia should be considered carefully in future studies of interoceptive impairments and social deficits in ASD.

Prejudices can lead to discrimination, social exclusion, and violence particularly among young male adults. Previous findings suggest that the degree of holding prejudices is linked to low levels of empathy, while low levels of empathy have been associated with alexithymia, the inability to experience one's own feelings. We tested the hypothesis that the impact of a lack of empathy on reporting blatant and subtle prejudices is moderated by the inability to identify one's own feelings. In a sample of n = 136 young male adults aged 21 years (mean = 21.5 years; sd = 0.3), we conducted correlation and moderator analyses to determine possible relationships between prejudices, empathy, and alexithymia as assessed by self-report questionnaires. Prejudices were assessed by the Blatant and Subtle Prejudice Scale (BSPS), empathy was assessed by the German modified version of the Interpersonal Reactivity Index (IRI), and alexithymia by the 20-item Toronto Alexithymia Scale (TAS-20). Self-reported empathy levels were correlated with the strength of subtle and blatant prejudices. The moderation analyses revealed that the negative association between empathy and subtle prejudice increased with decreasing alexithymia. The negative association between empathy and blatant prejudice, on the other hand, was significant only for participants with low levels of alexithymia. These results suggest that empathy can limit the expression of blatant and to some degree also subtle prejudice when subjects are capable to identify their own feelings in a group of young males.

People vary in their self-awareness of their own emotions, and this may predict psychological well-being. Evidence suggests that emotional self-awareness is diminished in autism, but these findings may be biased by self-report or confounded by verbal intelligence. To address this issue, we developed the emotional consistency (EC) task, measuring emotional self-awareness through consistency in emotional decision-making. In the EC-Task, we showed participants pairs of emotional images, asking them to judge which evoked the more intense emotional experience. The logical consistency of decision making, based on transitive relationships between stimuli, reflects precision of judgment of experience of emotional intensity, which in turn reflects emotional self-awareness. Emotional consistency significantly correlated with lower self-reported alexithymia but not autistic traits. Instead, autistic traits predicted greater discrepancy between EC-Task performance and self-reported difficulties identifying feelings. Participants with higher autistic traits were more likely to underestimate their emotional self-awareness, possibly because of greater metacognitive difficulties and negative self-beliefs. Our study suggests emotional self-awareness is not diminished in autism and provides a novel method to investigate this issue. (PsycInfo Database Record (c) 2021 APA, all rights reserved).