Alexithymia in schizophrenia: Associations with neurocognition and emotional distress

Abstract

While alexithymia, or difficulties identifying and describing affect, has been commonly observed in schizophrenia, little is known about its causes and correlates. To test the hypothesis that deficits in emotion identification and expression result from, or are at least related to, deficits in neurocognition and affective symptoms, we assessed alexithymia using the Toronto Alexithymia Scale (TAS-20), symptoms using the Positive and Negative Syndrome Scale (PANSS), and neurocognition using the MATRICS battery among 65 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Partial correlations controlling for the effects of social desirability revealed that difficulty identifying feelings and externally oriented thinking were linked with greater levels of neurocognitive deficits, while difficulty describing feelings was related to heightened levels of emotional distress. To explore whether neurocognition and affective symptoms were uniquely related to alexithymia, a multiple regression was conducted in which neurocognitive scores and affective symptoms were allowed to enter to predict overall levels of alexithymia after controlling for social desirability. Results revealed both processing speed and anxiety uniquely contributed to the prediction of the total score on the TAS-20. Results suggest that dysfunctions in both cognitive and affective processes may be related to alexithymia in schizophrenia independently of one another.

Validation of the UCSD Performance-based Skills Assessment (UPSA) in Hispanics with and without schizophrenia

“…Similarly, Patterson et al (2005) found Hispanics scored significantly worse than Caucasians even when controlling for age and severity of illness. However, Bengoetxea et al (2014) found no significant differences between monolingual Spanish speaking Hispanics, English-speaking Hispanics, and English-speaking non-Hispanics.…”

Acquired alexithymia following damage to the anterior insula

“…Alexithymia has traditionally been studied with respect to its comorbidity with neurodevelopmental disorders such as autism spectrum disorders (Bird and Cook, 2013) and schizophrenia (Fogley et al, 2014), but recent studies have suggested that alexithymia can be acquired following brain injury (Henry et al, 2006; Williams and Wood, 2013, 2010). The present findings extend this work by showing that alexithymia can be acquired following injuries to the AI specifically, with more pronounced lesions being associated with greater impairment.…”

“…The emotional symptoms of a variety of disorders have been linked to co-occurring alexithymia, such as autism (Bird et al, 2010), eating disorders (Brewer et al, 2015a), and schizophrenia (Fogley et al, 2014), suggesting that intact awareness of one’s own emotions might be critical to mental health. The potential translational value of this work has led to an increasing interest in alexithymia both in the public (Robson, 2015; Serani, 2014) and scientific (Bird and Cook, 2013; Lane et al, 2015) literatures, yet the neurocognitive impairments that lead to alexithymia remain unclear.…”

Distress, emotional clarity, and disordered eating in young people with complex emotional and behavioural difficulties

“…This in turn, is thought to increase their reliance on maladaptive behaviours such as binging and purging, to regulate distress (Barrett, Gross, Christensen, & Benvenuto, 2001;Sheppes, Suri, & Gross, 2015;Tull & Aldao, 2015;Whiteside et al, 2007). This argument is supported through several independent lines of enquiry; (1) individuals who engage in disordered eating experience increased difficulties in identifying emotions and/or distinguishing between them (i.e., LEC; Bydlowski et al, 2005;Speranza, Loas, Wallier, & Corcos, 2007); (2) LEC has been associated with increased distress (Fogarty, Warman, & Lysakerm, 2015); (3) increased distress has been identified as a precipitant to disordered eating particularly in individuals who show emotion regulation difficulties (Berner et al, 2017;Haynos & Fruzzetti, 2011;Lavender et al, 2016).…”