Background: Around 33-50% who attend treatment for substance use disorder (SUD) and alcohol use disorder (AUD) have a history of trauma. Experiencing trauma can lead to psychological disorders, difficulties with emotional regulation and dissociation. SUD and AUD can be chronic, relapsing disorders and understanding what individual factors affect addiction has important implications for treatment. Objective: The systematic review was interested in whether alexithymia affects abstinence after relapse prevention treatment (both psychological and pharmacological). The review was also interested in whether alexithymia is a stable trait after relapse prevention treatment (both psychological and pharmacological) as measured by the Toronto Alexithymia Scale. The research study investigates the relationships between trauma, dissociation, alexithymia, emotional regulation and SUD, AUD and polysubstance use. There has been little research looking at the relationships between these variables and how they compare in different types of substance use. It was hypothesised that patients with poly-substance addiction will have higher incidents of trauma, dissociation, alexithymia and poorer emotional regulation when compared to alcohol and drug dependence alone. Methods: A systematic search of articles published between January 1989 - January 2017 was carried out following the Cochrane (2008) guidelines. PSYCHInfo, Medline and Cinahl were the key databases searched. Papers were quality assessed to identify strengths and weaknesses. The research study is a qualitative, cross-sectional design that involved ninety-one AUD, SUD and poly-substance use participants who were attending outpatient NHS addiction services. They were asked to complete questionnaires assessing trauma, dissociation, alexithymia and emotional regulation. Results: The systematic review found twelve articles that related to the review questions. The systematic review found alexithymia did not impact on abstinence and there was no difference between abstinence after treatment between low and high alexithymic groups. There were mixed results for whether alexithymia score changes after relapse prevention treatment. Overall, the results suggest that alexithymia is relatively stable across SUD and AUD after relapse prevention treatment. The empirical study found that there is no difference between type of addiction and trauma, alexithymia and emotional regulation. People with polysubstance misuse reported significantly higher levels of dissociation than the other two groups. Multiple regression was conducted on the full data set and it was found that emotional regulation, alexithymia and dissociation were able to predict trauma in alcohol, drug and polysubstance users. Conclusions: The systematic review found that despite the assumption that people with alexithymia have higher rates of relapse and attrition this is not the case. Alexithymia has no impact on treatment outcome. The review also found that CBT was identified as an effective relapse prevention treatment for people with alexithymia. The research paper highlighted that the type of substance used by people who have experienced trauma may not be as important as previously thought. Also, understanding that poor emotional regulation, alexithymia and dissociation commonly co-occur with trauma so it may be important to screen for this when treating people with trauma who have co-morbid addictions.

Abstract The study was undertaken to determine the prevalence of facial pain and the association of facial pain with temporomandibular disorders (TMD) as well as with other factors, in a geographically defined population-based sample consisting of subjects born in 1966 in northern Finland, and in a case-control study including subjects with facial pain and their healthy controls. In addition, the influence of conservative stomatognathic and necessary prosthetic treatment on facial pain and TMD was evaluated in a sample of patients with facial pain. In the age group of 31-32-year-olds, facial pain was reported by 12 % of men and 18 % of women. Reported facial pain was strongly associated with TMD symptoms, and a relation was also seen with other factors, i.e. certain occlusal factors, previous traumas, other pain conditions in the body, clinically assessed tenderness in the neck muscles, and psychological problems, such as depressiveness and alexithymia. Conservative treatment of TMD seemed to be effective in relieving facial pain in a one-year follow-up. It can be concluded that facial pain is quite a common symptom with several both localized and generalized associated factors. Conservative stomatognathic treatment is recommended in the case of TMD-related facial pain. The possibility of psychological problems should be taken into account, especially in complex and chronic cases. When no response to conservative stomatognathic treatment is achieved, a multidisciplinary team, including mental health professionals, will be needed in both diagnosis and treatment. This study provides support for the suggestion that in future individualizing treatment of the patients with facial pain should be based on patient characteristics, which may improve treatment efficacy.

Alexithymia is conceptualized as a personality variable involving profound affective deficits. Individuals with high levels of alexithymia are characterized by difficulty in describing emotions, a preoccupation with somatic symptoms, and an insensitive interpersonal style. Alexithymia is commonly found among chronic pain patients. Despite a burgeoning literature, researchers have not identified either the precise characteristics and source of the poor interpersonal performance associated with alexithymia, or how the presence of alexithymia relates to the phenomenology and conceptualization of pain. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia in a sample of 145 female university students who had reported experiencing significant pain during the past year. An exploratory factor analysis was conducted to check the factor structure of the TAS-20 with this sample. A series of three studies was designed to explore the relationship with alexithymia and: 1) reactions to facial expressions of emotion, 2) reactions to others' pain, and 3) conceptualization of own pain. The cleanest factor solution was yielded by a Maximum Likelihood Analysis with oblique rotation. In this sample, the TAS-20 is adequately represented as 4 factors: 1) Difficulty Identifying Bodily Sensations (Body); 2) Confusion about Emotions (Emotions); 3) External Cognitive Style (External), and 4) Interpersonal Awkwardness (Awkward). Study 1 investigated the ability to judge and respond to facial expressions of emotion, as a potential source of interpersonal difficulties. Participants examined slides of adults modeling specific emotions, and attempted to identify the modeled affective states. Alexithymia was expected to be related to difficulty in assessing facial expressions of emotion. As predicted, the ability to identify and appropriately respond to modeled emotional expressions was significantly lower in high-alexithymia participants. Alexithymia scores were related to a tendency to rate various modeled emotions as "pain," providing support for the association with a somatic preoccupation. Study 2 entailed evaluation of interpersonal perception in the context of pain by investigating the relationship between alexithymia and judgement of pain in infants. Participants evaluated two dimensions of pain (sensory discomfort and emotional distress) while watching videotapes of neonates undergoing invasive but routine medical procedures. It was hypothesized that the somatic preoccupation and emotional insensitivity associated with alexithymia would lead high-alexithymia individuals to exaggerate the sensory component of pain in infants and underestimate the affective domain. Predictions were only partially supported. When depressed mood and extent of current pain were controlled, the hypothesized relationship emerged between the TAS-20 External factor and lower ratings of perceived emotional distress, and between the Body factor and higher ratings of perceived sensory discomfort. Contrary to expectations, Body factor scores were related to higher emotional distress ratings. In Study 3, participants assessed retroactively the sensory and affective components of their own painful experiences. There is an increasing trend for multidisciplinary pain clinics to include psychological interventions, treatments whose success is largely dependent upon patients distinguishing the sensory and affective components of pain. It was predicted that high-alexithymia participants would emphasize the sensory rather than the affective dimension, a judgement pattern which could explain the link found between high levels of alexithymia and poorer recovery from chronic pain conditions. Contrary to expectations, it was found that alexithymia scores were unrelated to ratings of sensory intensity. After controlling for depressed mood and extent of current pain, the only significant result to emerge was between the TAS-20 Awkward factor and higher (not lower) ratings of the affective component of participants' own painful experiences. Results suggest that a source of the social awkwardness associated with alexithymia may arise from an insensitivity to facially expressed mood states. There is some evidence that individuals with an external cognitive style pay less attention to the affective distress entailed in infants' pain experiences. The overall pattern of results suggests that alexithymia, as measured by the TAS-20, is best viewed as factorially complex. While the factors display some interdependence, there is greater utility in computing and examining all factor scores rather than describing individuals by a global TAS-20 total score. / Arts, Faculty of / Psychology, Department of / Graduate

Chronic back pain is a pervasive and debilitating phenomenon contributing to staggering health costs and a host of psychological, medical, vocational, and social consequences. The etiology of chronic back pain remains unclear and traditional biomedical, psychological, and interdisciplinary treatments have not been completely effective at eliminating pain or restoring long-term functionality. Psychodynamic models of chronic back pain have not been fully explored due to methodological difficulties. Explorations of psychodynamic-related constructs such as alexithymia (i.e., lack of emotional awareness) may offer vital clues to help increase the understanding of chronic back pain. The purpose of this study was to serve as a preliminary descriptive analysis of alexithymia among patients seeking interdisciplinary treatment for chronic back pain. First, the prevalence of alexithymia in an interdisciplinary treatment seeking sample of patients with chronic back pain and comparisons to other chronic pain and psychosomatic samples were addressed. Second, the relationship between alexithymia and somatic complaints, pain, anxiety, depression, and health-related quality of life was explored. Finally, a meditational analysis was conducted to examine if the relationship between alexithymia and somatic complaints was mediated by negative affect. Eighty-one patients seeking interdisciplinary treatment for chronic back pain participated in the study. Analyses revealed that 14.8% patients met criteria for alexithymia, which was similar to other chronic pain samples but not significantly different from general medical samples. Higher alexithymia scores were found to be associated with higher levels of somatic complaints, negative affect, and mental-health related quality of life. Unexpectedly, higher alexithymia scores were also associated with better physical-related quality of life. There were no significant relationships between alexithymia and pain. The relationship between alexithymia and somatic complaints was found to be mediated by negative affect, which was consistent with psychodynamic models of chronic back pain. Findings were discussed in relation to clinical implications and future research.

Psychopathy has long been lauded as a premier predictor of negative behavioral outcomes because of its demonstrated associations with violence, antisocial conduct, and institutional maladjustment. Traditional conceptualizations of psychopathy highlight the relatively equal importance placed on personality features (i.e., a grandiose, deceitful interpersonal style and deficits in affective experience) and behavioral elements (i.e., an impulsive and irresponsible lifestyle marked by social deviance) of the syndrome. However, little research to date has investigated psychopathy dimensions in female samples, particularly as they relate to maladaptive behaviors beyond forensic settings. The current study comprehensively examined personality (i.e., Axis II Cluster B traits and alexithymia) and behavioral (i.e., suicide-related behavior and aggression) expressions of psychopathy in a sample of female inpatients recruited from trauma and dual-diagnosis units at a psychiatric hospital in Dallas, Texas. Contrary to expectations, the essential components of psychopathy in female psychiatric patients emphasized APD and NPD traits over features of HPD and BPD, which were relatively similar to elements traditionally highlighted in male psychopathy. On this point, two latent dimensions comprehensively addressed female psychopathy in the current sample: impulsive antisociality and narcissistic and histrionic interpersonal style. Interestingly, psychopathy (M r = .01) and Cluster B traits (M r = .05) were virtually unrelated to suicide-related behavior in female patients with trauma and substance use histories, but APD and BPD traits were more discerning for impulsive and premeditated aggression than variants of psychopathy. Aggression's relationship to BPD traits is at least partially mediated by alexithymia. These results are discussed in terms of improving evaluation and intervention efforts aimed at identifying and managing psychopathic females beyond forensic settings.

This paper examined the claims postulated by the somatic marker hypothesis and compares those claims to the current evidence surrounding the neural basis of alexithymia. The results were then compared to see if they contradict or have a distinct localisation in the brain separate from those behavioural brain regions hypothesized by the somatic marker hypothesis. It was concluded that the somatic marker hypothesis and the neural basis for alexithymia share certain regions of interest, primarily the amygdala and insula, but also potentially the anterior cingulate cortex.

Alexithymia is a multidimensional psychiatric construct indicating impaired emotional awareness. Its main features are (i) difficulties in identifying feelings and distinguishing them from bodily sensations, (ii) difficulties describing feelings to others, (iii) an externally oriented style of thinking, and (iv) a poor imaginal capacity. Alexithymia attracts great attention among practitioners and researchers in the clinical field because it has the potential to unveil the emotional disturbances occurring in several mental and physical diseases. As has recently been shown, most of these diseases are not only characterized by an altered perception of emotional states but, more generally, by an altered perception of internal bodily states, namely an altered interoceptive awareness. Consequently, a large body of research has focused on the interplay between alexithymia and interoceptive deficits. Yet, the extent of their association is to date unclear. This question is coupled with a further one concerning whether all or just a few features of alexithymia have clinical relevance and/or an association with interoceptive deficits. Indeed, differences in interoceptive ability are not the only candidate to explain differences in emotional awareness. Rather, the sociocultural environment the individual is surrounded by might play a role at least in the way emotions are expressed, but also in the way emotions are felt. This thesis considers both the mentioned issues, thus addressing the relationship that alexithymia entertains with interoceptive abilities on the one hand and with sociocultural factors on the other. I call these, respectively, the embodied and the embedded aspects of alexithymia. This manuscript is articulated in four parts. Part I introduces alexithymia and shows how the operationalization of the construct through time has facilitated the broadening of its conceptual nucleus. Part II focuses on the embodied aspect of alexithymia, namely its relationship with interoceptive deficits. This section outlines results from two empirical studies testing the association between alexithymia and self-reported interoceptive awareness across three large nationality samples. Part III examines the embedded aspect of alexithymia, namely its relationship with sociocultural factors. Together these studies show that (1) interoceptive deficits are a core component of alexithymia, although the latter cannot be reduced to the former, and (2) differences in externally–oriented thinking are empirically predicted by sociocultural factors more than by self-reported interoceptive awareness, even within the same ethnocultural group. In the fourth and last part, a general discussion summarizes the contribution of this work, raising criticisms regarding the current operationalization of alexithymia and the misunderstandings it can cause, especially when combined with a fallacious interpretation of nosological categories. The thesis concludes with the suggestion that adopting a stricter conception of alexithymia and analyzing the interplay between its interoceptive and cognitive subcomponents is beneficial for both emotion theory and clinical practice.

The relationship between alexithymia, PTSD symptoms, attachment, and depression was examined using archival data from a university-based trauma clinic. Participants were 62 women and 20 men, ages ranging from 17 to 59, with childhood histories of physical or sexual abuse. Measures included the Structured Clinical Interview on Childhood Sexual Abuse History (SI-SA), Impact of Events Scale-Revised (IES-R), Attachment Style Questionnaire (ASQ), Beck Depression Inventory-Second Edition (BDI-II), and Toronto Alexithymia Scale-20 (TAS-20). As predicted, alexithymia, PTSD symptoms, and depression were negatively correlated with secure attachment and positively correlated with insecure attachment. Also as predicted, depression and insecure attachment styles containing negative models of the self (need for approval, discomfort with closeness) mediated the relationship between alexithymia and PTSD symptoms while styles involving positive models of the self (confidence, relationships as secondary) did not. Preoccupation with relationships was excluded from mediation analyses because alexithymia was not a significant predictor of this construct. Results suggest that the symptom profile of adult survivors of childhood abuse can be complex and may require interventions that target a broad range of symptoms and difficulties including alexithymia, attachment, and depression.

Normative Male Alexithymia (NMA; Levant 1992) and Gender Role Conflict (GRC; O’Neil, 2008) have emerged in the literature as empirically supported masculinity-based constructs that could be possible predictors of men’s psychological well-being. Moreover, several researchers examined the impact of masculinity in the contexts of men’s romantic relationships. Yet, there exists a paucity of research that investigates the intersection of the GRC, NMA, and men’s friendships, and psychological well-being of men. The purpose of this study was to examine the triadic relationship of GRC, NMA, and men’s friendships with other men; and the impact of this triadic relationship on men’s psychological well-being. The researcher collected survey data from 216 participants who identified as male. Data collection included responses to demographic questionnaires, Normative Male Alexithymia Scale (NMAS; Levant et al., 2006), Gender Role Conflict Scale (GRCS; O'Neil et al, 1986), Network of Relationships Questionnaire- Relationship Qualities Version (NRI-RQV; Buhrmester, 1992; Buhrmester & Furman, 2008), and the scales of Psychological Well-Being (SPWB; Ryff, 1989). Bivariate correlations revealed significant correlations among all four variables. NMAS scores yielded a small positive correlation (Cohen, 1988) with the NRI-RQV discordant scales scores (r = .202, p < .01), and a moderate negative correlation (Cohen, 1988) with the total full scale scores of PWB (r = -.427, p < .01). NRI-RQV discordant had a strong negative correlation (Cohen, 1988) with total scores of PWB (r = -.517, n = 216, p < .01). GRCS had a small negative correlation (Cohen, 1988) with the total scores of PWB full scales (r = -.166, n = 216, p < .05). The moderation analysis indicated that GRC significantly moderated the effect of NMA on men’s PWB scores (∆R² = .073, F (1,212) = 20.795, p < .001). High levels of NMA and friendship discords factored in as the best predictor of men’s PWB, and accounted for the 37% variation in overall PWB scores with an effect size of f² = .60. Clinical implications for mental health counselors are discussed based on the study’s results; limitations of the study and future directions are provided.

Stuttering is a developmental disorder which may adversely affect the individual on many functional and emotional levels. Common sequelae of speech disfluency include powerful emotions such as anxiety, shame, and anger, as well as speech-avoidant behaviors. For males, the influence of gender role socialization may present an additional burden. From a traditional perspective of masculinity, emotional expression and exposing one's flaws are strongly discouraged in most forms and contexts and may be seen as signs of weakness. While expression of emotions is a common developmental milestone for many who stutter, it is unclear what impact awareness, repression, and avoidance of emotions have on the well-being of people who stutter. This study explored the effects of disruptions in emotional expression and the influence of masculinity on the impact of disfluency for adult males who stutter (n=65). It was hypothesized that masculine-type emotional restriction would mediate the relationship between disruptions in emotional expression and the perceived impact of stuttering. Regression analysis revealed disruptions in emotional expression accounted for 25% of the variance in self-reported perceptions of stuttering, and self-regulation of emotion was negatively correlated with perceived impact of stuttering. Contrary to hypothesis, masculine-type emotional restriction was not significantly correlated with perceived impact of stuttering and thus invalidated impetus for mediation analysis. Implications and suggestions for further exploration are discussed.