Cross-sectional investigation into the antecedents and sequelae of alexithymia: a comparison of children and adults

The term alexithymia, meaning “no words for emotions”, is a subclinical personality trait associated with both affective (e.g., difficulties identifying and describing emotions) and cognitive (e.g., externally oriented thinking) deficits in emotional awareness. Despite being relatively common in the general populace (~10% prevalence rate), alexithymia’s antecedents and consequences in healthy individuals remain poorly understood. As comorbid alexithymia has been found to have numerous adverse psychological and health implications in clinical populations, it is important to investigate if heightened alexithymic traits have similar negative consequences in nonclinical populations. Therefore, this thesis contains a series of novel and unique studies to clarify this. The thesis first aimed to better understand the psychometric and behavioural correlates of alexithymia in adult individuals from the general population (Chapters 2 and 3). It has been speculated childhood trauma shares separate relationships with later-life alexithymia, depression and anxiety. Considering this, Chapter 2 aimed to ascertain alexithymia’s potential mediating role in the known relationship between childhood adversity and depressive/anxiety symptoms. A significant mediating role of the alexithymia construct, ‘difficulty identifying feelings’ was found in the relationship between psychological trauma and the development of depressive/anxiety symptoms in later-life. Next, it was of interest to assess the possible behavioural correlates of alexithymia (Chapter 3). The role of alexithymia on the known association between depressive/anxiety symptoms and attentional biases towards emotional facial expressions was then investigated. Consistent with the findings of Chapter 2, Chapter 3 identified a novel and unique relationship between the alexithymia construct ‘difficulty identifying feelings’ and decreased sensitivity towards happy facial expressions; an association once thought to be solely a consequence of depressive symptoms. In light of this, the aim of Chapter 4 was to ascertain if depressive/anxiety symptoms and alexithymia emerge as separate psychological constructs. Chapter 4 found alexithymia distinct from co-occurring depressive/anxiety symptoms, additionally suggesting the alexithymia construct ‘difficulty identifying feelings’ may constitute as ‘core’ alexithymia. Taken together, the findings from the first section of this thesis may aid the development of treatment strategies for both clinical and at-risk healthy individuals who exhibit marked alexithymic traits. Mental health issues are a common occurrence in preadolescents, with an estimated one in ten children in the UK suffering from a diagnosable mental health disorder. Despite this, many of these children go unrecognised and untreated. It may be speculated early-life alexithymia may exacerbate the severity of these mental health issues, however the literature on the presentation, measurement and adverse psychological consequences of alexithymia in children is currently scarce. As such, the thesis then aimed to assess alexithymic traits in preadolescent children aged 8 to 13 in a series of novel studies (Chapters 5, 6 and 7). As it has been speculated children lack the emotional introspection to adequately rate auto-evaluative measures of alexithymia, Chapter 5 aimed to assess the congruent validity of a newly published parent-rated scale of a child’s alexithymic traits. When compared with a complementary self-reported measure, the two assessment tools appeared to be equally able to measure the child’s alexithymia. However, unique patterns of associations emerged. Children themselves were found to be more capable at rating the internal manifestations of alexithymia (e.g., depressive symptoms), whereas parents were better at detecting the external manifestations (e.g., decreased empathy). Next, the mediating role of child alexithymia in the known association between emotion dysregulation and depressive symptoms was investigated. Results from Chapter 6 indicated both self- and parent-reported alexithymia played significant but differing roles in this relationship, dependant on the alexithymia measure’s subfactor. Lastly, Chapter 7 aimed to replicate the findings from Chapter 3 by being the first study to assess the potential influence of child alexithymia on performance in a novel emotion recognition task. In partial support of the findings from adults, parent-rated child alexithymia was found to be uniquely associated with a significant delay in recognising happy expressions. In contrast, an increase in sensitivity towards sad expressions was predominantly explained by underlying depressive symptoms. Chapters 5, 6 and 7 have provided new information on early-life alexithymia and confirmed children and adults with alexithymic traits may have similar psychopathological tendencies. Additionally, this research has highlighted some constraints in administering self-evaluative measures of alexithymia, as children may be unable to differentiate between their affective alexithymic traits and depressive symptoms. Taken together, results from the last section of the thesis may be utilised in the development of early-intervention strategies targeting at-risk children with elevated early-life alexithymic traits