Adult Symptoms of ASD and ADHD in Relation to Alcohol Use: Potential Roles of Transdiagnostic Features.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common comorbidity in Autism Spectrum Disorder (ASD). ADHD is a risk factor for alcohol misuse whereas ASD is often regarded as protective; however, research on ASD and alcohol use has yielded conflicting findings, sometimes implicating the role of comorbid ADHD. The possibility that certain transdiagnostic features (i.e., characteristics associated with multiple disorders) may underlie relationships of both disorders to alcohol use in adults was examined in the present study. A nonclinical young adult sample of 248 alcohol users (117 men, 131 women) completed validated self-report measures of ASD and ADHD symptoms as well as the transdiagnostic features alexithymia, impulsivity, and negative moods. ASD and ADHD symptoms were normally distributed, suggesting that the respective disorders represent extreme, dysfunctional ends of population distributions of symptoms. Path analysis indicated that the significant positive association between ASD and ADHD symptom measures was fully mediated by alexithymia, impulsivity, and negative moods. Hierarchical regression and path analysis indicated that the positive relationship between ADHD symptoms and alcohol use severity was fully mediated by transdiagnostic features, particularly alexithymia and impulsivity, whereas the relationship between ASD and alcohol use severity was positively mediated by these features (especially alexithymia), with a highly significant and negative direct effect. Present findings may help reconcile previous conflicting evidence on the relationship of ASD to alcohol use, and the role of comorbid ADHD, by emphasizing the roles of alexithymia and impulsivity in both ASD and ADHD as transdiagnostic traits promoting excessive drinking.

Alexithymia and aspects of dreaming: Differential associations of alexithymia facets with dream variables.

Research on aspects of dreaming associated with alexithymia has yielded mixed results. The present study recruited a young adult online sample of 577 participants who completed validated indices of alexithymia, emotion suppression, negative moods, and eight aspects of dreaming, with a focus on evaluating a counterintuitive previous finding that alexithymia and two of its core facets were associated with greater self-reported typical emotional intensity of dreams. Total alexithymia and facet scores showed differential relationships to aspects of dreaming including dream recall frequency, emotionality, meaningfulness, nightmare frequency, nightmare distress, usefulness of dreams in problem-solving and creativity, and learning about oneself through dreams. Planned hierarchical regression controlling for demographics, alcohol use, and dream recall frequency indicated that the difficulties identifying feelings (DIF) facet of alexithymia was a significant positive predictor of dream emotionality, whereas the externally oriented thinking (EOT) facet was a significant negative predictor. Stress, but not emotion suppression, mediated the positive relationship between DIF and dream emotionality. The likely role of dream emotionality in higher ratings of nightmare distress, dream meaningfulness, and learning about oneself through dreams among those with higher DIF scores is noted, along with other findings and the strengths and limitations of the study.

Depression Moderates the Relationship between Trait Anxiety, Worry and Attentional Control in Melanoma Survivors.

Cancer survivors commonly contend with concurrent cognitive difficulties such as problems with attention and concentration, and psychological distress, including anxiety and depression. However, the associations between attentional and emotional difficulties within the specific context of melanoma survivors remain relatively unexplored. Premised on attentional control theory, the current study employed a cross-sectional design to explore the interplay among trait anxiety (dispositional) and situational anxiety (cancer-related worry), depression and attentional control (ability to inhibit distractors and flexibly shift within and between tasks) in a sample of 187 melanoma survivors aged 18 to 58 years (Mage = 36.83 years, SDage = 5.44 years; 93% female). Data were analyzed using a moderated multiple regression, with anxiety, cancer worry and depression as predictors, and attentional control as the criterion variable. After statistically controlling for the variance of chemotherapy, we found that individuals with higher trait anxiety and higher cancer-related worry reported greater attentional control at low levels of depression, yet poorer attentional control at high depression, relative to individuals with low anxiety. Our findings suggest that anxiety and depression are differentially related to attentional control in melanoma survivors. The results provide a marker for clinicians addressing anxiety and depression in this population. Implications for primary healthcare are discussed.

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness.

Alexithymia has been linked to risky or problematic alcohol use, with a common interpretation invoking deficient emotion regulation and use of alcohol to cope with distress. An alternative explanation positing a general deficit of interoception in alexithymia suggested that poor awareness of internal cues of overconsumption may promote excessive drinking. The present study assessed predictions based on these hypotheses in 337 young adult alcohol users recruited online. Participants completed validated questionnaire indices of alcohol use, alexithymia, emotion regulation, interoceptive sensibility, and sensitivity to reward and punishment. Alcohol use was positively correlated with alexithymia and reward sensitivity, and negatively correlated with emotion regulation as expected, but was uncorrelated with interoceptive sensibility. Alexithymia was not significantly correlated with most dimensions of interoceptive sensibility but was highly negatively correlated with emotion regulation. Hierarchical regression controlling for demographic variables indicated that alexithymia, emotion regulation, sex, and sensitivity to reward and punishment were significant predictors of alcohol use levels. Bootstrapped mediation test controlling for all other variables indicated mediation of the association between alexithymia and alcohol use by deficient emotion regulation but not interoceptive sensibility. Results supported the emotion regulation deficit interpretation of the association of alexithymia with alcohol use. Limitations concerning interoception measurement, online samples, self-report measures, cross-sectional designs, and collection of data during the COVID-19 pandemic are discussed. Future research could follow up on these findings by testing interoceptive accuracy in addition to interoceptive sensibility in relation to alexithymia and alcohol use.

Alexithymia, reward sensitivity and excessive exercise in non-binge-eaters versus severe binge eaters: Implications for primary and secondary exercise dependence.

A distinction has been made between primary and secondary exercise dependence, with the latter defined as excessive exercise secondary to disordered eating and weight concerns. Based on theoretical considerations from research on the roles of trait factors in addictions, the present study used validated scales to assess alexithymia, sensitivity to reward and punishment, emotion regulation and interoception in relation to exercise dependence symptoms in Australian male and female non-binge eaters (n = 228) and severe binge eaters (n = 126) aged 18-30 yr. In both groups, exercise dependence symptoms were significantly positively associated with reward sensitivity and interoceptive awareness, with the latter two variables predicting exercise dependence symptoms in hierarchical regression models; punishment sensitivity was significantly negatively related to such symptoms. Alexithymia was significantly associated with exercise dependence symptoms only in non-binge eaters; in severe binge eaters, alexithymia explained 0% of unique variance. Male sex was associated with more exercise dependence symptoms in severe binge eaters only. Participants in the severe binge group scored significantly higher on measures of exercise dependence, alexithymia, risky alcohol use, and sensitivity to reward and punishment, and significantly lower on emotion regulation, compared to those in the non-binge group. Hierarchical regression models explained 25% of variance in exercise dependence symptoms in non-binge-eaters and 43% in severe binge eaters. Findings are discussed in terms of the distinction between primary and secondary exercise dependence, the role of alexithymia, study limitations including data collection during the COVID-19 pandemic in Australia, and suggestions for future research.

Alexithymia and binge eating: Maladaptive emotion regulation strategy or deficient interoception?

Alexithymia has been linked to various excessive behaviors as a likely risk factor, including binge eating. Such relationships are often attributed to deficient emotional self-regulation in alexithymia, ostensibly leading to the use of maladaptive, externalized behaviors as strategies for coping with distress. An alternative view is that alexithymia reflects a fundamental deficit of interoceptive awareness that, in the case of binge eating, would suggest that internal satiety cues are poorly recognized, promoting overconsumption. The present study assessed the relationship between alexithymia and binge eating in the context of these competing hypotheses. A large online sample of young adults (n = 532) completed validated measures of alexithymia, emotion regulation, interoception, binge eating, emotional eating motivation, and sensitivity to reward and punishment. Correlations were as expected except for interoception, which showed minimal association with alexithymia or binge eating. In a hierarchical regression controlling for age, gender, education level and student status as covariates, binge eating was predicted by emotional eating motivation, emotion regulation (a negative predictor), alexithymia, and reward sensitivity, with the final model explaining 53% of variance in binge eating. Bootstrapped path analyses controlling for all other variables indicated that the relationship between alexithymia and binge eating was mediated by deficient emotion regulation but not deficient interoception, and that the relationships of both alexithymia and emotion regulation with binge eating were mediated by emotional eating motivation. Results are consistent with the notion that the association of alexithymia with binge eating reflects deficient emotion regulation in alexithymia, which can lead to adoption of maladaptive, externalized behaviors such as binge eating for coping with distress.

Alexithymia, narcissism and social anxiety in relation to social media and internet addiction symptoms.

There has been considerable interest in trait correlates of excessive or problematic use of the internet, known as internet addiction. However, the concept of internet addiction has been criticised as too broad. Specific forms of excessive internet use, for example, social media, may have different trait correlates compared to internet use in general. The present study compared levels of internet and social media addiction symptoms in relation to three traits previously linked to one or the other form of excessive behaviour: alexithymia, narcissism and social anxiety. There were 217 young adult social media- and internet-using participants aged 18-35 years recruited from two university campuses in southeast Queensland, Australia. They completed an online questionnaire battery that included a demographics questionnaire and widely used, validated measures of narcissism, alexithymia and social anxiety. Hierarchical regressions indicated that after controlling for demographic variables, internet addiction symptoms were predicted by social anxiety, narcissism and alexithymia, whereas social media addiction symptoms were predicted only by social anxiety and narcissism. Results suggest that the association of alexithymia with internet addiction symptoms does not encompass excessive use of social media, and support the contention that the concept of internet addiction may be too broad.

The Influence of Alexithymia on Alcohol Craving, Health-Related Quality of Life and Gender in Alcohol-Dependent Outpatients.

Alexithymia is a vulnerability factor for physical and mental illness that can significantly influence the daily function of alcohol-dependent patients. The aim of this study was to examine the indirect effect of obsessive thoughts and compulsive behaviors involving alcohol craving on the relationship between alexithymia, quality of life (QoL) of psychological well-being and health status. Three hundred and eighty-one outpatients (263 males and 118 females) in treatment for alcohol dependence completed self-report measures of alexithymia, alcohol craving, GHQ-28 (QoL-psychological well-being) and SF-36 (QoL-health status). Males scored significantly higher than females on aspects of alexithymia, and females reported significantly higher levels of alcohol craving. Path analysis showed an indirect effect of alcohol craving on the relationship between alexithymia, QoL-psychological well-being and self-reported QoL-health status for males only. The current study provides important new information about impaired self-reported health status and well-being among male alcohol-dependent treatment seekers with alexithymia.

Alexithymia and Alcohol Dependence: The Roles of Negative Mood and Alcohol Craving.

Background: Alexithymia is a personality trait associated with emotion regulation difficulties. Up to 67% of alcohol-dependent patients in treatment have alexithymia. Objectives: The objective of this study was to investigate the direct and indirect effects of alexithymia, negative mood (stress, anxiety, and depression) and alcohol craving on alcohol dependence severity. Methods: Three hundred and fifty-five outpatients (mean age = 38.70, SD = 11.00, 244 males, range 18-71 years) undergoing Cognitive-Behavioral Therapy for alcohol dependence completed the Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scales (DASS-21), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Use Disorders Identification Test (AUDIT) prior to the first treatment session. Results: Alexithymia had an indirect effect on alcohol dependence severity, via both negative mood and alcohol craving (b = 0.03, seb = 0.008, 95% CI: 0.02-0.05). An indirect effect of negative mood on alcohol dependence via alcohol craving was also observed (b = 0.12, seb = 0.03, 95% CI: 0.07-0.16). Conclusions/importance: Alexithymia worked through negative mood and alcohol craving leading to increased alcohol dependence severity, indicating that craving had an indirect effect on the relationship between alexithymia and alcohol dependence severity. Targeting alcohol craving and negative mood for alcohol-dependent patients with alexithymia seems warranted.

Parental bonding, adult attachment, and theory of mind: A developmental model of alexithymia and alcohol-related risk.

OBJECTIVE: A developmental model of alexithymia in relation to alcohol-related risk was examined. METHOD: Validated indices of parental bonding, adult attachment, alexithymia, theory of mind (ToM), alcohol-related risk, and mood were administered to a nonclinical sample of 286 alcohol-using men and women. RESULTS: Hierarchical regression incorporating demographic and psychosocial variables accounted for 44% of the variance in alexithymia. Modeling indicated a significant path from dysfunctional maternal bonding to insecure adult attachment to alexithymia to risky drinking; a separate path indicated an indirect effect of alexithymia in association between the deficient ToM and risky drinking. CONCLUSIONS: Findings were consistent with a developmental model where dysfunctional parental bonding in childhood manifests in adulthood as insecure attachment and alexithymia, the latter reflecting the insufficient acquisition of emotion regulation skills; alexithymia, in turn, increases the risk of problematic drinking as an emotion regulation strategy.

Is it the Taste or the Buzz? Alexithymia, Caffeine, and Emotional Eating.

BACKGROUND: Alexithymia, a relatively stable personality trait characterized by difficulties identifying and describing feelings and externally oriented thinking, has been linked to both substance use disorders and eating disorders. In nonclinical samples, alexithymia is associated with heavier consumption of alcohol and caffeine. Both are psychoactive drugs, but unlike most drugs they are typically consumed in the context of palatable and calorie-rich products. OBJECTIVES: Given the association of alexithymia with disordered eating, the present study evaluated the hypothesis that heavier consumption of caffeine by those with high levels of alexithymia may be motivated by the palatable and caloric aspects of common caffeine products rather than by drug-seeking. METHODS: There were 224 participants aged 17-63 years who completed instruments assessing demographics, alexithymia, emotional eating, caffeine consumption, alcohol consumption, negative moods, and reward sensitivity. RESULTS: As predicted, alexithymia was positively related to emotional eating as well as consumption of caffeine and alcohol, and alexithymia was a significant predictor of caffeine intake in regression models. However, there was no indication of mediation by emotional eating. CONCLUSIONS: Alexithymia is characterized by deficient emotion regulation and negative moods, hence use of drugs and/or foods to regulate emotions, combined with poor interoceptive awareness, may account for excessive consumption of drugs or foods as alternative emotion regulation strategies in those with high levels of this trait.

Alexithymia, Impulsivity, and Reward Sensitivity in Young Adult University Student Children of Alcoholics.

BACKGROUND AND OBJECTIVES: Personality traits previously known as risk factors for alcohol use disorder (AUD) were assessed in 29 young adult children of alcoholics (COAs) and 68 young adult children of nonalcoholics (non-COAs). Male and female university students (Mage = 22.11 years) completed questions pertaining to demographics and alcohol use, and the Children of Alcoholics Screening Test; Toronto Alexithymia Scale; Barratt Impulsiveness Scale; Sensitivity to Punishment and Sensitivity to Reward Questionnaire; and Depression Anxiety Stress Scales. RESULTS: Results indicated that personality traits of alexithymia, reward sensitivity, and impulsivity, as well as negative moods, were significantly elevated in COAs compared to non-COAs, independent of current alcohol consumption and drinking history. CONCLUSIONS: Findings are consistent with familial transmission of AUD-associated personality traits in COAs, presumably via influences of genetics and/or familial environment.

Social Interaction Anxiety, Alexithymia, and Drinking Motives in Australian University Students.

In young adults at university, social interaction anxiety has been linked to elevated risk of alcohol-related problems, as has alexithymia. The present study sought to assess whether social interaction anxiety is, like alexithymia, associated with the primary motive of drinking to cope with negative affect. There were 126 undergraduates (76 females, 50 males), aged 18-25 years, who were recruited from two southeast Queensland universities to complete validated self-report measures of problematic drinking, alexithymia, drinking motives, and social interaction anxiety. As predicted, social interaction anxiety was positively related to problematic drinking and coping motives for drinking. Alexithymia mediated the relationship of social interaction anxiety with coping motives. Findings were consistent with a developmental hypothesis of the links between social anxiety, alexithymia, and drinking motives. Given the cross-sectional design of the current study, longitudinal research is ultimately needed to confirm such interpretations of alexithymia and alcohol use among socially anxious young adults at university.

Rash Impulsiveness and Negative Mood, but not Alexithymia or Reward Sensitivity, Differentiate Young to Middle-Aged Chronic Daily Smokers from Never-Smokers.

Given the well-established associations of the personality traits alexithymia, impulsivity, and reward sensitivity with problematic use of a variety of substances, including alcohol and cannabis, the present study sought to determine whether daily tobacco smoking is similarly linked to these traits. Male and female adults aged 18 to 40 years were recruited from the local Australian community, allowing comparison of demographically similar samples of current daily smokers (n = 47) to never-smokers (n = 59) on the relevant self-report measures. Multivariate analysis of covariance revealed that current smokers scored significantly higher than never-smokers on indices of negative mood, impulsiveness, and risky alcohol use, after controlling for social desirability. No significant group differences were found on indices of alexithymia, reward sensitivity, or punishment sensitivity. Results suggest that chronic daily cigarette smoking may be an exception to the maladaptive behaviors associated with alexithymia, and is driven primarily by mood regulation and poor impulse control.

Alexithymia and Mood: Recognition of Emotion in Self and Others.

The present study explored relationships between alexithymia-a trait characterized by difficulties identifying and describing feelings and an external thinking style-and negative moods, negative mood regulation expectancies, facial recognition of emotions, emotional empathy, and alcohol consumption. The sample consisted of 102 university (primarily psychology) students (13 men, 89 women) aged 18 to 50 years (M = 22.18 years). Participants completed the Toronto Alexithymia Scale (TAS-20), Negative Mood Regulation Scale (NMRS), Depression Anxiety Stress Scales (DASS-21), Reading the Mind in the Eyes Test (RMET), Interpersonal Reactivity Index (IRI), and Alcohol Use Disorders Identification Test (AUDIT). Results were consistent with previous findings of positive relationships of TAS-20 alexithymia scores with both alcohol use (AUDIT) and negative moods (DASS-21) and a negative relationship with emotional self-regulation as indexed by NMRS. Predicted negative associations of both overall TAS-20 alexithymia scores and the externally oriented thinking (EOT) subscale of the TAS-20 with both RMET facial recognition of emotions and the empathic concern (EC) subscale of the IRI were supported. The mood self-regulation index NMRS fully mediated the relationship between alexithymia and negative moods. Hierarchical linear regressions revealed that, after other relevant variables were controlled for, the EOT subscale of the TAS-20 predicted RMET and EC. The concrete thinking or EDT facet of alexithymia thus appears to be associated with diminished facial recognition of emotions and reduced emotional empathy. The negative moods associated with alexithymia appear to be linked to subjective difficulties in self-regulation of emotions.

Cognitive trait anxiety, stress and effort interact to predict inhibitory control.

Few studies have focussed on the link between anxiety and inhibitory control in the absence of stimulus-driven external threat. This two-part experiment examined the interactions between (1) somatic trait anxiety, somatic situational stress (i.e. threat of electric shock), and effort, and (2) cognitive trait anxiety, cognitive situational stress (i.e. ego-threat instructions), and effort, on inhibitory processes using a Go-No-Go paradigm. Trait anxiety was operationalised using questionnaire scores and effort was operationalised using a visual analogue scale. Performance effectiveness was measured using the d' parameter from signal detection theory and processing efficiency was indexed by the ratio of d' to response time on correct trials. Results indicated that somatic trait anxiety and stress did not predict effectiveness or efficiency. Cognitive trait anxiety and stress were associated with both inhibitory effectiveness and efficiency deficits; however, contrary to expectations these deficits were evident at higher rather than lower mental effort. Results suggest a distinction between how somatic and cognitive anxiety manifest on tasks involving inhibitory control.

Interrelationships between trait anxiety, situational stress and mental effort predict phonological processing efficiency, but not effectiveness.

Attentional control theory (ACT) describes the mechanisms associated with the relationship between anxiety and cognitive performance. We investigated the relationship between cognitive trait anxiety, situational stress and mental effort on phonological performance using a simple (forward-) and complex (backward-) word span task. Ninety undergraduate students participated in the study. Predictor variables were cognitive trait anxiety, indexed using questionnaire scores; situational stress, manipulated using ego threat instructions; and perceived level of mental effort, measured using a visual analogue scale. Criterion variables (a) performance effectiveness (accuracy) and (b) processing efficiency (accuracy divided by response time) were analyzed in separate multiple moderated-regression analyses. The results revealed (a) no relationship between the predictors and performance effectiveness, and (b) a significant 3-way interaction on processing efficiency for both the simple and complex tasks, such that at higher effort, trait anxiety and situational stress did not predict processing efficiency, whereas at lower effort, higher trait anxiety was associated with lower efficiency at high situational stress, but not at low situational stress. Our results were in full support of the assumptions of ACT and implications for future research are discussed. (PsycINFO Database Record

A Meta-analysis of Theory of Mind in Alcohol Use Disorders.

AIM: Research into Theory of Mind (ToM) in alcohol use disorder (AUD) is sparse and the extant findings contradictory. The objective of this paper was to conduct a meta-analysis to determine whether individuals with AUD show ToM deficits across the available published literature. METHOD: A comprehensive literature search was performed with the PsychInfo, PubMed and Web Science databases for studies from 1990 to March 2015, pairing the keywords 'alcohol' and 'theory of mind'. Results were filtered and eight studies met the inclusion criteria and were included in the final meta-analysis. RESULTS: Results showed that individuals with AUD (n = 187) displayed reduced ToM compared to controls (n = 187). Hedges' g was -1.62 [(-2.28, -0.96), SE = 0.66, P < 0.01], which is indicative of a large effect size. The percentage of males had a significant impact on the effect size, Q = 7.90, P = 0.005, while IQ and level of education did not. CONCLUSIONS: Results of this study suggest that AUD may be associated with impaired understanding of others' intentions and emotions, which can leave an individual vulnerable to misinterpreting social cues. Clinical care implications of the findings, limitations of the study, and suggestions for future research are discussed.

Alexithymia in relation to alcohol expectancies in alcohol-dependent outpatients.

Alexithymia and alcohol outcome expectancies were investigated in 355 alcohol-dependent treatment seekers. Patients with alexithymia gave stronger self-report ratings of expectancies of affective change related to beliefs that alcohol leads to negative mood states and assertion, that alcohol enhances social skills, compared to those without alexithymia. The findings suggest that alcohol-dependent outpatients with alexithymia may drink to experience intensified negative emotions and improved social functioning.

A longitudinal mediational study on the stability of alexithymia among alcohol-dependent outpatients in cognitive-behavioral therapy.

Alexithymia is characterized by difficulty identifying feelings, difficulty describing feelings, and an externally oriented thinking style. Alexithymia has been described as a trait-like risk factor for the development of alcohol use disorders. Few studies have investigated the absolute (whether mean scores change over time) and relative (extent to which relative differences among individuals remain the same over time) stability of alexithymia among men and women with alcohol dependence, or have considered potential underlying mechanisms. Social learning processes contribute to and maintain alcohol problems. The reinforcement of alcohol expectancies is one plausible mechanism that links the difficulties in emotional processing associated with alexithymia and alcohol use. The present study investigated the stability of alexithymia as well as alcohol expectancy as a mediator of alexithymia. Three hundred fifty-five alcohol-dependent patients were enrolled in a cognitive behavioral treatment program. Ninety-two alcohol-dependent patients completed assessments at baseline and at 3-month follow-up. Results indicated that total Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994) mean score, difficulty identifying feelings, and difficulty describing feelings decreased significantly over time with a larger decrease in alexithymia mean scores for females. Externally oriented thinking mean scores did not change. The TAS-20 and its subfactors demonstrated significant correlations, from baseline to follow-up, which were stronger for males than for females. Regression analyses showed that the total TAS-20 mean scores, difficulty identifying feelings, and difficulty describing feelings were partially mediated through assertion alcohol expectancies. In conclusion, this suggests that alexithymia has relative stability and is a trait-like factor among alcohol-dependent treatment seekers.