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      A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations

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          Abstract

          Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations. Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels. This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning. We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations. Studies using two common measures of these constructs were included ( i.e., the Toronto Alexithymia Scale - TAS, and the Dissociative Experiences Scale - DES). Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation. The strength of the association was higher in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations..

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          Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale.

          Christian Schmahl, Lisa Lyssenko, Ruben Vonderlin … (2018)
          Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to higher burden of illness and poorer treatment response, and not only in disorders with high levels of dissociation. This meta-analysis offers a systematic and evidence-based study of the prevalence and distribution of dissociation, as assessed by the Dissociative Experiences Scale, within different categories of mental disorders, and it updates an earlier meta-analysis.
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            Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

            Heather Westwood, Jess Kerr-Gaffney, Daniel Stahl … (2017)
            Objective The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups. Method Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs. Results Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions. Conclusion Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.
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              The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis.

              Shuwen Li, Bin Zhang, Yufang Guo … (2015)
              Patients with depression exhibit high rates of alexithymia, representing a major public health concern. We sought to examine relationships between depression severity and alexithymia as assessed by the Toronto Alexithymia Scale (TAS-20) and the TAS-20 subscales of difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). Potentially relevant studies were obtained independently by two reviewers. Chi-square statistics based on the Q-test and I(2) index assessed statistical heterogeneity between studies. Subgroup analyses were mainly used to explore sources of heterogeneity. Begg׳s test and Duval and Tweedie' trim and fill were used to assess potential publication bias. Altogether, 3572 subjects from 20 study groups across 19 studies were included. Medium relationships were observed between depression and TAS-total score (TAS-TS), DIF, and DDF. There was also a weak relationship between EOT and depression. Subgroup analyses showed a stronger correlation between TAS-TS and depression assessed by self-reported tools than that assessed by the Hamilton Rating Scale for Depression. The heterogeneity significantly decreased only in the subgroup analysis by depression tool. We conclude that alexithymia, as assessed by the TAS-20 and its subscales DIF and DDF, is closely related to depression. These relationships were affected by depression measurement tools.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Res Psychother
                Journal ID (publisher-id): RIPPPO
                Title: Research in Psychotherapy : Psychopathology, Process, and Outcome
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2499-7552
                ISSN (Electronic): 2239-8031
                Publication date (Electronic): 21 May 2020
                Publication date Collection: 20 May 2020
                Volume: 23
                Issue: 1
                Electronic Location Identifier: 439
                Affiliations
                [1 ]Queen Elizabeth II Health Sciences Centre , Halifax NS
                [2 ]Department of Psychiatry, Dalhousie University , Halifax NS, Canada
                Author notes
                Mental Health Day Program, Queen Elizabeth II Health Sciences Centre, Halifax NS, Canada. Sandra.reyno@ 123456nshealth.ca

                Citation: Reyno, S.M., Simmons, M., & Kinley, J. (2020). A metaanalytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1), 99-107. doi: 10.4081/ripppo.2020.439

                Conflict of interests: The authors declare no potential conflict of interest.

                Article
                DOI: 10.4081/ripppo.2020.439
                PMC ID: 7451292
                PubMed ID: 32913826
                SO-VID: 6ed9366c-9b14-42c4-9f97-abe2301b4fac
                Copyright © ©Copyright: the Author(s)
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 November 2019
                Date accepted : 06 February 2020
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 68, Pages: 9
                Categories
                Subject: Article

                Keywords: alexithymia,dissociation,meta-analysis
                Data availability:
                Keywords: alexithymia, dissociation, meta-analysis

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