https://doi.org/10.4081/ripppo.2020.439
A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations
Submitted: November 7, 2019
Accepted: February 6, 2020
Published: May 21, 2020
Accepted: February 6, 2020
Abstract Views: 1546
PDF: 729
HTML: 460
HTML: 460
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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 and the Dissociative Experiences Scale). 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 increased in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations.
Alfasi, D., & Soffer-Dudek, N. (2018). Does alexithymia moderate the relation between stress and general sleep experiences? Personality and Individual Differences, 122, 87-92.
DOI: https://doi.org/10.1016/j.paid.2017.10.014
Arntz, A., Stupar-Rutenfrans, S., Bloo, J., van Dyck, R., & Spinhoven, P. (2015). Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy. Behavior Research and Therapy, 74, 60-71.
DOI: https://doi.org/10.1016/j.brat.2015.09.002
Aust, S., Härtwig, E.A., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma, 5, 225-232.
DOI: https://doi.org/10.1037/a0027314
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.
DOI: https://doi.org/10.1016/0022-3999(94)90005-1
Baker D., Hunter E., Lawrence E., Medford N., Patel M., Senior C., Sierra M., Lambert M.V., Phillips M.L., & David A.S. (2003). Depersonalisation disorder: Clinical features of 204 cases. British journal of Psychiatry, 182, 428–33.
DOI: https://doi.org/10.1192/bjp.182.5.428
Berenbaum, H., Valera, E. M., & Kerns, J.G. (2003). Psychological trauma and schizotypal symptoms, Schizophrenia Bulletin, 29, 143-152.
DOI: https://doi.org/10.1093/oxfordjournals.schbul.a006985
Bucci, W. (1997). Psychoanalysis and Cognitive Science. A Multiple Code Theory. New York, NY: Guilford Press.
Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014) Changes in alexithymia following psychological intervention: A review. Harvard Review of Psychiatry, 22, 162-178.
DOI: https://doi.org/10.1097/HRP.0000000000000036
Carlson E.B., & Putnam F.W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders. Dissociation, 6, 6–27
Cloitre, M., Petkova, E., Wang, J., & Lu Lassell, F. (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse. Depression and Anxiety, 29, 709-717.
DOI: https://doi.org/10.1002/da.21920
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed). New Jersey: Lawrence Erbaum.
Corchs, F., Corregiari, F., Ferrão, Y.A., Takakura, T., Mathis, M. E., Lopes, A. C., Miguel, E. C. & Bernik, M. (2008). Personality traits and treatment outcome in obsessive-compulsive disorder. Brazilian Journal of Psychiatry, 30, 246-250.
DOI: https://doi.org/10.1590/S1516-44462008000300012
Craparo, G., Gori, A., Mazzola, E., Petruccelli, I., Pellerone, M., & Rotondo, G. (2014). Posttraumatic stress symptoms, dissociation and alexithymia in an Italian sample of flood victims. Neuropsychiatric Disease and Treatment, 10, 2281-2284.
DOI: https://doi.org/10.2147/NDT.S74317
Da Silva, A.N., Vasco, A.B., & Watson, J.C. (2018). Alexithymia and emotional processing: A longitudinal mixed methods research. Research in Psychotherapy: Psychopathology, Process and Outcome, 21, 40-54.
DOI: https://doi.org/10.4081/ripppo.2018.292
Dalenberg, C.J., Brand, B.L., Gleaves, D.H., Dorahy, M.J., Loewenstein, R.J., Cardena, E., . . . Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissection. Psychological Bulletin, 138, 550-588.
DOI: https://doi.org/10.1037/a0027447
De Berardis, D., Serroni, N., Campanella, D., Carano, A., Gambi, F., Valchera, A., . . . Ferro, F.M. (2009). Alexithymia and its relationships with dissociative experiences, body dissatisfaction and eating disturbances in a non-clinical female sample. Cognitive Therapy and Research, 33, 471-479.
DOI: https://doi.org/10.1007/s10608-009-9247-9
Evren, C., & Can, S. (2007). Clinical correlates of dissociative tendencies in male soldiers with conversion disorder. Israel Journal of Psychiatry and Related Sciences, 44, 33-39.
Evren, C., Cinar, O., & Evren, B. (2012). Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Comprehensive Psychiatry, 53, 854-859.
DOI: https://doi.org/10.1016/j.comppsych.2011.11.009
Evren C., Sar, V., Evren, B., Semiz, U., Dalbudak, E., & Cakmak, D. (2008). Dissociation and alexithymia among men with alcoholism. Psychiatry and Clinical Neurosciences, 62, 40-47.
DOI: https://doi.org/10.1111/j.1440-1819.2007.01775.x
Frewen, P.A., Lanius, R. L., Dozois, D.J.A., Neufeld, R.W.J., Pain, C., Hopper, J.W. . . . & Stevens T.K. (2008). Clinical and neural correlates of alexithymia in posttraumatic stress disorder. Journal of Abnormal Psychology, 117, 171-181.
DOI: https://doi.org/10.1037/0021-843X.117.1.171
Frewen, P., Dozois, D., Neufeld, R., & Lanius, R. (2008). Meta‐analysis of alexithymia in posttraumatic stress disorder. Journal of Traumatic Stress, 21, 243-246.
DOI: https://doi.org/10.1002/jts.20320
Frewen, P. A., Dozois, D. A., Neufeld, R. J., & Lanius, R. A. (2012). Disturbances of emotional awareness and expression in posttraumatic stress disorder: Meta-mood, emotion regulation, mindfulness, and interference of emotional expressiveness. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 152–161.
DOI: https://doi.org/10.1037/a0023114
Grabe, H. J., Frommer, J., Ankerhold, A., Ulrich, C., Groger, R., Franke, G.H., . . . Spitzer, C. (2008). Alexithymia and outcome in psychotherapy. Psychotherapy and Psychosomatics, 77, 189-194.
DOI: https://doi.org/10.1159/000119739
Groves, S., Douglas, K., & Porter, R. (2018). A Systematic Review of Cognitive Predictors of Treatment Outcome in Major Depression. Frontiers in Psychiatry, 9, 382, doi: 10.3389/fpsyt.2018.00382.
DOI: https://doi.org/10.3389/fpsyt.2018.00382
Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A., editors (2019). Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons.
DOI: https://doi.org/10.1002/9781119536604
Mark G. Haviland (1996) Structure of the Twenty-Item Toronto Alexithymia Scale, Journal of Personality Assessment, 66, 116-125.
DOI: https://doi.org/10.1207/s15327752jpa6601_9
Jepson, E.K.K., Langeland, W., & Heir, T. (2014). Early traumatized inpatients high in psychoform and somatoform dissociation: Characteristics and treatment response. Journal of Trauma and Dissociation, 15, 572-587.
DOI: https://doi.org/10.1080/15299732.2014.924461
Kienle, J., Rockstroh, B., Bohus, M., Fiess, J., Huffziger S., & Steffen-Klatt, A. (2017). Somatoform dissociation and postraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms, and patients with PTSD. BMC Psychiatry, 17, 248.
DOI: https://doi.org/10.1186/s12888-017-1414-z
Kefeli, M.C., Turow, R.G., Yildirim, A., & Boysan, M. (2018). Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Research, 260, 391-399.
DOI: https://doi.org/10.1016/j.psychres.2017.12.026
Kenny, D.A. (1999). Meta-analysis easy to answer – Meta. Available: http://davidakenny.net/meta.htm (last visited June 26, 2019).
Kihlstrom, J.E., Glisky, M.L., & Angiulo, M.J. (1994). Dissociative tendencies and dissociative disorders. Journal of Abnormal Personality, 103, 117-124.
DOI: https://doi.org/10.1037/0021-843X.103.1.117
Kinley, J.L., & Reyno, S.M. (2019). The price of needing to belong: Neurobiology of working through attachment trauma. Psychodynamic Psychiatry, 47, 39-51.
DOI: https://doi.org/10.1521/pdps.2019.47.1.39
Kinley, J.L., & Reyno, S.M. (2017). Advancing Freud’s dream: A dynamic-relational neurobiologically informed approach to psychotherapy. Neuropsychoanalysis, 19, 127-142.
DOI: https://doi.org/10.1080/15294145.2017.1367260
Kinley, J.L., & Reyno, S.M. (2016). Project for a scientific psychiatry: A neurobiologically informed, phasic, brain-based model of integrated psychotherapy. Journal of Psychotherapy Integration, 26, 61-73.
DOI: https://doi.org/10.1037/a0039636
Kleindienst, N., Limberger, M.F., Ebner-Priemer, U.W., Keibel-Mauchnik, J-K., Dyer, A., . . .Berger, M. (2011). Dissociation predicts poor response to dialectical behavioral therapy in female patients with borderline personality disorder. Journal of Personality Disorders, 25, 432-447.
DOI: https://doi.org/10.1521/pedi.2011.25.4.432
Kong, S.S., Kang, D.R., Oh, J.M., & Kim, N.H. (2018). Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation. Journal of Trauma and Dissociation, 19, 214-231.
DOI: https://doi.org/10.1080/15299732.2017.1329772
Kooiman, C.G., Spinhoven, P., & Trijsburg, R.W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale -20. Journal of Psychosomatic Research, 53, 1083-1090.
DOI: https://doi.org/10.1016/S0022-3999(02)00348-3
Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015). The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Research, 227, 1, 1-9.
DOI: https://doi.org/10.1016/j.psychres.2015.02.006
Lipsanen, T., Saarijärvi, S., & Lauerma, H. (2004). Exploring the relations between depression, somatization, dissociation and alexithymia – Overlapping or independent constructs? Psychopathology, 37, 200-206.
DOI: https://doi.org/10.1159/000080132
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2017). Dissociation in psychiatric disorders: A meta-analysis of studies using the Dissociative Experiences Scale. The American Journal of Psychiatry, 175, 37–46.
DOI: https://doi.org/10.1176/appi.ajp.2017.17010025
Maaranen, P., Tanskananen, A., Hintikka, J., Honkalampi, K., Haatainen, K., Koivumaa-Honkanen, H., Viinamaki, H. (2008). The course of dissociation in the general population: A 3-year follow-up study. Comprehensive Psychiatry, 49, 269-274.
DOI: https://doi.org/10.1016/j.comppsych.2007.04.010
Meganck, D., Vanheule, S., & Desmet, M. (2013). Affective Processing and Affect Regulation: A Clinical Interview Study. Journal of the American Psychoanalytic Association, 61, 12-6
DOI: https://doi.org/10.1177/0003065113516365
Majohr, K. L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M. (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. The Journal of Nervous and Mental Disease, 199, 773-77
DOI: https://doi.org/10.1097/NMD.0b013e31822fcbfb
Mason, O., Tyson, M., Jones, C., & Potts, S. (2005). Alexithymia: Its prevalence and correlates in a British undergraduate sample. Psychology and Psychotherapy, 78, 113-125.
DOI: https://doi.org/10.1348/147608304X21374
Mattila, A. K., Salminen, J. K., Nummi, T., & Joukamaa, M. (2006). Age is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 61, 629–635.
DOI: https://doi.org/10.1016/j.jpsychores.2006.04.013
Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wolfting, K., . . . Zwerenz, R. (2016). A case series of 223 patients with depersonalization -derealization syndrome. BMC Psychiatry, 16, 203.
DOI: https://doi.org/10.1186/s12888-016-0908-4
Modestin, J., Lötscher, K., & Erni, T., (2002). Dissociative experiences and their correlates in young non-patients. Psychology and Psychotherapy, 75, 53-64.
DOI: https://doi.org/10.1348/147608302169544
New, A.S., Rot, M.A.H., Ripoll, L.H., Perez-Rodriguez, M.M., Lazarus, S., Zipursky, E., . . . Siever, L.J. (2012). Empathy and alexithymia in borderline personality disorder: Clinical and laboratory measures. Journal of Personality Disorders, 26, 660-675.
DOI: https://doi.org/10.1521/pedi.2012.26.5.660
O’Brien, F.M., Fortune, G.M., Dicker, P., O’Hanlon, E., Cassidy E., Delanty N., … & Murphy, K. C. (2015). Psychiatric and neuropsychological profiles of people with psychogenic nonepileptic seizures. Epilepsy and Behavior, 43, 39-45.
DOI: https://doi.org/10.1016/j.yebeh.2014.11.012
Ogrodniczuk, J.S., Piper, W. E., & Joyce, S.J. (2011). Effect of alexithymia on the process and outcome of psychotherapy: A programmatic review. Psychiatry Research, 190, 43-48.
DOI: https://doi.org/10.1016/j.psychres.2010.04.026
Onor, M.L., Trevisiol, M., Spano, M., Aguglia, E., & Paradiso, S. (2010). Alexithymia and aging. The Journal of Nervous and Mental Disease, 198, 891-895.
DOI: https://doi.org/10.1097/NMD.0b013e3181fe743e
Paivio, S.C., & McCulloch, C.R. (2004). Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse and Neglect, 28, 339-354.
DOI: https://doi.org/10.1016/j.chiabu.2003.11.018
Parker, J.D., Taylor, G.J., & Bagby, R.M. (1998). Alexithymia: relationship with ego defense and coping styles. Comprehensive Psychiatry, 39, 91-98.
DOI: https://doi.org/10.1016/S0010-440X(98)90084-0
Prasko, J., Grambal, A., Kasalova, P., Kamardova, D., Ociskova, M., Holubova, M., . . . Zatkova, M. (2016). Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders. Neuropsychiatric Disease and Treatment, 12, 2659-2676.
DOI: https://doi.org/10.2147/NDT.S118058
Preece, D., Becerra, R., Robinson, K., & Dandy, J. (2018). Assessing alexithymia: Psychometric properties and factorial invariance of the 20-item Toronto Alexithymia Scale. Journal of Psychopathology and Behavioral Assessment, 40, 276-287.
DOI: https://doi.org/10.1007/s10862-017-9634-6
Rafiq, S., Campodonico, C., & Varese, F. (2018). The relationship between childhood adversities and dissociation in severe mental illness: A meta-analytic review. Acta Psychiatrica Scandinavica, 138, 509-525
DOI: https://doi.org/10.1111/acps.12969
Rufer, M., Held, D., Cremer, J., Fricke, S., Moritz, S., Peter, H., & Hand, I. (2006). Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. Psychotherapy and Psychosomatics, 75, 40-46.
DOI: https://doi.org/10.1159/000089225
De Ruiter, M.B., Elzinga, B., & Phaf, H. (2008). Dissociation: Cognitive capacity or dysfunction. Journal of Trauma and Dissociation. Journal of Trauma and Dissociation, 7, 115-134.
DOI: https://doi.org/10.1300/J229v07n04_07
Saariaho, A.S., Saariaho, T.H., Mattila, A.K., Karukivi, M., & Joukamaa, N.I. (2015). Alexithymia and early maladaptive schemas in chronic pain patients. Scandinavian Journal of Psychology, 56, 428-437.
DOI: https://doi.org/10.1111/sjop.12226
Schimmenti, S. (2017). The developmental roots of dissociation: A multiple mediation analysis. Psychoanalytic Psychology, 34, 96-105.
DOI: https://doi.org/10.1037/pap0000084
Schimmenti, A., & Caretti, V. (2016). Linking the overwhelming with the unbearable. Developmental trauma, dissociation, and the disconnected self. Psychoanalytic Psychology, 33, 106-128.
DOI: https://doi.org/10.1037/a0038019
Schimmenti, A., Sideli, L., LaMarca, L., Gori, A., & Grazia, T. (2109). Reliability, validity, and factor structure of the Maladaptive Daydreaming Scale (MDS-16) in and Italian sample. Journal of Personality Assessment, 23, 1-13.
Spitzer, C., Barrow, S., Freyberger, H.J., & Grabe, H. (2007). Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Australian and New Zealand Journal of Psychiatry, 41, 682-687.
DOI: https://doi.org/10.1080/00048670701449146
Suurmond R, van Rhee, H, Hak T. (2017). Introduction, comparison and validation of Meta-Essentials:
A free and simple tool for meta-analysis. Research Synthesis Methods. 8, 537-553.
Taylor, G.J., Bagby, R.M., & Parker, J.D.A. (1997). Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge University Press, New York, N.Y.
DOI: https://doi.org/10.1017/CBO9780511526831
Terock, J., Janowitz, D., Spitzer, C., Miertsch, M., Freyberger, H.J., & Grabe, H.J., (2015). Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome. Comprehensive Psychiatry, 62, 34-41.
DOI: https://doi.org/10.1016/j.comppsych.2015.06.007
Terock, J., Janowitz, D., Grabe, H.J., Freyberger, H.J., Schneider, W., & Klauer, T. (2017). Alexithymia and Psychotherapeutic treatment motivation: Main and interactional effects on treatment outcome. Psychotherapy and Psychosomatics, 86, 185-1286.
DOI: https://doi.org/10.1159/000457961
Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66-81.
DOI: https://doi.org/10.1016/j.jpsychores.2017.06.007
Yilmaz, O., Ateş, M.A., Semiz, Ü.B., Tütüncü, R., Bez, Y., Algül, A…& Çetin, M. (2016). Childhood traumas in patients with bipolar disorder: Association with alexithymia and dissociative experiences. Australian Journal of Psychiatry, 17, 188-195.
DOI: https://doi.org/10.5455/apd.188358
Zamir, O., Szepsenwol, O., Englund, M.M., & Simpson, J.A. (2018). The role of dissociation in revictimization across the lifespan: A 32-year prospective study. Child Abuse and Neglect, 79, 144-153.
DOI: https://doi.org/10.1016/j.chiabu.2018.02.001
Ziadni, M.S., Jasinsji, M.J., Labouvie-Vief, G., & Lumley, M.A. (2016). Alexithymia, defenses, and ego strength: Cross sectional and longitudinal relationships with psychological well-being and depression. Journal of Happiness Studies, 18, 1799-1813.
DOI: https://doi.org/10.1007/s10902-016-9800-7
Zlotnick, C., Shea, M.T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse and self-mutilation. Comprehensive Psychiatry, 37, 12-16.
DOI: https://doi.org/10.1016/S0010-440X(96)90044-9
Zorzella, K.P., Muller, R.T., Cribbie, R.A., Bambrah, V., & Classen, C.C. (2019). The role of alexithymia in trauma therapy outcomes: Examining improvements in PTSD, dissociation and interpersonal problems. Psychological Trauma: Theory, Research, Practice and Policy, doi: 10.1037/tra0000433.
DOI: https://doi.org/10.1037/tra0000433
How to Cite
Reyno, S. M., Simmons, M., & Kinley, J. (2020). A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1). https://doi.org/10.4081/ripppo.2020.439
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Sabine van Thiel, Margot C.W. Joosen, Anne-Linde Joki, Arno van Dam, Jac J.L. van der Klink, Kim de Jong, Psychometric analysis of the Dutch language Facilitative Interpersonal Skills (FIS) video clips , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 24 No. 1 (2021)
- Paul Schröder-Pfeifer, Alessandro Talia, Jana Volkert, Svenja Taubner, Developing an assessment of epistemic trust: a research protocol , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 21 No. 3 (2018)
- Jose L. Vilchez, Mental footnotes: knowledge constructivism from logical thinking to personal beliefs and therapy , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 2 (2016)
You may also start an advanced similarity search for this article.
