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OBJECTIVE: Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use. METHOD: As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator. RESULTS: The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher). CONCLUSION: These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects. PLAIN LANGUAGE TITLE: Does difficulty identifying/describing emotions or externally-oriented thinking influence the effectiveness of an intervention among people with both depression and hazardous alcohol use?

In a recent study we recruited participants who were concerned with both their alcohol use and low mood. We provided two different online interventions. Half of the participants received an intervention designed for both concerns and half received an intervention that addressed only depression. We hypothesized that receiving the combined intervention for both concerns would result in greater benefits, however, our results indicated no apparent difference. This analysis uses the same data, but investigated the influences of alexithymia on the effectiveness of the interventions. Alexithymia is defined as having difficulty identifying/describing emotions and/or thinking more about external events than internal feelings. It commonly co-occurs with depression and with hazardous alcohol use and can increase the challenge of supporting individuals with these co-occurring concerns. The results of this analysis showed support for our original hypothesis that participants who received the intervention that addressed both their mood and alcohol concerns had lower depression scores 6-months later, but only among individuals who also had alexithymia scores above 60.5. Taking alexithymia severity into consideration during treatment planning may help optimize the effectiveness of interventions. These results show merit for future research to consider alexithymia as a variable that could potentially impact outcomes among individuals with co-occurring depression and hazardous alcohol use.

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INTRODUCTION: Despite the high rate of somatic symptom disorder (TSS) in the pediatric population, etiological mechanisms remain poorly understood. Previous studies conducted in youths with anxiety, eating disorder, or autistic disorder support a relation between difficulties in the perception of sensory signals (i.e., interoception) and difficulties in identifying emotions. METHOD: A cross-sectional study was carried out at the University Hospital of Amiens-Picardie in 19 young people aged 9 to 17 hospitalized in the pediatric ward for TSS. A mental heartbeat tracking task was used to assess interoceptive accuracy, awareness and sensibility. The Porges Body Perception Questionnaire (PBPQ) was used to assess interoceptive attention. Other questionnaires were used to assess associated clinical dimensions such as depression, anxiety, emotional dysregulation and alexithymia. RESULTS: The mean interoceptive accuracy score was lower in TSS subjects compared to expected scores in the general population (33% error vs. 20%). A statistically significant correlation was found between, on the one hand, interoceptive sensibility and the "avoidance" subscore of the ECAP (r=0.51) and, on the other hand, between interoceptive awareness and the total score of the Child Depression Inventory (r=0.51). A significant relationship was found between the PBPQ scale total score and the Children-Toronto Alexithymia Scale total score (r=0.42), in particular with the "difficulty expressing emotions" subscore (r=0.62). CONCLUSION: This study confirms that interoceptive difficulties occur in young patients with severe TSS. Our finding adds empirical evidence supporting the relations between interoceptive difficulties, alexithymia and somatic symptoms in children and adolescents.

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A critical analysis of the basic hypotheses of psychosomatic research and the sometimes hasty assertions drawn from the previous works makes it possible to better discern the data confirmed by the most recent works or the most rigorous meta-analyses and to highlight the emerging tracks. If the hypothesis of behavioral patterns specifically related to the risk of certain pathologies seems abandoned, the predictive value of depression in the cardiovascular field, more than in that of oncology, becomes clearer. Negative affect and impaired emotional awareness emerge as two complementary factors of somatic vulnerability. Several vulnerability factors seem all the more effective as they affect individuals of lower socio-economic status. Social exclusion feeling and its links with the inflammatory response appear to be a possible common denominator, both for depression and for many somatic conditions. A series of studies on the cerebral regulation of emotions and stress, as well as on bidirectional brain-bowel relations and on the mediating role of the gut microbiota, complements the available epidemiological data. The same is true for certain advances in behavioral neuro-economics, which inform the decision-making processes of patients facing preventive health choices. Lastly, it appears that a significant part of the excess mortality associated with the existence of severe mental disorders is not due to factors inherent to the patients themselves, but to disparities in the quality of the care provided to them.

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In the title of this text, by somatic disorders we mean those physical illnesses clearly related to a non-psychiatric medical field, frequently termed psychosomatic illnesses and somatoform disorders. For forty years, a trend of thought has focused with pertinence on the psychological peculiarities in patients with severe somatic diseases. Moreover, causality was often supposed in the regularly mentioned association between personality features and somatoform disorders. However, the revival of the study of the earlier field of relationships between mind and body by Briquet, Charcot, Janet and Freud in his first period has led to the reassessment of the meaning of these observations. This reexamination is marked out by several assertions. Two of them work as preliminaries to argumentation: 1. existential wounds may produce long-lasting personality alterations; 2. existential wounds may produce somatoform disorders. These phenomena have been rediscovered over the last few years among assaulted subjects as well as war veterans in whom a frequent occurrence of somatizations has been, in addition, closely linked to the incidence of behavior or personality disorders. Two theses then emerge: 1. somatic diseases may produce long-lasting personality alterations; 2. until now no premorbid personality univocally predisposing to somatic diseases could be found. Indeed, during the 1980s a growing body of negative results coming from retrospective and prospective studies as well as anatomical comparisons have accumulated upon the potential role of certain personality factors in the incidence of somatic illnesses. This dialectic leads to the connection of two corollary assertions: 1. "pensée opératoire" and "alexithymia" in patients with somatic diseases may represent only an effect of the announcement or chronicity of the organic disease; 2. the old "dissociative hysteria" with somatic manifestations finds its substratum in existential wounds and not in pre-trauma personality. Indeed, on the one hand, recent publications do not allow the assertion to be confirmed that alexithymia and "pensée opératoire" predispose to somatizations. On the other hand, personality disorders in subjects with "dissociative hysteria" as well as their somatoform symptoms appear mainly as an effect of an existential wound and express in fact the Janetian concept of "a drop in Psychological Tension". Then, in spite of their differences, conversion and psychosomatic symptoms share the property of being a primitive response to existential wounds in which the subject cannot produce any appropriate psychic or behavioral response to his distress. Light is shed on these phenomena when put alongside the field of "fixed ideas" thought of by Pierre Janet as the recourse to archaic automatisms. Indeed, the experience which contradicts the vision of existence provokes an "unspeakable terror". It is mentally unrepresented or represented in too slight a way. In such cases, no previous personality prevails, but the resulting personality often appears modified, including when the breakdown of vision of the existence results from the diagnosis of an illness or its protracted course.

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OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale. METHOD: One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12-18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2<3 and RMSEA<0.05. Cronbach α were also calculated. RESULTS: Fit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items. CONCLUSION: The Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

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OBJECTIVES: Although many authors have highlighted similarities between conduct disorder (CD) and alexithymia, little empirical research has actually investigated the contribution of emotion processing to CD. The purpose of this study was to explore the relationships between CD and scores on affect regulation scales among 75 adolescents: a group of 30 adolescents with CD and a group of 45 controls, ranging in age from 13 to 18. METHOD: All participants filled in a socio-demographic questionnaire. CD diagnosis was assessed in regard to DSM-IV criteria using the specific CD section of the Kiddie-Sads. Affect regulation was measured with two self-reports: TAS-20 (Toronto Alexithymia Scale), known as the gold standard for alexithymia measurement, and DERS (Difficulties in Emotion Regulation Scale), a recently validated scale. In addition, since depression may influence the correlations between CD and alexithymia, it was also measured with the BDI. In order to have more information on the CD group, the CTQ was also used. One way analyses of variance adjusting for age were used for mean score comparisons. Partial correlations adjusting for age were used to investigate the link between the CD severity (the severity index was calculated from the Kiddie-Sads) and affect regulation scores. Finally, discriminant analyses were conducted to explore whether affect regulation could correctly categorize controls and adolescents with CD. RESULTS: These results provided some additional data in order to understand the relationship between affect regulation and CD. Controls and adolescents with CD had significantly different emotion regulation scales scores at both scales (TAS-20 and DERS) and in most of their dimensions. Moreover, they also point out the positive correlation between difficulties in affect regulation and CD severity. To our knowledge, this is the first study to have investigated relationships between CD and alexithymia using a severity index of CD. Finally, discriminant analyses showed that the two emotion regulation scales permitted the significant discrimination of both groups. These results are consistent with previous works highlighting the theoretical relationship between deficit in mental elaboration and acting-out. They point to the need to develop therapeutic programs in order to improve emotion regulation of teenagers with CD. Finally, an additional analysis showed a relationship between emotional neglect in childhood (measured with CTQ) and the CD severity. A task for future research would be to study the relationships between attachment, emotional regulation and CD in adolescence.

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OBJECTIVES: This paper focus on studying the prevalence of alexithymia in diabetes type 1 and type 2 and its impact on diabetes's clinical and therapeutic characteristics. We also studied the relationship between alexithymia and emotional disorders in diabetics. MATERIALS AND METHODS: The study involved a sample of 125 diabetic patients, among whom 50 had type 1 and 75 had type 2 diabetes mellitus compared with respectively 70 and 52 control subjects matched for age and sex. Alexithymia was assessed using the Toronto Alexithymia Scale, while emotional disorders were evaluated using the Hospital Anxiety and Depression Scale. RESULTS: Type 1 diabetics were more alexithymic than controls while type 2 diabetics had higher cognitive component score than control subjects. Alexithymic type 1 diabetics had a higher average of fasting blood sugar than non-alexithymic patients did (P=0.021). Moreover, with type 1 diabetes, erectile dysfunction was associated with difficulties in identifying feelings (P=0.012). We found that the presence of depression was a predictor of alexithymia in type 1 diabetes (ß=1.78, P=0.04) and the presence of psychiatric history was indicative of the presence of alexithymia in type 2 diabetes (ß=2.09, P=0.042). CONCLUSION: Given the impact of alexithymia on diabetes types 1 and 2, the detection and treatment of alexithymic subjects are important for a better prognosis of diabetic disease.

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INTRODUCTION: The aim of this study was to evaluate the impact of physical activity on alexithymia and coping strategies among people with multiple sclerosis aged over 40. The hypotheses were that physical activity should have a protective effect on alexithymia, and more particularly, on "emotional identification" and could influence coping strategies because it can be considered as a distractive coping strategy. METHODS: Thirty-seven patients aged 40 years or older were asked to complete a form including an identification sheet and standardized questionnaires: the Bermond-Vorst Alexithymia Questionnaire (version B), the Coping with Health Injuries and Problem Questionnaire, the Fatigue Impact Scale, and the Hospital Anxiety and Depression Scale. RESULTS: The participants with a high or moderate level of physical activity used "information research" as a coping strategy better than those who had a lower level of physical activity. They also analyzed their emotions better. The results revealed an association between these variables and anxiety, depression and fatigue. DISCUSSION: This study provides insight for future research about the impact of physical activity on multiple sclerosis.

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