Alexithymia subscales have distinct roles in both the variability of arousal ratings and in associations with anxiety and psychological inflexibility

Abstract

Alexithymia is a subclinical cluster of deficits in emotional processing prevalent across a wide variety of clinical populations. One alexithymia component, difficulty identifying feelings (DIF), appears the most related to both distress and treatability. Unfortunately, effects of alexithymia on important variables remain inconclusive, including subjective emotional arousal ratings, arousal-relevant clinical symptoms, and risk factors for mental illness. We proposed that this inconclusiveness was due partly to differences across alexithymia models and questionnaires. In a behavioral study (N=241), participants provided emotional arousal ratings of stimuli paired by verbal label and core affect, and questionnaire responses. We computed rating variability as difference scores between paired stimuli. High alexithymia and DIF increased variability of arousal ratings, and generalized anxiety increased both ratings and their variability, but only for low-arousal stimuli. The strongest effects involved another alexithymia subscale, Difficulty Emotionalizing (DE), which decreased both emotional arousal ratings and rating variability for low-arousal stimuli. These findings are consistent with the theory that strong situations can overshadow differences in behavior, while weaker situations reveal both individual differences and intraindividual variability. Intriguingly, DE also decreased ratings of high-arousal stimuli, superseding the strong situation. Because DE affected behavior more than DIF, DE and the heterogeneity of alexithymia warrant further study. In a large study (N=1977), respondents completed questionnaires for alexithymia; anxiety; and psychological inflexibility, including cognitive fusion. In the two most common alexithymia questionnaires, we replicated aspects of the construct’s structure, including common subscales and higher-order dimensions, and extended them to the newer Perth Alexithymia Questionnaire. Based on psychometric properties we found and computed, we recommend when to choose a given alexithymia questionnaire. In regression models, the concurrence of anxiety and psychological inflexibility consistently predicted alexithymia, especially DIF. Moderations suggested psychological inflexibility may contribute to the development of alexithymia in individuals with anxiety symptoms. Even at subclinical levels of anxiety, anxiety’s interaction with experiential avoidance may lead to alexithymia. Individuals with clinical levels of generalized anxiety and high cognitive fusion may be at risk for increased DIF. Individuals high in both social anxiety and psychological inflexibility may have clinical distress related to Difficulty Identifying Negative Feelings.