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Journal ArticleDOI

Alexithymia and eating disorders: a critical review of the literature

TL;DR: The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithsymia levels across eating disorders, the role of alexITHymia in binge eating disorder, and the influence of aLexithymic on the development of eating disorders as well as treatment outcome.
Abstract: Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

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Citations
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Journal ArticleDOI
TL;DR: Both anorexia nervosa and bulimia nervosa are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders.

355 citations


Cites background from "Alexithymia and eating disorders: a..."

  • ...A majority of the relevant research in BN suggests greater alexithymia compared to controls (e.g., Corcos et al., 2000; Jimerson, Wolfe, Franko, Covino, & Sifneos, 1994; Nowakowski et al., 2013; Sureda, Valdes, Jodar, & de Pablo, 1999), although results are less consistent when controlling for depression and/or anxiety (e....

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  • ...…research in BN suggests greater alexithymia compared to controls (e.g., Corcos et al., 2000; Jimerson, Wolfe, Franko, Covino, & Sifneos, 1994; Nowakowski et al., 2013; Sureda, Valdes, Jodar, & de Pablo, 1999), although results are less consistent when controlling for depression and/or…...

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Journal ArticleDOI
TL;DR: The facets of social processing in ED according to the NIMH RDoC 'Systems for Social Processes' framework are reviewed, showing evidence that people with ED had attachment insecurity, and less evidence for problems with production and reception of non-facial communication, animacy and action.

240 citations

Journal ArticleDOI
TL;DR: It is concluded that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.
Abstract: Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience and biomedical science. To illustrate the multifaceted nature of interoception we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.

213 citations


Cites background from "Alexithymia and eating disorders: a..."

  • ...Interoceptive dysfunction in AN can also be located within descriptions of “emotion dysregulation” (190), “poor distress tolerance,” (191) and perhaps most tellingly, “alexithymia” or the inability to discriminate between emotional states and bodily sensations (192, 193)....

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Journal ArticleDOI
TL;DR: Evidence from developmental and cognitive science is reviewed to reveal that language scaffolds concept knowledge in humans, helping humans to acquire abstract concepts such as emotion categories across the lifespan.
Abstract: Common sense suggests that emotions are physical types that have little to do with the words we use to label them. Yet recent psychological constructionist accounts reveal that language is a fundamental element in emotion that is constitutive of both emotion experiences and perceptions. According to the psychological constructionist Conceptual Act Theory (CAT), an instance of emotion occurs when information from one’s body or other people’s bodies is made meaningful in light of the present situation using concept knowledge about emotion. The CAT suggests that language plays a role in emotion because language supports the conceptual knowledge used to make meaning of sensations from the body and world in a given context. In the present paper, we review evidence from developmental and cognitive science to reveal that language scaffolds concept knowledge in humans, helping humans to acquire abstract concepts such as emotion categories across the lifespan. Critically, language later helps individuals use concepts to make meaning of on-going sensory perceptions. Building on this evidence, we outline predictions from a psychological constructionist model of emotion in which language serves as the “glue” for emotion concept knowledge, binding concepts to embodied experiences and in turn shaping the ongoing processing of sensory information from the body and world to create emotional experiences and perceptions.

211 citations


Cites background from "Alexithymia and eating disorders: a..."

  • ...…a recent review of alexithymia in depression and anxiety, see De Berardis et al., 2008; for a recent review of alexithymia in eating disorders, see Nowakowski et al., 2013; for a recent review and meta-analyses of alexithymia’s connection with schizophrenia, see O’Driscoll et al., 2014; for other…...

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Journal ArticleDOI
TL;DR: Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions, and research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.

199 citations


Cites background or result from "Alexithymia and eating disorders: a..."

  • ...The reference list of a previously published review [18] was also screened for relevant studies....

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  • ...Nowakowski, McFarlane [18] found that individuals with EDs score higher on the DIF and DDF subscales of the TAS-20 but not on the EOT subscale....

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  • ...This is consistent with a previous systematic review of alexithymia [18] and extends previous research by demonstrating that the differences between clinical groups and HCs are of the same magnitude i....

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  • ...In a critical review of the literature on alexithymia in EDs, Nowakowski, McFarlane [18] report that individuals with EDs consistently report higher levels of alexithymia on the TAS than controls....

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  • ...Nowakowski, McFarlane [18] report that individuals with EDs score higher on two of the TAS-20 subscales: DDF and DIF but not on EOT....

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References
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Book
01 Jan 1993
TL;DR: The treatment of Borderline personality disorder (BPD) has been studied extensively in the literature as discussed by the authors, with a focus on the treatment of the behavioral patterns of patients with BPD.
Abstract: Part I: Theory and Concepts Borderline Personality Disorder: Concepts, Controversies, and Definitions Dialectical and Biosocial Underpinnings of Treatment Behavioral Patterns: Dialectical Dilemmas in the Treatment of Borderline Patients Part II: Treatment Overview and Goals Overview of Treatment: Targets, Strategies, and Assumptions in a Nutshell Behavioral Targets in Treatment: Behaviors to Increase and Decrease Structuring Treatment around Target Behaviors: Who Treats What and When Part III: Basic Treatment Strategies Dialectical Treatment Strategies Core Strategies: Validation Core Strategies: Problem Solving Change Procedures: Contingency Procedures of Managing Contingencies and Observing Limits Change Procedures: Skills Training, Exposure, Cognitive Modification Stylistic Strategies: Balancing Communication Case Management Strategies: Interacting with the Community Part IV: Strategies for Specific Tasks Structural Strategies Special Treatment Strategies Appendix: Suggesting Reading References Index

6,378 citations

Journal ArticleDOI
TL;DR: Addressing shortcomings of the self-report Toronto Alexithymia Scale, two studies were conducted to reconstruct the item domain and resulted in the development of a new twenty-item version of the scale--the TAS-20.

4,285 citations


"Alexithymia and eating disorders: a..." refers background or methods in this paper

  • ...The discrepant findings between the LEAS and the TAS-20 highlight the need to more precisely define the specific constructs that are being assessed by the various measures of alexithymia, and to identify overlapping and unique features....

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  • ...When the TAS-20 subscales were examined, across diagnostic groups, only the difficulties identifying feelings factor showed a statistically significant reduction from pre- to post-treatment....

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  • ...The majority of studies using patient and non-patient samples have replicated the 3-factor structure of the TAS-20 [16-20], although some studies using patient samples have found a 2-factor structure, with the difficulties identifying and difficulties describing feelings factors comprising a single factor [21,22]....

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  • ...Across diagnostic groups, patients who completed the treatment reported significant reductions in eating disorder symptomatology as well as significant reductions in TAS-20 total scores....

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  • ...An examination of alexithymia scores across studies, however, shows that across non-treatment studies, the control group scores on the TAS and TAS-20 range from 53.0 [5] to 63.7 [43] and 43.10 [28] to 47.0 [41], respectively....

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Journal ArticleDOI
TL;DR: The Mini International Neuropsychiatric Interview (MINI) as mentioned in this paper is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria.

3,143 citations


"Alexithymia and eating disorders: a..." refers background in this paper

  • ...EDI = Eating Disorder Inventory [44]; MINI = The Mini-International Neuropsychiatric Interview [45]; DSM-III-R = Diagnostic Statistical Manual of Mental Disorders 3 Edition Revised [46]; DSM-IV = Diagnostic Statistical Manual of Mental Disorders 4 Edition [47]; AN-R = Anorexia Nervosa – Restricting Type; AN-B/P = Anorexia Nervosa – Bingeing/Purging Type; BN = Bulimia Nervosa; BED = Binge Eating Disorder; HC = healthy control; TAS = Toronto Alexithyma Scale 26-item Version [13]; TAS-20 = Toronto Alexithymia Scale 20-item Version [16]; TAS Total = Toronto Alexithymia Scale Total Score; DIF = Toronto Alexithymia Scale Difficulties Identifying Feelings factor; DDF = Toronto Alexithymia Scale Difficulties Describing Feelings factor, EOT = Toronto Alexithymia Scale Externally Orienting Thinking factor....

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Journal ArticleDOI
TL;DR: A new transdiagnostic theory of the maintenance of the full range of eating disorders is proposed, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa.

2,659 citations


"Alexithymia and eating disorders: a..." refers background in this paper

  • ...; licensee BioMed Ce Creative Commons Attribution License (http:/ distribution, and reproduction in any medium their emotions [9-11]....

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Journal ArticleDOI
TL;DR: The question is raised whether these defects are due to biological or developmental factors, and the conclusion is reached that patients with these characteristics may not be good candidates for dynamic psychotherapy.
Abstract: An attempt is made in this paper to investigate the prevalence among patients who suffer from various psychosomatic diseases, of a relative constriction in emotional functioning, poverty of fantasy life, and inability to find appropriate words to describe their emotions. For lack of a better term, I call these characteristics ‘alexithymic’. Twenty-five psychosomatic patients outnumbered 25 control patients by better than two to one as far as possession of these ‘alexithymic’ characteristics. The question is raised whether these defects are due to biological or developmental factors, and the conclusion is reached that patients with these characteristics may not be good candidates for dynamic psychotherapy.

2,309 citations