Alexithymia, state‐emotion dysregulation, and eating disorder symptoms: A mediation model

Goetz, Dana B.; Johnson, Erica Catherine; Naugle, Amy E.; Borges, Lauren M.

doi:10.1111/cp.12210

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…Conceptually, mediators are of interest as the causal links or mechanisms through which a certain feature (in this instance, autism or autistic traits) increases vulnerability for certain psychopathologies (in this case, ED). Both alexithymia [37,55] and anxious/depressive symptoms are common in autistic people and individuals with high degrees of autistic traits [56], and in populations with ED [13,33,34]. Like non-autistic counterparts [57], autistic participants with anorexia nervosa describe feelings of 'emotional confusion' and anxiety which are quietened or numbed through restrictive behaviours [58].…”

Section: Alexithymia Anxiety and Depression; Their Relation To Ed Psy...mentioning

confidence: 99%

“…Having reduced access to adaptive emotion-regulation strategies, they are more likely to rely on maladaptive and damaging strategies such as substance misuse, disordered eating and self-injury. Unsurprisingly, alexithymia (and corresponding emotion-regulation deficits) has been implicated in the aetiology of many psychopathologies and physical illnesses [10], including ED [12][13][14]. Alexithymia is also a common feature in autistic people, where it has been linked with a number of deleterious outcomes [15]-including disordered eating.…”

Section: Introductionmentioning

confidence: 99%

“…Recent literature suggests that alexithymia, and the maladaptive emotion regulation which appears to occur as a consequence of the same [13,14], may comprise an emotion-related mechanism that explains the higher risk of disordered eating and ED in autistic people and those with higher autistic traits [16][17][18][19]. Indeed, in this latter population, previous data collected by our group [16] showed that the relationship between having higher autistic traits and higher eating psychopathology was explained by the higher degrees of alexithymia.…”

Section: Introductionmentioning

confidence: 99%

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Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

et al. 2023

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Background A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth ‘autism’). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships. Methods Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales. Results In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia. Conclusions While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.

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Section: Alexithymia Anxiety and Depression; Their Relation To Ed Psy...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

et al. 2023

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“…suppression) and ED behaviour is not moderated by sex [ 4 ]. While deficits in emotion processing, such as alexithymia, have also been robustly linked to eating psychopathology in predominantly female samples [ 5 , 54 , 55 ], very few have examined associations between alexithymia and ED psychopathology in males. Two studies suggest that associations between alexithymia, bulimia and “emotional eating” might be stronger in males than females [ 56 , 57 ], but both involved very small male samples.…”

Section: Introductionmentioning

confidence: 99%

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

et al. 2022

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Objective While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males. Methods In a sample of 1604 participants (n = 631 males), we assessed emotion processing and emotion regulation in males with EDs (n = 109) and compared results to both females with EDs (n = 220) and males from the general population (n = 522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire. Results We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males. Discussion Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs.

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“…suppression) and ED behaviour is not moderated by sex (4). While de cits in emotion processing, such as alexithymia, have also been robustly linked to eating psychopathology in predominantly female samples (5,50,51), very few have examined associations between alexithymia and ED psychopathology in males. Two studies suggest that associations between alexithymia, bulimia and "emotional eating" might be stronger in males than females (52,53), but both involved very small male samples.…”

Section: Introductionmentioning

confidence: 99%

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

Vuillier

Joseph

Greville-Harris

et al. 2022

Preprint

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Objective: While eating disorders (ED) are more commonly diagnosed in females, there is growing awareness that men also experience ED and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in ED, but as studies have involved predominantly female samples, it is unclear whether this is also true for males.Methods: In the largest sample to date, consisting of 1604 participants (n=631 males), we assessed emotion processing and emotion regulation in males with ED and compared results to both females with ED and males from the general population. We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, and emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire.Results: We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with ED tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with ED. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restrictive eating in females but not in males. Discussion: Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those who are traditionally overlooked in ED.

show abstract

Alexithymia, state‐emotion dysregulation, and eating disorder symptoms: A mediation model

Cited by 11 publications

References 27 publications

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

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