The relationship between self‐harm and alexithymia: A systematic review and meta‐analysis

Abstract

Self-harm, defined for the purpose of this review as any act of self-injury without explicit suicidal intent, is an increasing public health concern, with potential long-term implications for those who engage in it. Previous research has identified a correlational relationship between self-harm and alexithymia, an emotion processing deficit characterized by difficulties identifying and describing feelings, and an externally orientated thinking style. Through a systematic search of the literature, the current review examines the association between alexithymia and self-harm. A meta-analysis based on 23 studies found a significant, positive relationship between self-harm and alexithymia, with a medium effect size (g = 0.57, 95% CI 0.46-0.69). All 23 studies used the Toronto Alexithymia Scale (TAS20) to measure alexithymia. The alexithymia subcomponents difficulty identifying feelings and difficulty describing feelings were significantly associated with self-harm, but there was no significant association between self-harm and externally orientated thinking. The effect size of the relationship was significantly larger in adolescent samples compared with adult samples and in female compared with male samples. The definition of self-harm did not affect the effect size of the relationship between alexithymia and self-harm and the results are consistent with previous metaanalyses focused more narrowly on non-suicidal self-injury and, separately, suicidal behaviors. Heterogeneity between the included studies was high. The results support an affect regulation model of self-harm, in which self-harm is used to regulate an emotional experience that is poorly understood.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

“…This has made it possible to substantiate the observation that alexithymia is related with psychosomatic diseases. Moreover, alexithymic characteristics were found in various clinical conditions characterized by a disordered affect regulation (5), such as depression (16), self-harm and suicidality (17)(18)(19), schizophrenia (20), eating disorders (21,22), substance use disorder (23) and autism spectrum disorder (24,25). Hence, alexithymia started to be considered a non-specific vulnerability factor involved in the development of physical and mental disorders as well as a specifier associated with adverse outcomes when treating such conditions [see e.g., (26,27)].…”

Latent profiles of emotion regulation strategies associated with alexithymia, nonsuicidal self‐injury and resilience among nursing students

“…A meta‐analysis by Norman et al. (2020) suggested that alexithymia is moderately associated with NSSI, and the relationship was more significant in women than in men. This study also speculated that the association between alexithymia and NSSI might be due in part to poor emotion regulation skills.…”

“…Because of this peculiarity, alexithymia is thought to adversely impact nursing students' communication skills (Sancar & Aktas, 2019). There is increasing recognition that poor emotion regulation is a core process underlying alexithymia (Norman et al., 2020). Evidence suggests that people with alexithymia usually adopt more suppression and choose fewer reappraisal strategies (J. Chen et al., 2011).…”

A Cross-Sectional Study Investigating the Relationship Between Alexithymia and Suicide, Violence, and Dual Harm in Male Prisoners

“…Finally, the review concluded that there might be evidence of clinical variables, particularly depression, impacting the relationship between alexithymia and suicide ideation and behavior. Other meta-analyses have found a medium effect size for the relationship between alexithymia and self-harm outcomes, and have again found the subcomponents of difficulty identifying and describing feelings to be strongest correlates ( 15 , 16 ).…”