Alexithymia and affective symptoms: A construct level evaluation of the emotion regulation pathway in a community...

Alexithymia has been proposed as a potential risk/vulnerability factor for affective disorder symptoms, but the processes accounting for this association require further specification. Preece et al. (2022) reported that emotion regulation difficulties statistically mediated the alexithymia-affective symptom association in a U.S. community sample (N = 501). Independent replication across alternative measures and in clinical and clinically enriched community samples is needed.

In a community sample of 661 U.S. adults (28.6% reporting at least one lifetime psychiatric diagnosis; 41% reporting a history of mental health treatment), we conducted a conceptual and extended replication of the Preece et al. (2022) model with the Perth Alexithymia Questionnaire (PAQ), Perth Emotion Regulation Competency Inventory (PERCI), and Depression Anxiety Stress Scales-21 (DASS-21), and tested three additional models substituting the 20-item Toronto Alexithymia Scale (TAS-20) for the PAQ and the Difficulties in Emotion Regulation Scale (DERS) for the PERCI in a fully crossed design. Sensitivity analyses re-estimated the DERS-based models with a "purified" DERS excluding the Awareness and Clarity subscales.

Standardized indirect effects were similar for both PERCI-based models (β = 0.32-0.34) and notably larger for both full-DERS models (β = 0.50-0.51). When the DERS Awareness and Clarity subscales were excluded, the standardized indirect effects in the purified-DERS models fell to β = 0.33-0.34, converging with the PERCI-based estimates. The pattern was preserved with depression, anxiety, and stress subscales examined separately, and within the lifetime-diagnosis subsample.

The data are cross-sectional and rely on self-report, with associated risk of common-method variance.

When shared item content between alexithymia and emotion regulation measures is minimized, the standardized indirect effect of alexithymia on affective symptoms through emotion regulation difficulties converges around β ≈ 0.33 across the two alexithymia operationalizations and both emotion regulation instruments. This pattern is consistent with, but does not establish, the hypothesized ordering in which alexithymia relates to affective symptoms through emotion regulation difficulties, and the robustness across operationalizations should not be interpreted as adjudicating between the original, affect-deficit and attention-appraisal models of alexithymia.