Alexithymia and paradoxical regulatory success in posttraumatic stress: An ecological momentary assessment study

Alexithymia, difficulty identifying and describing feelings, is associated with posttraumatic stress symptomology, yet the underlying mechanisms remain unclear. We tested whether alexithymia's regulatory effects operate through disrupted emotion regulation monitoring, the capacity to accurately evaluate whether regulation has succeeded, or broader interoceptive deficits that compromise access to bodily emotional signals. Trauma-exposed participants (N = 49) completed baseline measures of alexithymia, posttraumatic stress symptoms, depression, anxiety, and interoceptive awareness, followed by three waves of ecological momentary assessment. At each wave, participants received five daily prompts for 5 consecutive days across 3 months (2,420 observations), reporting emotional clarity, perceived regulation success, body connection, and response-focused strategies (rumination, emotional hiding, pretending). Lagged models showed that among individuals high in alexithymia, higher perceived regulation success paradoxically predicted lower next-assessment emotional clarity, and greater emotional hiding and perceived success predicted worsening posttraumatic stress symptoms over 3 months. Interoceptive findings were mixed: Emotional awareness predicted better outcomes at the person level, but momentary body connection showed inconsistent associations. These findings reveal a paradoxical pattern in which subjective impressions of regulatory success precede worsening downstream emotional outcomes among individuals high in alexithymia. This pattern is consistent with a disrupted regulatory monitoring account, although whether it reflects miscalibrated evaluation, divergent regulatory goals, or systematic reporting biases cannot be determined from self-report alone and warrants replication in larger samples with objective indicators of emotional change. (PsycInfo Database Record (c) 2026 APA, all rights reserved).