Alexithymia and personality pathology in relation to dimensions of general psychopathology

To investigate whether alexithymia is uniquely associated with major dimensions of psychopathology beyond maladaptive personality trait dimensions.

We conducted a cross-sectional study using archival data collected from a diagnostically heterogeneous sample of psychiatric outpatients (N = 154). Patients in this study sample had completed the 20-item Toronto Alexithymia Scale (TAS-20), the Personality Inventory for DSM-5 (PID-5), and the Restructured Clinical (RC) scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Hierarchical linear regressions were used to examine eight major psychopathology dimensions.

PID-5 domains showed the expected overall pattern of associations with RC scale scores. After accounting for these traits, TAS-20 total scores were incrementally associated with Demoralization, Somatic Complaints, and Dysfunctional Negative Emotions. Follow-up analyses indicated these relationships were driven primarily by the difficulty identifying feelings facet. TAS-20 total scores were not incrementally associated with the remaining RC scales. Because maladaptive traits (including Negative Affectivity) were controlled and the RC scales were designed to reduce (though not eliminate) saturation with demoralization, these findings are consistent with TAS-20 scores capturing variance in affective dysregulation not wholly attributable to general distress, although content overlap between TAS-20 items and the criterion scales cannot be ruled out in a mono-method design.

Alexithymia accounted for unique variance in psychopathology dimensions involving affective dysregulation (distress, somatization, and negative emotionality). The findings offer some support for positioning alexithymia as a transdiagnostic correlate and suggest that measures of emotional awareness deficits may complement dimensional models of maladaptive personality.