Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms.

Bethany F M Oakley,Jan Buitelaar,Tony Charman,Declan G Murphy,Julian Tillmann,Eva Loth,Daisy Crawley,Emily J H Jones

doi:10.1017/s0033291720003244

Abstract

Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood. In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms. Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62). Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.

Highlights

BackgroundAlexithymia, literally translated as ‘no words for emotions’, is a subclinical trait with an estimated prevalence of 10% in the general population (Berthoz & Wessa, 2011; Nemiah, Freyberger, & Sifneos, 1976)
Autistic females in our sample scored higher than males for self-reported social-communication difficulties ( p = 0.01, r = 0.20)
T1 difficulty in identifying feelings remained associated with T2 anxiety symptoms in individuals with sufficient longitudinal data from both the whole sample (N = 76; p = 0.002, β = 0.32, 95% confidence interval (CI) 0.12–0.52) and autism spectrum disorder (ASD) group (N = 51; p = 0.01, β = 0.31, 95% CI 0.08–0.62), after accounting for demographic factors, core autism traits and T1 anxiety/depression symptoms

Summary

Introduction

BackgroundAlexithymia, literally translated as ‘no words for emotions’, is a subclinical trait with an estimated prevalence of 10% in the general population (Berthoz & Wessa, 2011; Nemiah, Freyberger, & Sifneos, 1976). Has been shown to be a significant barrier to intervention success across psychiatry and healthcare (Grabe et al, 2008; Ogrodniczuk, Piper, & Joyce, 2011) In light of these issues, poor self-knowledge of one’s internal emotions (i.e. alexithymia) is recognised as a transdiagnostic mechanism that modulates mental health outcomes in the general population (Fernandez, Jazaieri, & Gross, 2016; National Institute of Mental Health, 2019). Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. The role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood. 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits

Methods

Results

Discussion

Conclusion