Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder

Lara Henco,Bert Timmermans,Hanna Thaler,Leonie Weindel,Imme Christina Zillekens,Marie-Luise Brandi,Laura Albantakis,Lena Schliephake,Leonhard Schilbach

doi:10.1177/1362361320936024

Abstract

High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder (n = 122), patients with social interaction difficulties other than autism (n = 62), and neurotypical participants (n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology.Lay abstractAdults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with core deficits in social communication and social interaction aside from restricted, repetitive patterns of behavior, interests, or activities according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM5; American Psychiatric Association, 2013) criteria
We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia
The results are described in detail for the ASD group, while the results for the non-ASD and neurotypical groups are summarized in the text

Summary

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with core deficits in social communication and social interaction aside from restricted, repetitive patterns of behavior, interests, or activities according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM5; American Psychiatric Association, 2013) criteria. In addition to the underlying core symptoms of ASD, autistic individuals often experience comorbid mental health problems. Approximately 50% of autistic patients display clinically significant levels of alexithymia (Hill et al, 2004; Kinnaird et al, 2019; Milosavljevic et al, 2016; Morie et al, 2019). This raises the need to enhance our understanding of alexithymia in ASD and its contribution to comorbid mental health problems. Some researchers have even suggested that emotional impairments seen in ASD are due to concurrent alexithymia rather than representing a genuine feature of autism (Bird & Cook, 2013; Trevisan et al, 2016)

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