A family history of alcoholism relates to alexithymia in substance use disorder patients.

Previous research identified alexithymia as a potential risk factor for substance use disorders (SUD). More insight into the relation between alexithymia and SUD is needed in order to treat SUD effectively. Therefore, we investigated whether a familial vulnerability to alcoholism relates to the presence and severity of alexithymia in SUD patients.



Hospitalized, abstinent SUD-patients (n=187), were assessed with the Toronto Alexithymia Scale (TAS-20) and Addiction Severity Index (EuropASI). A maternal, paternal, and total continuous measure of the Family History of Alcohol (FHA) was developed. Kruskal-Wallis tests and Spearman correlations were used to relate the composite scores of FHA to alexithymia as a categorical and continuous measure. Multivariate regression models were performed to control for the effects of confounders on the relation between FHA and alexithymia.



Compared to moderate (33%) and low (17%) alexithymic SUD-patients, high alexithymic (50%) patients were more likely to have fathers with alcohol problems (P=0.004). Such a difference was not found for mothers with alcohol problems. The composite FHA-score was significantly associated with alexithymia (Rs=.19, P=0.01). However, only a paternal FHA, independent from disturbed family functioning, related to the degree of alexithymia (β=.13, P=0.06), especially to the Difficulty Identifying Feelings as measured by the TAS-20 (β=.16, P=0.02).



The relation between a paternal FHA and a higher degree of alexithymia in SUD-patients suggests that alexithymia could mediate the familiality of alcoholism or SUD in the paternal line.

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abstract: An attempt is made in this paper to investigate the prevalence among patients who suffer from various psychosomatic diseases, of a relative constriction in emotional functioning, poverty of fantasy life, and inability to find appropriate words to describe their emotions. For lack of a better term, I call these characteristics ‘alexithymic’. Twenty-five psychosomatic patients outnumbered 25 control patients by better than two to one as far as possession of these ‘alexithymic’ characteristics. The question is raised whether these defects are due to biological or developmental factors, and the conclusion is reached that patients with these characteristics may not be good candidates for dynamic psychotherapy.

title: Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland.
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title: Alexithymia and alcohol use disorders: a critical review.
abstract: All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional "deficits' is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.

title: Validation of the Toronto Alexithymia Scale with substance abusers.
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title: Self-injurious behaviour, traumatic life events and alexithymia among treatment-seeking opiate addicts: prevalence, pattern and correlates.
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title: Age is strongly associated with alexithymia in the general population.
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The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue.



The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression.



The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed.

title: Alexithymia in the German general population
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title: Alexithymia in psychiatric consultation-liaison patients.
abstract: Alexithymic characteristics were assessed by the Toronto Alexithymia Scale (TAS), a self-report measure of alexithymia, in 230 consecutive outpatients referred to a psychiatric consultation-liaison service. The prevalence of alexithymia was 37.8% (50.5% in men and 28.2% in women). Alexithymia was significantly associated with the following variables: male gender, low socioeconomic status, the presence of psychiatric disorder, especially depression, with old age and with a high level of psychological distress. No significant association between alexithymia and the presence of somatic illness was found.

title: Alexithymia in women and men hospitalized for psychoactive substance dependence.
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title: Is alexithymia a negative factor for maintaining abstinence? A follow-up study.
abstract: The prevalence of alexithymia in 46 inpatients with alcohol abuse or dependence was 67.4%. Pretreatment characteristics predicting outcome at 15 months were determined. At the 15-month time point, 67.4% of patients met criteria for abuse or alcohol dependence and 32.6% were abstinent. In patients who relapsed, the total score for the 20-item Toronto Alexithymia Scale (TAS-20) and the score for the TAS-20-feelings factor were significantly higher than in subjects who were abstinent, even when depressive symptoms were taken into account. Stepwise multiple linear regression showed that the TAS-20-feelings factor significantly predicted abstinence. The results may suggest that alexithymia predicted poor outcome in alcoholic inpatients.

title: Does alexithymia in male alcoholics constitute a negative factor for maintaining abstinence?
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title: Alexithymia in males at high genetic risk for alcoholism.
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title: Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample.
abstract: Recent studies have indicated that 45-67% of those in treatment for alcohol use disorders suffer from alexithymia, a multifaceted personality trait characterized by difficulties identifying and describing emotions and an externally oriented cognitive style. The high reported prevalence rates of alexithymia among those with alcohol dependence led to speculation that alexithymia is a personality dimension that may predispose to risky or problematic alcohol use.



This notion was examined in 314 adult volunteers (54% female) aged 18-45 years (M=27.6 years), all of whom reported at least occasional alcohol consumption, who completed online surveys assessing alexithymia (Toronto Alexithymia Scale, or TAS-20), parental alcoholism (Children of Alcoholics Screening Test, or CAST), everyday signs of frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe) and risky alcohol use (Alcohol Use Disorders Identification Test, or AUDIT).



TAS-20 scores were positively correlated with the index of parental alcoholism CAST, index of frontal lobe dysfunction FrSBe and measure of alcohol-related problems AUDIT. Chi-square test showed an association between TAS-20-defined alexithymia and being the offspring of an alcoholic parent as defined by CAST. Regression analysis showed that frontal lobe dysfunction (FrSBe) mediated the relationship between alexithymia (TAS-20 total score) and risky alcohol use (AUDIT).



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title: A Twin Study of Alexithymia
abstract: Factors contributing to the development of alexithymia and the nature of alexithymia’s relation with trait negative and positive affectivity are unclear. In this study, a twin approach was used to examine the degree of genetic and environmental contributions to the different facets of alexithymia, and the nature of their relations to trait negative and positive affectivity.  Forty-five monozygotic and 32 same-sex dizygotic twin pairs completed the Toronto Alexithymia Scale-20, the Eysenck Personality Inventory, and a zygosity questionnaire.  Model fitting analyses indicated that familial influences contributed significantly to all three facets of alexithymia. Parameter estimates and intraclass correlations suggested, though could not confirm, that it was shared environmental factors that contributed to difficulty identifying and communicating emotions (ID and COM), but shared genetic factors that contributed to externally oriented thinking (EOT). Between-twin cross-trait twin analyses revealed strong correlations between ID and neuroticism, and between COM and extraversion, and suggested that it is shared familial influences which account for these associations.  The results of this study indicate that: (a) the different facets of alexithymia are influenced by familial factors; (b) the previously noted associations between ID and COM and trait affectivity are not merely methodological artifacts; and (c) the associations between ID and COM and trait affectivity are influenced by familial factors. The results also suggest that ID and COM are largely influenced by shared environmental factors, but that EOT is influenced by genetic factors.

title: Genetic influences on alexithymia and their relationship with depressive symptoms.
abstract: The factors involved in the etiology of alexithymia are still unclear. While a few studies suggested substantial genetic influences on alexithymia, it remains to be determined if these influences are independent of genetic influences on other mental health variables correlated with alexithymia, such as depression. This study is aimed at confirming previous findings of a genetic contribution to alexithymia, examining whether there are genetic or environmental influences common to alexithymia facets, and investigating whether genetic influences on alexithymia are independent of genetic influences on depression.



The 20-item Toronto Alexithymia Scale and a validated measure of depression were administered to a sample of 729 twins (45% males) aged 23-24 years drawn from the population-based Italian Twin Register. Genetic structural equation modeling was performed with the Mx program.



Genetic factors accounted for 42% of individual differences in alexithymia. Unshared environmental factors explained the remaining proportion of variance. There was a substantial (0.65) genetic correlation between alexithymia and depression. The inclusion of depression as a covariate in the genetic models reduced the heritability estimate for alexithymia to 33%.



Despite some limitations, this study corroborates the notion that genetic factors contribute substantially to individual differences in alexithymia, with unshared environmental factors also playing an important role. Also, it suggests a genetic link between alexithymia and depression.

title: The genetics of substance dependence.
abstract: A large segment of the population suffers from addiction to alcohol, smoking, or illicit drugs. Not only do substance abuse and addiction pose a threat to health, but the consequences of addiction also impose a social and economic burden on families, communities, and nations. Genome-wide linkage and association studies have been used for addiction research with varying degrees of success. The most well-established genetic factors associated with alcohol dependence are in the genes encoding alcohol dehydrogenase (ADH), which oxidizes alcohol to acetaldehyde, and aldehyde dehydrogenase (ALDH2), which oxidizes acetaldehyde to acetate. Recently emerging genetic studies have linked variants in the genes encoding the α3, α5, and β4 nicotinic acetylcholine receptor subunits to smoking risk. However, the influence of these well-established genetic variants accounts for only a small portion of the heritability of alcohol and nicotine addiction, and it is likely that there are both common and rare risk variants yet to be identified. Newly developed DNA sequencing technologies could potentially advance the detection of rare variants with a larger impact on addiction risk.

title: Parental bonding and alexithymia: A meta-analysis
abstract: The primary purpose of this meta-analysis was to explore, clarify and report the strength of the relationship between alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), and parenting style as measured by the Parental Bonding Instrument (PBI).  Web of Science, PsycInfo, PubMed and ProQuest: Dissertations and Theses searches were undertaken, yielding nine samples with sufficient data to be included in the meta-analysis.  Evidence indicated moderate to strong relationships between maternal care and alexithymia, and between maternal care and two of the three TAS-20 alexithymia facets (Difficulties Describing Feelings and Difficulties Identifying Feelings, but not Externally Oriented Thinking). Moderate relationships were observed for both maternal- and paternal-overprotection and alexithymia respectively, and for overprotection (both maternal and paternal) and Difficulties Describing Feelings.  This study is the first meta-analysis of the relationship between parenting styles and alexithymia, and findings confirm an especially strong association between maternal care and key elements of alexithymia. This review highlights the issues that still remain to be addressed in exploring the link between parenting style and alexithymia.

title: Family Factors Related to Alexithymia Characteristics
abstract: There is little empirical research on the familial and parental correlates of alexithymia.A two-part study explored how the affective and cognitive characteristics of alexithymia are related to family dysfunction and maternal alexithymia. In Part I, 127 young adults were evaluated for alexithymia with the Toronto Alexithymia Scale-20 (TAS-20), for impaired imagination with the Scored Archetypal Test with Nine Elements, and for family dysfunction with the McMaster Family Assessment Device. In Part II, 80 of their mothers completed the TAS-20 about themselves, and maternal alexithymia characteristics were correlated with those of their offspring. In Part I, general family pathology was associated with alexithymia. In particular, difficulty identifying feelings was related to dysfunctional family affective involvement, externally oriented thinking was related to deficient family behavior control, and impaired imagination was related to inadequate family problem solving; these relationships were independent of general family pathology and subjects' positive and negative affect. In Part II, maternal alexithymia characteristics were correlated significantly with the offsprings', controlling for both respondents' positive and negative affect. These findings implicate disturbed family functioning and maternal alexithymia in the development of alexithymia characteristics in children.

title: Childhood abuse, alexithymia and personality disorder.
abstract: I examined the relationships among childhood abuse, alexithymia, and personality disorder. Participants were 60 adults who were receiving outpatient psychotherapy. Both the participants and their therapists used the Toronto Alexithymia Scale to provide independently information concerning the client's level of alexithymia. The therapists provided information concerning DSM-III-R personality disorder diagnoses, and participants completed portions of the Personality Diagnostic Questionnaire-Revised. Information concerning childhood abuse history was obtained from the therapists. As expected, childhood abuse, alexithymia, and personality disorder were all associated with each other. The abilities to identify and communicate emotions were differentially associated with childhood abuse and personality disorder.

title: Impact of Severe Childhood Sexual Abuse on the Development of Alexithymia in Adulthood
abstract: 260 the SCL-90-R and the PSQ, there were no significant differences in change scores between the groups at any point in time. All analyses were repeated applying the intention-to-treat principle. The overall pattern of results remained stable. The results show that the intervention had the desired effect of increasing MSE. This effect was more pronounced at follow-up, which is in line with previous research  and could be explained by the fact that cognitive restructuring as well as integrating stress management strategies into one’s everyday life is a process that takes practice and time. The lack of an effect on the SCL-90-R might be explained by taking into consideration that this instrument measures general psychological health. None of its subscales are specifically related to the symptoms of FMD. An exploratory analysis of change scores on the depression subscale revealed no significant effects either. Thus, depression alone cannot be responsible for FMD symptoms. The lack of an effect on the PSQ is more surprising, as the therapy was directed at stress management. One possible explanation is that a heightened sensitivity for the relation between stress and memory was induced through the therapy, and that this led to possible effects of perceived stress reduction becoming ‘confounded’. However, an exploratory regression analysis showed that change in PSQ was indeed the best predictor of change in MSE. Regarding the small OC population, the stability of the main results across intention-to-treat analyses is encouraging. An important limitation of the study is the fact that only self-report measures were used. However, the lack of FMD patients’ impairment on memory tests deprived us of an objective measure of their everyday memory performance. Nevertheless, it has to be taken into consideration that self-report measures are more prone to bias than objective tests, potentially leading to an overestimation of therapy effects. Therefore, new measures to assess therapy effects in FMD need to be developed. Finally, in the absence of other treatment groups it is uncertain whether the effects found here are in fact due to specific treatment factors. To sum up, this pilot study showed preliminary results of improving MSE in FMD patients through a new group therapy program. However, future studies with larger groups, comparisons between different treatments and a broader range of measures are required.

title: Childhood Abuse and Neglect as a Risk Factor for Alexithymia in Adult Male Substance Dependent Inpatients
abstract: The prevalence of childhood abuse and neglect (CAN) histories and their associations with alexithymia among male substance-dependent inpatients were studied. Participants were 159 consecutively admitted male substance dependents (115 alcohol and 44 other drugs). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Patients were investigated with the Toronto Alexithymia Scale (TAS-20) and Childhood Abuse and Neglect Questionnaire. Among substance-dependent patients, 57.0% had at least one type of CAN and 45.3% were considered as alexithymic since they had a score greater than 60 on the TAS-20. Rate of unemployment, low educational status, emotional abuse and history of suicide attempts were higher in alexithymic substance dependent patients. Those who had histories of two or more types of childhood abuse or neglect had also higher mean score on TAS-20, particularly on the item “difficulty in identifying feelings-DIF.” Also, the number of childhood trauma types was positively correlated with TAS-20 andDIF and the “difficulty in describing feelings-DDF' items of TAS-20. History of childhood emotional abuse was the only determinant for alexithymia. Childhood emotional abuse might be a risk factor for alexithymia among inpatient substance dependents.

title: Shared Decision-Making Reduces Drug Use and Psychiatric Severity in Substance-Dependent Patients
abstract: In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions.  Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement.  A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F(1, 124) = 248.38, p < 0.01) and addiction severity (F(8) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients’ quality of life measured at baseline, exit and follow-up (F(2, 146) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F(1, 164) = 7.40, p < 0.01) and psychiatric problems (F(1, 164) = 5.91, p = 0.02) at 3-month follow-up.  SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.

title: The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure.
abstract: Addressing shortcomings of the self-report Toronto Alexithymia Scale (TAS), two studies were conducted to reconstruct the item domain of the scale. The first study resulted in the development of a new twenty-item version of the scale--the TAS-20. The TAS-20 demonstrated good internal consistency and test-retest reliability, and a three-factor structure theoretically congruent with the alexithymia construct. The stability and replicability of this three-factor structure were demonstrated in the second study with both clinical and nonclinical populations by the use of confirmatory factor analysis.

title: The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity.
abstract: A previous paper described the development of the twenty-item Toronto Alexithymia Scale (TAS-20) and reported preliminary evidence of reliability and factorial validity of the scale. This paper describes a study that further evaluated the construct validity of the TAS-20 by examining its relationship with measures of personality traits theoretically related or unrelated to the alexithymia construct, as well as its relationship with an observer-rated measure of alexithymia. Evidence of convergent and discriminant validity of the TAS-20 was demonstrated in samples of university students by a pattern of correlations with the scales of the NEO Personality Inventory and separate measures of psychological mindedness and need-for-cognition that was consistent with theoretical predictions. The concurrent validity of the scale was demonstrated by positive correlations with observer-ratings of alexithymia in a sample of behavioural medicine out-patients.

title: The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20.
abstract: The objectives were to give an overview of studies on the validity of the Toronto Alexithymia Scale (TAS-20) and to present data regarding the validity of the TAS-20.



The literature on the psychometric properties of the TAS-20 was reviewed and a study was conducted of its psychometric properties in a sample of students and a sample of psychiatric outpatients using a statistical method allowing identification of a stable factor structure.



The review revealed that the majority of studies on the TAS-20 were conducted with nonpatient samples. The factorial validity and reliability of the dimensions 'identifying feelings' (DIF) and 'describing feelings' (DDF) could be replicated in many of these studies. However, in practically all studies the dimension 'externally oriented thinking' (EOT) appears to be unreliable. In addition, the presupposed fantasy aspect of the alexithymia construct is not included in the TAS-20. Although many studies were conducted on the construct validity of the TAS-20, no studies have been published on its criterion validity. Some studies show a different factor structure to exist in patient samples. This was confirmed in our own study in which the dimensions 'identifying feelings' and 'describing feelings' collapsed into one single subscale. As in other studies, the reliability of the dimension 'EOT' was low.



The TAS-20 has some important shortcomings with respect to validity and reliability. For the assessment of alexithymia in empirical research, it is recommended to use the TAS-20 in combination with other instruments. We do not recommend the TAS-20 to be used in clinical practice.

title: Comparing assessments of DSM-IV substance dependence disorders using CIDI-SAM and SCAN.
abstract: The main question addressed by this paper is whether DSM-IV substance dependence diagnoses obtained from two different instruments (the semi-structured WHO Schedules for Clinical Assessment in Neuropsychiatry, SCAN and the highly structured WHO Composite International Diagnostic Interview--Substance Abuse Module, SAM) are as consistent as diagnoses obtained from a single instrument (SAM) administered twice. Such comparisons of results from the two different instruments provide some measure of validity of the lay-administered SAM and of the underlying diagnostic concepts. Chance-corrected concordance was estimated using the kappa coefficient for SAM/SCAN (test/validation) and SAM/SAM (test/retest) comparisons. Analyses of agreement between SAM and SCAN for DSM-IV dependence diagnoses indicated good agreement for alcohol and cocaine, and fair agreement for opiates and cannabis. SAM/SAM (test/retest) agreement was excellent for alcohol and opiate dependence, good for cocaine dependence, and fair for cannabis dependence. Agreement on individual dependence criteria was generally consistent with overall diagnostic agreement though more variable. Notable was the poor agreement for cannabis criteria in the SAM/SCAN protocol. This may indicate that the dependence syndrome is less applicable to cannabis, while the consistency of agreement for alcohol, opiate, and cocaine dependence criteria supports the validity of these dependence syndromes. Finally, these data indicate that both the clinical (SCAN) and non-clinical (SAM) interviews can be used effectively for a variety of substances and dependence diagnoses.

title: The Addiction Severity Index: reliability and validity in a Dutch addict population.
abstract: In order to meet the need for a multidimensional diagnostic instrument in the field of drug addiction in The Netherlands, the Addiction Severity Index (ASI) has been applied to a sample of Dutch drug addicts. In this article the usefulness and psychometric characteristics of the Dutch version of the ASI are discussed. Overall, there was no evidence of a general relationship between the ASI ratings of problem severity. The severity ratings showed good concurrent validity, and subscales of selected items in each problem area of the ASI were demonstrated to have good internal consistency reliability. Regression analysis indicated that the ASI items accounted for a considerable proportion of the variance in the severity ratings, indicating a strong relationship between "subjective" rating and "objective" data. On the basis of the general concept of the ASI and the satisfactory psychometric characteristics, implementation of the instrument in The Netherlands is advocated.

title: Latent structure of the alexithymia construct: a taxometric investigation.
abstract: Despite a wealth of research on the validity of alexithymia and its association with a number of common medical and psychiatric disorders, the fundamental question of whether alexithymia is best conceptualized as a dimensional or categorical construct remains unresolved. In the current investigation, taxometric analysis is used to examine the nature of the latent structure of alexithymia. Several nonredundant taxometric procedures were performed with item sets from the 20-item Toronto Alexithymia Scale (R. M. Bagby, J. D. A. Parker, & G. J. Taylor, 1994) as indicators. These procedures were applied separately in large community (n = 1,933) and undergraduate (n = 1,948) samples and in a smaller sample of psychiatric outpatients (n = 302). The results across various taxometric procedures and the different samples provide strong support that alexithymia is a dimensional construct. Some theoretical implications of these findings for research on the alexithymia construct are discussed.

title: Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond
abstract: The goal of typology research is to identify subtypes of alcohol dependent (AD) patients sharing fundamental characteristics and try to match each subtype, with the most precise treatment strategy. This review provides a comprehensive history of the literature on alcohol dependent subtypes starting from the earliest attempt made by Jellinek. The binary models identified most closely with Cloninger and Babor as well as the successively more complex classifications are discussed. Typology classification potentially useful in guiding the treatment of AD patients, especially in the case of the serotonergic medications. Contrasting data suggests that other factors could influence the response to a medication and/or that more complex typologies should be identified. In summary, typology models may assist in the ascertainment criteria for clinical trials performed in behavioral and pharmacotherapeutic interventions. Greater emphasis, however, must be made to more clearly delineate this field of research, while moving toward more standardized typologies.

title: Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: Relationship to depression and anxiety
abstract: To evaluate whether alexithymia in alcohol-dependent patients is a personality trait or a state-dependent phenomenon related to depression and anxiety, we evaluated absolute stability (the extent to which alexithymia scores change over time) and relative stability (the extent to which relative differences among individuals remain the same over time) of alexithymia during alcohol withdrawal. Seventy alcohol-dependent inpatients were assessed for alexithymia, depression and anxiety with the 20-item Toronto Alexithymia Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory at the onset of withdrawal, after 2 days and 2 weeks. Paired t-tests and correlational analyses were performed to evaluate absolute and relative stability of alexithymia and hierarchical regression analyses to assess whether alexithymia was related to anxiety and depression. Alexithymia decreased significantly from onset to end of withdrawal, but two of its three subfactors remained stable. Alexithymia scores at onset correlated significantly with scores at end, after partialling out the effects of depression and anxiety. In conclusion, the relative stability of alexithymia contrasting with large decreases in depression and anxiety during alcohol withdrawal supports the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon.

title: The alexithymia construct: relationship with sociodemographic variables and intelligence.
abstract: Conflicting results have been reported in studies examining the relationships between alexithymia and the variables of age, gender, social class, and intelligence. Moreover, these results are of dubious validity and generalizability because many of the studies used psychometrically poor scales to measure the alexithymia construct. The present study reexamined the relationships between alexithymia and sociodemographic variables and intelligence in a sample of normal adults using the Toronto Alexithymia Scale (TAS), a recently developed self-report measure with evidence of reliability and validity. The results indicate that alexithymia, as measured by the TAS, is not associated with age, gender, educational level, socioeconomic status, and intelligence.

title: A cognitive model for the intergenerational transference of alcohol use behavior.
abstract: A family history of alcoholism has shown to be one of the greatest consistent risk factors in the intergenerational transference of alcohol problems. Whereas a large number of studies have attempted to identify the processes responsible for this interfamilial transfer, the mechanisms remain unclear. Family, twin and adoption studies, and environmental theories have resulted in a number of unanswered questions regarding the extent that these factors influence the transmission of alcohol behavior. Recently, cognitive theories have suggested that the observation of parental drinking habits contributes to the child's beliefs and expectations of alcohol's effects. A hypothesised cognitive model will be proposed suggesting that the mechanism for the transference of particular drinking styles from parent to offspring may be further explained by the transference of alcohol cognitions, in particular, alcohol expectancies and drinking refusal self-efficacy. This review focuses on research of bio/psycho/social factors that perpetuate alcohol misuse across generations, and will delineate the proposed cognitive mechanisms for the interfamilial transference of alcohol problems and discuss the implications of the proposed model.

title: Association between the Catechol O-Methyltransferase Val108/158Met Polymorphism and Alexithymia
abstract: It has been suggested that the characteristics of alexithymia result from deficits in frontal lobe functioning, and the prefrontal cortex is particularly dependent on the catechol O-methyltransferase (COMT) pathway. We investigated the relationship between COMT Val108/158Met, serotonin transporter coding sequence (5-HT transporter gene-linked polymorphic region; 5-HTTLPR) polymorphisms, and alexithymia.The study sample comprised 109 students at the Korea University. All participants were tested using the 20-item Toronto Alexithymia Scale (TAS-20). They were genotyped for COMT Val108/158Met and 5-HTTLPR polymorphisms. Genotyping was analyzed using polymerase chain reaction. Subjects with Val/Val genotype had significantly higher TAS-20 scores than those with Met/Met or Met/Val genotypes. However, there was no significant relationship between the 5-HTTLPR genotype and TAS-20 scores. This indicates a possible association between the COMT Val108/158Met gene polymorphism and alexithymia.

title: Interaction Effect of Functional Variants of the BDNF and DRD2/ANKK1 Gene Is Associated With Alexithymia in Healthy Human Subjects
abstract: To test the hypothesis that the interaction between the brain-derived neurotrophic factor (BDNF) and dopamine receptor D2 (DRD2)/ANKK1 gene contributes to individual differences in alexithymia. The personality construct of alexithymia refers to difficulties in emotional self-regulation and contributes as a risk factor to several mental disorders. Alexithymic individuals show an impoverished conscious experience of emotions but an intact autonomic emotional response. Persons with high alexithymia scores reportedly show a reduced activation of the anterior cingulate cortex (ACC) during the processing of emotional stimuli. An interaction between two polymorphisms on the BDNF and DRD2/ANKK1 gene has been recently associated with reduced gray matter volume in the ACC and higher trait anxiety.  We conducted a genetic association study. A total of 664 healthy participants completed the Toronto Alexithymia Scale questionnaire and were genotyped for the BDNF Val66Met (rs6265) and the DRD2/ANKK1 Taq IA (rs1800497) polymorphisms.  Carriers of at least one BDNF 66Met and one DRD2/ANKK1 A1 allele showed the highest scores in the total Toronto Alexithymia Scale and in the subscale “Difficulties Identifying Feelings.”  In line with recent studies investigating the role of BDNF Val66Met and DRD2/ANKK1 Taq IA polymorphisms on anxiety and gray matter volume in the ACC, our findings provide the first evidence for a genetic contribution to alexithymia. ACC = anterior cingulate cortex; TAS-20 = Toronto Alexithymia Scale; DIF = TAS-20 subscale Difficulties Identifying Feelings; DDF = TAS-20 subscale Difficulties Describing Feelings; EOT = TAS-20 subscale Externally Oriented Thinking; BDNF = brain-derived neurotrophic factor; DRD2 = dopamine receptor D2; CBF = cerebral blood flow; TCI = Temperament and Character Inventory; VTA = ventral tegmental area; PD = panic disorder.