Background
The term
alexithymia stems from the Greek, literally meaning ‘lacking words for feelings’ [
1] and refers to a multidimensional personality trait with the main facets difficulty identifying feelings and differentiating them from the bodily sensations, difficulty describing feelings to others, and an externally orientated cognitive style [
2‐
4]. Currently, the most widely used measure to assess these alexithymic characteristics is the 20-Item Toronto Alexithymia Scale (TAS-20 [
5,
6]). Alexithymia is considered to be an important vulnerability factor for the development of psychological distress, mental disorders, and physical illness [
7,
8]. It is considered a transdiagnostic, non-specific feature in many mental disorders [
9]. There is evidence that alexithymic characteristics occur more frequently in men, elderly people, and individuals with low socioeconomic status or low educational level [
10,
11]. About 10% of the general population manifests clinically relevant alexithymia [
12,
13]. For young women, the prevalence rate of clinically relevant alexithymia could be lower (about 5%) [
14]. Relative and absolute stabilities were found to be high for alexithymia in non-clinical populations, even for long follow-up periods [
15]. There is considerable debate about the etiology of alexithymic features. Besides biological models, which associate alexithymia, for example, with dysfunctions of specific brain structures [
16,
17] or genetic factors [
18,
19], it has been argued that alexithymia may develop as a reaction to early life stress and traumatic events [
20,
21].
Already in the early years of clinical alexithymia research it was observed that alexithymia is concomitant with interpersonal problems. Nemiah and Sifneos [
22], for example, noticed that alexithymic patients typically remain detached, indifferent, and distant with others, burdening therapeutic relationships. Marty and M’Uzan [
23] reported interpersonal deficits such as chaotic interpersonal relations in psychosomatic patients with difficulties processing emotions. Although alexithymia was defined by intrapersonal deficits, early observations also highlighted interpersonal deficits.
In the last decades, research based on standardized assessment measures has started to systematically investigate the associations between alexithymia and interpersonal problems. In this research, the Inventory of Interpersonal Problems (IIP [
24,
25]) was often administered, an internationally used self-report questionnaire assessing interpersonal impairment in clinical contexts. From a general perspective, interpersonal problems are recurrent difficulties, which people exhibit in relating to others [
26]. Efforts to conceptualize interpersonal problems have relied primarily on the interpersonal circumplex, which is a model for assessing, and integrating interpersonal traits, motives, and behaviors [
27]. The interpersonal circumplex is defined by two orthogonal dimensions or axes,
agency or
social dominance and
communion or
social closeness [
28]. Agency refers to an individual’s control of others and includes traits such as assertiveness, dominance, and independence. It seems relevant to negotiating social hierarchies. Communion relates to involvement with others and includes traits such as cooperation, caring, and friendliness. Communion seems relevant to negotiating interpersonal distance. The IIP follows the circumplex model of interpersonal functioning with two bipolar axes and comprises eight specific domains of interpersonal problems: domineering, vindictive, cold, socially avoidant, non-assertive, exploitable, overly nurturant, and intrusive [
24,
25].
To our knowledge, eight studies have been conducted hitherto examining the relationship between alexithymia and interpersonal problems [
29‐
36]. Most of these studies examined samples of patients suffering from various mental [
29‐
33] or physical disorders [
35]. Two studies recruited patients and healthy individuals [
34,
36] but only Weinryb et al. [
36] analyzed the link between alexithymic features and interpersonal difficulties in healthy individuals. Overall, across studies, most but not all reported correlations between alexithymia and interpersonal problems were positive. The global level of alexithymia (i.e., the total alexithymia score) was found to be related most consistently to the interpersonal problem domains cold [
29,
32‐
36] and non-assertive [
29,
32‐
34]. These findings indicate that individuals scoring generally high in alexithymia tend to have problems in connecting with and feeling close to other people and manifest difficulties in taking initiative in relation to others and coping with social challenges.
Even though many studies have examined alexithymia as a unitary construct (i.e., using the total score), recent research underlines the importance of considering the alexithymia facets separately when investigating cognitive-emotional functioning, i.e., behavior and processes of attention, appraisal, memory, and language [
37,
38]. Eight studies examined the relationship between alexithymia and interpersonal problems [
29‐
36] of which only five studies conducted analyses at the subscale level [
29,
31,
33,
35,
36]. Importantly, results between studies differed considerably: difficulties identifying feelings was positively correlated with interpersonal problem domains in the studies of Spitzer et al. [
33], Vanheule et al. [
35], Hermes et al. [
29] and Ogrodniczuk et al. [
31] and with the total score of the IIP in the studies of Spitzer et al. [
33], Hermes et al. [
29] and Ogrodniczuk et al. [
31]. In contrast, difficulties describing feelings correlated positively with interpersonal problem domains (cold and socially avoidant) in the studies of Spitzer et al. [
33], Hermes et al. [
29] and Weinryb et al. [
36] and with the total score of the IIP in the studies of Spitzer et al. [
33], and Hermes et al. [
29]. A negative correlation between difficulties describing feelings and the scale intrusive was reported by Weinryb et al. [
36]. Finally, externally oriented thinking showed positive correlations with the scales cold and vindictive in the studies of Vanheule et al. [
35] and Weinryb et al. [
36] and negative correlations with the scales exploitable and overly nurturant in the investigation of Vanheule et al. [
35]. No correlations were observed between externally oriented thinking and the total score of the IIP. It is interesting to note that the findings of the only study based on a sample of healthy individuals [
36] differ substantially from the results reported in the patient-based investigations. The presence of a mental (or physical) disorder could have an effect on severity and type of alexithymia and interpersonal problems and change its relationship. An important methodological limitation of many of the above-mentioned studies is the failure to assess negative affects such as anxiety and depression of study participants. Only three studies measured and controlled participants’ negative affectivity in some way (general psychological distress [
33], negative affect [
30], or depressive symptoms [
31]). On the one hand, negative affects frequently accompany experiences of interpersonal failure and may further intensify relationship problems [
39,
40]. On the other hand, anxiety and depressed mood have been found to be linked to heightened levels of alexithymia [
17,
41]. Thus, control of participants’ negative affects seems essential to reach clear conclusions on the relationship between alexithymia and interpersonal problems.
In the present study, we explored the relationship between alexithymia facets and interpersonal problems in a sample of healthy individuals. The results of the only previous study based on a sample with healthy individuals are inconclusive since participants’ negative affects were not considered in the analyses. In our study, we assessed participants’ state and trait anxiety and level of depressive symptoms and recruited an equal number of men and women. It should be noted that, besides negative affects, gender is also a variable, which plays a role in the present research context, since men have been found to describe themselves as less caring and more assertive [
42,
43] and more alexithymic than women [
10,
11]. Interestingly, in all previous studies concerning the association of alexithymia and interpersonal problems [
29‐
36] the number of female participants clearly exceeded the number of male participants.
Recent comprehensive analyses of responses on the IIP confirmed that the latent structure of interpersonal problems is best represented by two continuous dimensions, which are largely independent of each other, agency and communion [
44]. In our correlation analyses, we focus on these two interpersonal dimensions and the global index of severity concerning interpersonal problems (i.e., the total score of the IIP). Based on the results from previous patient-based studies [
29,
31,
33] it was hypothesized that the alexithymia facets difficulties identifying feelings and difficulties in describing feelings are positively related to the global severity of interpersonal problems. Moreover, it was expected that difficulties identifying feelings, difficulties in describing feelings, and externally oriented thinking are positively related to the interpersonal problem domain cold (cf. [
29,
35,
36]) and negatively related to the interpersonal dimension of communion [
30]. Finally, it was assumed that difficulties identifying feelings and difficulties in describing feelings are positively related to the interpersonal problem domain nonassertive [
29,
33] and against this backdrop we expected a negative correlation of these TAS-20 subscales with the interpersonal dimension of agency. We performed linear regression analyses to examine which alexithymia facets were associated independently from each other with interpersonal problem dimensions and global severity of interpersonal distress, after adjusting for negative affect.
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