The alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients
Introduction
Alcohol dependence and its disorders are associated with the increased risk of suicidality (Nemtsov, 2003, Cherpitel et al., 2004).
45–67% of the people having alcohol dependence, showed alexithymia (Thorberg et al., 2009). The alexithymia construct was first proposed by Sifneos (1973). It refers to the difficulties in identifying and describing subjective feelings, distinguishing between feelings and the bodily sensations of emotional arousal, fantasizing and using an internal-oriented cognitive style, and a tendency to focus on real events (Taylor and Bagby, 2000). Alexithymia was correlated with psychiatric disorders and physical symptoms (Chung et al., 2013, Khosravani et al., 2016, Ghorbani et al., 2017).
Studies reported that alexithymia is significantly associated with the problems related to alcohol (Uzun et al., 2003, Thorberg et al., 2009, Thorberg et al., 2012). On the other hand, research findings obtained from several clinical and non-clinical populations have shown that alexithymia, particularly difficulty in identifying feelings and difficulty in describing feelings, positively associated with the suicide risk (De Berardis et al., 2013, Alpaslan et al., 2015, Kim et al., 2016).
Emotion regulation which is a multi-faceted construct contains the experience and separation of positive and negative emotions, and the capability to regulate strong emotions (Gratz and Roemer, 2004). Gross and John (2003) suggested multiple common emotion regulation strategies but especially emphasized on two independent central strategies: reappraisal and suppression. Reappraisal is an adaptive strategy resulting in positive emotional and physical responses to emotion-eliciting stimuli. Unlike these adaptive strategies, suppression is a less adaptive strategy to modulate an individual's emotions and is a risk factor for psychopathology (Gross and John, 2003). Gratz and Roemer (2004) have suggested a conceptualization of the difficulties in emotion regulation as impairments considering one or more of the following capabilities related to the regulation of emotions: (1) awareness/understanding of emotions, (2) acceptance of emotions, (3) control of impulsive behaviors/ behaving in line with one's goals, and (4) use of appropriate emotion regulation strategies. It has been shown that emotion regulation difficulties are broadly associated with the problematic use of alcohol, alcohol dependence and risk for relapse in situations involving negative emotions (Berking et al., 2011, Simons et al., 2009, Bandura et al., 2003). Also, research evidence indicated that difficulties in emotion regulation were related to suicidality (Rajappa et al., 2012, Forkmann et al., 2014).
Negative affect refers to the degree to which an individual experiences negative emotions and positive affect deals with the degree to which a person experiences positive emotions (Mroczek and Kolarz, 1998). It has been suggested that negative affect predicts drinking problems (Rohsenow et al., 1989, Wray et al., 2012). Also, affective states may play a critical role in the suicide risk (Bradley et al., 2011). The evidence revealed that high negative affect was linked to the suicide risk (Capron et al., 2012, Rojas et al., 2015).
Although there are studies which revealed that alexithymia, emotion regulation, difficulties in emotion regulation as well as positive and negative affects related to suicide, 1- The relationships of alexithymia, emotion regulation difficulties, emotion regulation, positive and negative affects, and clinical risk factors (e. g., depression and alcohol dependence) to suicidal risk have not yet been studied in alcohol-dependent outpatients, 2- It remains unclear whether the alexithymia, emotion regulation, difficulties in emotion regulation, positive and negative affect as well as clinical factors were specific to suicidal risk or whether these variables resulted from non-specific factors such as co-morbidity, disability, or functional impairment, and 3- Analysis of suicidal risk in terms of alexithymia, emotion regulation and its difficulties, positive and negative affects, and clinical factors may reveal factors specific to suicidal risk in alcoholic patients.
The aims of this study were: 1) To evaluate the differences between alcohol-dependent outpatients and normal controls in alexithymia, emotion regulation, difficulties in emotion regulation, and positive and negative affect, 2) To examine the differences between alcohol-dependent outpatients with and without lifetime suicidal attempts in socio-demographic characteristics and variables, and 3) To investigate the potential contributing factors such as alexithymia, emotion regulation, difficulties in emotion regulation, positive and negative affects as well as clinical factors including the severity of alcohol dependence and depression to predict suicidal risk and lifetime suicidal attempts in alcohol-dependent outpatients.
Section snippets
Patients
230 treatment-seeking alcohol dependent outpatients, aged 18–65 years old, with principal diagnoses of alcohol dependence were recruited randomly from Aramesh addiction treatment clinic in Karaj, Iran since October 2015 to May 2016. The study inclusion criteria included a diagnosis of alcohol dependence in accordance with DSM-IV-TR (DSM-IV-TR; American Psychiatric Association, 2000) criteria. All patients scored 20 or higher (M=28.73, SD=9.27) on the Alcohol Use Disorders Identification Test
Results
Demographic and clinical characteristics are presented in Table 1, Table 2. The results showed that alcohol-dependent outpatients had higher age, lower education levels as well as higher scores on depression than normal controls. The results indicated that by controlling age, gender, education, and depression as covariates, the alcoholic outpatients revealed higher means in the alexithymia, suppression, emotion regulation difficulties, negative affect, and suicide ideation. Also, normal
Discussion
The main aim of the study was to investigate the potential risk factors contributing to suicide risk in alcoholic outpatients. The findings showed that lifetime suicide attempts predicted by negative affect, duration of alcohol use, externally-oriented thinking, and severity of alcohol dependence. Also, depression, impulsivity, severity of alcohol dependence, reappraisal (as reversely), externally-oriented thinking, difficulties engaging in goal-directed behaviors, and negative affect were
Conclusion
It was concluded that findings may constitute useful evidence of the relations of alexithymia, emotion regulation, emotion regulation difficulties, and affects to suicidality in alcoholic patients.
Role of funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Contributors
All authors contributed substantively to the preparation of the manuscript. The second author designed the study and wrote the manuscript. All authors were involved in the statistical analyses and data collection of the study. All authors contributed to and have approved the final manuscript.
Conflict of interest
None.
References (68)
- et al.
Disordered eating attitudes, alexithymia and suicide probability among Turkish high school girls
Psychiatry Res.
(2015) - et al.
The pursuit of death versus escape from negative affect: an examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury
Compr. Psychiatry
(2014) - et al.
The twenty-item Toronto alexithymia scale – I. Item selection and cross-validation of the factor structure
J. Psychosom. Res.
(1994) - et al.
A longitudinal population-based study exploring treatment utilization and suicidal ideation and behavior in major depressive disorder
J. Affect. Disord.
(2012) - et al.
The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: a moderated mediation analysis
Psychiatry Res.
(2013) - et al.
Alexithymia, suicide risk and serum lipid levels among adult outpatients with panic disorder
Compr. Psychiatry
(2013) - et al.
The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: evidence from Iranian asthmatic patients
Psychiatry Res.
(2017) - et al.
Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12years
Schizophr. Res.
(2012) - et al.
Relationships of impulsiveness and depressive symptoms in alcohol dependence
J. Affect. Disord.
(2012) - et al.
Value priorities as predictors of hedonic and eudaimonic aspects of well-being
Personal. Individ. Differ.
(2009)