Elsevier

Psychiatry Research

Volume 252, June 2017, Pages 223-230
Psychiatry Research

The alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients

https://doi.org/10.1016/j.psychres.2017.03.005Get rights and content

Highlights

  • 76.6% of alcoholic patients were classified as having high suicide risk.

  • Alcoholics showed higher means in the studied variables than normal controls.

  • Clinical factors of use duration and dependence severity predicted lifetime suicide attempt.

  • Clinical factors of depression and alcohol dependence severity explained suicide ideation.

  • Negative affect and EOT were predictors of lifetime suicide attempt.

  • Impulsivity, reappraisal, EOT, negative affect and lack of goals predicted suicide ideation.

Abstract

The aim of this study was to evaluate the potential contributing factors such as alexithymia, emotion regulation and difficulties in emotion regulation, positive/negative affects and clinical factors including severity of alcohol dependence and depression connected to high suicidality in alcohol-dependent outpatients. 205 alcohol-dependent outpatients and 100 normal controls completed the demographic questionnaire, the Persian version of the Toronto Alexithymia Scale (FTAS-20), the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), the Positive/Negative Affect Scales, the Alcohol Use Disorders Identification Test (AUDIT), and the Beck Depression Inventory-II (BDI-II). The suicidal risk was assessed using the Scale for Suicide Ideation (SSI) and history taking. Alcohol-dependent outpatients showed higher means in alexithymia, difficulties in emotion regulation, suppression subscale, negative affect, and suicide ideation than normal controls. Logistic regression analysis revealed that negative affect, duration of alcohol use, externally-oriented thinking, and severity of alcohol dependence explained lifetime suicide attempts. Depression, impulsivity, severity of alcohol dependence, reappraisal (reversely), externally-oriented thinking, difficulties engaging in goal-directed behaviors, and negative affect significantly predicted the suicidal risk. The findings may constitute useful evidence of the relevancies of alexithymia, emotion regulation, emotion regulation difficulties, and affects to suicidality in alcoholic patients.

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)

  • V. Khosravani et al.

    The alexithymia, cognitive emotion regulation, and physical symptoms in Iranian asthmatic patients

    Personal. Individ. Differ.

    (2016)
  • H. Kim et al.

    Alexithymia and perfectionism traits are associated with suicidal risk in patients with obsessive–compulsive disorder

    J. Affect. Disord.

    (2016)
  • G. Loas et al.

    Relationships between the emotional and cognitive components of alexithymia and dependency in alcoholics

    Psychiatry Res.

    (2000)
  • A.K. Malla et al.

    Duration of untreated psychosis is associated with orbital–frontal grey matter volume reductions in first episode psychosis

    Schizophr. Res.

    (2011)
  • A. Nemtsov

    Suicides and alcohol consumption in Russia, 1965–1999

    Drug. Alcohol, Depend.

    (2003)
  • N. Rüsch et al.

    Inferior frontal white matter volume and suicidality in schizophrenia

    Psychiatry Res. Neuroimaging

    (2008)
  • I. Spoletini et al.

    Suicidal attempts and increased right amygdala volume in schizophrenia

    Schizophr. Res.

    (2011)
  • F.A. Thorberg et al.

    Alexithymia and alcohol use disorders: a critical review

    Addict. Behav.

    (2009)
  • T.B. Wray et al.

    Trait-based affective processes in alcohol-involved ‘‘risk behaviors

    Addict. Behav.

    (2012)
  • A.C. Altamura et al.

    Duration of untreated illness and suicide in bipolar disorder: a naturalistic study

    Eur. Arch. Psychiatry Clin. Neurosci.

    (2010)
  • American Psychiatric Association D, 2000. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington,...
  • A.M. Arria et al.

    Suicide ideation among college students: a multivariate analysis

    Arch. Suicide Res.

    (2009)
  • T.F. Babor et al.

    Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care

    (2001)
  • A. Bandura et al.

    Role of affective self-regulatory efficacy in diverse spheres of psychosocial functioning

    Child Dev.

    (2003)
  • R.F. Baumeister

    Suicide as escape from self

    Psychol. Rev.

    (1990)
  • A.T. Beck et al.

    Assessment of suicidal intention: the scale for suicide ideation

    J. Consult. Clin. Psychol.

    (1979)
  • A.T. Beck et al.

    Manual for the Beck Depression Inventory-II

    (1996)
  • M. Berking et al.

    Deficits in emotion-regulation skills predict alcohol use during and after cognitive behavioral therapy for alcohol dependence

    J. Consult. Clin. Psychol.

    (2011)
  • M.A. Besharat

    Reliability and factorial validity of Farsi version of the Toronto Alexithymia Scale with a sample of Iranian students

    Psychol. Rep.

    (2007)
  • M.A. Besharat

    Assessing reliability and validity of the Farsi version of the Toronto Alexithymia scale in a sample of substance-using patients 1, 2

    Psychol. Rep.

    (2008)
  • J.M. Boden et al.

    Alcohol and depression

    Addiction

    (2011)
  • B. Bradley et al.

    Emotion dysregulation and negative affect: association with psychiatric symptoms

    J. Clin. Psychiatry

    (2011)
  • J. Brezo et al.

    Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

    Acta Psychiatry Scand.

    (2006)
  • R.W. Brislin

    The wording and translation of research instruments

  • Cited by (0)

    View full text