Table 1.
Characteristics of included studies
| Reference | Country | Objectives | SD | N | AoA | ATs | Diagnosis | Results |
|---|---|---|---|---|---|---|---|---|
| Bach et. al, 1994 [38] | Austria | Alexithymia: relationship to PD | CS | 182 overweight women | TAS |
TAS SCID PDQ-R |
PD | 17% scored in the alexithymic range, schizotypal, dependent, and avoidant personality dimensions significant predictors of alexithymia |
| Berembaum, 1996 [52] | USA | Childhood abuse, alexithymia and PD | CS | 60 out-patients (44 women) receiving PT. | TAS-20 | PDQ-R | PD | Childhood abuse, alexithymia, and PD were associated with each other, differential associations for abilities to identify and communicate emotions |
| Bøen et al., 2020 [50] | Norway | Alexithymia study assessing borderline and bipolar type II patients | CS | 22 BPD patients (20 females), 22 BP-II (17 females), 22 HC (17 females) | TAS |
MINI SCID-II PDQ-4 GBB HoNOSR |
BPD | Significant correlation found between difficulties describing feelings and HoNOSR values in BPD patients |
| Coolidge et al., 2013 [24] | USA | Correlation between alexithymia and SPD | CS | 199 students (93 women) | OAS |
CATIHCTI 5DPD |
SPD | Modest significant positive correlation between SPD and alexithymia. Secondary measures supported that SPD and alexithymia are not synonymous entities |
| Domes et. al, 2011 [40] | Germany | Alexithymic traits and facial emotion recognition in BPD | CS | 19 female BPD in-patients, 25 female controls | TAS-20 |
TAS-20 BDI BSL-95 DFMT |
BPD | Significant differences between groups in depressive symptoms, severity of borderline symptoms, and alexithymic traits |
| Guttman et al., 2002 [51] | Canada | measure the level of alexithymia in members of three types of families | CS | 35 women with BPD, 34 women with AN, 33 HC | TAS-20 |
IRI DIB-R SL-90-R BSI |
BPD | Families of women with BPD showed more alexithymia than families of women with AN |
| Honkalampi et al., 2004 [31] | Finland | Alexithymia as a risk for PD major depression or AUD | cohort | 333 subjects from the NPR | TAS-20 |
SCID-I BDI-21 SCID-II |
PD (DSM-IV) |
TAS scores not associated with subsequent major depressive disorder, PD, or AUD |
| Kiliç et al., 2020 [25] | Turkey | comparisons in empathy, alexithymia and theory of mind among HC and BPD patients | CS | 35 female BPD patients, 35 female HC | TAS-20 |
SCID-I SCI-II RMET EQ BIS-11 BDI |
BPD | BPD group had significantly worse RMET scores and higher alexithymia levels, predicting BPD diagnosis |
| Loas et al.,2015 [28] | Belgium | Relationship between alexithymia and DPD | CS | 477 non-clinical subjects (311 women) | TAS-20 |
DPQ BDI-II |
DPD | DPD is distinct from alexithymia and depression, with moderate correlation between DPQ and TAS-20 |
| Lysaker et. al, 2017 [41] |
USA Italy Czech Republic |
Contrasting metacognitive, social cognitive and alexithymia profiles in adults with BPD, SZ and SUD | CS | SZ (n=65, 3 female), BPD (n=34, 5 female), SUD (n=32, 1 female) | TAS-20 |
MAS-A BLERT TAS SCID-I SCID-II |
SZ BPD SUD without psychosis or borderline traits |
BPD and SZ groups had higher levels of alexithymia than the SUD group |
| Németh et. al, 2020 [43] | Hungary | Examining the relationship between executive functions and mentalizing abilities of BPD patients | CS | 18 BPD patients (17 females), 18 HC (17 females) | TAS-20 |
WCST LST FT LFT RMET FPT |
BPD | BPD patients exhibited significant impairments in emotional self-awareness and ToM reasoning, with comorbid psychiatric symptoms negatively predicting alexithymia and ToM decoding |
| New et al., 2012 [44] | USA | Empathy and alexithymia in BPD | CS | 79 BPD (53 females) patients, 76 HC (48 females), 39 AVPD patients (15 females) | TAS-20 |
SCID-I SCID IRI ISEL |
BPD AVPD |
BPD and AVPD scored higher in TAS than HC, with BPD patients reporting impaired ability to identify/describe feelings |
| Nicolo et al., 2011 [42] | Italy | alexithymia in PD and its correlation with symptoms and interpersonal functioning | CS | 388 individuals in an out-patient clinic (208 female) | TAS-20 |
SCID-II SL-90-R IIP |
PD (DSM-IV) |
Higher levels of alexithymia associated with high levels of global psychopathology and interpersonal dysfunction |
| Panfilis et al., 2015 [45] | Italy | Relationship between PD and alexithymia | CS | 167 out-patients (111 females) | TAS-20 |
SCID-I GSI |
PD | Cognitive aspects of alexithymia associated with PD criteria, particularly in borderline, avoidant, and dependent PDs |
| Pedersen et al., 2022 [46] | Norway | Psychometric evaluation of TAS-20 in a multisite clinical sample of patients with PD and personality problems | CS | 1611 psychiatric out-patients (1256 females) | TAS-20 |
SCID-5 MINI |
PD | Anxiety disorders, BPD, and AVPD highly related to levels of TAS-20 |
| Pourmohammad et al., 2021 [48] | Iran | Examine emotion recognition, complex TOM, and alexithymia in BPD patients compared to HC | CS | 50 BPD out-patients (20 females), 50 HC (20 females) | TAS-20 |
RMET TAS-20 FPT Digit Span subtest of WAIS |
BPD | BPD patients scored lower on FPT and its subtests but comparable to HC in emotion recognition ability, lower overall alexithymia |
| Pluta et. al, 2018 [47] | Poland | Assessing advanced theory of mind and alexithymia in patients with BPD | CS | 30 female BPD patients, 38 female HC | TAS-20 |
SCID-II BPI STAI CESD-R RPM |
BPD | BPD patients scored worse on ToM abilities but had a similar level of alexithymia to HCs, no correlation between FPT and TAS-20 |
| Ritz et al., 2018 [26] | Hungary | Facial emotion recognition deficits and alexithymia in BPD, NPD, HPD | CS | 80 (31 females) subjects: 20 of each PDs and 20 HCs | TAS-20 |
FEEST SCL-90-R SCID-II |
BPD NPD HPD |
BPD and NPD were more alexithymic than HCs, with severity in SCL-90-R predicting emotion recognition deficits. |
| Simonsen et al., 2021 [27] | Norway and Denmark | Alexithymia as a measure of personality dysfunction in AVPD | CS | 56 AVPD patients (41 females) | TAS-20 |
SCL 90-R MINI SCID-II CIP SIPP-118 GAF WSAS |
AVPD | Alexithymia is heterogeneous in AVPD, with highly alexithymic patients showing higher levels of personality dysfunction |
| Sleuwaegen et. al, 2017 [49] | Belgium | Investigate whether NSSI was associated with alexithymia controlling for gender and depression | CS | 185 BPD inpatients (160 females) | TAS-20 |
TAS-20 SIQ-TR |
BPD inpatients |
82.7% reported lifetime NSSI, 71.3% scored in the alexithymic range, significant association between NSSI and TAS-total |
AoA Assessment of Alexithymia, AN Anorexia Nervosa, AUD Alcohol Use Disorder, AVPD Avoidant Personality Disorder, BDI-21 Beck Depression Inventory, BDI-II Beck Depression Inventory-II, BPD Borderline Personality Disorder, BP-2 Bipolar type 2, BSI Borderline Syndrome Index, BSL Borderline Symptom List, CATI Coolidge Axis II Inventory, CIP Circumplex of Interpersonal Problems, CS Cross-Sectional, DBI-II Beck Depression Inventory-II, DES Dissociative Experiences Scale, DFMT Dynamic Facial Morph Task, DIB-R Revised Retrospective Diagnostic Interview for Borderlines, DPQ Dependent Personality Questionnaire, DPD Dependent Personality Disorder, EQ Empathic Quotient, FEEST Ekman 60 Faces Test, FPT Faux Pas Task, FT Eriksen Flanker Task, GAF Global Assessment of Functioning, GBB Giessener Subjective Complaints List, GSI General Severity Index, HC Healthy Controls, HCTI Horney-Coolidge Tridimensional Inventory, HoNOSR Health of the Nation Outcome Scales, PD Personality Disorders, HPD Histrionic Personality Disorder, IIP Inventory of Interpersonal Problems, IRI Interpersonal Reactivity Index, ISEL Interpersonal Support Evaluation List, LFT Letter Fluency Task, LST Listening Span Task, MAS-A Metacognition Assessment Scale-Abbreviated, MINI Mini International Neuropsychiatric Interview, NPD Narcissistic Personality Disorder, NPR National Population Register, OAS Observer Alexithymia Scale, PDQ-4 Personality Disorder Questionnaire, version 4, PDQ-R Personality Disorder Questionnaire - Revised, PT Psychotherapy, RMET Reading the Mind in the Eyes Test, SCID-I Structured Clinical Interview for DSM-IV Axis I, SCID-II Clinical Interview for DSM-IV Axis II, SCID-5 Structured Clinical Interview for DSM-5 Personality Disorder, SCL-90-R Symptom Checklist-90-R, SD Study Design, SIQ-TR Self-Injury Questionnaire-Treatment Related, SIPP-118 Severity Indices of Personality Problems, SPD Schizoid Personality Disorder, STAI Spielberger State-Trait Anxiety Inventory, SUD Substance Use Disorder, SZ Schizophrenia, TAS-20 Toronto Alexithymia Scale 20 item, WAIS Wechsler Adult Intelligence Scale, WCST Wisconsin Card Sorting Test, WSAS Work and Social Adjustment Scale