Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Jun 24.
Published in final edited form as: J Psychiatr Res. 2025 Dec 1;193:261–266. doi: 10.1016/j.jpsychires.2025.11.040

Role of childhood trauma in interoception and alexithymia in schizophrenia

Samantha Narvaez a, Krista Wisner b, Alina Siatka c, L Elliot Hong c, Joshua Chiappelli a,*
PMCID: PMC13288558  NIHMSID: NIHMS2187420  PMID: 41344226

Abstract

Childhood trauma (CT) is a notable risk factor for schizophrenia. Separately, CT has been associated with alexithymia, referring to difficulties in identifying and describing one’s own feelings, as well as disturbed interoception, referring to difficulties sensing and responding to signals that originate from within the body. Both self-perception impairments have been observed in schizophrenia; however, the role of CT in these observations in schizophrenia is unclear. To address this gap, interoception was assessed using the Multidimensional Assessment of Interoceptive Awareness (MAIA), alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), and CT was measured using the Childhood Trauma Questionnaire (CTQ) in a sample of 73 patients with schizophrenia or schizoaffective disorder (SSD) and 50 healthy controls. Patients had higher TAS-20 total score compared to controls (F = 36.0, p < 0.001) but groups were not different on any of the MAIA subscales. Across the full sample, CTQ total score was correlated with MAIA “trusting” subscale (ρ = −0.26, p = 0.005), and with TAS total score (ρ = 0.22, p = 0.016). Moreover, the MAIA “trusting” relationship remained significant within the SSD group. CT is associated with decreased feelings of trust in bodily sensations in schizophrenia, similar to findings in other major psychiatric disorders.

1. Introduction

Childhood trauma (CT) is a known risk factor for the development of schizophrenia spectrum disorders (SSD; De-Nardin et al., 2022; Chen et al., 2024; Howes et al., 2017). In this study we examine the potential role of CT in abnormalities in interoception and alexithymia within SSD, as these may be processes connecting early life stress such as CT to psychotic symptoms. Interoception broadly refers to the capacity for detecting and interpreting signals from within the body, such as heart rate, breathing pattern, hunger, and muscle tension. These internal sensations are critical to emotional experience, as the brain integrates internal signals with external situational factors to help determine emotional states (Nord and Garfinkel, 2022). Alexithymia is described as difficulty identifying and describing one’s emotional states, and interoceptive dysfunctions may contribute to alexithymia, and vice-versa (Brewer et al., 2016; Gaggero et al., 2021). Together these processes are crucial to self-perception and adaptive everyday functioning (Ospina et al., 2019). Notably, CT has been linked to reduced awareness of bodily sensations and emotions in some people (Schaan et al., 2019; Putica et al., 2023). Traumatic experiences have long been recognized to contribute to somatic symptoms that are otherwise difficult to understand from a purely biological perspective, and it has been suggested that a disturbance in interoception may underlie these observations (Scaer, 2014; Duncan et al., 2019; Dutcher et al., 2024).

Within the psychosis-spectrum, previous studies of individuals with SSD have found evidence of reduced interoceptive accuracy (Koreki et al., 2021; Torregrossa et al., 2022) aberrant interoceptive tendencies (Torregrossa et al., 2022) and abnormal alexithymia (Fogley et al., 2014; Huo et al., 2023; Yi et al., 2023). Alexithymia has been found to predict worse social and everyday functioning in a mixed sample of people with SSD and bipolar disorder (Ospina et al., 2019), highlighting the functional importance of these processes. Having a history of CT may partially contribute to a decreased ability to recognize or be aware of emotions in people with SSD (Rokita et al., 2020; Beals et al., 2024). Similarly, adolescents diagnosed with depression or bipolar disorder show an association between alexithymia and CT (Yang et al., 2024). However, there is limited data available to date on the relationship of trauma to interoception in SSD. One study in the psychosis-spectrum observed that body disturbances link CT to positive symptoms (Torregrossa et al., 2024). Moreover, no study has tested these associations in the same sample, Therefore, a simultaneous investigation is needed to test whether CT is related to both interoception and alexithymia in SSD to clarify the growing literature on these closely aligned processes and to inform future interventions.

The current study employs commonly used self-report measures of interoception, alexithymia, and CT in three sets of analyses. First, we hypothesized people with SSD would report decreased self-reported interoceptive tendencies, increased self-reported alexithymia, and increased CT compared to healthy controls. Second, we predicted that across the sample, CT would be associated with decreased interoceptive tendencies and higher alexithymia. As a follow-up analysis we will explore which type of CT most contributed to significant associations. Third, given nascent and mixed findings regarding relationships of interoceptive tendencies and alexithymia to clinical variables in SSD, we explored how significant findings related to psychiatric symptoms and cognitive deficits to inform our interpretations.

2. Methods

2.1. Participants

People (age range 18–69) with schizophrenia or schizoaffective disorder (SSD; n = 73) and healthy controls (n = 50) participated in the study. Patients were recruited from outpatient clinics at the Maryland Psychiatric Research Center, as well as several nearby mental health clinics. Healthy controls were recruited through local media advertisements. Psychiatric diagnoses in patients, or lack of psychiatric diagnoses in controls, were confirmed with Structured Clinical Interview for DSM-5 completed by clinicians experienced in the assessment and treatment of psychosis. A history of neurological conditions, traumatic brain injury, active and uncontrolled medical conditions, and substance abuse or dependence other than nicotine or cannabis in the previous six months were considered exclusion criteria for all participants. By self-report, 5 control and 6 patient participants reported cannabis use in the month prior to the study. All but 4 patients were on antipsychotic medications, with 11 taking typical antipsychotics, 49 taking atypical (including 19 taking clozapine), and 9 taking a combination of typical and atypical antipsychotics. Additionally, 19 patients were taking a mood stabilizer and 35 were taking an antidepressant at the time of study. All assessments were completed in person. All participants provided written informed consent. This study was approved by the IRB for the University of Maryland, Baltimore.

2.2. Self-perception measures

The Multidimensional Assessment of Interoceptive Awareness (MAIA) is a self-report instrument containing 32 questions with a 6-point Likert scale (0–5) that are used to calculate scores for 8 factor scales: Noticing (awareness of body sensations), Not-Distracting (tendency not to distract from uncomfortable sensations), Not-Worrying (tendency not to be worried by uncomfortable sensations), Attention Regulation (ability to maintain attention on body sensations), Emotional Awareness (recognition of link between body sensations and emotions), Self-Regulation (ability to control distress through attention to body sensations), Body Listening (tendency to monitor body for sensations), and Trusting (tendency to perceive body sensations as safe and trustworthy). Factor analyses of the MAIA do not support a unitary hierarchical factor (Mehling et al., 2012; Ferentzi et al., 2021). Thus, scores are calculated as the average response to items in each scale, with higher scores reflecting stronger interoceptive tendencies and/or greater use of bodily sensations in informing emotional experience (Mehling et al., 2012).

The Toronto Alexithymia Scale (TAS) is a self-report instrument containing 20 questions with a 5-point Likert scale (1–5) from which a total score can be calculated in addition to 3 subscales: Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally-Oriented Thinking, with greater scores indicating greater alexithymia (Parker et al., 2003).

2.3. Childhood trauma measure

The Childhood Trauma Questionnaire - Short Form (CTQ) was used to assess traumatic experiences occurring in childhood. Responses are used to calculate a total score, as well as subscales for physical abuse and neglect, emotional abuse and neglect, and sexual abuse, with higher scores indicating greater experience of trauma (Bernstein et al., 2003). Five patients and 2 control participants declined to complete the CTQ. Accordingly, correlation analyses were completed on this smaller subset of the total sample.

2.4. Clinical measures

Overall psychiatric symptoms, positive and negative symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS); a positive symptoms subscale was calculated as the sum of scores for conceptual disorganization, suspiciousness, hallucinations, and unusual thought content (Overall and Gorham, 1962) and Brief Negative Symptom Scale (BNSS – Kirkpatrick et al., 2011). Cognitive measures included the Digit Symbol Coding task of the Wechsler Adult Intelligence Scale-3 to assess processing speed (Wechsler, 1997) and the Digit Sequencing task from the Brief Assessment of Cognition in Schizophrenia (Keefe et al., 2008) to assess working memory. Symptoms of depression, an important symptom domain in SSD and across other psychiatric diagnoses, were assessed using the Maryland Trait and State Depression (MTSD) scales (Chiappelli et al., 2014).

3. Statistics

The primary hypothesis of increased CT in SSD, along with decreased self-reported interoceptive tendencies and increased alexithymia in SSD, was tested using analysis of covariance (ANCOVA) with diagnosis as the primary independent variable, plus age and sex covariates. After confirming elevated CT in the SSD group, ANCOVAs were completed for each of the eight MAIA subscales and the TAS total score; if indicated, follow-up analyses were completed for the TAS subscales. The second hypothesis testing relationships between CT and levels of both interoceptive tendencies and alexithymia was examined with Spearman’s correlations. Specifically, associations were calculated between CTQ total scores and each of the MAIA subscales and the TAS total score; if indicated, follow-up analyses were completed for the TAS subscales. To maximize power, this analysis was done in the whole sample; but to determine if findings were different between patients and controls, exploratory analyses were also completed within each group. For the first and second set of analyses, findings were considered significant after Bonferroni correction for multiple comparisons within questionnaires (MAIA (p < 0.00625) or TAS (p < 0.017 if subscales tested, respectively). Finally, we completed two sets of follow-up analyses limited to the patient group to better understand the relationships self-perception subscales found to be significantly related to CT. The first used Spearman’s correlation tests to determine if significantly CT-associated subscales in patients were driven by particular forms of trauma using the subscales of the CTQ. The second used Spearman’s correlation tests to determine if significantly CT-associated subscales in patients were also related to clinical measures, including total symptoms (BPRS), positive symptoms (BPRS positive symptoms subscale), negative symptoms (BNSS), symptoms of depression (MTSD), or cognition (processing speed and working memory measures). All tests were two-tailed. Reported p-values are unadjusted.

4. Results

4.1. Group differences

For demographics, women were overrepresented in the control group compared to the patient group, and the patient group was non-significantly younger than the control group (see Table 1); furthermore, the patient group reported marginally higher levels of CT. For the self-perception scales, findings showed there were no significant differences between patients and controls on subscales of the MAIA (Fig. 1). However, patients had significantly higher total scores on the TAS (F (3,119) = 36.0, p < 0.001); follow-up analyses also showed patients had significantly higher scores on all three TAS subscales (Table 1).

Table 1.

Descriptive information regarding sample demographics and self-perception scales.

SSD (n = 73) Controls (n = 50) Test Stat p
Age (years) 39.0 ± 14.6 44.3 ± 15.6 t = 1.90 .059
Sex (Male/Female) 53/20 18/32 χ2 = 16.3 <.001
CTQa 46.8 ± 17.7 39.6 ± 15.3 F = 3.84 .052
MAIA - Noticing 2.78 ± 1.5 2.74 ± 1.5 F = 0.26 .61
MAIA - Not Distracting 2.63 ± 1.3 2.59 ± 1.3 F = 0.01 .96
MAIA - Not Worrying 2.50 ± 1.0 2.83 ± 1.1 F = 2.96 .09
MAIA - Attention Regulation 2.59 ± 1.4 2.65 ± 1.1 F = 0.09 .77
MAIA - Emotional Awareness 3.04 ± 1.4 2.99 ± 1.3 F = 0.31 .58
MAIA - Self-Regulation 2.78 ± 1.5 2.47 ± 1.4 F = 3.39 .07
MAIA - Body Listening 2.45 ± 1.7 1.95 ± 1.4 F = 3.06 .08
MAIA - Trusting 3.29 ± 1.5 3.75 ± 1.2 F = 2.06 .15
TAS - Total 51.3 ± 11.7 38.4 ± 8.0 F = 36.0 <.001
TAS - Difficulty Identifying Feelings 15.9 ± 6.3 10.9 ± 4.1 F = 18.2 <.001
TAS - Difficulty Describing Feelings 14.5 ± 4.5 10.2 ± 3.8 F = 24.0 <.001
TAS - Externally-Oriented Thinking 20.8 ± 4.7 17.2 ± 3.8 F = 17.2 <.001
Open in a new tab

Note. CTQ, Childhood Trauma Questionnaire; MAIA, Multidimensional Assessment of Interoceptive Awareness; TAS, Toronto Alexithymia Scale; SSD, Schizophrenia Spectrum Disorders;

a

n = 68 for schizophrenia group, 48 for control group. Means ± standard deviation presented except for sex. For MAIA and TAS variables, analysis of covariances were completed to test group differences using age and sex as covariates.

Fig. 1.

Fig. 1.

Open in a new tab

Group differences in mean score of the Multidimensional Assessment of Interoceptive Awareness.

4.2. Associations between CTQ and self-perception measures

In the full sample, CTQ total score was significantly correlated with the MAIA “trusting” subscale (ρ = −0.26, p = 0.005), but not any of the other MAIA subscales; moreover, this relationship was stronger, and nominally significant, in patients with SSD (Table 2). In the full sample, CTQ total score was significantly correlated with TAS total score (ρ = 0.22, p = 0.016). Follow-up analyses with TAS subscales showed CTQ total was also significantly correlated with the Externally-Oriented Thinking subscale (ρ = 0.23, p = 0.014), but not the other two TAS subscales. However, these TAS associations with CTQ were not significant in the patient group alone. Follow-up specificity tests of CTQ subscales for the MAIA “trusting” association showed that in the patient group MAIA “trusting” was correlated with physical (ρ = −0.28, p = 0.023) and emotional neglect (ρ = −0.37, p = 0.002), but not the other CTQ subscales; correlations between other MAIA subscales and CTQ subscales are shown in Table 3 as exploratory analyses.

Table 2.

Relationships between self-perception scales and childhood trauma scores across groups.

Full sample SSD Controls
MAIA - Noticing .04 .00 .12
MAIA - Not Distracting .01 .19 −.26
MAIA - Not Worrying −.14 −.12 .03
MAIA - Attention Regulation −.13 −.20 .09
MAIA - Emotional Awareness −.07 −.10 −.05
MAIA - Self-Regulation −.16 −.23 −.12
MAIA - Body Listening −.05 −.08 −.07
MAIA - Trusting −.26** −.29* −.10
TAS - Total .22** .11 .18
TAS - Difficulty Identifying Feelings .13 .02 .13
TAS - Difficulty Describing Feelings .18 .05 .23
TAS - Externally-Oriented Thinking .23** .21 .04
Open in a new tab

Note. MAIA, Multidimensional Assessment of Interoceptive Awareness; TAS, Toronto Alexithymia Scale; SSD, Schizophrenia Spectrum Disorders; Spearman’s correlation coefficients presented for relationship of each self-perception scale to the Childhood Trauma Questionnaire (CTQ) total score.

*

Nominally significant p < 0.05;

**

Significant after Bonferroni correction for multiple comparisons within questionnaires (MAIA or TAS respectively). Follow-up correlations were completed separately within each group for variables significant after correction, which are reported in the main text.

Table 3.

Follow-up analysis in SSD group of relationships for trauma-associated self-perception subscales with CTQ subscales.

Physical neglect Physical abuse Emotional abuse Emotional neglect Sexual abuse
MAIA - Trusting −.28* −.10 −.21 −.37** −.06
MAIA - Noticing .10 .05 .03 −.14 −.02
MAIA - Not Distracting .11 −.02 .14 .28* .06
MAIA - Not Worrying −.08 −.11 −.15 .05 −.14
MAIA - Attention Regulation −.12 −.03 −.15 −.25* −.11
MAIA - Emotional Awareness −.03 .02 .02 −.22 −.04
MAIA - Self-Regulation −.09 −.03 −.16 −.35** −.05
MAIA - Body Listening −.03 .03 .00 −.21 .05
Open in a new tab

Note. MAIA, Multidimensional Assessment of Interoceptive Awareness. Spearman’s correlation coefficients presented for relationship of each subscale from the Childhood Trauma Questionnaire (CTQ) in the schizophrenia spectrum group only;

*

p < 0.05,

**

p < 0.01.

4.3. Association between symptoms and self-perception measures

In patients, MAIA “trusting” was correlated with a subset of clinical variables as shown in Table 4. Specifically, correlations were observed for BPRS total score (ρ = −0.24, p = 0.042), but not BPRS positive symptoms subscale or BNSS. Current ‘state’ and ‘trait’ symptoms of depression from the MTSD scale were also correlated with MAIA “trusting” (ρ = −0.24, p = 0.041; and ρ = −0.28, p = 0.014, respectively). Cognitive variables were not related to MAIA “trusting”.

Table 4.

Follow-up analysis in SSD group of relationships of trauma-associated self-perception subscales with clinical measures.

BPRS total BPRS psychosis subscale BNSS total MTSD-state MTSD-trait Processing speed Working memory
MAIA - Trusting −.24* −.16 −.18 −.24* −.28* −.18 −.18
Open in a new tab

Note. MAIA, Multidimensional Assessment of Interoceptive Awareness; Brief Psychiatric Rating Scale (BPRS); Brief Negative Symptom Scale (BNSS); Maryland Trait State Depression (MTSD); Spearman’s correlation coefficients presented for relationship of MAIA Trusting subscale with each clinical measure in the schizophrenia spectrum group only.

*

Nominally significant p < 0.05.

5. Discussion

The current study investigated self-perception impairments, specifically interoception and alexithymia, in SSD and the role of elevated CT in these experiences. Contrary to our predictions, we did not find notable group differences in self-reported interoceptive tendencies in people with SSD compared to controls. However, consistent with previous studies, we found elevated levels of self-reported alexithymia in SSD. Additionally, partially consistent with our hypotheses, we found that higher levels of CT was associated with lower scores of the MAIA ‘trusting’ subscale and associated with higher alexithymia scores, both in the combined sample. Moreover, lower scores of the MAIA ‘trusting’ subscale were associated with higher levels of total psychiatric symptoms, and in particular depressive symptoms, in people with SSD.

Disturbances in self-perception have been proposed to be a core feature of SSD, with impaired bottom-up processes of multisensory integration thought to be a potential mechanism (Park and Nasrallah, 2014; Sandsten et al., 2022). However, the results from this study are not consistent with the hypothesis that SSD patients subjectively experience and respond to interoceptive body sensations differently from healthy controls, as we did not find significant group differences on any of the MAIA scales. Our findings add to an array of mixed findings in the literature using self-reports of interoception and body sensations across the psychosis spectrum. However, we highlight our correlational findings of reduced MAIA “trusting” scores being associated with more psychiatric symptoms, and our trend-level reduction in MAIA “not worrying” scores at the group level are both in line with previous reports of reduced scores on these MAIA subscales in the psychosis-spectrum (Barbato et al., 2021; Torregrossa et al., 2022). Heterogeneity across samples in terms of psychosis chronicity, medication use, and co-occurring symptomatology such as depression, may impact findings, and future studies should aim to parse this heterogeneity in larger datasets to gain clarity.

Our data are consistent with previous findings of decreased emotional awareness in people with SSD (Beals et al., 2024). Notably, alexithymia in this group has previously been associated with difficulties in social functioning (van ’t Wout et al., 2007), which in turn have been identified as a predictor of real-world outcomes (Pinkham, 2014). Together these findings suggest alexithymia should be a treatment target for people with SSD. A systematic review found that dialectical behavioral therapy may be beneficial in decreasing alexithymia (Salles et al., 2023). Inclusion of this form of therapy in treatment plans may improve the functioning of people with SSD, which is an area of future research to pursue.

Our analyses of CT additionally highlighted that worse scores on both self-perception domains of interoception and alexithymia were associated with higher levels of CT across the whole sample. For interoception, this relationship was limited to the MAIA ‘trusting’ subscale, which was driven by a significant relationship in the SSD patient group, suggesting they feel less trust and safety for body signals. These findings are consistent with previous findings of a relationship between CT and alexithymia in other samples (Beals et al., 2024; Putica et al., 2023). More broadly, our findings may also be in line with results regarding tendencies for people with CT to experience body dissociation, which was observed in a mixed sample of healthy controls and people with mood disorder or PTSD (Schmitz et al., 2023). Importantly, this previous study also found that body dissociation mediated the relationship between CT and emotion dysregulation, suggesting that disconnecting from bodily sensations may limit processing of emotional responses and regulation thereof, which may represent a mechanism by which childhood trauma leads to psychopathology later in life (Schmitz et al., 2023). It is possible that reduced trust for body sensations and its association with both CT and depression in the current study of SSD could be supported by a similar theory, which future research will need to investigate. Previous studies using the MAIA in other clinical samples have identified the ‘trusting’ subscale to be associated with depressive symptoms broadly (Dunne et al., 2021) and more specifically feelings of physical agitation and suicidal thoughts (Duffy et al., 2018, 2020). Similarly, alexithymia has been found to be associated with suicidal ideation and non-suicidal self-injury (NSSI) across clinical and non-clinical populations (Iskric et al., 2020), and that CT, specifically physical neglect (Zhang et al., 2021) plus emotional neglect and abuse (Xie et al., 2018), are risks factor for suicidal ideation. In the present study, the relationship between CT and alexithymia was only significant in the combined sample, and not in the SSD group, which diverges from previous studies on this relationship (Beals et al., 2024). Nonetheless, the combined set of findings from the present study highlight the importance of considering CT in how people experience their physiological and emotional states, which may be important to consider during treatment planning in psychosis. For example, acceptance and commitment therapy can reduce symptoms in people with psychosis and a history of childhood trauma (Spidel et al., 2018).

Limitations of our study include that it is cross-sectional, and no causal interpretations are possible. Additionally, a statistically significant difference in sex ratios between patients and controls; which analyses aimed to control for this effect, the sex imbalance could still have limited the power of detecting diagnosis effects. Our sample size is also modest given that the MAIA provides eight factor scores and thus requires highly powered studies to account for multiple comparisons. Furthermore, this study did not include a behavioral test of interoception but instead relied on a self-report questionnaire. Thus, although we did not identify differences in self-reported interoceptive tendencies in SSD, we cannot rule out limitations in interoceptive ability when objectively measured. Because of our modest sample size, we also had limited power to identify associations of particular types of childhood abuse on alexithymia and interoception; specifically, our sample was limited in number of people who reported sexual abuse. Likewise, the lack of significant difference in CTQ scores between patients and controls may have had an effect on the correlation between trauma, alexithymia and interoception; in a sample with statistically significant differences in CTQ, analyses may yield results more similar to our hypotheses. Although we had few participants who self-reported recent use of cannabis, we did not collect data on use of synthetic cannabinoids; in a recent study use of either natural or synthetic cannabis was found to be associated with elevated dissociative symptoms in a sample of people experiencing first-episode psychosis (Valerio et al., 2025).

In summary, our results partially replicate previous findings of aberrant affective experiences in SSD and their relationship with CT, plus extends these relationships to a combined sample while studying two domains of self-perception simultaneously: interoception and alexithymia. The combined set of findings from the present study highlight the importance of considering CT in how people experience their physiological and emotional states. In particular, the perceived trustworthiness of body sensations appears especially related to CT, as well as related to psychiatric symptoms and specifically depression within SSD, which appears consistent with previous findings in (Wechsler, 1997) other samples. Taken together, trauma-related changes in perceived safety and trustworthiness of body sensations may be associated with psychological distress regardless of diagnosis, which future studies can explore with comprehensive transdiagnostic studies.

Funding

L.E.H and J.C. were supported by NIH grants R01MH116948 and P50MH103222. The findings and conclusions in this article are those of the authors and do not necessarily represent the views or opinions of these organizations, which had no role in designing or planning this study; in collecting, analyzing, or interpreting the data; in writing the article; or in deciding to submit this article for publication.

Declaration of competing interest

LEH has received or plans to receive research funding or consulting fees on research projects from Mitsubishi, Your Energy Systems LLC, Neuralstem, Taisho, Heptares, Pfizer, Luye Pharma, IGC Pharma, Sound Pharma, Regeneron, and Takeda. Other authors declare no conflicts of interest with respect to this work.

Footnotes

CRediT authorship contribution statement

Samantha Narvaez: Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization. Krista Wisner: Writing – review & editing, Supervision, Conceptualization. Alina Siatka: Writing – review & editing. L. Elliot Hong: Writing – review & editing, Supervision, Project administration, Funding acquisition. Joshua Chiappelli: Writing – review & editing, Writing – original draft, Supervision, Formal analysis, Conceptualization.

References

  1. Barbato M, Arora T, Al Hemeiri S, AlJassmi MA, 2021. Looking within: interoceptive sensibility in young adults with psychotic-like experiences. Early Interv Psychiatry 15 (6), 1705–1712. 10.1111/eip.13117. [DOI] [PubMed] [Google Scholar]
  2. Beals K, Torregrossa LJ, Smith R, Lane RD, Sheffield JM, 2024. Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia. Front. Psychiatr 11 (14), 1325617. 10.3389/fpsyt.2023.1325617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. , 2003. Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse Neglect 27, 169–190. [DOI] [PubMed] [Google Scholar]
  4. Brewer R, Cook R, Bird G, 2016. Alexithymia: a general deficit of interoception. R. Soc. Open Sci 3 (10), 150664, 12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chen Y-J, Lu M-L, Chiu Y-H, Chen C, Santos VHJ, Goh KK, 2024. Linking childhood trauma to the psychopathology of schizophrenia: the role of oxytocin. Schizophrenia (Heidelberg, Germany) 10 (1), 24. 10.1038/s41537-024-00433-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chiappelli J, Nugent KL, Thangavelu K, Searcy K, Hong LE, 2014. Assessment of trait and state aspects of depression in schizophrenia. Schizophr. Bull 40 (1), 132–142. 10.1093/schbul/sbt069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. De-Nardin EMS, Muratori CA, Ribeiro IS, Huguete RB, Salgado JV, 2022. Childhood trauma is associated with onset of symptoms, functioning and cognition in patients with schizophrenia. Trend. Psychiat. Psychoth 44, e20190081. 10.47626/2237-6089-2019-0081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Duffy ME, Rogers ML, Joiner TE, 2018. Body trust as a moderator of the association between exercise dependence and suicidality. Compr. Psychiatry 85, 30–35. 10.1016/j.comppsych.2018.06.005. [DOI] [PubMed] [Google Scholar]
  9. Duffy ME, Rogers ML, Gallyer AJ, Joiner TE, 2020. Body trust and agitation: pathways to suicidal thoughts and behaviors. Arch. Suicide Res 24 (Suppl. 2), S236–S250. 10.1080/13811118.2019.1592039. [DOI] [PubMed] [Google Scholar]
  10. Duncan R, Mulder R, Wilkinson SH, Horwood J, 2019. Medically unexplained symptoms and antecedent sexual abuse: an observational study of a birth cohort. Psychosom. Med 81 (7), 622–628. [DOI] [PubMed] [Google Scholar]
  11. Dunne J, Flores M, Gawande R, Schuman-Olivier Z, 2021. Losing trust in body sensations: interoceptive awareness and depression symptom severity among primary care patients. J. Affect. Disord 282, 1210–1219. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dutcher EG, Verosky SC, Mendes WB, Mayer SE, 2024. Localizing somatic symptoms associated with childhood maltreatment. Proc. Natl. Acad. Sci. U. S. A 121 (19), e2318128121, 7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ferentzi E, Olaru G, Geiger M, Vig L, Köteles F, Wilhelm O, 2021. Examining the factor structure and validity of the multidimensional assessment of interoceptive awareness. J. Pers. Assess 103 (5), 675–684. [DOI] [PubMed] [Google Scholar]
  14. Fogley R, Warman D, Lysaker PH, 2014. Alexithymia in schizophrenia: associations with neurocognition and emotional distress. Psychiatry Res. 218 (1–2), 1–6. 10.1016/j.psychres.2014.04.020. [DOI] [PubMed] [Google Scholar]
  15. Gaggero G, Bizzego A, Dellantonio S, Pastore L, Lim M, et al. , 2021. Clarifying the relationship between alexithymia and subjective interoception. PLoS One 16 (12), e0261126. 10.1371/journal.pone.0261126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Howes OD, McCutcheon R, Owen MJ, Murray R, 2017. The role of genes, stress and dopamine in the development of schizophrenia. Biol. Psychiatry 81 (1), 9–20. 10.1016/j.biopsych.2016.07.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Huo L, Qu D, Pei C, Wu W, Ning Y, Zhou Y, Zhang XY, 2023. Alexithymia in chronic schizophrenia and its mediating effect between cognitive deficits and negative symptoms. Schizophr. Res 261, 275–280. 10.1016/j.schres.2023.10.006. [DOI] [PubMed] [Google Scholar]
  18. Iskric A, Ceniti AK, Bergmans Y, McInerney S, Rizvi SJ, 2020. Alexithymia and self-harm: a review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res. 288, 112920. 10.1016/j.psychres.2020.112920. [DOI] [PubMed] [Google Scholar]
  19. Keefe RS, Harvey PD, Goldberg TE, Gold JM, Walker TM, Kennel C, Hawkins K, 2008. Norms and standardization of the brief assessment of cognition in schizophrenia (BACS). Schizophr. Res 102 (1–3), 108–115. [DOI] [PubMed] [Google Scholar]
  20. Kirkpatrick B, Strauss GP, Nguyen L, Fischer BA, Daniel DG, Cienfuegos A, Marder SR, 2011. The brief negative symptom scale: psychometric properties. Schizophr. Bull 37 (2), 300–305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Koreki A, Funayama M, Terasawa Y, Onaya M, Mimura M, 2021. Aberrant interoceptive accuracy in patients with schizophrenia performing a heartbeat counting task. Schizophrenia Bulletin Open 2 (1) sgaa067. [Google Scholar]
  22. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A, 2012. The multidimensional assessment of interoceptive awareness (MAIA). PLoS One 7 (11), e48230. 10.1371/journal.pone.0048230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nord CL, Garfinkel SN, 2022. Interoceptive pathways to understand and treat mental health conditions. Trends Cognit. Sci 26 (6), 499–513. 10.1016/j.tics.2022.03.004. [DOI] [PubMed] [Google Scholar]
  24. Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE, 2019. Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res. 273, 218–226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Overall JE, Gorham DR, 1962. The brief psychiatric rating scale. Psychol. Rep 10, 790–812. [Google Scholar]
  26. Park S, Nasrallah HA, 2014. The varieties of anomalous self experiences in schizophrenia: splitting of the mind at a crossroad. Schizophr. Res 152 (1), 1–4. 10.1016/j.schres.2013.11.036. [DOI] [PubMed] [Google Scholar]
  27. Parker JD, Taylor GJ, Bagby RM, 2003. The 20-Item Toronto alexithymia scale. III. Reliability and factorial validity in a community population. J. Psychosom. Res 55 (3), 269–275. [DOI] [PubMed] [Google Scholar]
  28. Pinkham AE, 2014. Social cognition in schizophrenia. J. Clin. Psychiatry 75 (Suppl. 2), 14–19. 10.4088/JCP.13065su1.04. [DOI] [PubMed] [Google Scholar]
  29. Putica A, O’Donnell ML, Felmingham KL, Van Dam NT, 2023. Emotion response disconcordance among trauma-exposed adults: the impact of alexithymia. Psychol. Med 53 (12), 5442–5448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Rokita KI, Holleran L, Dauvermann MR, Mothersill D, Holland J, Costello L, Kane R, McKernan D, Morris DW, Kelly JP, Corvin A, Hallahan B, McDonald C, Donohoe G, 2020. Childhood trauma, brain structure and emotion recognition in patients with schizophrenia and healthy participants. Soc. Cognit. Affect Neurosci 15 (12), 1325–1339. 10.1093/scan/nsaa160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Salles BM, Maturana de Souza W, dos Santos VA, Mograbi DC, 2023. Effects of DBT-based interventions on alexithymia: a systematic review. Cogn. Behav. Ther 52 (2), 110–131. 10.1080/16506073.2022.2117734. [DOI] [PubMed] [Google Scholar]
  32. Sandsten KE, Wainio-Theberge S, Nordgaard J, Kjaer TW, Northoff G, Parnas J, 2022. Relating self-disorders to neurocognitive and psychopathological measures in first-episode schizophrenia. Early Intervent. Psych 16 (11), 1202–1210. 10.1111/eip.13269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Scaer Robert, 2014. The Body Bears the Burden: Trauma, Dissociation, and Disease. Routledge. [Google Scholar]
  34. Schaan VK, Schulz A, Rubel JA, Bernstein M, Domes G, Schächinger H, Vögele C, 2019. Childhood trauma affects stress-related interoceptive accuracy. Front. Psychiatr 10, 750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Schmitz M, Back SN, Seitz KI, Harbrecht NK, Streckert L, Schulz A, Herpertz SC, Bertsch K, 2023. The impact of traumatic childhood experiences on interoception: disregarding one’s own body. Borderline Personal Disord Emot Dysregul 10 (1), 5. 10.1186/s40479-023-00212-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Spidel A, Lecomte T, Kealy D, Daigneault I, 2018. Acceptance and commitment therapy for psychosis and trauma: improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychol. Psychoth 91 (2), 248–261. 10.1111/papt.12159. [DOI] [PubMed] [Google Scholar]
  37. Torregrossa LJ, Amedy A, Roig J, Prada A, Park S, 2022. Interoceptive functioning in schizophrenia and schizotypy. Schizophr. Res 239, 151–159. 10.1016/j.schres.2021.11.046. [DOI] [PubMed] [Google Scholar]
  38. Torregrossa LJ, Liu J, Armstrong K, Heckers S, Sheffield JM, 2024. Interplay between childhood trauma, bodily self-disturbances, and clinical phenomena in schizophrenia spectrum disorders: a network analysis. Schizophr. Res 266, 107–115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Valerio R, Ilenia DM, Gianluca M, Franca C, Celeste CM, Francesco DC, Mauro P, Giovanni M, Giuseppe M, 2025. Alexithymia and psychopathological dimensions in first-episode psychosis: comparative patterns in natural cannabis versus synthetic cannabinoid users. J. Psychiatr. Res 189, 325–334. [DOI] [PubMed] [Google Scholar]
  40. van ’t Wout M, Aleman A, Bermond B, Kahn RS, 2007. No words for feelings: alexithymia in schizophrenia patients and first-degree relatives. Compr. Psychiatry 48 (1), 27–33. 10.1016/j.comppsych.2006.07.003. [DOI] [PubMed] [Google Scholar]
  41. Wechsler D, 1997. Wechsler Adult Intelligence Scale–Third Edition (WAIS-III) [Database record]. APA PsycTests. 10.1016/j.psyneuen.2020.104632. [DOI] [Google Scholar]
  42. Xie P, Wu K, Zheng Y, Guo Y, Yang Y, He J, Ding Y, Peng H, 2018. Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China. J. Affect. Disord 228, 41–48. 10.1016/j.jad.2017.11.011. [DOI] [PubMed] [Google Scholar]
  43. Yang J, Wang L, Jin C, Wu Y-W, Zhao K, 2024. The bridge between childhood trauma and alexithymia among adolescents with depressive and bipolar disorders: a network bridge analysis. Child Psychiatr. Hum. Dev 10.1007/s10578-024-01737-8. [DOI] [PubMed] [Google Scholar]
  44. Yi Y, Huang Y, Jiang R, Chen Q, Yang M, Li H, Feng Y, Feng S, Zhou S, Zhang L, Ning Y, Li Z, Wu F, 2023. The percentage and clinical correlates of alexithymia in stable patients with schizophrenia. Eur. Arch. Psychiatr. Clin. Neurosci 273 (3), 679–686. 10.1007/s00406-022-01492-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Zhang Y, Fang X, Tang B, Fan K, Wen N, Zhao K, Xu W, Tang W, Chen Y, 2021. Childhood trauma and insomnia increase suicidal ideation in schizophrenia patients: a cross-sectional study. Front. Psychiatr 12, 769743. 10.3389/fpsyt.2021.769743. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES