Elsevier

Addictive Behaviors

Volume 38, Issue 4, April 2013, Pages 2014-2017
Addictive Behaviors

Short Communication
I don't know how I feel, therefore I act: Alexithymia, urgency, and alcohol problems

https://doi.org/10.1016/j.addbeh.2012.12.014Get rights and content

Abstract

This study examined the relationships between alexithymia, impulsivity, and alcohol use and related problems. The sample consisted of 429 undergraduate students who reported drinking alcohol at least once in the past 3 months. Negative urgency mediated the relationship between alexithymia and alcohol-related problems, whereas positive urgency mediated the relationship between alexithymia and alcohol consumption. In addition, positive urgency moderated the relationship between alexithymia and alcohol-related problems, increasing the strength of this association. These results indicate distinct relationships between alexithymia and negative urgency and positive urgency in predicting alcohol consumption and related problems. The findings of this research contribute to the body of the literature on alexithymia, self-regulation, and etiology of alcohol misuse and related consequences. Furthermore, the findings of the current study provide support for the importance of emotion identification and expression skills training in substance abuse treatment.

Highlights

► We tested associations between alexithymia, urgency, and alcohol outcomes. ► Negative urgency mediated the association between alexithymia and alcohol problems. ► Positive urgency mediated the relationship between alexithymia and consumption. ► The alexithymia by positive urgency interaction significantly predicted problems. ► Deficits in cognitive representation of emotions increase emotional dysregulation.

Introduction

This study examined the nature of the relationship between alexithymia and impulsivity, and how they contribute to increased alcohol use and alcohol-related problems. Alexithymia is a multifaceted personality construct that is characterized by difficulty identifying and describing feelings, externally oriented thinking, and lack of imagination (Taylor, 2000). Alexithymia is associated with a range of disorders, many of which are associated with poor impulse control (Kauhanen et al., 1992, Lumley and Roby, 1995, Parker et al., 2005, Thorberg et al., 2009, Troisi et al., 1997).

The development of emotional awareness and skills to express feelings are strongly linked to cognitive development because humans use language to identify and express their feelings. According to Taylor, Bagby, and Parker (1997), all individuals have emotions (i.e., neurophysiological arousal), but how we feel the emotions differ based on our subjective cognitive understanding and experiences. Without adequate words to describe various neurophysiological stimuli, we cannot feel (identify and describe) them accurately and precisely, and thus we have difficulties regulating our behaviors that follow the emotions (Lane and Schwartz, 1987, Taylor et al., 1997).

The emotional awareness theory presented by Lane and Schwartz (1987) has provided some explanations for the development of alexithymia (Taylor, 2000, Taylor et al., 1997). According to this theory, individuals with alexithymia are considered to be on the first two levels of emotional awareness (i.e., sensorimotor reflexive and sensorimotor enactive) as their abilities to cognitively identify various feelings precisely by recognizing specific physiological signs of emotions are not yet fully developed (Taylor et al., 1997).

Perhaps, lack of cognitive representations for neurophysiological stimuli may make individuals with alexithymia distressed in social situations, and thus they may use alcohol to alleviate their discomfort (Kauhanen et al., 1992, Thorberg et al., 2009, Uzun, 2003). According to the dual process models of impulsivity, impulsive individuals tend to rely on reflexive affective processes, rather than on reflective cognitive processes, to lead their behaviors (Lieberman, 2007, Metcalfe and Mischel, 1999).

Among several constructs of impulsivity, negative urgency and positive urgency are specific types of impulsivity that increase the risks of alcohol misuse and alcohol-related problems (Cyders et al., 2009, Cyders and Smith, 2008, Verdejo-García et al., 2007). Negative urgency is a tendency to act recklessly in response to negative affect, and positive urgency is a tendency to act rashly in response to positive emotion (Cyders & Smith, 2008).

As both impulsivity and alexithymia research emphasize the necessity of using reflective and sophisticated cognitive processes in order to better regulate emotions and behaviors (Carlson, 2007, Cyders and Smith, 2008, Lane and Schwartz, 1987, Lieberman, 2007), it is plausible that these constructs relate to each other when predicting increased alcohol use and problems. In addition, alexithymia (Bagby, Taylor and Parker, 1994, De Gucht et al., 2004) and urgency have both been related to neuroticism (Carver, 2005, Whiteside and Lynam, 2001), a personality trait marked by emotional instability (John & Gross, 2007). Thus, it is plausible that alexithymia and impulsivity are related under a higher order structure, namely neuroticism, and thus they robustly predict behaviors associated with emotion dysregulation, including alcohol use and problems.

The current study tested whether positive urgency and negative urgency mediate associations between alexithymia and alcohol use and problems. These hypotheses are based on research findings showing that deficits in cognitive processing of emotion-related information underlie both alexithymia and impulsivity (Lane and Schwartz, 1987, Lieberman, 2007, Metcalfe and Mischel, 1999, Taylor et al., 1997). Hence, urgency was hypothesized to mediate the associations between alexithymia and alcohol use and problems. Alternatively, alexithymia and urgency could have synergistic effects whereby the lack of cognitive representation of emotional experiences combined with the tendency to act rashly when emotionally aroused may be increasing the risks of increased alcohol use and consequences. Thus, we tested interactions between alexithymia and urgency predicting alcohol use and problems, increasing the strength of the associations (i.e., potential conditional indirect effects).

Section snippets

Participants

The sample included 429 undergraduate students between the ages of 18 and 25 (M = 19.92, SD = 1.45) who reported drinking at least once in the past 90 days. The sample was 31% male and 69% female. Approximately 2% of the sample identified their ethnicity as Hispanic or Latino. The sample was predominantly White (95.1%) and 1.4% were Black or African American, 0.9% were Asian, 0.7% were Native American or Alaskan Native, and 1.4% were Multiracial.

Alexithymia

Alexithymia was assessed by 20-item Toronto

Descriptive statistics and bivariate correlations

Descriptive statistics and the correlation matrix are presented in Table 1. Alexithymia exhibited moderate positive associations with both negative urgency and positive urgency. Alexithymia was moderately associated with alcohol-related problems but was not associated with alcohol consumption. Both positive urgency and negative urgency were associated with alcohol use and problems as expected.

Path analysis

The initial path model was tested by using Mplus (Muthén & Muthén, 2010). The interaction terms between

Discussion

This study investigated associations between alexithymia, impulsivity, alcohol use, and alcohol-related problems among college students. Overall, the hypotheses were supported. Distinct paths from alexithymia to alcohol variables through negative urgency and positive urgency emerged. Findings are discussed below.

Alexithymia exhibited independent effects on both positive urgency and negative urgency. This supports the hypothesis that the inability to effectively identify and describe feelings

Role of funding sources

Not applicable.

Contributors

All authors have contributed to and have approved the final manuscript.

Conflict of interest

All authors declare they have no conflict of interest.

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