A Comparison of Alexithymia in Individuals with Suicidal Ideation, Attempted Suicide, and Non-Suicidal Self-Injury

Yıl 2024, , 386 - 391, 30.06.2024

Sertaç Zengil , Orhan Delice , Hilal Uygur

https://doi.org/10.54005/geneltip.1444016

Öz

Background/Aims: Alexithymia is a concept characterized by the impairment of an individual’s awareness of his feelings and ability to clearly identify and describe them. This study investigated whether alexithymia levels would differ in three different groups consisting of participants exhibiting suicidal ideation, attempted suicide, and non-suicidal self-injury (NSSI).
Methods: Seventy-five cases presenting to the psychiatry clinic and emergency department due to suicidal ideation, attempted suicide, or non-suicidal self-injury and 25 healthy controls were included in the study. The Toronto Alexithymia Scale (TAS-20) and Hamilton Depression Rating Scale (HDRS) were applied to all participants. The individuals taking part were assigned into three different groups for comparisons, suicidal ideation, attempted suicide, and NSSI.
Results: TAS-20 scores (55.88±13.23) and HDRS scores (21.89±9.14) were higher in the case groups than in the healthy controls (38.44±11.72 and 1.96±2.51, respectively) (p<0.001). Significantly higher TAS-20 scores were determined in the group with NSSI than in the attempted suicide group. Mean scores for the TAS subscales TAS-A (difficulty identifying feelings) and TAS-B (difficulty describing feelings) were significantly higher in the NSSI group than in the attempted suicide group. Positive correlation was detected between severity of depression and alexithymia levels, TAS-20 scores, TAS-A scores, TAS-B scores, and TAS-C (externally oriented thinking) scores.
Conclusion: The data from this study indicate that alexithymia levels in NSSI are higher than in individuals with attempted suicide and suicidal ideation. This finding reveals the importance of also examining individuals with NSSI in terms of alexithymia.

Anahtar Kelimeler

Alexithymia, attempted suicide, non-suicidal self-injury, suicidal ideation

İntihar Düşüncesi Olan, İntihar Girişiminde Bulunan ve İntihar Amaçlı Olmayan Kendine Zarar Verme Davranışı Bulunan Bireylerde Aleksitiminin Karşılaştırılması

Öz

Amaç: Aleksitimi, bireyin duygularının farkına varmasında, bunları tanıma ve açıkça tanımlama becerisinde bozulma ile karakterize bir kavramdır. Bu çalışma, intihar düşüncesi olan, intihar girişiminde bulunan ve intihar amaçlı olmayan kendine zarar verme (NSSI) davranışı sergileyen katılımcılardan oluşan üç farklı grupta aleksitimi düzeylerinin farklı olup olmayacağını araştırdı.
Gereç ve Yöntemler: Çalışmaya intihar düşüncesi olan, intihar girişiminde bulunan veya intihar amaçlı olmayan kendine zarar verme nedeniyle psikiyatri kliniğine ve acil servise başvuran 75 olgu ve 25 sağlıklı kontrol dahil edildi. Tüm katılımcılara Toronto Aleksitimi Ölçeği (TAÖ-20) ve Hamilton Depresyon Derecelendirme Ölçeği (HAM-D) uygulandı. Olgular intihar düşüncesi olan, intihar girişiminde bulunan ve NSSI olmak üzere üç farklı gruba ayrılarak kendi aralarında ve sağlıklı kontroller ile karşılaştırıldı.
Bulgular: Olgu gruplarında TAÖ-20 skorları (55,88±13,23) ve HAM-D skorları (21,89±9,14) sağlıklı kontrollere göre (sırasıyla 38,44±11,72 ve 1,96±2,51) daha yüksekti (p<0,001). NSSI grubunda intihar girişimi grubuna göre TAÖ-20 puanlarının anlamlı derecede yüksek olduğu belirlendi. TAÖ-20 alt ölçekleri TAÖ-A (duyguları tanımada zorluk) ve TAÖ-B (duyguları tanımlamada zorluk) ortalama puanları, NSSI grubunda intihar girişiminde bulunan gruba göre anlamlı derecede yüksekti. Depresyonun şiddeti ile aleksitimi düzeyleri, TAÖ-20 puanları, TAÖ-A puanları, TAÖ-B puanları ve TAÖ-C (dışa dönük düşünme) puanları arasında pozitif korelasyon tespit edilmiştir.
Sonuç: Bu çalışmadan elde edilen veriler NSSI'de aleksitimi düzeylerinin intihar girişiminde bulunan ve intihar düşüncesi olan bireylere göre daha yüksek olduğunu göstermektedir. Bu bulgu NSSI'li bireylerin aleksitimi açısından da incelenmesinin önemini ortaya koymaktadır.

Anahtar Kelimeler

Aleksitimi, intihar girişimi, intihar amaçlı olmayan kendine zarar verme, intihar düşüncesi

Kaynakça

• Hogeveen J, Grafman J. Alexithymia. Handb Clin Neurol. 2021;183:47-62.
• Jessar AJ, Hamilton JL, Flynn M, Abramson LY, Alloy LB. Emotional clarity as a mechanism linking emotional neglect and depressive symptoms during early adolescence. J Early Adolesc. 2017;37:414-432.
• Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61:629-35.
• Koelen JA, Eurelings-Bontekoe EH, Stuke F, Luyten P. Insecure attachment strategies are associated with cognitive alexithymia in patients with severe somatoform disorder. Int J Psychiatry Med. 2015;49:264-78.
• American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing.
• Hemming L, Haddock G, Shaw J, Pratt D. Alexithymia and its associations with depression, suicidality and aggression: An overview of theliterature. Front Psychiatry. 2019;10:203.
• Parker JD, Taylor GJ, Bagby RM. Alexithymia and the recognition of facial expressions of emotion. Psychother Psychosom. 1993;59:197–202.
• Spitzer C, Siebel-Jürges U, Barnow S, Grabe HJ, Freyberger HJ. Alexithymia and interpersonal problems. Psychother Psychosom. 2005;74:240–246.
• Lesser IM. Current concepts in psychiatry: Alexithymia. N Engl J Med. 1985;312.11: 690-692.
• Nicolò G, Semerari A, Lysaker PH, Dimaggio G, Conti L, D’Angerio S.  Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Res. 2011;190:37–42.
• Sayar K, Öztürk M, Acar B. Psychological factors in adolescents who attempted suicide by drug overdose. Clin Psychopharmacol Bul. 2000;10:133-138.
• Iskric A, Ceniti AK, Bergmans Y, McInerney S, Rizvi SJ. Alexithymia and self-harm: A review of non-suicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Res. 2020;288:112920.
• Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014;44:273-303.
• Ribeiro JD, Franklin JC, Fox KR, Bentley KH, Kleiman EM, Chang BP, et al. Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts and death: a meta-analysis of longitudinal studies. Psychol Med. 2016;46:225-36.
• Hasking P, Whitlock J, Voon D, Rose A. A cognitive-emotional model of NSSI: Using emotion regulation and cognitive processes to explain why people self-injure. Cogn Emot. 2017;31:1543-1556.
• Edmondson AJ, Brennan CA, House AO. Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. J Affect Disord. 2016;191:109-17.
• Norman H, Borrill J. The relationship between self-harm and alexithymia. Scand J Psychol. 2015 Aug;56:405-19.
• First B, Williams BW, Karg S, Spitzer L. User’s guide for the SCID-5-CV Structured Clinical Interview for DSM-5® disorders: Clinical version, 2016.
• Elbir M, Alp Topbaş Ö, Bayad S, Kocabaş T, Topak OZ, Çetin Ş, et al. Adaptation of the Clinician Version of the Structured Clinical Interview for DSM-5 Disorders into Turkish and its Reliability Study. Turkish J Psychiatry. 2019;30:51-56.
• Bagby RM, Parker JD, Taylor GJ. The Twenty-İtem Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38:23-32.
• Sayar K, Güleç H, Ak İ Yirmi soruluk Toronto Aleksitimi Ölçeği’nin geçerlik ve güvenirliği. 37. Ulusal Psikiyatri Kongresi Kitabı, 02- 06 Ekim 2001, İstanbul, s.130.
• Güleç H, Yenel A. 20 Maddelik Toronto Aleksitimi Ölçeği Türkçe uyarlamasının kesme noktalarına göre psikometrik özellikleri. Klinik Psikiyatri Dergisi. 2010;13:108-112.
• Williams JB. A structured interview guide for Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988;45:742-747.
• Akdemir A, Orsel S, Dag I, Turkcapar H, Iscan N, Ozbay H. Validity, reliability and clinical use of Hamilton depression rating scale. J Psychiatry Psychology Psychopharmacology. 1996; 4:251-259.
• Kokkonen P, Karvonen JT, Veijola J, Läksy K, Jokelainen J, Järvelin MR, et al. Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults. Compr Psychiatry. 2001;42:471-6.
• Montebarocci O, Codispoti M, Baldaro, B, et al. Adult attachment style and alexithymia. Personality and Individual differences. 2004;36:499-507.
• Todarello O, Taylor GJ, Parker JD, Rossi N. Alexithymia in essential hypertensive and psychiatric outpatients: a comparative study. J Psychosom Res. 1995;39:987-94.
• Aslan H. Alexithymia in psychiatric and psychosomatic patients. Neuropsychiatry Arch,1996; 33: 13-18.
• İzci F, Zincir S, Zincir SB, Bilici R, Gica S, İris Koc MS, et al. Suicide attempt, suicidal ideation and hopelessness levels in majör depressive patients with and without alexithymia. The J Psychiatry and Neurol Sciences. 2015;28:27-33.
• Iancu I, Dannon PN, Poreh A, et al. Alexithymia and suicidality in panic disorder. Compr Psychiatry. 2001;42:477-81.
• Kim H, Seo J, Namkoong K, Lepkifker E, Grunhaus L. Alexithymia and perfectionism traits are associated with suicidal risk in patients with obsessive-compulsive disorder. J Affect Disord. 2016;192:50-5.
• Hintikka J, Honkalampi K, Koivumaa-Honkanen H, Hwang EH, Sohn SY, Kim SJ, et al. Alexithymia and suicidal ideation: a 12-month follow-upstudy in a general population. Compr Psychiatry. 2004;45:340-5.
• Zlotnick C, Shea MT, Pearlstein T, Simpson E, Costello E, Begin A, et al. The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse and self-mutilation. Compr Psychiatry. 1996;37:12-6.
• Petrie K, Brook R. Sense of coherence, self-esteem, depression and hopelessness as correlates of reattempting suicide. Br J Clin Psychol. 1992;31:293