Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms

• Published in: Psychological medicine Vol. 52; no. 8; pp. 1458 - 1470
• Main Authors: Oakley, Bethany F. M., Jones, Emily J. H., Crawley, Daisy, Charman, Tony, Buitelaar, Jan, Tillmann, Julian, Murphy, Declan G., Loth, Eva
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2022
• Subjects: Alexithymia; Anxiety; Autism; Autistic adolescents; Clinical outcomes; Communication; Emotions; Health problems; Intellectual disabilities; Males; Men; Mental depression; Mental disorders; Mental health; Original; Original Article; Population; Regression analysis; Social anxiety; Symptoms; anxiety; depression; mental health; autism; Alexithymia
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291720003244

BackgroundAlexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social–emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood.MethodsIn total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12–24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms.ResultsAutistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44–0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07–0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41–0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08–0.62).ConclusionsOur findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.