Does alexithymia moderate the relation between stress and general sleep experiences?

Beyond sleepless nights: Unraveling the complexity of alexithymia and suicide risk among university students

BACKGROUND

There is a solid relationship between alexithymia and suicide risk. Nonetheless, the specific impact of alexithymia's distinct subscales on suicide risk has received the attention it deserves. This article presents a comprehensive exploration of suicide risk among university students, focusing on the interconnections among alexithymia, insomnia, and suicidal behavior. Three components of alexithymia including difficulties in describing emotions or feelings (DDF), difficulties in identifying emotions or feelings (DIF), and the externally oriented thinking were considered.

METHODS

The study involved 208 participants from a Persian university sample, examining the significance of incorporating both alexithymia and insomnia in suicide risk assessment and intervention planning. Insomnia was positioned as a pivotal mediator. A secure electronic link in the Telegram application was employed to collect the data. Both linear and nonlinear prediction models were used to explore potential associations among alexithymia, insomnia, and suicide risk.

RESULTS

The study revealed substantial positive correlations between alexithymia and suicide risk, as well as between insomnia and suicide risk. Additionally, specific components of alexithymia exhibited noteworthy links to suicide risk. The inclusion of insomnia scores in suicide risk predictions is critical, as it greatly enhances the precision of risk assessments and facilitates the design of targeted and effective therapeutic interventions. The association between alexithymia and suicide risk showed a significant relationship (r = .29, p < .01). Moreover, a significant correlation was observed between alexithymia and insomnia (r = .32, p < .01). Additionally, insomnia exhibited a significant positive correlation with suicide (r = .35, p < .01). Interestingly, DDF and DIF showed positive correlations with suicide (r = .28, p < .01; r = .33, p < .01).

CONCLUSION

The findings carry profound implications for suicide prevention efforts, providing valuable insights to safeguard the well-being and resilience of university students facing suicide risk challenges.

Sleep, stress and aggression: Meta-analyses investigating associations and causality

Prior research suggests that sleep is associated with increased subjective stress and aggression, but important questions remain about the typical magnitude of these relationships, as well as their potential moderators. We therefore conducted the first meta-analysis of this literature. Across 340 associational and experimental studies, significant associations were identified between sleep with both subjective stress (r = 0.307, p < .001) and aggression (r = 0.258, p < .001) in individuals from the general population, as well as between sleep with subjective stress (r = 0.425, p < .001) in individuals with sleep disorders. Experimental sleep restriction also led to increased subjective stress (g = 0.403, p = .017) and aggression (g = 0.330, p = .042). These findings suggest that poorer sleep is associated with - and leads to - heightened levels of subjective stress and aggression. These findings, and their implications, are discussed in relation to neurobiological literature, which highlights the complex interplay between metabolic activity in the brain, hormonal changes, and behavior.

Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The path to dissociative experiences: A direct comparison of different etiological models

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

Nightmare Distress Questionnaire: associated factors

STUDY OBJECTIVES

The diagnosis of a nightmare disorder is based on clinically significant distress caused by the nightmares, eg, sleep or mood disturbances during the day. The question what factors might be associated with nightmare distress in addition to nightmares frequency is not well studied.

METHODS

Overall, 1,474 persons (893 women, 581 men) completed an online survey. Nightmare distress was measured with the Nightmare Distress Questionnaire.

RESULTS

The findings indicated that nightmare distress, measured by the Nightmare Distress Questionnaire, correlated with a variety of factors in addition to nightmare frequency: neuroticism, female sex, low education, extraversion, low agreeableness, and sensation seeking. Moreover, the percentage of replicative trauma-related nightmares was also associated with higher nightmare distress.

CONCLUSIONS

A large variety of factors are associated with nightmare distress, a finding that is of clinical importance. The construct harm avoidance, however, was not helpful in explaining interindividual differences in nightmare distress. Furthermore, the relationship between nightmare distress and other factors, eg, education or agreeableness, is not yet understood.

A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations

Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations. Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels. This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning. We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations. Studies using two common measures of these constructs were included (i.e., the Toronto Alexithymia Scale - TAS, and the Dissociative Experiences Scale - DES). Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation. The strength of the association was higher in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations..

The Mediating Effect of Alexithymia on the Relationship Between Schizotypal Traits and Sleep Problems Among College Students

A body of research has investigated the relationship between alexithymia and sleep problems, as well as the relationship between schizophrenia and alexithymia. However, there have been few studies on the relationships between the three. The current study explored the relationship between schizotypal traits and sleep problems among college students, and the potential role of alexithymia as a mediator of this relationship. The participants were all first-year students at a medical university in Guangdong province, China. A total of 2,626 college students participated. They were asked to complete a questionnaire that incorporated the Schizotypal Personality Questionnaire (SPQ), the Toronto Alexithymia Scale (TAS-20), and the Insomnia Severity Index (ISI). The results revealed a relatively high percentage of students with mild insomnia (74.8%) and a smaller percentage with moderate to severe insomnia (7.9%). Correlation analysis revealed that both the TAS-20 and ISI scores had significant positive correlations with the SPQ score (p < 0.01). There was also a significant positive correlation between the TAS-20 and ISI scores (p < 0.01). The ISI score was significantly influenced by the SPQ score in a direct way, and increased considerably with increases in the TAS-20 score, indicating the importance of alexithymia as a mediator. The mediation model was tested via regression analysis and the bias-corrected bootstrap method, and these results further confirmed the role of alexithymia as a mediator.