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

  • Sandra Marie Reyno | sandra.reyno@nshealth.ca Queen Elizabeth II Health Sciences Centre, Halifax NS, Canada.
  • Maria Simmons Queen Elizabeth II Health Sciences Centre, Halifax NS, Canada.
  • Jackie Kinley Department of Psychiatry, Dalhousie University, Halifax NS, Canada.


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 and the Dissociative Experiences Scale).  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 increased in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations.            



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Alfasi, D., & Soffer-Dudek, N. (2018). Does alexithymia moderate the relation between stress and general sleep experiences? Personality and Individual Differences, 122, 87-92. DOI: https://doi.org/10.1016/j.paid.2017.10.014

Arntz, A., Stupar-Rutenfrans, S., Bloo, J., van Dyck, R., & Spinhoven, P. (2015). Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy. Behavior Research and Therapy, 74, 60-71. DOI: https://doi.org/10.1016/j.brat.2015.09.002

Aust, S., Härtwig, E.A., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma, 5, 225-232. DOI: https://doi.org/10.1037/a0027314

Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32. DOI: https://doi.org/10.1016/0022-3999(94)90005-1

Baker D., Hunter E., Lawrence E., Medford N., Patel M., Senior C., Sierra M., Lambert M.V., Phillips M.L., & David A.S. (2003). Depersonalisation disorder: Clinical features of 204 cases. British journal of Psychiatry, 182, 428–33. DOI: https://doi.org/10.1192/bjp.182.5.428

Berenbaum, H., Valera, E. M., & Kerns, J.G. (2003). Psychological trauma and schizotypal symptoms, Schizophrenia Bulletin, 29, 143-152. DOI: https://doi.org/10.1093/oxfordjournals.schbul.a006985

Bucci, W. (1997). Psychoanalysis and Cognitive Science. A Multiple Code Theory. New York, NY: Guilford Press.

Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014) Changes in alexithymia following psychological intervention: A review. Harvard Review of Psychiatry, 22, 162-178. DOI: https://doi.org/10.1097/HRP.0000000000000036

Carlson E.B., & Putnam F.W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders. Dissociation, 6, 6–27

Cloitre, M., Petkova, E., Wang, J., & Lu Lassell, F. (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse. Depression and Anxiety, 29, 709-717. DOI: https://doi.org/10.1002/da.21920

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed). New Jersey: Lawrence Erbaum.

Corchs, F., Corregiari, F., Ferrão, Y.A., Takakura, T., Mathis, M. E., Lopes, A. C., Miguel, E. C. & Bernik, M. (2008). Personality traits and treatment outcome in obsessive-compulsive disorder. Brazilian Journal of Psychiatry, 30, 246-250. DOI: https://doi.org/10.1590/S1516-44462008000300012

Craparo, G., Gori, A., Mazzola, E., Petruccelli, I., Pellerone, M., & Rotondo, G. (2014). Posttraumatic stress symptoms, dissociation and alexithymia in an Italian sample of flood victims. Neuropsychiatric Disease and Treatment, 10, 2281-2284. DOI: https://doi.org/10.2147/NDT.S74317

Da Silva, A.N., Vasco, A.B., & Watson, J.C. (2018). Alexithymia and emotional processing: A longitudinal mixed methods research. Research in Psychotherapy: Psychopathology, Process and Outcome, 21, 40-54. DOI: https://doi.org/10.4081/ripppo.2018.292

Dalenberg, C.J., Brand, B.L., Gleaves, D.H., Dorahy, M.J., Loewenstein, R.J., Cardena, E., . . . Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissection. Psychological Bulletin, 138, 550-588. DOI: https://doi.org/10.1037/a0027447

De Berardis, D., Serroni, N., Campanella, D., Carano, A., Gambi, F., Valchera, A., . . . Ferro, F.M. (2009). Alexithymia and its relationships with dissociative experiences, body dissatisfaction and eating disturbances in a non-clinical female sample. Cognitive Therapy and Research, 33, 471-479. DOI: https://doi.org/10.1007/s10608-009-9247-9

Evren, C., & Can, S. (2007). Clinical correlates of dissociative tendencies in male soldiers with conversion disorder. Israel Journal of Psychiatry and Related Sciences, 44, 33-39.

Evren, C., Cinar, O., & Evren, B. (2012). Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Comprehensive Psychiatry, 53, 854-859. DOI: https://doi.org/10.1016/j.comppsych.2011.11.009

Evren C., Sar, V., Evren, B., Semiz, U., Dalbudak, E., & Cakmak, D. (2008). Dissociation and alexithymia among men with alcoholism. Psychiatry and Clinical Neurosciences, 62, 40-47. DOI: https://doi.org/10.1111/j.1440-1819.2007.01775.x

Frewen, P.A., Lanius, R. L., Dozois, D.J.A., Neufeld, R.W.J., Pain, C., Hopper, J.W. . . . & Stevens T.K. (2008). Clinical and neural correlates of alexithymia in posttraumatic stress disorder. Journal of Abnormal Psychology, 117, 171-181. DOI: https://doi.org/10.1037/0021-843X.117.1.171

Frewen, P., Dozois, D., Neufeld, R., & Lanius, R. (2008). Meta‐analysis of alexithymia in posttraumatic stress disorder. Journal of Traumatic Stress, 21, 243-246. DOI: https://doi.org/10.1002/jts.20320

Frewen, P. A., Dozois, D. A., Neufeld, R. J., & Lanius, R. A. (2012). Disturbances of emotional awareness and expression in posttraumatic stress disorder: Meta-mood, emotion regulation, mindfulness, and interference of emotional expressiveness. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 152–161. DOI: https://doi.org/10.1037/a0023114

Grabe, H. J., Frommer, J., Ankerhold, A., Ulrich, C., Groger, R., Franke, G.H., . . . Spitzer, C. (2008). Alexithymia and outcome in psychotherapy. Psychotherapy and Psychosomatics, 77, 189-194. DOI: https://doi.org/10.1159/000119739

Groves, S., Douglas, K., & Porter, R. (2018). A Systematic Review of Cognitive Predictors of Treatment Outcome in Major Depression. Frontiers in Psychiatry, 9, 382, doi: 10.3389/fpsyt.2018.00382. DOI: https://doi.org/10.3389/fpsyt.2018.00382

Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A., editors (2019). Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons. DOI: https://doi.org/10.1002/9781119536604

Mark G. Haviland (1996) Structure of the Twenty-Item Toronto Alexithymia Scale, Journal of Personality Assessment, 66, 116-125. DOI: https://doi.org/10.1207/s15327752jpa6601_9

Jepson, E.K.K., Langeland, W., & Heir, T. (2014). Early traumatized inpatients high in psychoform and somatoform dissociation: Characteristics and treatment response. Journal of Trauma and Dissociation, 15, 572-587. DOI: https://doi.org/10.1080/15299732.2014.924461

Kienle, J., Rockstroh, B., Bohus, M., Fiess, J., Huffziger S., & Steffen-Klatt, A. (2017). Somatoform dissociation and postraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms, and patients with PTSD. BMC Psychiatry, 17, 248. DOI: https://doi.org/10.1186/s12888-017-1414-z

Kefeli, M.C., Turow, R.G., Yildirim, A., & Boysan, M. (2018). Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Research, 260, 391-399. DOI: https://doi.org/10.1016/j.psychres.2017.12.026

Kenny, D.A. (1999). Meta-analysis easy to answer – Meta. Available: http://davidakenny.net/meta.htm (last visited June 26, 2019).

Kihlstrom, J.E., Glisky, M.L., & Angiulo, M.J. (1994). Dissociative tendencies and dissociative disorders. Journal of Abnormal Personality, 103, 117-124. DOI: https://doi.org/10.1037/0021-843X.103.1.117

Kinley, J.L., & Reyno, S.M. (2019). The price of needing to belong: Neurobiology of working through attachment trauma. Psychodynamic Psychiatry, 47, 39-51. DOI: https://doi.org/10.1521/pdps.2019.47.1.39

Kinley, J.L., & Reyno, S.M. (2017). Advancing Freud’s dream: A dynamic-relational neurobiologically informed approach to psychotherapy. Neuropsychoanalysis, 19, 127-142. DOI: https://doi.org/10.1080/15294145.2017.1367260

Kinley, J.L., & Reyno, S.M. (2016). Project for a scientific psychiatry: A neurobiologically informed, phasic, brain-based model of integrated psychotherapy. Journal of Psychotherapy Integration, 26, 61-73. DOI: https://doi.org/10.1037/a0039636

Kleindienst, N., Limberger, M.F., Ebner-Priemer, U.W., Keibel-Mauchnik, J-K., Dyer, A., . . .Berger, M. (2011). Dissociation predicts poor response to dialectical behavioral therapy in female patients with borderline personality disorder. Journal of Personality Disorders, 25, 432-447. DOI: https://doi.org/10.1521/pedi.2011.25.4.432

Kong, S.S., Kang, D.R., Oh, J.M., & Kim, N.H. (2018). Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation. Journal of Trauma and Dissociation, 19, 214-231. DOI: https://doi.org/10.1080/15299732.2017.1329772

Kooiman, C.G., Spinhoven, P., & Trijsburg, R.W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale -20. Journal of Psychosomatic Research, 53, 1083-1090. DOI: https://doi.org/10.1016/S0022-3999(02)00348-3

Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015). The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Research, 227, 1, 1-9. DOI: https://doi.org/10.1016/j.psychres.2015.02.006

Lipsanen, T., Saarijärvi, S., & Lauerma, H. (2004). Exploring the relations between depression, somatization, dissociation and alexithymia – Overlapping or independent constructs? Psychopathology, 37, 200-206. DOI: https://doi.org/10.1159/000080132

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2017). Dissociation in psychiatric disorders: A meta-analysis of studies using the Dissociative Experiences Scale. The American Journal of Psychiatry, 175, 37–46. DOI: https://doi.org/10.1176/appi.ajp.2017.17010025

Maaranen, P., Tanskananen, A., Hintikka, J., Honkalampi, K., Haatainen, K., Koivumaa-Honkanen, H., Viinamaki, H. (2008). The course of dissociation in the general population: A 3-year follow-up study. Comprehensive Psychiatry, 49, 269-274. DOI: https://doi.org/10.1016/j.comppsych.2007.04.010

Meganck, D., Vanheule, S., & Desmet, M. (2013). Affective Processing and Affect Regulation: A Clinical Interview Study. Journal of the American Psychoanalytic Association, 61, 12-6 DOI: https://doi.org/10.1177/0003065113516365

Majohr, K. L., Leenen, K., Grabe, H. J., Jenewein, J., Nuñez, D. G., & Rufer, M. (2011). Alexithymia and its relationship to dissociation in patients with panic disorder. The Journal of Nervous and Mental Disease, 199, 773-77 DOI: https://doi.org/10.1097/NMD.0b013e31822fcbfb

Mason, O., Tyson, M., Jones, C., & Potts, S. (2005). Alexithymia: Its prevalence and correlates in a British undergraduate sample. Psychology and Psychotherapy, 78, 113-125. DOI: https://doi.org/10.1348/147608304X21374

Mattila, A. K., Salminen, J. K., Nummi, T., & Joukamaa, M. (2006). Age is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 61, 629–635. DOI: https://doi.org/10.1016/j.jpsychores.2006.04.013

Michal, M., Adler, J., Wiltink, J., Reiner, I., Tschan, R., Wolfting, K., . . . Zwerenz, R. (2016). A case series of 223 patients with depersonalization -derealization syndrome. BMC Psychiatry, 16, 203. DOI: https://doi.org/10.1186/s12888-016-0908-4

Modestin, J., Lötscher, K., & Erni, T., (2002). Dissociative experiences and their correlates in young non-patients. Psychology and Psychotherapy, 75, 53-64. DOI: https://doi.org/10.1348/147608302169544

New, A.S., Rot, M.A.H., Ripoll, L.H., Perez-Rodriguez, M.M., Lazarus, S., Zipursky, E., . . . Siever, L.J. (2012). Empathy and alexithymia in borderline personality disorder: Clinical and laboratory measures. Journal of Personality Disorders, 26, 660-675. DOI: https://doi.org/10.1521/pedi.2012.26.5.660

O’Brien, F.M., Fortune, G.M., Dicker, P., O’Hanlon, E., Cassidy E., Delanty N., … & Murphy, K. C. (2015). Psychiatric and neuropsychological profiles of people with psychogenic nonepileptic seizures. Epilepsy and Behavior, 43, 39-45. DOI: https://doi.org/10.1016/j.yebeh.2014.11.012

Ogrodniczuk, J.S., Piper, W. E., & Joyce, S.J. (2011). Effect of alexithymia on the process and outcome of psychotherapy: A programmatic review. Psychiatry Research, 190, 43-48. DOI: https://doi.org/10.1016/j.psychres.2010.04.026

Onor, M.L., Trevisiol, M., Spano, M., Aguglia, E., & Paradiso, S. (2010). Alexithymia and aging. The Journal of Nervous and Mental Disease, 198, 891-895. DOI: https://doi.org/10.1097/NMD.0b013e3181fe743e

Paivio, S.C., & McCulloch, C.R. (2004). Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse and Neglect, 28, 339-354. DOI: https://doi.org/10.1016/j.chiabu.2003.11.018

Parker, J.D., Taylor, G.J., & Bagby, R.M. (1998). Alexithymia: relationship with ego defense and coping styles. Comprehensive Psychiatry, 39, 91-98. DOI: https://doi.org/10.1016/S0010-440X(98)90084-0

Prasko, J., Grambal, A., Kasalova, P., Kamardova, D., Ociskova, M., Holubova, M., . . . Zatkova, M. (2016). Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders. Neuropsychiatric Disease and Treatment, 12, 2659-2676. DOI: https://doi.org/10.2147/NDT.S118058

Preece, D., Becerra, R., Robinson, K., & Dandy, J. (2018). Assessing alexithymia: Psychometric properties and factorial invariance of the 20-item Toronto Alexithymia Scale. Journal of Psychopathology and Behavioral Assessment, 40, 276-287. DOI: https://doi.org/10.1007/s10862-017-9634-6

Rafiq, S., Campodonico, C., & Varese, F. (2018). The relationship between childhood adversities and dissociation in severe mental illness: A meta-analytic review. Acta Psychiatrica Scandinavica, 138, 509-525 DOI: https://doi.org/10.1111/acps.12969

Rufer, M., Held, D., Cremer, J., Fricke, S., Moritz, S., Peter, H., & Hand, I. (2006). Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. Psychotherapy and Psychosomatics, 75, 40-46. DOI: https://doi.org/10.1159/000089225

De Ruiter, M.B., Elzinga, B., & Phaf, H. (2008). Dissociation: Cognitive capacity or dysfunction. Journal of Trauma and Dissociation. Journal of Trauma and Dissociation, 7, 115-134. DOI: https://doi.org/10.1300/J229v07n04_07

Saariaho, A.S., Saariaho, T.H., Mattila, A.K., Karukivi, M., & Joukamaa, N.I. (2015). Alexithymia and early maladaptive schemas in chronic pain patients. Scandinavian Journal of Psychology, 56, 428-437. DOI: https://doi.org/10.1111/sjop.12226

Schimmenti, S. (2017). The developmental roots of dissociation: A multiple mediation analysis. Psychoanalytic Psychology, 34, 96-105. DOI: https://doi.org/10.1037/pap0000084

Schimmenti, A., & Caretti, V. (2016). Linking the overwhelming with the unbearable. Developmental trauma, dissociation, and the disconnected self. Psychoanalytic Psychology, 33, 106-128. DOI: https://doi.org/10.1037/a0038019

Schimmenti, A., Sideli, L., LaMarca, L., Gori, A., & Grazia, T. (2109). Reliability, validity, and factor structure of the Maladaptive Daydreaming Scale (MDS-16) in and Italian sample. Journal of Personality Assessment, 23, 1-13.

Spitzer, C., Barrow, S., Freyberger, H.J., & Grabe, H. (2007). Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Australian and New Zealand Journal of Psychiatry, 41, 682-687. DOI: https://doi.org/10.1080/00048670701449146

Suurmond R, van Rhee, H, Hak T. (2017). Introduction, comparison and validation of Meta-Essentials:

A free and simple tool for meta-analysis. Research Synthesis Methods. 8, 537-553.

Taylor, G.J., Bagby, R.M., & Parker, J.D.A. (1997). Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge University Press, New York, N.Y. DOI: https://doi.org/10.1017/CBO9780511526831

Terock, J., Janowitz, D., Spitzer, C., Miertsch, M., Freyberger, H.J., & Grabe, H.J., (2015). Alexithymia and self-directedness as predictors of psychopathology and psychotherapeutic treatment outcome. Comprehensive Psychiatry, 62, 34-41. DOI: https://doi.org/10.1016/j.comppsych.2015.06.007

Terock, J., Janowitz, D., Grabe, H.J., Freyberger, H.J., Schneider, W., & Klauer, T. (2017). Alexithymia and Psychotherapeutic treatment motivation: Main and interactional effects on treatment outcome. Psychotherapy and Psychosomatics, 86, 185-1286. DOI: https://doi.org/10.1159/000457961

Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66-81. DOI: https://doi.org/10.1016/j.jpsychores.2017.06.007

Yilmaz, O., Ateş, M.A., Semiz, Ü.B., Tütüncü, R., Bez, Y., Algül, A…& Çetin, M. (2016). Childhood traumas in patients with bipolar disorder: Association with alexithymia and dissociative experiences. Australian Journal of Psychiatry, 17, 188-195. DOI: https://doi.org/10.5455/apd.188358

Zamir, O., Szepsenwol, O., Englund, M.M., & Simpson, J.A. (2018). The role of dissociation in revictimization across the lifespan: A 32-year prospective study. Child Abuse and Neglect, 79, 144-153. DOI: https://doi.org/10.1016/j.chiabu.2018.02.001

Ziadni, M.S., Jasinsji, M.J., Labouvie-Vief, G., & Lumley, M.A. (2016). Alexithymia, defenses, and ego strength: Cross sectional and longitudinal relationships with psychological well-being and depression. Journal of Happiness Studies, 18, 1799-1813. DOI: https://doi.org/10.1007/s10902-016-9800-7

Zlotnick, C., Shea, M.T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse and self-mutilation. Comprehensive Psychiatry, 37, 12-16. DOI: https://doi.org/10.1016/S0010-440X(96)90044-9

Zorzella, K.P., Muller, R.T., Cribbie, R.A., Bambrah, V., & Classen, C.C. (2019). The role of alexithymia in trauma therapy outcomes: Examining improvements in PTSD, dissociation and interpersonal problems. Psychological Trauma: Theory, Research, Practice and Policy, doi: 10.1037/tra0000433. DOI: https://doi.org/10.1037/tra0000433

Alexithymia, Dissociation, Meta-analysis
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How to Cite
Reyno, S. M., Simmons, M., & Kinley, J. (2020). A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1). https://doi.org/10.4081/ripppo.2020.439