Alexithymia and Suicidal Behavior

Article excerpt

Abstract: A number of factors including hopelessness have been identified as amplifying suicide risk. Alexithymia has recently been investigated as a predictor of suicidal behavior. The prevalence of the personality trait alexithymia in suicide attempters as well as other predictors of suicidal behavior were investigated in this study. One hundred suicide attempters were compared to 60 healthy controls on the measures of hopelessness, alexithymia, depression and suicidal ideation. First-timers and repetitive suicide attempters, males and females, married and unmarried suicide attempters were compared to each other in the suicide attempter group. The correlations of hopelessness, depression and alexithymia with suicidal intent and suicide lethality were investigated. The suicide attempter group did not display significantly higher scores on the alexithymia measure, compared to healthy controls. Alexithymia neither seemed to be a prevalent personality trait in suicide attempters nor a sensitive predictor of suicidality. The subscales of Toronto Alexithymia Scale measuring difficulty in identification and expression of feelings also did not reveal a significant difference between the two groups. Suicide attempters were more depressive, more hopeless and displayed greater suicidal ideation than healthy controls. Severity of depression was a stronger predictor of suicidal intent than hopelessness in the suicide attempter group. The lethality of the suicide attempt did not correlate with any of the psychometric measures. These findings propose that difficulty in the identification and articulation of feelings does not comprise a risk factor for suicidal behavior.

Introduction

Suicide attempt or parasiticide is defined as "an act with nonfatal outcome in which an individual deliberately initiates a non-habitual behavior that, without intervention by others, will cause self-harm, or ingests a substance in excess of the prescribed or generally recognized therapeutic dosage, and which is aimed at realizing changes which he/she desired via the actual or expected physical consequences" (1). A number of factors including hopelessness have been identified as amplifying the suicide risk. Hopelessness has been defined as a negative expectation or pessimistic attitude toward oneself or the future and may be regarded as part of the cognitive distortion of depressed and suicidal patients (2). In a study by Beck et al., hopelessness was 1.3 times more important than depression in explaining suicidal ideation (3). Recently the hypothetical personality construct of alexithymia has been investigated as a predictor of suicidal behavior.

The personality construct of alexithymia describes individuals with an inability to identify and express emotions, an externally oriented mode of thinking, and a restricted fantasy life (4). Although initially reported as more prevalent in psychosomatic disorders, recent studies indicate that alexithymic characteristics are also common in various psychiatric disorders such as post-traumatic stress disorder, eating disorders, panic disorder and substance use disorders (5). Alexithymic individuals are reported to have a limited capacity to verbalize and comment on life events, particularly events with high affective content (6). Certain personality characteristics have been associated with alexithymia such as social introversion, impulse expression, perceived difficulties of self-disclosure, neuroticism and emotional suppression (7). Similar to alexithymic individuals, the suicidal individual is also emotionally and cognitively restricted, unable to differentiate his feelings, verbalize them and solve the problem (8). A study with adolescent suicide attempters revealed that suicide attempters were more socially withdrawn and less talkative than depressed adolescent non-attempters (9). Taiminen et al. (8), studying 50 suicide attempters, did not find alexithymia to be more prevalent than non-suicidal depressive patients. …