The Perth Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia

Background: Alexithymia is a trait characterized by difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is widely regarded as an important transdiagnostic risk factor for a range of psychopathologies, including depressive and anxiety disorders. Whilst several well-validated psychometric measures of alexithymia exist, these are relatively lengthy, thus limiting their utility in time-pressured settings. In this paper, we address this gap by introducing and validating a brief 6-item version of the Perth Alexithymia Questionnaire, called the Perth Alexithymia Questionnaire-Short Form (PAQ-S). Method: Across two studies with adult samples (Study 1 N = 508 United States community; Study 2 = 378 Australian college students), we examined the psychometric properties of the PAQ-S in terms of its factor structure, reliability, and concurrent/criterion validity. Results: In exploratory and confirmatory factor analyses, all PAQ-S items loaded well on a single general alexithymia factor. The PAQ-S total score had high reliability, and correlated as expected with the long-form of the PAQ, as well as other established markers of alexithymia, emotion regulation, and affective disorder symptoms. Limitations: Our samples were general community or college student samples from two Western countries; future validation work in clinical samples and more diverse cultural groups is thus needed. Conclusions: The PAQ-S retains the psychometric strengths of the PAQ. As such, the PAQ-S can be used as a quick, robust measure of overall alexithymia levels. The introduction of the PAQ-S hence enables valid assessments of alexithymia in a more diverse range of settings and research designs

Alexithymia and emotion regulation

BackgroundAlexithymia is a key transdiagnostic risk factor for emotion-based psychopathologies. Conceptual models specify that this is because alexithymia impairs emotion regulation. However, the extent of these putative emotion regulation impairments remains underexplored. Our aim in this study was to begin to address this gap by examining whether people with high, average, or low levels of alexithymia differ in the types of emotion regulation strategies they typically use.MethodGeneral community adults from the United States (N = 501) completed a battery of alexithymia and emotion regulation measures. Participants were grouped into high, average, and low alexithymia quantiles.ResultsAfter controlling for demographics and current levels of distress, the high, average, and low alexithymia groups differed in their use of cognitive and behavioral emotion regulation strategies. Compared to the other groups, the high alexithymia group reported lesser use of generally adaptive regulation strategies (cognitive reappraisal, approaching problems, and seeking social support) and greater use of generally maladaptive regulation strategies (expressive suppression, behavioral withdrawal, ignoring).LimitationsOur data were cross-sectional and from self-report questionnaires. Future work in other cultural groups would be beneficial.ConclusionsOur results support the view that alexithymia is associated with impaired emotion regulation. In particular, people with high alexithymia seem to exhibit a less adaptive profile of emotion regulation strategies. Direct targeting of these emotion regulation patterns in psychotherapy may therefore be a useful pathway for the treatment of emotional disorder symptoms in people with high alexithymia.</p

Assessment of the revised Difficulties in Emotion Regulation Scales among adolescents and adults with severe mental illness

The Difficulties in Emotion Regulation Scale (DERS) comprising 36 items has been widely used across age, gender, psychopathology, language, and culture. Recently several alternative abridged forms have been introduced, namely, the DERS-16 (Bjureberg et al. 2016), the DERS-SF (Kaufman et al. 2016), and the DERS-18 (Victor and Klonsky, 2016), each composed of 16 or 18 items, to provide researchers and clinicians with a shorter measure of emotion dysregulation. However, no study to date has directly compared the psychometrics of these alternative forms. In the present study, using confirmatory factor analysis we first examined the factor structure of the four models of the DERS in two inpatient samples of 636 adolescents in the age-range of 12–17 years (M = 15.33, SD = 1.43), and 1807 adults in the age-range of 18–76 years (M = 34.86, SD = 14.63) with severe mental illness. Next, measurement invariance was tested comparing the two age groups across the four models of DERS. Only the DERS-SF established metric and scalar measurement invariance. Findings suggest that the factor structure of the original and the abridged models of DERS have acceptable fit, however only DERS-SF had equivalence of factor loadings and item intercepts across adolescents and adults

Standard set of patient-reported outcomes for personality disorder

Purpose The purpose of the article is to present standard set of outcomes for people with personality disorder (PD), in order to facilitate patient outcome measurement worldwide. Methods The International Consortium for Health Outcomes Measurement (ICHOM) gathered a multidisciplinary international working group, consisting of 16 experts, including clinicians, nurses, psychologists, methodologists and patient representatives, to develop a standard set of outcome measures for people with PD. The Delphi method was used to reach consensus on the scope of the set, outcome domains, outcome measures, case-mix variables and time points for measuring outcomes in service users. For each phase, a project team prepared materials based on systematic literature reviews and consultations with experts. Results The working group decided to include PD, as defined by International Classification of Diseases 11th revision (ICD-11). Eleven core outcomes and three optional outcomes across four health domains (mental health, behaviour, functioning and recovery) were defined as those relevant for people with PD. Validated measures for the selected outcomes were selected, some covering more than one outcome. Case-mix variables were aligned to other ICHOM mental health standard sets and consisted of demographic factors and those related to the treatment that people received. The group recommended that most outcomes are measured at baseline and annually. Conclusion The international minimum standard set of outcomes has the potential to improve clinical decision making through systematic measurement and comparability. This will be key in improving the standard of health care for people with PD across the world

Emotion beliefs are associated with emotion regulation strategies and emotional distress.

Emotion regulation strategies such as rumination and suppression have been consistently associated with distress and psychopathology. However, it is not yet known why people engage in maladaptive strategies instead of adaptive strategies despite their negative consequences. Beliefs about emotion have been theorized to influence which emotion regulation strategies are used, and therefore, the development of emotional disorders. This research seeks to test these predictions. We present a cross-sectional study (N = 400) using confirmatory factor analysis, as well as mediation analysis within a structural equation modeling framework. Beliefs that emotions are undesirable and uncontrollable emerged as interrelated yet separate factors. Both types of beliefs were associated with emotional distress (r = .36 for emotion undesirability, r = .53 for emotion uncontrollability), and more use of maladaptive emotion regulation strategies (r = .32; r = .44; respectively). SEM analyses showed that maladaptive emotion regulation strategies mediated the link between undesirability and uncontrollability beliefs and emotional distress. These results provide preliminary support for the hypothesis that negative beliefs about emotions influence the use of generally maladaptive emotion regulation strategies, intensifying symptomatology

Testing the impaired disengagement hypothesis: The role of attentional control and positive metacognitive beliefs in depression.

The impaired disengagement hypothesis holds that people ruminate – and thus increase their risk for depression – due to impaired attentional control and conflict signaling. We tested this hypothesis by examining the role of attentional control and conflict signaling (operationalized as positive metacognitive beliefs) in rumination and depressive symptoms. We expected that attentional control and positive metacognitive beliefs would be associated with depressive symptoms and that these associations would be cross-sectionally mediated by rumination. We tested two community samples (Study 1, N = 289; Study 2, N = 292), assessing attentional control, positive metacognitive beliefs, rumination, and depressive symptoms. In both studies, attentional control and positive metacognitive beliefs were significantly associated with rumination and depression, and path analyses corroborated the proposed mediation model. Our findings support the impaired disengagement hypothesis, and suggest that attentional control and positive metacognitive beliefs may be informative in the personalization of depression assessment and treatment

Association between deliberate self-harm and violent criminality

Importance Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. Objective To investigate the association between nonfatal self-harm and violent crime. Design, setting, and participants This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, &lt;2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016. Exposures Receipt of self-harm–associated clinical care. Main outcome and measures Conviction of a violent crime according to the Swedish penal code. Results The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group.Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95%CI, 1.8-1.9). Conclusions and relevance Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.</p