Alexithymia in maltreated children and adolescents: A meta-analysis

• In Event: Effects of maltreatment across the life course and across generations

Abstract

Introduction: Children who experience maltreatment, including emotional, sexual and physical abuse and emotional and physical neglect, are at elevated risk for many forms of psychopathology. Childhood maltreatment impedes the development of emotion skills, including the ability to recognize and differentiate emotions in other people and the ability to understand one’s own emotions, a phenomenon known as alexithymia. Alexithymia is characterized by difficulty in recognizing, describing, distinguishing and expressing one’s own emotions and difficulty in fantasizing. Many studies support the role of alexithymia as a mediator between childhood maltreatment and various psychological disorders. The goal of this meta-analytic review was to summarize the magnitude of the association between maltreatment and alexithymia and to test whether the magnitude of the effect size varied across subtypes of maltreatment: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). We included a number of moderators, including study and sample characteristics to examine if they were associated with the magnitude of the relationship between maltreatment and alexithymia.
Method: Studies (54 studies, n=25,899) were selected through an extensive search of PsycInfo, Web of Science and ERIC using a comprehensive list of search criteria to capture both general maltreatment as well as subtypes. All titles and abstracts were reviewed for inclusion by two coders, requiring agreement by both coders. All disagreements were settled through consensus and discussion. Effect sizes for this study were calculated based on Cohen’s d, which examines the difference between two means. Six separate meta-analyses were conducted in R 4.0.0 using the package “metafor” to examine the differences in alexithymia for those who experienced maltreatment compared to those who did not. This was repeated for the five subtypes of maltreatment: PA, EA, SA, PN, and EN. Due to substantial heterogeneity between studies, random effects models were used for all models, additionally allowing for generalizability outside of the study sample. Meta-regressions were conducted to examine moderator effects on the overall maltreatment model.
Results: There was a significant, small-moderate effect size for overall maltreatment, indicating that levels of alexithymia were higher for individuals who experienced maltreatment versus those who did not (d = 0.44, CI95%[0.37, 0.51], p<0.0001; Figure 1). Effect sizes for physical abuse (d = 0.23, CI95%[0.15, 0.31], p<0.0001) and sexual abuse (d = 0.26, CI95%[0.18, 0.34], p<0.0001) were small. Effect sizes for emotional abuse (d = 0.44, CI95%[0.35, 0.52] p<0.0001) and physical neglect (d = 0.41, CI95%[0.31, 0.51], p<0.0001) were small-moderate. The effect size for emotional neglect was moderate (d = 0.50, CI95%[0.40, 0.59], p<0.0001). Although there was significant heterogeneity among the overall maltreatment effects, none of the moderators were significant.
Conclusion: Childhood maltreatment, particularly emotional abuse and neglect, is moderately associated with difficulties in the ability to understand one’s own emotions. This deficit in emotion knowledge, combined with difficulties in understanding other people’s emotions, may be an important mechanism in linking maltreatment with multiple forms of psychopathology. Treatments that target emotion understanding (e.g., TF-CBT) may be particularly effective in reducing risk for psychopathology in maltreated youth.

Authors

• Anika Khan, University of Pennsylvania
  Presenting Author

• Sara R Jaffee, University of Pennsylvania
  Non-Presenting Author