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International Journal of Social and Educational Innovation (IJSEIro) 

Volume 10/ Issue 19/ 2023 

 
 

42 

 

 

ALEXITHYMIA AND MENTAL HEALTH IN ADOLESCENTS: 

A SCOPING REVIEW 

 

Remus RUNCAN1, Patricia RUNCAN2, Dana RAD1*, Marius MARICI3* 

1 Faculty of Educational Science, Psychology and Social Work, Aurel 

Vlaicu University of Arad, 310032 Arad, Romania 

2 Faculty of Sociology and Psychology, West University of Timisoara, 

300223 Timisoara, Romania 

3 Faculty of Educational Science, Ștefan cel Mare University, 720229, 

Suceava, Romania. 

* Correspondence: dana@xhouse.ro (D.R.); marius.marici@usm.ro (M.M.) 

Tel.: +40-727-803-036 (D.R.); +40-747-494-707 (M.M.) 

 

Abstract 

The aim of the study was to review alexithymia in adolescents-related studies (AARS) pub-

lished between 2004 (since the first public archive volume is available) and 2022 in the In-

ternational Journal of Environmental Research and Public Health. The present paper attempts 

to explain the increasing interest in alexithymia as shown by the large number of alexi-

thymia-related studies (ARS) on this disorder, published in this journal, in the last six years, as 

well as by the forthcoming special issue ‘Alexithymia and Mental Health in Adolescents: 

Theory, Research and Clinical Practice’ of the same journal, with a scoping review approach. 

The participants were adolescents from 13 counties and 2 continents. Only two interventions 

were subjected to the study. The systematic literature review conducted observed the Preferred 

Reporting Items for Systematic Literature Reviews and the Meta-Analyses (PRISMA) method. 

Twenty-nine ARS were selected, of which 17 are AARS. Results indicate that there is a great 

research interest in studying alexithymia, although IJERPH does not cover all research topics 

in the field. 

 

Keywords: alexithymia; mental health; adolescents; review. 

 

1. Introduction 

Considered, in psychiatry, a ‘difficulty in experiencing, expressing, and describing emotional 

responses’ and, in medicine, an inability to describe emotions in a verbal manner’ (The Ran-

dom House Dictionary of the English Language, 2022), alexithymia is, defined as ’deficits in 

cognitive processing of emotions’ [1] and not as a mental disorder. The most likely source of 

alexithymia is considered to be a mix of biology and environment. In other words, some indi-

viduals may be predisposed to alexithymia from birth, and then encounter traumatic events or 

relationships deterioration that act as ultimate triggers. 



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Teenagers may have a specific need to control their emotions in reaction to stresses because of 

the increased independence and unique demands they face throughout adolescence compared 

to childhood. Failure to do so might increase the chance of mental health issues. 

Researchers have studied alexithymia in adolescents from various perspectives: behavioral [2], 

biological [3], epistemological [4], legal, medical [2,5-8], neurobiological [9,10], psychiatric 

[11-17], psychological [7,18-22], and psychosomatic [23]. 

Scoping reviews are first and rapid exploratory evaluations of the evidence that is already 

accessible. This kind of investigation is necessary for having a preview over a phenomenon, 

such as alexithymia. The aim of a scoping review is to map a phenomenon, and it is more an 

exploratory project, which is focused to map different elements such as correlates, instruments 

or other significant information available, in a specific research field. The main purpose of the 

study was not to draw clear-cut conclusions about alexithymia as it happens in meta-analyses 

investigations or in classical systematic reviews, but to map the phenomenon, regarding sev-

eral more obvious elements. This specific purpose allowed us to limit our research to only one 

journal, The International Journal of Environmental Research and Public Health. 

 

2. Literature Review 

 

2.1. Definition and Features of Alexithymia 

Researchers defined alexithymia in different ways. Alexithymia is considered ‘not a diagnosis’ 

[24] but rather an idea or a theory formed of multiple concepts, which is related to individuals’ 

subjective world and it is not founded on empirical evidence [24], a ‘clinical construct’ [19, 

p.152] useful for describing patients [24, p.1], ‘a cognitive and affective disturbance’ [25, 

p.287], a similar to animals kind of ‘stress induced analgesia’ [26, p.30] or a ‘multidimensional 

construct’ [27, p.9, 28-29]. It is also considered a ‘difficulty’ [25, p.287, 27, p.12], ‘a deficit’ 

[30, p.156, 31], a ‘lack’ of qualities [32, p.158], or a cognitive or emotional deficit, emotional 

numbness, emotional indifference or emotional impairment [9], or a decrease of altruism [29] 

or a ‘poor ability’ [19, p.152]. It can be also viewed as a difficutly emotionalizing [27]. 

Alexithymia is also described as a intergenerational transmissibility (from both parents) [29] or 

as a decrease of altruism in social decisions [17,33]. 

Generally, alexithymia refers to the way individuals experience and express their emotions 

[27]. Alexithymia refers maily to a reduced emotional ability to prefer inner expereinces or 

understand, name, identify, distinguish, analyze and describe in words emotions [19, 27, 26]. It 

can be refered to as a diminished cognitive processing and a low ability to regulate emotional 



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states [30]. Other researchers define alexithymia in the social context refering to it as an 

inability to build and maintain relationships [31]. 

More often researchers refer to a number of features observed in individuals with alexithymia. 

These individuala have ‘poor interoceptive awareness’ [19, p.152], and manifest obstacles in 

fantasizing or emotionalizing [25] and are not fully aware of the emotions they are obviously 

experiencing, and they do not find words to describe the experiences they have towards other 

people [24]. They find it difficult to dissociate between bodily sensations and feelings [25] and 

they prefer to foccus rather on external events and actions than on internal experiences [25]. 

They prefere to describe events in detail than doing the same with their inner world [9]. 

Individuals with alexithymia have an ‘externally oriented thinking’ [27, p.12], find it difficult 

to introspect or even socially conform [32]. They have a difficult time communicating with 

others , using symbols in conversations or even identifying vocal or facial signs of emotion [9]. 

They live an ‘impoverished fantasy life’ [25, p.287] as their fantasies are reduced [27] or they 

have a decreased capacity for fantacy [9] and their dream recall are poor [32]. Their emotional 

experiences are rather blunting [9]. 

 

2.2. Alexithymia in Adolescents 

Researchers have associated alexithymia in adolescents with antisocial behavior (including 

ADHD) [34], anxiety [7,13,34]), delinquency [18], depression [7,13,19,34-36], dissociation 

[12] or eating disorders [8,13,37]. Alexithymia is also associated with generalized anxiety 

disorder [21], other mental disorders [13,34], with psychiatric symptoms [17], with somatic 

symptom disorder [13] or even suicide risk [36]. 

According to researchers, alexithymia in adolescents may contribute to aggressive behavior in 

teenage violent psychiatric outpatients [5]. It can facilitate deliberate self-harm in bullied ad-

olescents [17], it can lead to a higher risk of problematic Internet use in female adolescents 

with low affective regulation [2,7]. It can make it difficult to generate cognitive reappraisal 

strategies in autism spectrum disorder [16,38], or it can be a mediator in the relationship be-

tween attachment and the incidence of borderline personality disorder [15]. Alexithymia can be 

associated with anxiety and depression in anorexia nervosa female adolescents [8]. 

The present progress in research indicates that it is paramount to identify alexithymia early, as 

it can be a risk factor for suicide, especially when adolescents suffer from depression and in the 

context in which there are signs of maladaptive early schemata [36]. Studies indicate that there 

are a number of predictors of alexithymia. Fear of separation found in anxious attachment style 

was a predictor of alexithymia and also the low ability to identify feelings. In addition, con-



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45 

 

straints on closeness found in avoidant attachment was a significant predictor of difficulties 

expressing feelings verbally. Individuals who have a predominant exterior-oriented way of 

thinking reported also a low attachment to the primary figure of attachment [20]. Alexithymia 

can be also predicted by other variables such as: children’s perception of a neglectful parenting 

style [17,39-43], a speech development deficit in childhood [13,44], a lower cognitive ability to 

evaluate, naming and expressing in words the emotional states experienced [2], a low 

self-control of emotions [45,46] or parents’ alexithymic traits [17]. 

 

3. Materials and Methods 

 

3.1. Study Design 

This research represents a single journal scoping review of literature, taking into account the 

Preferred Reporting Items for Systematic Literature Reviews and the Meta-Analyses 

(PRISMA) method [17,47,48]. This research method was chosen due to its relevance for ac-

ademic studies [49-55]. 

The main research questions that this scoping review is addressing are: 

(1) What topics have been recently studied to address alexithymia in adolescents? 

(2) What research progress has been made in the publications disseminated by International 

Journal of Environmental Research and Public Health? 

 

3.2. Conducting the Scoping Review 

The systematic literature review was conducted in the International Journal of Environmental 

Research and Public Health. The database was searched between the 3rd of September and the 

23rd of September, 2022, for studies published from 2004 up to the 1st of September, 2022. 

Although the time interval for this scoping review was large, about 15 years, and included 

hundreds of articles, actually, the first published article on alexithymia, in this journal, which 

we found, was in 2009. But the first volume available in the IJERPH public archive database 

was found starting with 2004. 

Only studies containing the search term ‘alexithymia’ in the title, abstract and/or keywords 

were included in the study in the first phase (see Table 1, Figure 1, Table 2). The search term 

‘adolescents’ in the title, abstract and/or keywords was included in the study, in the second 

phase (see Table 3). 

Table 1. ARS between 2004 and the 1st of September, 2022. 

Year Number Issues Studies Year Number Issues Studies 



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2004 1 2 absent 2014 11 12 absent 

2005 2 3 absent 2015 12 12 absent 

2006 3 4 absent 2016 13 12 absent 

2007 4 4 absent 2017 14 12 2 

2008 5 5 absent 2018 15 12 1 

2009 6 12 1 2019 16 24 1 

2010 7 12 absent 2020 17 24 5 

2011 8 12 absent 2021 18 24 10 

2012 9 12 absent 2022 19 17 9 

2013 10 12 absent     

 

Source: Table created with Microsoft Word. 

 

 

 

Figure 1. ARS between 2004 and the 1st of September, 2022. Blue bars refer to issues from 

IJERPH published every year. Orange bars refer to the number of articles published on alexi-

thymia. 

Source: Table created with Microsoft Word 

 

3.3. Search Strategy 

A single search strategy was applied: TITLE – ABS – KEY (alexithymia AND adolescents). 

Any research design, whether it used methodology, qualitative or quantitative approaches, or 

guideline reporting, was eligible. Our inclusion criteria were centered on approaches for re-

search in the area of alexithymia in adolescents, thus the only selection criteria was a targeted 

on age demographic approach. 

2
3

4 4
5

12 12 12 12 12 12 12 12 12 12

24 24 24

17

0 0 0 0 0
1

0 0 0 0 0 0 0
2

1 1

5

10
9

Number of issues Number of articles



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As a result of searching the IJERPH database, we identified a number of 17 articles on alexi-

thymia in adolescents. The process of identification, screening, assessment of eligibility, and 

inclusion of studies is show in Figure 2. 

 

Studies identified through searching the International 

Journal of Environmental Research and Public 

Health archive 

(n = 684) 

 

Out of scope studies excluded 

(n = 655) 

 

ARS included in analysis 

(n = 29) 

 

AARS included in analysis 

(n = 17) 

 

Figure 2. Procedure of identification, screening, assessment of eligibility, and inclusion of 

AARS within the systematic literature review. 

Source: Table created with Microsoft Word. 

 

3.4. Data Presentation 

A first set of data extracted from the studies selected consisted in the name of the first author, 

the year the study was published, the type of research, the country where the study was con-

ducted, the sample, the age of the respondents, and the research method. A second set of data 

was extracted from ARS and referred to the name of the first author, the year the study was 

published, the aim of research, and the findings of research. 

 

4. Results 

Of the 684 studies published between 2004 and the first of September, 2022 only 29 (4.24%) 

tackle alexithymia – directly or indirectly – and only 17 tackle alexithymia in adolescents. If, 

between 2004 and 2017, there was a single study on alexithymia, between 2017 and September 

2022 there were published 28 new studies (see Table 1, Figure 1). These numbers suggest that 



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the interest for such studies grew considerably. Future studies should find evidence whether 

this may be due to an increase of the incidence of alexithymia among adolescents in developed 

countries, or to the increasing sophistication of the measurement tools. 

The description of the 29 ARS included in the systematic literature review presented in this 

Section is divided into two sub-sections: (1) Section 4.1 – Details of ARS, and (2) Section 4.2 – 

Key/main findings of ARS. 

 

4.1. Details of ARS Included in the Systematic Literature Review 

Table 2 presents the general details of the ARS included in the systematic survey. 

 

Table 2. General details of the ARS included in the systematic survey. 

Author & Year Research 

Method 

Country Sample Age Method 

Celikel et al., 

2009 [56] 

quantitative Turkey 1870 late 

adolescents 

21.2 ± 2.0 

years old 

questionnaire 

(ASI, BDI, BHS, 

TAS-20) 

Popa-Velea et al., 

2017 [57] 

quantitative Romania 299 late ad-

olescents 

19.23 years 

old 

questionnaire 

(FSSQ, MBI, 

PSS, TAS-20) 

Wachs et al., 

2017 [58] 

quantitative Germany, 

Thailand 

1549 ado-

lescents 

12-18 years 

old 

questionnaire 

(MQS, TAS-20) 

Cimino et al., 

2018 [59] 

quantitative Italy 226 adoles-

cents 

14-17 years 

old 

questionnaire 

(BiES, BIS-11, 

TAS-20, YSR) 

Romero-Martínez 

et al., 2019 [60] 

quantitative Spain 118 intimate 

partner vio-

lence against 

women per-

petrators 

41.47 years 

old 

questionnaire 

(AUDIT, 

MCMI-III, PIS, 

SCL-90-R, 

TAS-20) 

Testoni et al., 

2020 [61] 

quantitative Italy 150 adoles-

cents 

12-14 years 

old 

questionnaire 

(AQC, HSC, 

READ, SCWBS, 

TAS-20) 

Song et al., 2020 

[62] 

quantitative China 1062 ado-

lescents 

11.92–

19.58 years 

old 

questionnaire 

(CAIHLQ, SDS, 

TAS-20) 

Paricio et al., 

2020 [63] 

quantitative Spain 176 adoles-

cents 

11-15 years 

old 

questionnaire 

(BaHS, BES, 

GSES, LSDSA, 

RSE, SSoS, 

SVPAD, 



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TAS-20, TGIS) 

Lin, 2020 [64] quantitative Taiwan 1060 ado-

lescents 

14.66 years 

old 

questionnaire 

(BIS, CHI, CIAS, 

DASS, FVI, 

RSE, SSuS, 

TAS-20, VSSS) 

Casagrande et al., 

2020 [65] 

quantitative Italy 210 medical 

patients 

40-75 years 

old 

questionnaire 

(TAS-20) 

Tomaszek et al., 

2021 [66] 

quantitative Poland 91 patients 18+ years 

old 

questionnaire 

(PTGI-R, SPP25, 

TAS-20) 

Barchetta et al., 

2021 [67] 

quantitative Italy 142 subjects 

including 

late adoles-

cents 

19-39 years 

old 

questionnaire 

(TAS-20, ZTPI) 

Hobson et al., 

2021 [68] 

quantitative UK 289 children 

& adoles-

cents 

9.17-16.33 

years old 

questionnaire 

(CAM, CCC, 

EAQ, TAS-20, 

WISC) 

Tambelli et al., 

2021 [69] 

quantitative Italy 454 late ad-

olescents 

18-25 years 

old 

questionnaire 

(CPDI, IPPA, 

TAS-20) 

Ballarotto et al., 

2021 [70] 

quantitative Italy 400 late ad-

olescents 

18-25 years 

old 

questionnaire 

(BIAS, CPDI, 

IAT, TAS-20) 

Gong et al., 2021 

[71] 

quantitative China 895 males 

with sub-

stance use 

disorder 

37.87 years 

old 

questionnaire 

(BIS, BWAQ, 

CPIC, DCS, FES, 

ITS, LES, PPQ, 

SQ, TAS-20) 

Wojciechowska 

et al., 2021 [72] 

quantitative Poland 66 emer-

gency call 

operators 

31.09 years 

old 

questionnaire 

(IES, TAS-20, 

WPSQ) 

Mancinelli et al., 

2021 [73] 

quantitative Italy 453 adoles-

cents 

15-19 years 

old 

questionnaire 

(IPPA, RPQ, 

TAS-20) 

Topino et al., 

2021 [74] 

quantitative Italy 193 online 

gamblers 

28.8 years 

old 

questionnaire 

(DES-II, 

FACES-IV, 

SOGS, TAS-20) 

Ikarashi et al., 

2021 [75] 

quantitative Japan 80 late ado-

lescents 

21 ± 0.5 

years old 

questionnaire 

(PVAQ, TAS-20) 

Maiorana et al., 

2022 [76] 

quantitative Italy 31 males 21-58 questionnaire 

(TAS-20) 



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Quinto et al., 

2022 [77] 

quantitative Italy 150 patients 

with psoria-

sis 

≥ 18 years 

old 

questionnaire 

(HAS, SF-12, 

PASI, TAS-20) 

Tsiori et al., 2022 

[78] 

quantitative Greece 104 patients 

with psoria-

sis 

No mention 

about the 

age of the 

respondents 

questionnaire 

(BDI, SCL-90, 

TAS-20) 

Manfredi, 2022 

[79] 

quantitative Italy 396 late ad-

olescents 

18-25 years 

old 

questionnaire 

(EDS, SHS, 

SWLS, TAS-20) 

Rossi et al., 2022 

[80] 

quantitative Italy 187 female 

patients 

18-56 questionnaire 

(FSFI, MPQ, 

PANAS, 

QCSASC, 

SCL-90-R, 

SDBQ, SDS, 

SMQ, TAS-20) 

La Grutta et al., 

2022 [81] 

quantitative Italy 229 children 7-8 years 

old 

Techniques 

(Classroom 

Drawing, Col-

oured Progres-

sive Matrices, 

DANVA-2 POS, 

Drawn Stories, 

Picture of Facial 

Affects) 

Liu et al., 2022 

[82] 

quantitative China 344 late ad-

olescents 

19-22 years 

old 

questionnaire 

(BPS, TAS-20, 

UINAQ) 

Giustiniani et al., 

2022 [83] 

quantitative France 83 gamers, 

47 former 

heroin ad-

dicts 

No mention 

about the 

age of the 

respondents 

questionnaire 

(BDHI, BIS, 

DAS, SSS, 

TAS-20) 

Di Vito et al., 

2022 [84] 

quantitative Italy 150 adoles-

cents 

14-17 years 

old 

questionnaire 

(PCFS, REM-71, 

TAS-20, YSR) 

Source: Table created with Microsoft Word. 

 

4.2. Key/Main Findings of ARS Included in the Systematic Literature Review 

The key/main findings of the 29 ARS included in the systematic literature review are shown in 

Table 3. 

Table 3. Main findings of the 29 ARS included in the systematic literature review. 



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Author(s) Aim of research Findings 

Celikel et al., 2009 

[56] 

identify a possible correlation 

between smoking habits and alex-

ithymia 

smoking is not related to alexi-

thymia 

Popa-Velea et al., 

2017 [57] 

examine the impact of alexithymia 

on burnout 

alexithymia may play a signifi-

cant role in the development of 

burnout syndrome 

Wachs et al., 2017 

[58] 

research the direct and indirect 

associations between cyberbully-

ing victimization and perpetration, 

mediated by alexithymia 

the effects of cyberbullying vic-

timization on cyberbullying per-

petration are partially mediated 

by alexithymia 

Cimino et al., 2018 

[59] 

identify specific clusters of mala-

daptive emotional-behavioral 

symptoms in adolescent victims of 

motorbike collisions considering 

their scores on alexithymia 

adolescents’ motor collisions 

could be associated with their 

difficulties in emotion regulation 

Romero-Martínez et 

al., 2019 [60] 

assess whether alexithymia is a 

good predictor of the discontinua-

tion of treatment and the risk of 

recidivism during the initial stages 

of intervention in a sample of men 

convicted of IPVAW perpetration 

high alexithymic traits lead to 

discontinuation of treatment and 

a high risk of recidivism during 

the initial stages of treatment 

Testoni et al., 2020 

[61] 

investigate the psychological ef-

fects of participation in Death 

Education 

Death Education improves the 

students’ ability to recognize 

emotions and communicate them 

verbally 

Song et al., 2020 

[62] 

explore the relation among alexi-

thymia, depressive symptoms and 

health literacy 

alexithymia and health literacy 

influence depressive symptoms 

and health literacy has a moder-

ating role on the association be-

tween alexithymia and depressive 

symptoms 

Paricio et al., 2020 

[63] 

implement a psychosocial inter-

vention pilot program in the 

significant improvements are 

observed in alexithymia, among 



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school environment in a rural set-

ting and evaluate its effects 

other variables 

Lin, 2020 [64] examine the prevalence of Internet 

addiction and identify the psy-

chosocial risk factors during the 

COVID-19 outbreak 

high alexithymia is predictive of 

Internet addiction 

Casagrande et al., 

2020 [65] 

investigate the relationship be-

tween alexithymia and dipping 

status in adults 

alterations in the circadian pat-

tern of blood pressure can be 

linked to emotional dysregulation 

Tomaszek et al., 

2021 [66] 

determine the role of alexithymia 

in the post-traumatic growth as a 

response to extreme stress in pa-

tients 

alexithymia correlates negatively 

with some aspects of 

post-traumatic growth on kidney 

recipients from cadaveric donors 

Barchetta et al., 

2021 [67] 

explore the relationship between 

alexithymia and time perspective 

alexithymia is associated with a 

negative bias for past and present 

events 

Hobson et al., 2021 

[68] 

examine parent and child report 

measures of alexithymia in chil-

dren with Developmental Lan-

guage Disorder, and their associa-

tion to children’s communication 

skills 

children with Developmental 

Language Disorder score higher 

on parental measures of alexi-

thymia 

Tambelli et al., 2021 

[69] 

assess alexithymia, attachment to 

parents and peers, and peritrau-

matic distress due to COVID-19 

attachment to fathers and peers, 

but not to mothers, and alexi-

thymia significantly predict lev-

els of peritraumatic distress 

Ballarotto et al., 

2021 [70] 

verify whether peritraumatic dis-

tress due to the COVID-19 pan-

demic mediated the relationship 

between emerging adults’ alexi-

thymia and their Inter-

net/Instagram addiction 

emerging adults’ levels of alexi-

thymia significantly predicts the 

levels of Internet and Instagram 

addiction and peritraumatic dis-

tress due to the COVID-19 pan-

demic mediated this relationship 

Gong et al., 2021 

[71] 

explore which factors had a great-

er impact on substance craving in 

alexithymia positively predicts 

substance cravings 



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people with substance use 

Wojciechowska et 

al., 2021 [72] 

investigate the relationship be-

tween alexithymia, stress at work, 

and post-traumatic stress disorder 

in impact emergency call center 

operators 

alexithymic individuals have a 

higher risk of developing 

post-traumatic stress disorder 

Mancinelli et al., 

2021 [73] 

understanding the interplay be-

tween adolescents’ perceived at-

tachment to parents, alexithymia, 

and reactive/proactive aggression 

behaviors 

lower alexithymia has direct and 

indirect effects on reactive ag-

gression behavior 

Topino et al., 2021 

[74] 

investigate the relationship be-

tween alexithymia, dissociation, 

and family functioning in contrib-

uting to online gambling problems 

higher levels of alexithymia are 

personal risk factors for online 

gambling problems 

Ikarashi et al., 2021 

[75] 

investigate whether the correlation 

between alexithymia and hyper-

vigilance to pain is influenced by 

catechol-O-methyltransferase 

polymorphism 

the correlation between alexi-

thymia and hypervigilance to 

pain is influenced by cate-

chol-O-methyltransferase poly-

morphism 

Maiorana et al., 

2022 [76] 

assess the effect of surgical masks 

on configural and featural pro-

cessing of faces and subsequent 

effects on emotion perception 

in subjects with low levels of 

alexithymia, the sight of a 

masked face can lead to the mal-

adaptive activation of configural 

face processing 

Quinto et al., 2022 

[77] 

examine the mediating role of 

anxiety and depression in the rela-

tionship between alexithymia and 

mental health in psoriasis patients 

assessing alexithymia and psy-

chological distress in clinical 

practice is important in identify-

ing vulnerable patients 

Tsiori et al., 2022 

[78] 

evaluate the relationship between 

depression, psychopathology 

symptoms, and alexithymia in 

psoriasis patients 

alexithymia is a significant factor 

in the development of psycho-

pathology in psoriasis patients 

Manfredi, 2022 [79] investigate if symptomatic and increased levels of alexithymia 



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at-risk subjects have higher values 

of alexithymia 

can increase the risk of exercise 

dependence 

Rossi et al., 2022 

[80] 

assess the psycho-emotional pro-

file of women with endometriosis 

and with alexithymia 

alexithymia seems to be impli-

cated in the low sexual function-

ing of women with endometriosis 

La Grutta et al., 

2022 [81] 

evaluate the effectiveness of im-

plementing a psycho-educational 

group intervention aimed at im-

proving children’s emotional 

competence 

psycho-educational programs in 

school for promotion of emo-

tional health prevent the devel-

opment of clinical conditions 

linked to alexithymia 

Liu et al., 2022 [82] explore the relationship between 

alexithymia, boredom proneness, 

and internet novel addiction 

alexithymia may directly and in-

directly predict internet novel 

addiction through boredom 

proneness 

Giustiniani et al., 

2022 [83] 

compare individuals with Internet 

gaming disorder and former hero-

in addicts with regard to alexi-

thymia 

alexithymia could influence the 

orientation towards massively 

multiplayer online role-playing 

games 

Di Vito et al., 2022 

[84] 

explore the emotional–behavioral 

functioning in adolescents that 

have experienced more than three 

motor vehicle collisions in a year 

alexithymia represents a crucial 

risk factor for adolescents’ motor 

vehicle collisions 

 

Source: Table created with Microsoft Word. 

 

5. Discussion 

 

As this is s scoping review investigation, the discussion section presents a mapping perspec-

tive, meant to group and categorize the existing articles published in International Journal of 

Environmental Research and Public Health, from the point of view of nature, features or 

volume. 

 

 

5.1. Details of ARS Included in the Systematic Literature Review 



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In this scoping review, 29 ARS published between 2009 and 2022 were included. Most studies 

were published in 2021 [66-75] – ten studies in 2022 [76-84]. Five publications were published 

in 2020 [61-65], two in 2017 [57,58], and three publications were each published in 2009 [56], 

2018 [59], and 2019 [60], respectively (see Table 2). 

The ARS were conducted in different countries: China [62,71,82], France [83], Germany [58], 

Greece [78], Italy [59,61,65,67,69,70,73,74,76,77,79-81,84], Japan [75], Poland [66,72], 

Romania [57], Spain [60,63], Taiwan [64], Thailand [58], Turkey [56], and United Kingdom 

[68]. It is worth noticing that most research respondents are from developed European coun-

tries, where Italy leads with 14 studies. Future studies might clarify whether these studies are 

the effect of multifaceted social development or they were published in the attempt to better 

understand and find solutions for alexithymia. 

The number of respondents varied significantly and ranged between up to 100 people in each of 

the four studies [66,72,75,76], 101-250 people in each of the thirteen studies 

[59-61,63,65,67,74,77,78,80,81,83,84], 251-500 people in each of the seven studies 

[57,68-70,73,79,82], and over 501 people in each of the five studies [56,58,62,64,71]. 

Various methods of statistical analysis were used, including: analysis of variance 

[61,63,65,70,74,81,84], binary/binomial logistic regression analysis [62,78], chi-squared 

analysis [62], correlation analysis [67,69-71,73-75,77,84], descriptive analysis 

[57,64,70,80,81], factor analysis [58,64,68,79], hierarchical cluster analysis [59], hierarchical 

regression analysis [68], linear regression analysis [60,66,83], logistic regression analysis 

[56,60,64], mediation analysis [58,69,70,72-74,77,82], moderation analysis [61], multi-group 

analysis [79], multiple regression analysis [69], multivariate analysis of variance [59,80,83], 

path analysis [77] post hoc power analysis [58,74], simple effects analysis [63], statistical 

analysis [65,67,69,70,73,74,76,78,79,81-83], and stepwise backward regression analysis [57]. 

Alexithymia is a relatively new research topic which allows researchers to explore and find 

associations between this phenomenon and other psycho-social realities. Our review indicated 

that seventy-five measurement tools were used to assess alexithymia and related concepts. 

These measurement tools were labelled as checklists, indexes, inventories, measures, ques-

tionnaires, scales, screens, self-reports, surveys, or tests (see Table 3). 

 

Table 3. Measurement tools used in the articles identified, which refer to alexithymia or di-

mensions which are associated with alexithymia. 

1. AQC - Alexithymia Questionnaire for 

Children, 

39. PANAS - Positive and Negative Affects 

Scale, 



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2. BaES - Basic Empathy Scale, 

3. BDHI - Buss-Durkee Hostility Inventory, 

4. BDI - Beck Depression Inventory, 

5. BFFQ - Brief Family Function Ques-

tionnaire, 

6. BIAS - Bergen Instagram Addiction 

Scale, 

7. BiES - Binge Eating Scale, 

8. BIS - Barratt Impulsiveness Scale, 

9. BIS-11 - Barratt Impulsiveness Scale-11, 

10. BPS - Boredom Proneness Scale for 

College Students, 

11. BWAQ - Buss-Warren Aggression 

Questionnaire, 

12. CAIHLQ - Chinese Adolescent Interac-

tive Health Literacy Questionnaire, 

13. CAM - Children’s Alexithymia Measure, 

14. CCC - Children’s Communication 

Checklist, 

15. CHI - Chinese Happiness Inventory, 

16. CIAS - Chen Internet Addiction Scale, 

17. CPDI - COVID-19 Peritraumatic Distress 

Index, 

18. CPIC - Children’s Perception of In-

ter-parental Conflict Scale, 

19. DAS - Substance Dependence Adapted 

Scale, 

20. DASS - Depression Anxiety Stress Scale, 

DCS - Drug Craving Scale, 

21. DES-II - Dissociative Experience 

Scale-II, 

22. EAQ - Emotional Awareness Question-

naire, 

23. EDS - Exercise Dependence Scale, 

40. PASI - Psoriasis Area Severity Index, 

41. PCFS - Perceived Collective Family Scale, 

42. PPQ - Positive Psychological Capital, 

43. PTGI-R - Post Traumatic Growth Inventory 

Questionnaire, 

44. PVAQ – Pain Vigilance and Awareness 

Questionnaire, 

45. QCSASC - Questionnaire of Cognitive 

Schema Activation in Sexual Context, 

46. READ - Resilience Scale for Adolescents, 

47. REM-71 - Response Evaluation Measure 

for Youth, 

48. RPQ - Reactive–Proactive Aggression 

Questionnaire, 

49. RSE - Rosenberg Self-Esteem Scale, 

50. SCL-90 - Symptom Checklist-90, 

51. SCL-90-R - Symptoms Checklist, 

52. SCWBS - Stirling Children’s Well-being 

Scale, 

53. SDBQ - Sexual Dysfunctional Belief 

Questionnaire, 

54. SDS - Self-Rating Depression Scale, 

55. SDS - Sexual Distress Scale, 

56. SF-12 - Short Form Health Survey, 

57. SHS - Subjective Happiness Scale, 

58. SMQ - Sexual Modes Questionnaire, 

59. SOGS - South Oaks Gambling Screen, 

60. SPP25 - Resilience Coping Scale Ques-

tionnaire, 

61. SQ - Security Questionnaire, 

62. SSoS - Scale of Social Skills, 

63. SSS - Sensation Seeking Scale, 

64. SSuS - Social Support Scale, 

65. SVPAD - Scale of Values for Positive 



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24. FACES-IV - Family Adaptability and 

Cohesion Evaluation Scales-IV, 

25. FES - Family Environment Scale, 

26. FSFI - Female Sexual Functioning Index, 

27. FVI - Five-Factor Inventory, 

28. GSES - General Self-Efficacy Scale, 

29. HADS - Hospital Anxiety and Depression 

Scale, 

30. HSC - Hopelessness Scale for Children, 

31. IAT - Internet Addiction Test, 

32. IES - Impact of Event Scale, 

33. IPPA - Inventory of Parent and Peer 

Attachment, 

34. ITS - Interpersonal Trust Scale, 

35. LES - Life Event Scale, 

36. LSDSA - Life Skills Development Scale 

for Adolescents, 

37. MPQ - McGill Pain Questionnaire, 

38. MQS - Mobbing Questionnaire for 

Students, 

Adolescent Development, 

66. SWLS - Satisfaction with Life Scale, 

67. TAS-20 - Toronto Alexithymia Scale, 

68. TGIS - Tarrant’s Group Identification 

Scale, 

69. UINAQ - Undergraduates’ Internet Novel 

Addiction Questionnaire, 

70. VSSS - Virtual Social Support Scale, 

71. WISC - Wechsler Intelligence Scale for 

Children, 

72. WPSQ - Workplace Perceived Stress 

Questionnaire, 

73. YSR - Youth Self-Report, and 

74. ZTPI - Zimbardo Time Perspective Inven-

tory. 

 

 

Source: Table created with Microsoft Word. 

 

5.2. Key/Main Findings of AARS Included in the Systematic Literature Review 

Only 17 of the ARS are AARS [5-58,60-63,66-69,72,74,78,81,83]. 

These AARS were conducted in China [62,82], Germany [58], Italy [59,61,67,69,70,73,79,84], 

Japan [75], Romania [57], Spain [63], Taiwan [64], Thailand [58], Turkey [56], United 

Kingdom [73]. 

Of the 17 AARS, eight studies [58,59,61-64,73,84] were conducted on samples of adolescents 

aged between 11 and 19), seven studies [56,57,69,70,75,79,82] were conducted on samples of 

late adolescents (aged between 18 and 25), and two studies [67,68], were conducted on mixed 

samples (adults and adolescents, and children and adolescents). 

The author(s) of the AARS focused on alexithymia and mental health from the following 

perspectives: alexithymia and burnout syndrome [57], alexithymia and cyberbullying victim-



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ization/perpetration [58], alexithymia and depressive symptoms (a risk factor in anxiety, sub-

stance use disorders, and suicide) [62], alexithymia and Developmental Language Disorder (a 

communication disorder from the group of neurodevelopmental disorders) [68], alexithymia 

and emotional–behavioral functioning/symptoms [58,83], alexithymia and hypervigilance 

(accompanied by increased anxiety) to pain [75]), alexithymia and Internet/Instagram addic-

tion (an excessive behavioral pattern) [64,70,78,82], alexithymia and peritraumatic distress 

(anxiety, great pain, sorrow) [69], alexithymia and reactive/proactive aggression behaviors 

[73], alexithymia and smoking (a risk factor for conduct disorder, erectile disorder, major or 

mild Vascular Neurocognitive Disorder, panic attacks, panic disorder, tobacco use disorder 

correlated with ADHD and COPD) [56], alexithymia and symptomatic and at-risk subjects 

[79], or alexithymia and time perspective [67]. This review indicated that the number of studies 

on most associations between alexithymia and its correlates, in the present journal is low. In 

addition, although the IJERPH is related to health, the association between alexithymia and 

health issues refers both to DSM disorders, such as addictions, or to health related issues, 

such psychological functioning, for example. 

Two studies have focused on possible interventions in alexithymic adolescents: a study fo-

cused on alexithymia and psychosocial intervention pilot programs [63] and another one on 

alexithymia and participation in Death Education [61]. 

 

5.3. Difficulties and Limitations 

A difficulty we faced is that we noticed an inconsistency of the age range of adolescent par-

ticipants in two cases, which refer to children [68], and adults [67]. These two articles were 

also included in the analysis. In addition, several studies provided only the mean age of the 

participants [56,57,62,64,75], which made it difficult to draw accurate conclusions. 

One limitation of the present study is that the present review focused only on one journal. 

Researching other journals might reveal new insights into the alexithymia phenomenon. 

 

6. Conclusions 

Several conclusions ca be drawn from the analysis of the AARS presented in Table 3. 

On the one hand, the present review indicates that alexithymia is related to a number of health 

issues: it can increase the risk of exercise dependence [79], it correlates with hypervigilance to 

pain [75], it has effects on reactive aggression behavior [73], it influences depressive symp-

toms [62], it is a crucial risk factor for adolescents’ motor vehicle collisions [84], it is associ-

ated with a negative bias for past and present events [67], and with Developmental Language 



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Disorder [68]. Alexithymia predicts Internet/Instagram addiction [64,70], and peritraumatic 

distress [69,70], while our review indicates that alexithymia is not related to smoking habits 

[56]. On the other hand, other studies from the journal indicate that alexithymia partially me-

diates the effects of cyberbullying victimization on cyberbullying perpetration [58], it could be 

associated with adolescents’ motor collisions [59], and it may play a significant role in the 

development of burnout syndrome [57]. In addition, it might predict Internet novel addiction 

[82]. 

Judging the content of the published articles in this journal, the conclusions are related to the 

number of articles selected for publication. Although is less important that the articles on 

alexithymia are not exhaustive regarding their aim and correlates, it is more important to 

mention that there is a growing interest to publish articles on the topic. Although the studies 

published in this journal indicate that there is a growing interest in this topic, future study 

should refine scientific investigation by advancing more intervention models. From a thera-

peutic standpoint, the scoping review indicates that at least in this journal there were published 

less articles referring to therapies and psychological interventions, which aim to address ado-

lescents who are highly alexithymic. Strong emotional regulation abilities may improve 

long-term wellness, career performance, personal relationships, and even general health in 

addition to the more obvious advantages like feeling better immediately. Yet, a limit of this 

scoping review is that it indicates that in the present journal, at present, articles on psycho-

logical interventions are lacking, either as a result of the article selection by editors or owing to 

a lower interest in such articles in general, as research in the field is somehow at the beginning. 

Future investigations should go beyond the scope of the present investigation and address 

alexithymia topic in all important journals. The present scoping review also focused only on 

the term ‘adolescents’, in searching for articles, which might have limited the number of arti-

cles selected. Future research might broad the aim of such investigations. 

 

CONFLICT OF INTEREST: The authors declare that they have no conflict of interest. 

DATA AVAILABILITY STATEMENT: The data used in the meta-analysis were taken 

from published studies. In a few cases, additional data were obtained from authors - these are 

listed in the results section. No new data were collected for this review study. 

 

 

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