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Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients

BMC Psychiatry volume 22, Article number: 276 (2022) Cite this article

Abstract

Background

Alexithymia, which is characterized by difficulty identifying and describing feelings, is a stable personality trait and it has been associated with early life experiences. Methamphetamine dependence patients with high level of alexithymia may be particularly vulnerable to engaging in more frequent methamphetamine use. Therefore, we aimed to evaluate whether alexithymia was associated with frequency of methamphetamine use. Additionally, the current study sought to examine early-life factors associated with the development of alexithymia, i.e., parental rearing styles.

Method

Participants were 108 non-injecting methamphetamine dependent patients from a male compulsory detoxification center. The level of alexithymia was assessed by Toronto Alexithymia Scale-20(TAS-20). In addition, we applied Egna Minneu av. Bardndosnauppforstran (EMBU) to assess the parental rearing styles, including the dimensions of warmth, rejection, punishment/strictness, overinvolvement, overprotection, and favoring.

Results

The total score of TAS-20 was positively correlated with frequency of methamphetamine use (r = 0.26, p < 0.01). Specifically, except for externally oriented thinking, difficulty identifying feelings (r = 0.23, p < 0.05) and difficulty describing feelings (r = 0.25, p < 0.05) were positively correlated with frequency of methamphetamine use. Multiple linear regression showed that more maternal rejection (B = 0.59, p = 0.002), or less maternal warmth (B = -0.22, p = 0.004) was associated with higher levels of alexithymia. Ordinal logistic regression showed that for every 1 score increase in the total score of TAS-20, there was a 1.06 times risk of a one level increase in the level of methamphetamine use frequency (OR = 1.06, p = 0.01).

Conclusions

These results have major implications for understanding the role of alexithymia in craving and addiction, while providing a further and explicit entry point for addiction treatment. Moreover, more attention should be focused on parenting in relation to early experiences.

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Introduction

Substance-related disorder is a prominent public health problem globally, which has complex pathophysiological and pathopsychological mechanisms [1]. Methamphetamine, as a highly addictive central nervous system stimulant, is associated with a range of health hazards, including mental disorders, somatic disorders, infectious diseases, and overuse [2, 3]. The prevalence and mortality rates associated with methamphetamine use have doubled in the past decade. Evidence suggested that methamphetamine use disorder could be the next drug use crisis after the opioid crisis worldwide [4].

Although multiple mechanisms exist for substance-related disorder, emotion-regulation dysfunctions are important factors in the onset, maintenance, recovery, and relapse of drug use [5]. Emotion processing, which includes emotion recognition, emotion regulation, and response, is closely related to the construct of alexithymia [6]. It is currently endorsed that alexithymia is the result of early emotion processing deficit rather than higher-order emotion regulation processes [7]. Alexithymia reflects inflexible emotion regulation, with underlying dysfunctions could occur in all phases of emotion processing, both psychologically and physically [8]. To be precise, alexithymia is characterized by difficulty identifying and describing feelings (one’s own and those of others), and an externally oriented cognitive style [9]. Considering that people with alexithymia have difficulty distinguishing various internal feelings from physical sensations, they complain about their various physical ailments, yet they are actually suffering from emotional distress [10]. Craving for methamphetamine is expressed as a physical “complaint” that is well identified by people with alexithymia.

Individuals with alexithymia appear to have difficulty coping with social and psychological stressors and are more inclined to use “addictive” patterns as a coping strategy to manage underlying feelings of distress [11]. Alexithymia has been recognized as an significant risk factor for a variety of psychological and behavioral problems, including maladaptive schemas [12], eating disorders [13], academic achievement [14], non-suicidal self-injury [15], etc. Furthermore, alexithymia has been widely associated with increased marijuana use [16], increased caffeine consumption [17], mobile phone addiction [11], and pathological gambling [18]. Psychiatrists began to focus on the characteristics of drug use, and a recent follow-up study found a link between alexithymia and relapses in patients with substance use disorders [19]. Previous research indicated that alexithymia was associated with more severe addictions such as increased substance use, intrusive and compulsive thoughts about substance use, and higher levels of cravings [20, 21]. Meanwhile, more severe alexithymia had been proved to be associated with more intense cue-elicited methamphetamine craving [22].

There is a controversy over whether alexithymia should be viewed as a stable personality trait or as a state-dependent phenomenon. Based on the accumulating research evidence on alexithymia, currently it is largely considered to be a personality trait of the general population throughout life [23]. Parents are the most important parts of one’s early life, and inappropriate parental rearing practices have lasting and detrimental impact on one’s mental and physical health [24]. Recent research suggested that parenting practices could influence adolescent adjustment [25]. Meanwhile, positive parental rearing styles can increase well-being by diminishing some of the potentially negative psychological traits of early adulthood [26]. Previous studies have shown significant differences in parental rearing styles among multiple substance dependent individuals compared to healthy individuals, primarily for rejection, lack of emotional warmth, and overprotection [27]. The perceived parental rearing styles of Internet-addicted adolescents were found to exhibited more overly intrusive, punitive, and unresponsive [28]. Besides, alexithymia was examined to display a mediating role between attachment and addictive behaviours [29]. Another study attempted to predict alexithymia from the perspective of attachment-related features, but this study was conducted with adult attention-deficit/hyperactivity disorder patients as the subjects and had significant flaws [30]. To our knowledge, only one documented study has linked inappropriate parental rearing styles to the initiation of drug use [31], yet there is a gap in research on the frequency of drug use.

Alexithymia is thought to be culturally relevant, and Asian cultures are perceived to be more inexpressive [32]. The parental rearing styles and emotional processing vary dramatically across cultures, and studies performed in Asian populations would be meaningful [33, 34]. Drug users most often initiate with non-injecting drug use and use drugs more and more frequently, then move on to injecting drug, which can have more serious consequences, such as infectious diseases and death [35, 36]. Therefore, studies addressing the frequency of drug use deserve more attention from clinicians and policy makers.

In view of the above, the objective of this study was to examine the relationship between alexithymia and frequency of drug use in methamphetamine dependence patients. As an exploratory analysis, we would investigate early life factors that shape alexithymia from the perspective of parental rearing styles.

Methods

Participants

All the participants were recruited from a male compulsory detoxification center in Anhui Province, China (from September to November 2019). Participants who met the following criteria were included in this study: (1) Han nationality, aged from 18 to 65 years; (; (2) met the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for methamphetamine dependence; (3) were non-injecting drug users, and (4) were available to provide informed consent. Also, participants who met any of the following exclusion criteria were excluded: (1) suffering from severe psychiatric disorder, such as schizophrenia or bipolar disorder; (2) having used psychoactive drugs within the last month; and (3) those who have comorbidity with serious somatopathy (e.g., cardiovascular disease, neurological disease, diabetes, etc.)

Measures

Sociodemographic and clinical variables

A self-designed questionnaire was used to collect and systematize the following variables: age, education level, marital status, income level, place of household registration, comorbidity, and addiction-related variables. The frequency of methamphetamine use was divided into 5 levels (level 1: about once per month or less; level 2: about once per 2 weeks; level 3: about once per week; level 4: about once per 1 to 3 days; level 5: about several times per day).

Alexithymia

The Toronto Alexithymia Scale-20 (TAS-20) is a self-report scale that was designed to assess alexithymia level [37]. The total score of TAS-20 ranged from 20 to 100, with higher scores representing a higher level of alexithymia. TAS-20 consists of three dimensions, including difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. TAS-20 has proved to be a reliable and effective tool for assessing alexithymia in the Chinese population [38, 39]. The recommended cut-off score for the Chinese population is a total score of 57 or above indicating a high level of alexithymia [39, 40]. The Cronbach’s alpha was reported to be 0.81.

Parental rearing styles

The original version of the Egna Minneu av. Bardndosnauppforstran was designed to assess participants’ perceived parental rearing styles in childhood [41], which was translated into Chinese and showed good reliability and validity [42, 43]. EMBU contains 66 items, including 11 factors, including M-warmth, F-warmth, M-rejection, F-rejection, M-Punishment/strictness, F-Punishment/strictness, M-overinvolvement-overprotection, F-overinvolvement, F-overprotection, M-favoring, F-favoring (M for mother, F for father). The Cronbach’s alpha was reported to be 0.92.

Procedures

Prior to the start of the research process, detailed information about the study was explained to the participants and we ensured that the participants could fully understood the study. Participants did not receive any financial compensation. Each participant had to sign an informed consent form and each participant could withdraw from this study at any stage of the study if they wished. During the study, we used questionnaires and structured talks, and no invasive or harmful tests were used, nor were any drugs applied. The Ethics Committee of Chaohu Hospital of Anhui Medical University approved the study (Ethics number: 201901- kyxm-02). All study procedures were in accordance with the Helsinki Declaration.

Statistical analysis

The IBM SPSS21.0. was applied for statistical analysis. Firstly, the Kolmogorov-Smirnov single-sample test was used to examine the type of data distribution. Next, independent sample t test or Mann Whitney U test was used to compare the continuous variables between H-alexithymia (high levels of alexithymia, TAS-20 ≥ 57) group and L-alexithymia (low levels of alexithymia, TAS-20 < 57) group. The Chi-square test was performed for categorical variables. Pearson correlations or Spearman correlations analysis was used to explore the correlations between alexithymia, parental rearing styles, and frequency of methamphetamine use. In addition, multiple linear regressions were used to analyze the effects of parental rearing styles on alexithymia. As a final step, ordinal logistic regressions were used to analyze the risk of alexithymia on the frequency of methamphetamine use. Statistical significance was defined as p < 0.05, and all reported p values were bilateral.

Result

Characteristics of methamphetamine dependence patients

There were 123 participants eligible to participate in the study, and after screening, 108 methamphetamine dependent individuals were eventually included in this study. Of the 15 excluded participants, 8 were heroin users, and 7 submitted incomplete data.

The characteristics of methamphetamine dependent patients are shown in Table 1. The current age of the total participants ranged from 22 to 47 years (30.8 ± 3.9 years), and the mean age of H-alexithymia group (29.3 ± 3.3) was younger than that of L-alexithymia group (31.8 ± 4.0). Moreover, the age of first drug use of H-alexithymia group (21.2 ± 3.9) was earlier than L-alexithymia group (23.5 ± 4.4) (t = − 2.78, p < 0.01). The frequency of drug use was found to be significantly more frequent in H-alexithymia group than in L-alexithymia group (Z = 2.15, p = 0.03). In addition, no differences were found between the two groups in terms of education level, place of household registration, income level, and marital status.

Table 1 Characteristics of methamphetamine dependence patients (n = 108)
Full size table

Correlations between alexithymia, parental rearing styles and frequency of methamphetamine use

Table 2. presented the results of the correlation analyses between all the variables. The total score of alexithymia was positively correlated with the frequency of methamphetamine use (r = 0.26, p < 0.01). Specifically, difficulty identifying feelings (r = 0.23, p < 0.05) and difficulty describing feelings (r = 0.25, p < 0.05) were positively correlated with the frequency of methamphetamine use, while externally oriented thinking was not found to be statistically correlated with the frequency of methamphetamine use. In addition, parental rearing styles of rejection (M-: r = 0.42, p < 0.01; F-: r = 0.28, < 0.01) and Punishment/strictness (M-: r = 0.33, p < 0.01; F-: r = 0.33, p < 0.05) were positively associated with alexithymia. In contrast, maternal rearing styles of warmth (r = 0.30, p < 0.01) was negatively associated with alexithymia.

Table 2 Correlations between alexithymia, parental rearing styles and frequency of methamphetamine use
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Multiple linear regressions of parental rearing styles and alexithymia

Multiple linear regression was used to analyze the effect of parental rearing styles on alexithymia. Using a stepwise approach, M-warmth and M-rejection were entered into the final regression model(R2 = 0.18). Table 3 showed that more rejection (B = 0.59, p = 0.002), or less warmth (B = -0.22, p = 0.004) in the mother’s parenting practices was associated with higher levels of alexithymia.

Table 3 Multiple linear regressions of parental rearing styles and alexithymia
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Ordinal logistic regressions of alexithymia and frequency of methamphetamine use

Ordinal logistic regression was applied to analyze the risk of alexithymia on the frequency of methamphetamine use. Table 4 showed that for every 1 score increase in the total score of alexithymia, there was a 1.06 times risk of a one level increase in the level of methamphetamine use frequency (OR = 1.06, p = 0.01).

Table 4 Odds ratios for the association of alexithymia with frequency of methamphetamine use by ordinal logistic regression
Full size table

Discussion

This study examined whether severe alexithymia was associated with more frequent drug use and the contributions of specific parental rearing styles to the formation of alexithymia among male methamphetamine dependence patients. The results showed that methamphetamine users with high levels of alexithymia used drugs more frequently, and more precisely, alexithymia was positively associated with the frequency of drug use. Furthermore, we explored possible parental rearing factors relevant to the formation of alexithymia. Our findings indicated that more maternal rejection and less maternal warmth contributed to high levels of alexithymia.

The relationship between alexithymia and addictions has been documented and discussed many times, including in such fields as heroin dependent [44], alcohol addiction [20], internet addiction [9], pathological gambling [45], etc.

However, to the best of our knowledge, very few studies have focused on specific characteristics of addiction, i.e., frequency of substance use. Our current study showed that alexithymia was significantly associated with the frequency of methamphetamine use. Based on online questionnaire surveys among people with pain in the general population, alexithymia is associated with frequently painkiller use, which supported our findings [46]. Alexithymia mainly characterized by difficulty in identifying feelings, which can be perceived as a deficit in cognitive processing and emotional regulation [47].

The frequency of drug use reflects a degree of craving, and patients with high subjective cravings will repeatedly self-administer drugs. One study on alcohol consumption found that alexithymia is associated with subjective hypersensitivity to bodily sensations, and difficulty identifying feelings mediated the relationship between sensitivity to bodily sensations and alcohol consumption [44]. Consistent with our research, one study tested cue-elicited craving responses in methamphetamine-dependent individuals and found a positive correlation between the difficulty identifying feelings and cue-elicited craving responses [22]. Although there have been no conclusive researches between drug cravings and alexithymia, there have found that alcohol craving was associated with alexithymia in alcohol-dependent patients [48]. Meanwhile high level of alexithymia was associated with significantly higher rates of higher levels of desire for alcohol and alcohol consumption [49]. Although there are similarities in the brain regions involved in each stage of the addiction cycle, there are differences in the specific mechanisms and psychopathology concerned by different substance addictions [50]. Our study effectively addressed the previous gap, that is, the association of alexithymia with frequent drug use. Besides, our data did not support the correlation between externally oriented thinking and the frequency of methamphetamine use, but it seemed to be well understood. Despite TAS-20 has been worldwide used in researches and clinical practices, a critical review of TAS-20 revealed that, in practically all studies, the dimension ‘externally oriented thinking (‘appears to be unreliable [51].

Regarding the relationship between alexithymia and parental rearing styles of methamphetamine dependence patients, we found that the development of alexithymia was associated with malpractice in parenting, mainly in the form of rejection, punishment/strictness, and warmth. In fact, warmth and rejection belong to opposite poles on one dimension. Punishment/strictness refers to strict parents who would punish their children roughly or in embarrassing ways for very small things or for no reason at all, and these parents tend to punish their children more than they deserve. In the Spanish population, parenting styles characterized by less warmth were associated with poorer psychosocial adjustment. However, indulgent parenting style (warmth but not strictness) was associated with equal or even better outcomes in terms of psychosocial adjustment than authoritative parenting (warmth and strictness) [52, 53]. Yet studies of adolescents from middle-class European-American families had shown that authoritative parenting (warmth and strictness) is most beneficial to adolescent development, but with a higher degree of internalized distress that manifests as complaints of somatic discomfort [54] Under strict parenting styles, children suppress and internalize their distressed feelings rather than choosing to express them, yet internally focused feelings and complaints about somatic discomfort represent high levels of alexithymia. The emerging view is that warmth but not strictness parental rearing styles appears to be the optimal parental rearing style, which can facilitate the psychosocial development in children [55]. As far as we know, the present study is the first to report the relationship between parental rearing styles and alexithymia among drug users. There are many possible factors that can explain the links between parental rearing styles and alexithymia. Improper parenting has been linked to the development of childhood trauma, and childhood trauma was a direct predictor of alexithymia [36, 56]. Furthermore, childhood emotional abuse was proved to be a risk factor for alexithymia in male substance dependence inpatients [57]. From another perspective, the frequent rejection and punishment of children by parents can be considered as a form of abuse. And on that basis, perceived parental rejection has been linked to insecure attachment, meanwhile, attachment styles would interact with alexithymia and elevate the risk of substance-related disorder [58, 59]. Additionally, parental rearing patterns of Chinese individuals with borderline personality exhibited greater rejection, punishment, and less emotional warmth, and that maternal emotional warmth may be an important protective factor against the development of borderline personality [60]. Moreover, individuals with borderline personality manifest higher levels of alexithymia [61], and they showed diminished accuracy in recognition of emotions in computerized tasks [62]. Given that substance-related disorders and borderline personality are common clinical comorbidities, Gratz et al. examined the complex relationship between substance-related disorders, borderline personality, childhood abuse, and emotion dysregulation among substance users, and found that borderline personality was associated with higher levels of childhood maltreatment, and that emotion dysregulation played a mediating role between childhood maltreatment and borderline personality [63]. Also, using path model analysis, Tom demonstrated that anxious attachment partially mediated the relationship between alexithymia and craving [64].

The extrinsic association between alexithymia and the frequency of drug use has a substantial intrinsic biological basis, and although the direct relationship has not been confirmed, the indirect relationship could be well understood. Brain structures involved in emotion processing have been investigated for functional and structural alterations associated with alexithymia. The fusiform gyrus and anterior cingulate cortex have been demonstrated repeatedly to be areas with functional and structural abnormalities associated with alexithymia [65, 66]. Recent researches suggested that the pathway by which childhood adversity leads to substance use in late adolescence may operate through hypofunctioning of the anterior cingulate cortex associated with inhibitory control and externalizing behavior [67]. The neurotransmission through dopamine D2-type receptors in the anterior cingulate and anterior insular cortex affects emotional processing in healthy individuals, yet this association was observed to be absent in methamphetamine dependence patients by positron emission tomography [68]. The fusiform gyrus is responsible for processing of faces and therefore for emotion recognition [69]. Voxel-based morphometry revealed that the density around the left fusiform gyrus of cannabis users differed from that of non-users [70].

Alexithymia was associated with a dampened basal activity of the thalamus-pituitary-adrenal (HPA) axis, the main endogenous stress response system [71]. Emotion-related physiological arousal-cortisol reactivity-and subjective emotion regulation have been independently linked to substance use. Parental acceptance-rejection is a primary factor in the establishment and development of attachment relationships [59], and individuals with insecure attachment show a reduced cortisol awakening response [72]. A study based on a stressful parent-child interaction task showed that adolescents with low levels of cortisol reactivity and high difficulties with emotion regulation were more likely to use substances [73].

On a more rigorous level, our study has some limitations. Firstly, this was a cross-sectional survey and we could not infer that alexithymia caused drug users to take drugs more frequently. Perhaps, in a dramatic reversal, drug users exhibit high levels of alexithymia, because frequently drug use could impair emotional functioning. Hence, higher levels of alexithymia could be a precursor of frequent drug use, or a result of frequent drug use, or both. Rigorous follow-up studies are needed to statistically clarify this association. Secondly, assessing perceived parental rearing styles was a method of retrospective recall, which may lead to recall bias. Thirdly, our sample size was limited, so a large sample size will be more convincing. Additionally, our current study did not include a control group, and a controlled study would provide more clarity and insight into the important role of alexithymia. Finally, the participants in this study were all Han Chinese adult males, and extreme caution should be taken when generalizing to other cultural contexts for parenting pattern recommendations.

Conclusion

Despite these limitations, the current study confirmed the association between alexithymia and the frequency of drug use, as well as revealed that parental rearing styles had an important contribution to the formation of alexithymia. Our findings have major implications for understanding the role of alexithymia in craving and addiction, while providing a further and explicit entry point for addiction treatment. Our results supported the debate about treatment approaches targeting the transdiagnostic process of alexithymia in substance dependence. Moreover, more attention should be focused on parenting in relation to early experiences. Applying family-related factors (i.e., parental rearing styles) of alexithymia could facilitate a tailored approach in psychiatry and psychotherapy.

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to no permission from participants to share anonymized participant data publicly but are available from the corresponding author on reasonable request.

Abbreviations

TAS-20:

Toronto Alexithymia Scale-20

EMBU:

Egna Minneu av. Bardndosnauppforstran

M-:

Mother

F-:

Father

References

  1. Karila L, Benyamina A. Addictions. Rev Mal Respir. 2019;36(2):233–40. https://doi.org/10.1016/j.rmr.2018.12.001.

    Article  CAS  PubMed  Google Scholar 

  2. Barr AM, Panenka WJ, MacEwan GW, Thornton AE, Lang DJ, Honer WG, et al. The need for speed: an update on methamphetamine addiction. J Psychiatry Neurosci. 2006;31(5):301–13.

    PubMed  PubMed Central  Google Scholar 

  3. Degenhardt L, Sara G, McKetin R, Roxburgh A, Dobbins T, Farrell M, et al. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev. 2017;36(2):160–70. https://doi.org/10.1111/dar.12426.

    Article  PubMed  Google Scholar 

  4. Paulus MP, Stewart JL. Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: a review. JAMA Psychiatry. 2020;77(9):959–66. https://doi.org/10.1001/jamapsychiatry.2020.0246.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Berking M, Margraf M, Ebert D, Wupperman P, Hofmann SG, Junghanns K. Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. J Consult Clin Psychol. 2011;79(3):307–18. https://doi.org/10.1037/a0023421.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fossati P. Neural correlates of emotion processing: from emotional to social brain. Eur Neuropsychopharmacol. 2012;22(Suppl 3):S487–91. https://doi.org/10.1016/j.euroneuro.2012.07.008.

    Article  CAS  PubMed  Google Scholar 

  7. van der Velde J, Gromann PM, Swart M, Wiersma D, de Haan L, Bruggeman R, et al. Alexithymia influences brain activation during emotion perception but not regulation. Soc Cogn Affect Neurosci. 2015;10(2):285–93. https://doi.org/10.1093/scan/nsu056.

    Article  PubMed  Google Scholar 

  8. Panayiotou G, Panteli M, Vlemincx E. Adaptive and maladaptive emotion processing and regulation, and the case of alexithymia. Cognit Emot. 2021;35(3):488–99. https://doi.org/10.1080/02699931.2019.1671322.

    Article  Google Scholar 

  9. Mahapatra A, Sharma P. Association of Internet addiction and alexithymia - a scoping review. Addict Behav. 2018;81:175–82. https://doi.org/10.1016/j.addbeh.2018.02.004.

    Article  PubMed  Google Scholar 

  10. Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, et al. Alexithymia and somatization in general population. Psychosom Med. 2008;70(6):716–22. https://doi.org/10.1097/PSY.0b013e31816ffc39.

    Article  PubMed  Google Scholar 

  11. Gao T, Li J, Zhang H, Gao J, Kong Y, Hu Y, et al. The influence of alexithymia on mobile phone addiction: the role of depression, anxiety and stress. J Affect Disord. 2018;225:761–6. https://doi.org/10.1016/j.jad.2017.08.020.

    Article  PubMed  Google Scholar 

  12. Basso LA, Fortes AB, Maia CPE, Steinhorst E, Wainer R. The effects of parental rearing styles and early maladaptive schemas in the development of personality: a systematic review. Trends Psychiatry Psychother. 2019;41(3):301–13. https://doi.org/10.1590/2237-6089-2017-0118.

    Article  PubMed  Google Scholar 

  13. Herraiz-Serrrano C, Rodríguez-Cano T, Beato-Fernández L, Latorre-Postigo JM, Rojo-Moreno L, Vaz-Leal FJ. Parental rearing and eating psychopathology. Actas Espanolas Psiquiatria. 2015;43(3):91–8.

    Google Scholar 

  14. Pinquart M, Kauser R. Do the associations of parenting styles with behavior problems and academic achievement vary by culture? Results from a meta-analysis. Cultural Divers Ethnic Minor Psychol. 2018;24(1):75–100. https://doi.org/10.1037/cdp0000149.

    Article  Google Scholar 

  15. Liu Y, Xiao Y, Ran H, He X, Jiang L, Wang T, et al. Association between parenting and non-suicidal self-injury among adolescents in Yunnan, China: a cross-sectional survey. PeerJ. 2020;8:e10493. https://doi.org/10.7717/peerj.10493.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dorard G, Bungener C, Phan O, Edel Y, Corcos M, Berthoz S. Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers. J Psychosom Res. 2017;95:74–80. https://doi.org/10.1016/j.jpsychores.2017.02.012.

    Article  PubMed  Google Scholar 

  17. Lyvers M, Duric N, Thorberg FA. Caffeine use and alexithymia in university students. J Psychoactive Drugs. 2014;46(4):340–6. https://doi.org/10.1080/02791072.2014.942043.

    Article  PubMed  Google Scholar 

  18. Marchetti D, Verrocchio MC, Porcelli P. Gambling problems and alexithymia: a systematic review. Brain Sci. 2019;9(8). https://doi.org/10.3390/brainsci9080191.

  19. Palma-Álvarez RF, Ros-Cucurull E, Daigre C, Perea-Ortueta M, Martínez-Luna N, Serrano-Pérez P, et al. Is alexithymia related to retention and relapses in patients with substance use disorders?: a one year follow-up study. Addict Behav. 2021;113:106681. https://doi.org/10.1016/j.addbeh.2020.106681.

    Article  PubMed  Google Scholar 

  20. Cruise KE, Becerra R. Alexithymia and problematic alcohol use: a critical update. Addict Behav. 2018;77:232–46. https://doi.org/10.1016/j.addbeh.2017.09.025.

    Article  CAS  PubMed  Google Scholar 

  21. Stasiewicz PR, Bradizza CM, Gudleski GD, Coffey SF, Schlauch RC, Bailey ST, et al. The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample. Addict Behav. 2012;37(4):469–76. https://doi.org/10.1016/j.addbeh.2011.12.011.

    Article  PubMed  Google Scholar 

  22. Saladin ME, Santa Ana EJ, LaRowe SD, Simpson AN, Tolliver BK, Price KL, et al. Does alexithymia explain variation in cue-elicited craving reported by methamphetamine-dependent individuals? Am J Addict. 2012;21(2):130–5. https://doi.org/10.1111/j.1521-0391.2011.00214.x.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Salminen JK, Saarijärvi S, Toikka T, Kauhanen J, Aärelä E. Alexithymia behaves as a personality trait over a 5-year period in Finnish general population. J Psychosom Res. 2006;61(2):275–8. https://doi.org/10.1016/j.jpsychores.2006.01.014.

    Article  CAS  PubMed  Google Scholar 

  24. Schuppert HM, Albers CJ, Minderaa RB, Emmelkamp PM, Nauta MH. Parental rearing and psychopathology in mothers of adolescents with and without borderline personality symptoms. Child Adolesc Psychiatry Ment Health. 2012;6(1):29. https://doi.org/10.1186/1753-2000-6-29.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Martínez I, Murgui S, Garcia OF, Garcia F. Parenting and adolescent adjustment: the mediational role of family self-esteem. J Child Fam Stud. 2021;30(5):1184–97. https://doi.org/10.1007/s10826-021-01937-z.

    Article  Google Scholar 

  26. Candel OS. The Link between Parenting Behaviors and Emerging Adults' Relationship Outcomes: The Mediating Role of Relational Entitlement. Int J Environ Res Public Health. 2022;19(2). https://doi.org/10.3390/ijerph19020828.

  27. Emmelkamp PM, Heeres H. Drug addiction and parental rearing style: a controlled study. Int J Addict. 1988;23(2):207–16. https://doi.org/10.3109/10826088809085116.

    Article  CAS  PubMed  Google Scholar 

  28. Xiuqin H, Huimin Z, Mengchen L, Jinan W, Ying Z, Ran T. Mental health, personality, and parental rearing styles of adolescents with internet addiction disorder. Cyberpsychol Behav Soc Netw. 2010;13(4):401–6. https://doi.org/10.1089/cyber.2009.0222.

    Article  PubMed  Google Scholar 

  29. Estévez A, Jauregui P, Macía L, López-González H. Gambling and attachment: the mediating role of alexithymia in adolescents and Young adults. J Gambl Stud. 2021;37(2):497–514. https://doi.org/10.1007/s10899-020-09965-y.

    Article  PubMed  Google Scholar 

  30. Edel MA, Edel S, Krüger M, Assion HJ, Juckel G, Brüne M. Attachment, recalled parental rearing, and ADHD symptoms predict emotion processing and alexithymia in adults with ADHD. Ann General Psychiatry. 2015;14:43. https://doi.org/10.1186/s12991-015-0082-y.

    Article  Google Scholar 

  31. Hock RS, Hindin MJ, Bass JK, Surkan PJ, Bradshaw CP, Mendelson T. Parenting styles and emerging adult drug use in Cebu, the Philippines. Int J Cult Ment Health. 2016;9(2):108–19. https://doi.org/10.1080/17542863.2015.1091486.

    Article  PubMed  Google Scholar 

  32. Lo C. Cultural Values and Alexithymia. SAGE Open. 2014;4(4):2158244014555117. https://doi.org/10.1177/2158244014555117.

    Article  Google Scholar 

  33. Weitkamp K, Seiffge-Krenke I. The association between parental rearing dimensions and adolescent psychopathology: a cross-cultural study. J Youth Adolesc. 2019;48(3):469–83. https://doi.org/10.1007/s10964-018-0928-0.

    Article  PubMed  Google Scholar 

  34. Le HN, Berenbaum H, Raghavan C. Culture and alexithymia: mean levels, correlates, and the role of parental socialization of emotions. Emotion (Washington, DC). 2002;2(4):341–60. https://doi.org/10.1037/1528-3542.2.4.341.

    Article  Google Scholar 

  35. Baluku M, Wamala T. When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment. Harm Reduct J. 2019;16(1):73. https://doi.org/10.1186/s12954-019-0350-2.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ivsins A, Marsh S. Exploring what shapes injection and non-injection among a sample of marginalized people who use drugs. Int J Drug Policy. 2018;57:72–8. https://doi.org/10.1016/j.drugpo.2018.04.006.

    Article  PubMed  Google Scholar 

  37. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23–32. https://doi.org/10.1016/0022-3999(94)90005-1.

    Article  CAS  PubMed  Google Scholar 

  38. Zou Z, Huang Y, Wang J, He Y, Min W, Chen X, et al. Association of childhood trauma and panic symptom severity in panic disorder: exploring the mediating role of alexithymia. J Affect Disord. 2016;206:133–9. https://doi.org/10.1016/j.jad.2016.07.027.

    Article  PubMed  Google Scholar 

  39. Zhu X, Yi J, Yao S, Ryder AG, Taylor GJ, Bagby RM. Cross-cultural validation of a Chinese translation of the 20-item Toronto alexithymia scale. Compr Psychiatry. 2007;48(5):489–96. https://doi.org/10.1016/j.comppsych.2007.04.007.

    Article  PubMed  Google Scholar 

  40. Mei S, Xu G, Gao T, Ren H, Li J. The relationship between college students' alexithymia and mobile phone addiction: testing mediation and moderation effects. BMC Psychiatry. 2018;18(1):329. https://doi.org/10.1186/s12888-018-1891-8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Perris C, Jacobsson L, Lindström H, von Knorring L, Perris H. Development of a new inventory assessing memories of parental rearing behaviour. Acta Psychiatr Scand. 1980;61(4):265–74. https://doi.org/10.1111/j.1600-0447.1980.tb00581.x.

    Article  CAS  PubMed  Google Scholar 

  42. Dongmei Y. Preliminary revision of EMBU and its application in neurotic patients. Chin Mental Health J. 1993;03:97–101+143.

  43. Xia G, Qian M. The relationship of parenting style to self-reported mental health among two subcultures of Chinese. J Adolesc. 2001;24(2):251–60. https://doi.org/10.1006/jado.2001.0375.

    Article  CAS  PubMed  Google Scholar 

  44. Psederska E, Savov S, Atanassov N, Vassileva J. Relationships between alexithymia and psychopathy in heroin dependent individuals. Front Psychol. 2019;10:2269. https://doi.org/10.3389/fpsyg.2019.02269.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Toneatto T, Lecce J, Bagby M. Alexithymia and pathological gambling. J Addict Dis. 2009;28(3):193–8. https://doi.org/10.1080/10550880903014775.

    Article  PubMed  Google Scholar 

  46. Elander J, Duarte J, Maratos FA, Gilbert P. Predictors of painkiller dependence among people with pain in the general population. Pain Med (Malden, Mass). 2014;15(4):613–24. https://doi.org/10.1111/pme.12263.

    Article  Google Scholar 

  47. Di Tella M, Castelli L. Alexithymia in chronic pain disorders. Curr Rheumatol Rep. 2016;18(7):41. https://doi.org/10.1007/s11926-016-0592-x.

    Article  CAS  PubMed  Google Scholar 

  48. Thorberg FA, Young RM, Hasking P, Lyvers M, Connor JP, London ED, et al. Alexithymia and alcohol dependence: the roles of negative mood and alcohol craving. Subst Use Misuse. 2019;54(14):2380–6. https://doi.org/10.1080/10826084.2019.1650773.

    Article  PubMed  Google Scholar 

  49. Knapton C, Bruce G, Williams L. The impact of alexithymia on desire for alcohol during a social stress test. Subst Use Misuse. 2018;53(4):662–7. https://doi.org/10.1080/10826084.2017.1355389.

    Article  PubMed  Google Scholar 

  50. Ozburn AR, Janowsky AJ, Crabbe JC. Commonalities and distinctions among mechanisms of addiction to alcohol and other drugs. Alcohol Clin Exp Res. 2015;39(10):1863–77. https://doi.org/10.1111/acer.12810.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kooiman CG, Spinhoven P, Trijsburg RW. The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto alexithymia Scale-20. J Psychosom Res. 2002;53(6):1083–90. https://doi.org/10.1016/s0022-3999(02)00348-3.

    Article  CAS  PubMed  Google Scholar 

  52. Garcia OF, Fuentes MC, Gracia E, Serra E, Garcia F. Parenting Warmth and Strictness across Three Generations: Parenting Styles and Psychosocial Adjustment. Int J Environ Res Public Health. 2020;17(20). https://doi.org/10.3390/ijerph17207487.

  53. Garcia O, Serra E, Zacarés González J, García F. Parenting styles and short-and long-term socialization outcomes: a study among Spanish adolescents and older adults. Psychosoc Interv. 2018;27:153–61. https://doi.org/10.5093/pi2018a21.

    Article  Google Scholar 

  54. Steinberg L, Lamborn SD, Darling N, Mounts NS, Dornbusch SM. Over-time changes in adjustment and competence among adolescents from authoritative, authoritarian, indulgent, and neglectful families. Child Dev. 1994;65(3):754–70. https://doi.org/10.1111/j.1467-8624.1994.tb00781.x.

    Article  CAS  PubMed  Google Scholar 

  55. Martinez-Escudero JA, Villarejo S, Garcia OF, Garcia F. Parental socialization and its impact across the lifespan. Behav Sci (Basel, Switzerland). 2020;10(6). https://doi.org/10.3390/bs10060101.

  56. Wurster HE, Sarche M, Trucksess C, Morse B, Biringen Z. Parents' adverse childhood experiences and parent-child emotional availability in an American Indian community: relations with young children's social-emotional development. Dev Psychopathol. 2020;32(2):425–36. https://doi.org/10.1017/s095457941900018x.

    Article  PubMed  Google Scholar 

  57. Evren C, Evren B, Dalbudak E, Ozcelik B, Oncu F. Childhood abuse and neglect as a risk factor for alexithymia in adult male substance dependent inpatients. J Psychoactive Drugs. 2009;41(1):85–92. https://doi.org/10.1080/02791072.2009.10400677.

    Article  PubMed  Google Scholar 

  58. Zakhour M, Haddad C, Salameh P, Akel M, Fares K, Sacre H, et al. Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder. Alcohol (Fayetteville, NY). 2020;83:1–8. https://doi.org/10.1016/j.alcohol.2019.08.007.

    Article  CAS  Google Scholar 

  59. Kaya E, Deveci A. Parental acceptance/rejection perceptions and attachment styles of men with online gambling disorder. J Gambl Stud. 2021. https://doi.org/10.1007/s10899-021-10084-5.

  60. Huang J, Napolitano LA, Wu J, Yang Y, Xi Y, Li Y, et al. Childhood experiences of parental rearing patterns reported by Chinese patients with borderline personality disorder. Int J Psychol. 2014;49(1):38–45. https://doi.org/10.1002/ijop.12007.

    Article  PubMed  Google Scholar 

  61. Kılıç F, Demirdaş A, Işık Ü, Akkuş M, Atay İM, Kuzugüdenlioğlu D. Empathy, alexithymia, and theory of mind in borderline personality disorder. J Nerv Ment Dis. 2020;208(9):736–41. https://doi.org/10.1097/nmd.0000000000001196.

    Article  PubMed  Google Scholar 

  62. Savage M, Lenzenweger MF. The impact of social exclusion on "Reading the mind in the eyes" performance in relation to borderline personality disorder features. J Personal Disord. 2018;32(1):109–30. https://doi.org/10.1521/pedi_2017_31_293.

    Article  Google Scholar 

  63. Gratz KL, Tull MT, Baruch DE, Bornovalova MA, Lejuez CW. Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Compr Psychiatry. 2008;49(6):603–15. https://doi.org/10.1016/j.comppsych.2008.04.005.

    Article  PubMed  Google Scholar 

  64. Thorberg FA, Young RM, Sullivan KA, Lyvers M, Connor JP, Feeney GF. Alexithymia, craving and attachment in a heavy drinking population. Addict Behav. 2011;36(4):427–30. https://doi.org/10.1016/j.addbeh.2010.12.016.

    Article  PubMed  Google Scholar 

  65. Xu P, Opmeer EM, van Tol MJ, Goerlich KS, Aleman A. Structure of the alexithymic brain: a parametric coordinate-based meta-analysis. Neurosci Biobehav Rev. 2018;87:50–5. https://doi.org/10.1016/j.neubiorev.2018.01.004.

    Article  PubMed  Google Scholar 

  66. van der Velde J, Servaas MN, Goerlich KS, Bruggeman R, Horton P, Costafreda SG, et al. Neural correlates of alexithymia: a meta-analysis of emotion processing studies. Neurosci Biobehav Rev. 2013;37(8):1774–85. https://doi.org/10.1016/j.neubiorev.2013.07.008.

    Article  PubMed  Google Scholar 

  67. Fava NM, Trucco EM, Martz ME, Cope LM, Jester JM, Zucker RA, et al. Childhood adversity, externalizing behavior, and substance use in adolescence: mediating effects of anterior cingulate cortex activation during inhibitory errors. Dev Psychopathol. 2019;31(4):1439–50. https://doi.org/10.1017/s0954579418001025.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Okita K, Ghahremani DG, Payer DE, Robertson CL, Mandelkern MA, London ED. Relationship of alexithymia ratings to dopamine D2-type receptors in anterior cingulate and insula of healthy control subjects but not methamphetamine-dependent individuals. Int J Neuropsychopharmacol. 2016;19(5). https://doi.org/10.1093/ijnp/pyv129.

  69. McCarthy G, Puce A, Gore JC, Allison T. Face-specific processing in the human fusiform gyrus. J Cogn Neurosci. 1997;9(5):605–10. https://doi.org/10.1162/jocn.1997.9.5.605.

    Article  CAS  PubMed  Google Scholar 

  70. Matochik JA, Eldreth DA, Cadet JL, Bolla KI. Altered brain tissue composition in heavy marijuana users. Drug Alcohol Depend. 2005;77(1):23–30. https://doi.org/10.1016/j.drugalcdep.2004.06.011.

    Article  CAS  PubMed  Google Scholar 

  71. Cascino G, Monteleone AM, Marciello F, Pellegrino F, Ruzzi V, Monteleone P. Alexithymia and cortisol awakening response in people with eating disorders. World J Biol Psychiatry. 2021;22(7):546–51. https://doi.org/10.1080/15622975.2020.1844291.

    Article  PubMed  Google Scholar 

  72. Monteleone AM, Patriciello G, Ruzzi V, Fico G, Pellegrino F, Castellini G, et al. Insecure attachment and hypothalamus-pituitary-adrenal Axis functioning in people with eating disorders. Psychosom Med. 2018;80(8):710–6. https://doi.org/10.1097/psy.0000000000000629.

    Article  CAS  PubMed  Google Scholar 

  73. Poon JA, Turpyn CC, Hansen A, Jacangelo J, Chaplin TM. Adolescent Substance use & Psychopathology: interactive effects of cortisol reactivity and emotion regulation. Cogn Ther Res. 2016;40(3):368–80. https://doi.org/10.1007/s10608-015-9729-x.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank all the participants who volunteered to participate in this study.

Funding

This study was supported by the National Natural Science Foundation of China (81801341), China International Medical Exchange Foundation (Z-2018-35-2002), and the Anhui Provincial Key R&D Programme (202004j07020030). Interdisciplinary project of clinical and basic disciplines of Anhui Medical University (No. 2101025103).

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Authors and Affiliations

  1. School of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032, Anhui Province, China

    Cui Huang, Qiuyu Yuan, Shengya Shi, Menglin Ge, Xuanlian Sheng, Meng Yang, Ling Zhang, Lei Wang, Kai Zhang & Xiaoqin Zhou

  2. Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000, China

    Cui Huang, Qiuyu Yuan, Shengya Shi, Menglin Ge, Xuanlian Sheng, Meng Yang, Ling Zhang, Lei Wang, Kai Zhang & Xiaoqin Zhou

  3. Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000, China

    Cui Huang, Qiuyu Yuan, Shengya Shi, Menglin Ge, Xuanlian Sheng, Meng Yang, Ling Zhang, Lei Wang, Kai Zhang & Xiaoqin Zhou

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Contributions

The manuscript was designed and written by author CH. CH, QY, MG, XS, MY, LW and SS collected data and performed literature search. CH, KZ and LZ performed data analysis and interpretation. XZ and KZ supervised conception and design of the work and provided critical revision of the article. All authors contributed approval of the final version of the manuscript.

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Correspondence to Kai Zhang or Xiaoqin Zhou.

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The ethics committee of Chaohu Hospital of Anhui Medical University approved this study (Ethics number: 201901- kyxm-02). All participants had signed an informed consent form.

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Huang, C., Yuan, Q., Shi, S. et al. Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients. BMC Psychiatry 22, 276 (2022). https://doi.org/10.1186/s12888-022-03897-0

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