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Meta-Analysis
. 2017 Aug:99:66-81.
doi: 10.1016/j.jpsychores.2017.06.007. Epub 2017 Jun 11.

Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

Heather Westwood  1 , Jess Kerr-Gaffney  2 , Daniel Stahl  3 , Kate Tchanturia  4
Affiliations
Meta-Analysis

Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

Heather Westwood et al. J Psychosom Res. 2017 Aug.

Abstract

Objective: The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups.

Method: Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs.

Results: Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions.

Conclusion: Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.

Keywords: Alexithymia; Eating disorder; Emotion recognition; Meta-analysis; Systematic review.

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Figures

Fig. 1
Fig. 1
Systematic review search process.
Fig. 2
Fig. 2
Funnel plot of Anorexia Nervosa (AN) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 3
Fig. 3
Funnel plot of Anorexia Nervosa, Restricting subtype (AN-R) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 4
Fig. 4
Funnel plot of Anorexia Nervosa, Binge-Purge subtype (AN-BP) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 5
Fig. 5
Funnel plot of Bulimia Nervosa (BN) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 6
Fig. 6
Funnel plot of Binge Eating Disorder (BED) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 7
Fig. 7
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Anorexia Nervosa (AN) and Healthy Controls. CI, confidence interval.
Fig. 8
Fig. 8
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Anorexia Nervosa, Restricting subtype (AN-R) and Healthy Controls (HC) and between Anorexia Nervosa, Binge-Purge subtype (AN-BP) and HCs. CI, confidence interval.
Fig. 9
Fig. 9
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Bulimia Nervosa (BN) and Healthy Controls. CI, confidence interval.
Fig. 10
Fig. 10
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Binge Eating Disorder (BED) and Healthy Controls. CI, confidence interval.
Fig. 11
Fig. 11
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Anorexia Nervosa (AN) and Healthy Controls (HC). CI, confidence interval.
Fig. 12
Fig. 12
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Anorexia Nervosa, Restricting subtype (AN-R) and Healthy Controls (HC). CI, confidence interval.
Fig. 13
Fig. 13
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Bulimia Nervosa (BN) and Healthy Controls (HC). CI, confidence interval.
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References

    1. Lesser I.M. A review of the alexithymia concept. Psychosom. Med. 1981;43:531–543. - PubMed
    1. Li S., Zhang B., Guo Y., Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis. Psychiatry Res. 2015;227:1–9. - PubMed
    1. Roh D., Kim W.J., Kim C.H. Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions. J. Nerv. Ment. Dis. 2011;199:690–695. - PubMed
    1. O'Driscoll C., Laing J., Mason O. Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clin. Psychol. Rev. 2014;34:482–495. - PubMed
    1. Frewen P.A., Dozois D.J., Neufeld R.W., Lanius R.A. Meta-analysis of alexithymia in posttraumatic stress disorder. J. Trauma. Stress. 2008;21:243–246. - PubMed