The relationship between self-harm and alexithymia: a systematic review and meta-analysis

Article

Norman, H., Oskis, A., Marzano, L. and Coulson, M. 2020. The relationship between self-harm and alexithymia: a systematic review and meta-analysis. Scandinavian Journal of Psychology. 61 (6), pp. 855-876. https://doi.org/10.1111/sjop.12668
TypeArticle
TitleThe relationship between self-harm and alexithymia: a systematic review and meta-analysis
AuthorsNorman, H., Oskis, A., Marzano, L. and Coulson, M.
Abstract

Self-harm, defined for the purpose of this review as any act of self-injury without explicit suicidal intent, is an increasing public health concern, with potential long-term implications for those who engage in it. Previous research has identified a correlational relationship between self-harm and alexithymia, an emotion processing deficit characterised by difficulties identifying and describing feelings, and an externally-orientated thinking style. Through a systematic search of the literature, the current review examines the association between alexithymia and self-harm. A meta-analysis based on 23 studies found a significant, positive relationship between self-harm and alexithymia, with a medium effect size (g = 0.57, 95% CI 0.45 to 0.71). All 23 studies used the Toronto Alexithymia Scale (TAS20) to measure alexithymia. The alexithymia subcomponents difficulty identifying feelings and difficulty describing feelings were significantly associated with self-harm, but there was no significant association between self-harm and externally-orientated thinking. The effect size of the relationship was significantly larger in adolescent samples compared with adult samples and in female compared with male samples. The definition of self-harm did not affect the effect size of the relationship between alexithymia and self-harm and the results are consistent with previous meta-analyses focused more narrowly on non-suicidal self-injury and, separately, suicidal behaviours. Heterogeneity between the included studies was high. The results support an affect regulation model of self-harm, in which self-harm is used to regulate an emotional experience that is poorly understood.

KeywordsSelf-harm; alexithymia; NSSI; emotion regulation; meta-analysis
Research GroupApplied Health Psychology group
PublisherWiley
The Scandinavian Psychological Associations
JournalScandinavian Journal of Psychology
ISSN0036-5564
Electronic1467-9450
Publication dates
Online24 Jul 2020
Print25 Nov 2020
Publication process dates
Deposited24 Jun 2020
Accepted02 Jun 2020
Output statusPublished
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Open
Accepted author manuscript
File Access Level
Restricted
Copyright Statement

© 2020 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited.

Digital Object Identifier (DOI)https://doi.org/10.1111/sjop.12668
Web of Science identifierWOS:000551515400001
LanguageEnglish
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Oskis, A., Clow, A., Hucklebridge, F., Bifulco, A., Jacobs, C. and Loveday, C. 2013. Understanding alexithymia in female adolescents: the role of attachment style. Personality and Individual Differences. 54 (1), pp. 97-102. https://doi.org/10.1016/j.paid.2012.08.023
Diurnal patterns of salivary cortisol across the adolescent period in healthy females
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2009. Diurnal patterns of salivary cortisol across the adolescent period in healthy females. Psychoneuroendocrinology. 34 (3), pp. 307-316. https://doi.org/10.1016/j.psyneuen.2008.09.009
Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report
Oskis, A., Loveday, C., Hucklebridge, F., Wood, D. and Clow, A. 2012. Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report. Case Reports in Psychiatry. 2012, pp. 1-7. https://doi.org/10.1155/2012/798512
Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2012. Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa. Stress. 15 (6), pp. 601-607. https://doi.org/10.3109/10253890.2012.661493
Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents
Oskis, A., Loveday, C., Hucklebridge, F., Thorn, L. and Clow, A. 2010. Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents. Journal of Child Psychology and Psychiatry. 52 (2), pp. 111-118. https://doi.org/10.1111/j.1469-7610.2010.02296.x
Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns
Marzano, L., Adler, J. and Ciclitira, K. 2013. Responding to repetitive, non-suicidal self-harm in an English male prison: staff experiences, reactions, and concerns. Legal and Criminological Psychology. https://doi.org/10.1111/lcrp.12025
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
The suicidal process in male prisoners making near-lethal suicide attempts
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2013. The suicidal process in male prisoners making near-lethal suicide attempts. Psychology, Crime and Law. 19 (4), pp. 305-327. https://doi.org/10.1080/1068316X.2011.631540
Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners
Marzano, L., Hawton, K., Rivlin, A. and Fazel, S. 2011. Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine. 72 (6), pp. 874-883. https://doi.org/10.1016/j.socscimed.2010.12.028
Near-lethal self-harm in women prisoners: contributing factors and psychological processes
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Impact on prisoners of participating in research interviews related to near-lethal suicide attempts
Rivlin, A., Marzano, L., Hawton, K. and Fazel, S. 2012. Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders. 136 (1), pp. 54-62. https://doi.org/10.1016/j.jad.2011.09.009
Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons
Rivlin, A., Fazel, S., Marzano, L. and Hawton, K. 2012. Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International. 220 (1), pp. 19-26. https://doi.org/10.1016/j.forsciint.2012.01.022
Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision
Starr, F., Ciclitira, K., Marzano, L., Brunswick, N. and Costa, A. 2013. Comfort and challenge: A thematic analysis of female clinicians’ experiences of supervision. Psychology and Psychotherapy: Theory, Research and Practice. 86 (3), pp. 334-351. https://doi.org/10.1111/j.2044-8341.2012.02063.x
Women counsellors' experiences of personal therapy: A thematic analysis
Ciclitira, K., Starr, F., Marzano, L., Brunswick, N. and Costa, A. 2012. Women counsellors' experiences of personal therapy: A thematic analysis. Counselling and Psychotherapy Research. 12 (2), pp. 136-145. https://doi.org/10.1080/14733145.2011.645050
The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives
Marzano, L., Ciclitira, K. and Adler, J. 2011. The impact of prison staff responses on self-harming behaviours: prisoners’ perspectives. British Journal of Clinical Psychology. 51 (1), pp. 4-18. https://doi.org/10.1111/j.2044-8260.2010.02007.x
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University School of Health and Social Sciences
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200.