How Alexithymia Increases Mental Health Symptoms in Adolescence: Longitudinal Evidence for the Mediating Role of Emotion Regulation

Alexithymia is characterised by difficulties identifying and describing feelings, as well as a lack of focus on feelings. Alexithymia is a transdiagnostic risk factor for developing a wide array of psychopathologies, such as anxiety and depression, with a key hypothesised mechanism being the impairing impact of alexithymia on emotion regulation. However, no study has tested whether difficulties with emotion regulation mediate the link between alexithymia and clinically relevant symptoms using longitudinal designs. The present study aimed to address this limitation by collecting data from 242 Iranian high school students at two time points, seven months apart. The results revealed that baseline alexithymia levels not only related to future emotion regulation difficulties but predicted increased emotion regulation difficulties in the future. Furthermore, these increased difficulties in emotion regulation mediated the relationship between baseline alexithymia and worsening of psychological distress (e.g., depression, anxiety, and stress symptoms) over time. This study, therefore, supports the attention-appraisal model of alexithymia in its theoretical account linking alexithymia and emotion regulation difficulties and highlights the critical role that alexithymia plays in emotional health and illness during adolescence.