The concept of alexithymia refers to difficulties in identifying and verbalizing emotions, an externally oriented thinking style and a paucity of fantasy. Theoretically and clinically we expect typical ways of regulating affect in alexithymic individuals. The few existing studies on this topic mainly rely on self-report methods, which are inherently problematic since affect representation and affect regulation are not conscious processes.

This study investigates whether alexithymia is associated with dysfunctional methods of affect regulation using clinical ratings of interviews. We hypothesize that alexithymic individuals will use affect regulation methods that do not reflect psychic mediation (H1) and will be unable to solicit cognitive resources (H2) or social support (H3) when confronted with emotional distress.

51 psychiatric in-patients were interviewed with

1. 1) the Clinical Diagnostic Interview which was coded with the Affect Regulation and Experiences Q-sort (ARE-q) and

2. 2) the Toronto Structured Interview for Alexithymia (TSIA).

In general, alexithymia was positively related to avoidant defenses and negatively to reality focused responses. On item level, we found relationships with for example self-destructive behavior and dissociation (H1), items referring to the inability to use self-talk to cope with distress and the inability to anticipate problems and develop realistic plans for them (H2), and finally a negative relation with ‘responds to potentially distressing situations by talking directly to the people involved.’ (H3).

Alexithymia is associated with typical dysfunctional methods of affect regulation. This should be taken into account in the diagnostic process as well as treatment for alexithymia.