ReviewSchizophrenia (Heidelberg, Germany)2026
Alexithymia in schizophrenia spectrum disorders and dissociative disorders: two meta-analytic reviews.
Review in Schizophrenia (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Schizophrenia-spectrum disorders (SSDs) and dissociative disorders (DDs) often co-occur, and both show emotion processing deficits. Alexithymia-comprising difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT)-is considered a shared vulnerability factor, yet the relative prominence of each facet within and across these disorders remains uncertain. The current two meta-analyses synthesised severity of overall alexithymia and its facets in SSDs (Meta-analysis 1) or DDs (Meta-analysis 2) compared to psychiatrically healthy controls. A preregistered search of PsycINFO, PubMed, and Embase (1970-31 December 2024) identified adult case-control studies. Pooled Hedges' g values were estimated with random-effects meta-analysis models, then compared across diagnoses (moderator analyses) with mixed-effects meta-analysis models. Meta-analysis 1 pooled 27 SSD studies (1477 patients, 1249 controls). Meta-analysis 2 pooled 30 DD studies (842 patients, 796 controls). Both patient groups scored higher than controls on overall alexithymia and all facets. In SSDs, DIF showed the largest group effect (g = 0.894; CI 0.667-1.122), whereas DDF (g = 0.622; CI 0.468-0.775) and EOT (g = 0.585; CI 0.400-0.770) showed moderate effects. In DDs, both DIF (g = 1.311; CI 0.991-1.632) and DDF (g = 0.954; CI 0.707-1.202) showed large effects, whereas EOT (g = 0.427; CI 0.163-0.690) showed a small-to-moderate effect. Between the disorder groups, after removing extreme effects, DDs exhibited greater DIF and DDF than SSDs, whereas SSDs showed higher EOT. Heterogeneity was moderate-to-high, and publication bias was possible in SSD studies. Alexithymia is a significant transdiagnostic deficit, but its facet profiles differ between SSDs and DDs. Emotion-focused interventions should therefore target facet-specific deficits prominent to each disorder group.
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