The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis

Background: Nonsuicidal self-injury (NSSI; direct harm to the body without suicidal intent) and risky drinking are two behaviours that serve emotion regulatory functions. When underlying emotional problems are untreated, individuals may shift between NSSI and risky drinking. Both behaviours are associated with alexithymia, difficulties identifying and describing emotions and retaining an externally orientated thinking style. However, it is unknown to what extent the associations are similar and under what circumstances (e.g. sex, age) they may differ. Method: To compare both associations we conducted an extensive review using several databases. Overall, 20 NSSI-related articles and 33 risky drinking-related articles ma the inclusion criteria. Results: A meta-analysis revealed significant positive associations between total alexithymia scores, difficulties identifying feelings, difficulties describing feelings and both NSSI and risky drinking. However, these associations appear stronger for NSSI. Further, externally orientated thinking was associated with risky drinking but not NSSI. Age had opposing moderating effects on the relationships, with the association between alexithymia and NSSI being stronger in younger samples and the association between alexithymia and risky drinking being stronger in older samples. Further, the association between alexithymia and NSSI was stronger for female only samples compared to male only samples. Limitations: The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional. Conclusion: These results imply that NSSI and risky drinking may have both shared and distinguishable correlates. Alexithymia can be targeted in treatment to potentially reduce the likelihood of individuals shifting between behaviours to regulate their emotions.