Advertisement

Sex Differences in Emotional Insight After Traumatic Brain Injury

      Abstract

      Objective

      To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls.

      Design

      Cross-sectional study.

      Setting

      TBI rehabilitation facility in the United States and a university in Canada.

      Participants

      Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120).

      Interventions

      Not applicable.

      Main Outcome Measures

      Toronto Alexithymia Scale-20 (TAS-20).

      Results

      Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P<.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI.

      Conclusions

      Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.

      Keywords

      List of abbreviations:

      DDF (difficulty describing feelings), DIF (difficulty identifying feelings), EOT (externally oriented thinking), ES (effect size), TAS-20 (Toronto Alexithymia Scale-20), TBI (traumatic brain injury)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wood R.L.
        • Williams C.
        Neuropsychological correlates of organic alexithymia.
        J Int Neuropsychol Soc. 2007; 13: 471-479
        • Bagby R.M.
        • Parker J.D.A.
        • Taylor G.J.
        The 20-Item Toronto-Alexithymia-Scale. 1. Item selection and cross-validation of the factor structure.
        J Psychosom Res. 1994; 38: 23-32
        • Williams C.
        • Wood R.L.
        Alexithymia and emotional empathy following traumatic brain injury.
        J Clin Exp Neuropsychol. 2010; 32: 259-267
        • Messina A.
        • Beadle J.
        • Paradiso S.
        Towards a classification of alexithymia: primary, secondary and organic.
        J Psychopathol. 2014; 20: 38-49
        • Henry J.
        • Phillips L.
        • Crawford J.
        • Theorodou G.
        • Summers F.
        Cognitive and psychosocial correlates of alexithymia following traumatic brain injury.
        Neuropsychologia. 2006; 44: 62-72
        • Neumann D.
        • Malec J.F.
        • Hammond F.M.
        Reductions in alexithymia and emotion dysregulation after training emotional self-awareness following traumatic brain injury: a phase i trial.
        J Head Trauma Rehabil. 2017; 32: 286-295
        • Neumann D.
        • Zupan B.
        • Malec J.
        • Hammond F.
        Relationships between alexithymia, affect recognition, and empathy after traumatic brain injury.
        J Head Trauma Rehabil. 2014; 29: E18-E27
        • Levant R.F.
        • Hall R.J.
        • Williams C.M.
        • Hasan N.T.
        Gender differences in alexithymia.
        Psychol Men Masculinities. 2009; 10: 190
        • Fischer A.R.
        • Good G.E.
        Men and psychotherapy: an investigation of alexithymia, intimacy, and masculine gender roles.
        Psychother Theor Res Pract Train. 1997; 34: 160
        • Levant R.F.
        • Hirsch L.S.
        • Celentano E.
        • Cozza T.M.
        The male role: An investigation of contemporary norms.
        J Ment Health Couns. 1992; 14: 325-337
        • Bagby R.M.
        • Taylor G.J.
        • Parker J.D.A.
        The 20-Item Toronto-Alexithymia-Scale. 2. Convergent, discriminant, and concurrent validity.
        J Psychosom Res. 1994; 38: 33-40
        • Taylor G.J.
        • Ryan D.
        • Bagby M.
        Toward the development of a new self-report alexithymia scale.
        Psychother psychosom. 1985; 44: 191-199
        • Levant R.F.
        • Allen P.A.
        • Lien M.-C.
        Alexithymia in men: how and when do emotional processing deficiencies occur?.
        Psychol Men Masculinities. 2014; 15: 324
        • Levant R.F.
        • Good G.E.
        • Cook S.W.
        • et al.
        The normative Male Alexithymia Scale: measurement of a gender-linked syndrome.
        Psychol Men Masculinities. 2006; 7: 212
        • Levant R.F.
        • Hall R.J.
        • Rankin T.J.
        Male Role Norms Inventory–Short Form (MRNI-SF): development, confirmatory factor analytic investigation of structure, and measurement invariance across gender.
        J Couns Psychol. 2013; 60: 228-238
        • Koponen S.
        • Taiminen T.
        • Honkalampi K.
        • et al.
        Alexithymia after traumatic brain injury: its relation to magnetic resonance imaging findings and psychiatric disorders.
        Psychosom Med. 2005; 67: 807-812
        • Neumann D.
        • Zupan B.
        Empathic responses to affective film clips following brain injury and the association with emotion recognition accuracy.
        Arch Phys Med Rehabil. 2019; 100: 458-463
        • Zupan B.
        • Neumann D.
        Affect recognition in traumatic brain injury: Responses to unimodal and multimodal media.
        J Head Trauma Rehabil. 2014; 29: E1-E12
        • Malec J.F.
        • Brown A.W.
        • Leibson C.L.
        • et al.
        The Mayo classification system for traumatic brain injury severity.
        J Neurotrauma. 2007; 24: 1417-1424
        • Nowicki S.
        • Duke M.P.
        Individual differences in the nonverbal communication of affect: The Diagnostic Analysis of Nonverbal Accuracy Scale.
        J Nonverb Behav. 1994; 18: 9-35
        • Williams C.
        • Wood R.L.
        The impact of alexithymia on relationship quality and satisfaction following traumatic brain injury.
        J Head Trauma Rehabil. 2013; 28: E21-E30
        • Wood R.L.
        • Doughty C.
        Alexithymia and avoidance coping following traumatic brain injury.
        J Head Trauma Rehabil. 2013; 28: 98-105
        • Neumann D.
        • Malec J.F.
        • Hammond F.M.
        The relations of self-reported aggression to alexithymia, depression, and anxiety after traumatic brain injury.
        J Head Trauma Rehabil. 2017; 32: 205-213
        • Lane R.D.
        • Sechrest L.
        • Riedel R.
        Sociodemographic correlates of alexithymia.
        Compr Psychiatry. 1998; 39: 377-385
        • Parker J.D.
        • Michael Bagby R.
        • Taylor G.J.
        • Endler N.S.
        • Schmitz P.
        Factorial validity of the 20-item Toronto Alexithymia Scale.
        Eur J Pers. 1993; 7: 221-232
        • Parker J.D.
        • Taylor G.J.
        • Bagby R.M.
        The 20-Item Toronto Alexithymia Scale: III. Reliability and factorial validity in a community population.
        J Psychosom Res. 2003; 55: 269-275
        • Salminen J.K.
        • Saarijärvi S.
        • Äärelä E.
        • Toikka T.
        • Kauhanen J.
        Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland.
        J Psychosom Res. 1999; 46: 75-82
        • Rigon A.
        • Turkstra L.S.
        • Mutlu B.
        • Duff M.C.
        Facial-affect recognition deficit as a predictor of different aspects of social-communication impairment in traumatic brain injury.
        Neuropsychology. 2018; 32: 476
        • Zupan B.
        • Babbage D.
        • Neumann D.
        • Willer B.
        Sex differences in emotion recognition and emotional inferencing following severe traumatic brain injury.
        Brain Impair. 2017; 18: 36-48
        • Zupan B.
        • Neumann D.
        • Babbage D.
        • Willer B.
        Sex-based differences in affective and cognitive empathy following severe traumatic brain injury.
        Neuropsychology. 2018; : 554-563
        • May M.
        • Milders M.
        • Downey B.
        • et al.
        Social behavior and impairments in social cognition following traumatic brain injury.
        J Int Neuropsychol Soc. 2017; 23: 400-411
        • Milders M.
        Relationship between social cognition and social behaviour following traumatic brain injury.
        Brain Inj. 2019; 33: 62-68
      1. Neumann D, Zupan B, Eberle R. Social Cognition. In: Jonathon M. Silver TWM, David B. Arciniegas, eds. Textbook of Traumatic Brain Injury. 3rd ed. Washington, DC: American Psychiatric Association Publishing; 2019;281-297.

        • Loas G.
        • Corcos M.
        • Stephan P.
        • et al.
        Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples.
        J Psychosom Res. 2001; 50: 255-261
        • Kooiman C.
        • Spinhoven P.
        • Trijsburg R.
        The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20.
        J Psychosom Res. 2002; 53: 1083-1090
        • Lane R.D.
        • Quinlan D.M.
        • Schwartz G.E.
        • Walker P.A.
        • Zeitlin S.B.
        The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion.
        J Pers Assess. 1990; 55: 124-134
        • Katsifaraki M.
        • Wood R.L.
        The impact of alexithymia on burnout amongst relatives of people who suffer from traumatic brain injury.
        Brain Inj. 2014; 28: 1389-1395
        • Wood R.L.
        • O'hagan G.
        • Williams C.
        • McCabe M.
        • Chadwick N.
        Anxiety sensitivity and alexithymia as mediators of postconcussion syndrome following mild traumatic brain injury.
        J Head Trauma Rehabil. 2014; 29: E9-E17
        • Wood R.L.
        • Williams C.
        • Kalyani T.
        The impact of alexithymia on somatization after traumatic brain injury.
        Brain Inj. 2009; 23: 649-654
        • Wood R.L.
        • Williams C.
        • Lewis R.
        Role of alexithymia in suicide ideation after traumatic brain injury.
        J Int Neuropsychol Soc. 2010; 16: 1108-1114