Emotion dysregulation and dissociation mediate the association between alexithymia and depressive symptoms in individuals with alcohol use disorder

Abstract Aims Dissociation may be considered both a severe psychopathological symptom and an everyday life experience. Still, little is known about the role of dissociation in emotion processing of individuals with alcohol use disorder (AUD), as the results of current studies remain inconclusive. The aim of this study was to examine associations between dissociation, emotional processing (emotion dysregulation; alexithymia) and depressive symptoms in patients with AUD and healthy individuals. Methods A total of 136 individuals who participated in an 8-week abstinence-based inpatient alcohol treatment program comprised the AUD group, and 80 healthy adults comprised the non-AUD [healthy controls (HC)] group. Self-report measures were used to assess alexithymia [difficulties describing and identifying feelings; Toronto Alexithymia Scale (TAS)-20], depressive symptom severity [Beck Depression Inventory (BDI)], emotion dysregulation [Difficulties in Emotion Regulation Scale (DERS)], and dissociative experiences [Dissociative Experiences Scale (DES)-II]. Results Individuals with AUD reported significantly higher levels of dissociation, emotion dysregulation, alexithymia, and depressive symptoms compared to HCs. Difficulties in emotion regulation and severity of depressive symptoms were positively associated with dissociation, but only in the AUD group. Difficulties in emotion regulation and dissociation serially mediated the association between alexithymia and severity of depressive symptoms, but only in the AUD group. Conclusions Associations between emotion processing characteristics, dissociation, and depressive symptom severity differ in individuals with and without AUD. These results suggest that dissociation might be a promising target for therapeutic interventions among individuals with AUD.