Chapter 4 118 In scoping the existing literature, we found no studies that directly assessed whether alexithymia actually mediates the associations of BPP with respectively DEP, DIS, and/or SIB. One study reported the finding that as levels of alexithymia decreased with cognitive behaviour therapy, so did depressive symptoms [95]. Another study found significant positive relationships between improvements in alexithymia and improvements in dissociation after trauma treatment [25]. Both studies did not include BPP, and both basically reported bivariate correlations between measures. Regarding SIB, we found a study [78] that assessed alexithymia and several personality disorders in relation to direct SIB in a sample of substance dependent patients. Results showed direct SIB to be increasing with higher BPP, as well as with two facets of alexithymia: difficulty identifying feelings and difficulty describing feelings. However, no mediation analyses were conducted. Another study yielded evidence that direct SIB is -again - associated with alexithymia in patients with BPD [28]. Yet another study yielded some preliminary empirical support for “clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD” [81]. Although these results all support the view that alexithymia is an important factor to consider in patients with BPP, DEP, DIS and/or SIB, they do not provide empirically derived information that can help to understand the way these phenomena are related. Goal of this exploratory study is to assess whether alexithymia acts as a mediator in the interplay between BPP on the one hand and SIB, depressive symptoms and dissociative experiences on the other hand in a sample of psychiatric patients. The choice of population from which the sample is chosen is relevant, as alexithymia is highly co-occurring with psychiatric disorders (30- 60%) [96-99]2. Based on our review of the literature, we postulated the following hypotheses. 1) BPP is positively associated with alexithymia, depressive symptomatology (DEP), dissociative experiences (DIS), and SIB; 2) alexithymia is positively associated with depressive symptomatology (DEP), dissociative experiences (DIS), and SIB; 3) The associations of BPP with depressive symptomatology (DEP), and dissociative experiences (DIS) and SIB are mediated by alexithymia. If our hypotheses on mediation prove to hold true, this could have an impact on the treatment of BPP. Psychotherapy would then best start by treating alexithymia and increasing emotional awareness before attempting to treat other problems. Several scholars and clinicians proclaim that alexithymia - or the ability to identify, describe 2 Ethical approval for this study was granted by a Dutch national ethical committee (file number NL59088.044.17).
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