Chapter 4 132 5. Discussion This study is one of the first to explore the potential mediating role of alexithymia in the relationship between borderline personality pathology (BPP) and other clinical variables, notably depressive symptoms (DEP), dissociative experiences (DIS) and self-injurious behaviors (SIB). Results support our first hypothesis. BPP was moderately positively associated with alexithymia - both when measured by self-report as via clinical interview. This finding adds to the body of empirical evidence of a robust – albeit yet to be clarified - association between alexithymia and BPP. Strengths of relationships between TAS20 measures of alexithymia and self-report measures of BPP were highly similar to those we found in a meta-analysis [22]. Next, relationships between BPP and depressive symptomatology (DEP), dissociative experiences (DIS), and SIB were also confirmed and concur with findings from other recent work in the field (BPP and SIB [3]; BPP and DEP [68, 115], BPP and DIS [116, 117]). The only ‘dissonant’ proved to be the relationship between BPP and indirect SIB, which was weak in strength and failed to reach significance. This was unexpected since there is accumulating evidence that there is little that sets apart the occurrence of direct and indirect forms of SIB [82, 86]. Our data showed a moderate strong association between both forms. Research suggests that at least where there is (some form of) direct SIB, there almost always is (some form of) indirect SIB [85]. With regard to the second hypothesis, i.e., the expectancy of significant positive bivariate relationships alexithymia and respectively DEP, DIS, and SIB, conclusions were less uniform. Alexithymia was found to be moderately to strongly positively associated with DEP, partially to DIS (depending on the instrument, see below), but generally not to SIB. With regard to DEP, outcomes were in line with those of our earlier meta-analysis [22], as well as with findings of a more recent study by Sleuwaegen, Houben [28]. The strength and significance of the relationship between alexithymia and DIS differed depending on whether alexithymia was assessed via TAS-20 versus via TSIA. It seems that psychometrical differences between the instruments that account for less than perfect convergence between outcomes [118] are in play here. As discussed in more detail below, one of the main differences between instruments is the degree to which it is related to negative affect [119, 120]. With the exception of one weak positive association between alexithymia assessed via TSIA and direct SIB in the past year, none of the SIB measures correlated with either measure of alexithymia. In analyses where the TAS-20 was used to assess the level of alexithymia – as is still common practice in the vast majority of studies on alexithymia – not a single significant association was found between alexithymia and SIB. We did not expect this outcome, as robust positive associations repeatedly and consistently have been reported in the literature [76].
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