4 Exploring the mediating role of alexithymia in BPP 133 Testing of our third hypothesis, i.e., alexithymia mediating the associations of BPP with DEP, DIS and SIB, yielded partial support for the underlying explanatory model in just one analysis. We did not find support for the contention of alexithymia acting as a ‘transmission mechanism’ in the relationship between BPP and DIS, nor BPP and SIB [32, 42]. Results from our analyses do not support the increasingly popular notion that ‘actions instead of words’ captures the interplay between BPP, alexithymia and SIB [28]. In the same vein, results of our analyses do not support the notion that dissociation, as a coping or emotion regulation mechanism, would decrease as patients would learn to become more aware of and attuned to their feelings [25, 26, 75]. According to our analyses, patients are not (more) prone to resort to dissociation, nor self-harming behaviors because of or due to alexithymia. The lack of a mediation effect of alexithymia seems puzzling at first, as the overall explanatory model has gained certain credibility in the field [25, 26]. Regarding DIS, the interrelationships between variables are robust, at least when alexithymia is measured by TAS-20 [26]. It could be the link between alexithymia and DIS is in fact spurious, and only there due to a shared dependency of a third (or more) variable(s). This third variable could, in fact, be BPP. BPP would then on the one hand be a ‘cause’ of DIS, and a ‘cause’ of alexithymia on the other. Since there would be no direct relationship between the two, and presuming a change in either alexithymia or DIS will not automatically affect the level of BPP given it’s (partial) genetic basis [44, 45], a change in the one will not lead to change in the other. The weak, non-significant correlations between alexithymia and the various measures of SIB provide a statistical explanation for the lack of a mediation effect. Yet, the lack of significant associations between alexithymia and SIB in our study deserves further attention. In a recent meta-analysis based on 23 studies, Norman, Oskis [76] found an overall significant, positive relationship between SIB and alexithymia with a medium effect size. One could assume it is due to our choice of instruments used to measure SIB. This is however improbable, as the results of the aforementioned meta-analysis show there a) has been very little consistency overall regarding the instruments used to measure SIB in other studies and, b) this does not affect the effect size of the relationship between alexithymia and SIB [76]. Also, associations of the various measures of SIB in this study (including the scale for indirect SIB) with the other variables (such as BPP) were in concordance with those reported in other studies [28, 81]. It could have been that associations of alexithymia with SIB in our study were clouded by unintended sampling bias. Norman, Oskis [76] found that the effect size of the relationship between alexithymia and SIB was significantly larger in adolescent samples than in adult samples. Our study included only adults that on average were well into adulthood, with a mean age of above 36 years. Yet, the inclusion of only adult participants is not a confounder of the ‘true association’ between alexithymia and SIB (and perhaps other variables) per se. In fact, Norman et al suggest the
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