Alexithymia in individuals maltreated as children and adolescents: a meta‐analysis

Khan, Anika N.; Jaffee, Sara R.

doi:10.1111/jcpp.13616

Cited by 69Child Abuse and TraumaPsychosomatic Disorders and Their TreatmentsChild Welfare and Adoption

Alexithymia in individuals maltreated as children and adolescents: a meta‐analysis

Khan, Anika N., Jaffee, Sara R.·2022·Journal of Child Psychology and Psychiatry

DOI 10.1111/jcpp.13616

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Abstract

Background: Children who are maltreated show deficits in emotion recognition, expression, and understanding. The goal of the current meta‐analysis was to determine the degree to which maltreatment is associated with deficits in the ability to recognize one’s own emotions – a phenomenon known as alexithymia. Alexithymia may be a mechanism explaining the association between childhood maltreatment and various psychological disorders. Methods: This meta‐analytic review (88 studies, n = 43,076) examined the association between the experience of childhood maltreatment and alexithymia, mainly in adulthood. Additional meta‐analyses were run to examine if the strength of the association between maltreatment as a child and alexithymia varied as a function of the type of maltreatment individuals reported and other moderators. Results: We found significant small effect sizes for all models, indicating higher levels of maltreatment in childhood or adolescence were associated with higher levels of alexithymia. Alexithymia was more strongly associated with forms of neglect than with physical or sexual abuse. The effect sizes also increased as the percentages of females in the sample increased. Conclusions: Results suggest that researchers should examine whether alexithymia is a transdiagnostic mechanism in the association between childhood maltreatment and psychopathology and whether targeting alexithymia in treatment could reduce a wide range of symptoms.

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Alexithymia and differences in conveying emotion in AN may be interlaced with atypical interoception and trauma survival, as well as autism-trauma intersections.
“Alexithymia and differences in conveying emotion in AN may also be interlaced with atypical interoception [96–99] and trauma survival, as well as autism-trauma intersections [100–104].”
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“…own childhood, this may interfere with developing a stable a ﬀ ective bond with her own o ﬀ spring, potentially via reduced emotional expressiveness (e.g. Yu et al., 2023) or higher levels of alexithymia (Khan & Ja ﬀ ee, 2022), the inability to express, describe, or distinguish one ’ s emotions.”
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“Alexithymia (i.e., dif ﬁ culty in recognizing, understanding, and verbalizing one ’ s emotions) could be another one, assuming that recognizing one ’ s emotional state could be an important precursor of engaging in adaptive coping strategies (Khan & Jaffee, 2022).”
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Zhong, Y., Chen, S. H., Zeng, Q., Ku, M., Zhang, Y., & Lyu, J. (2026) · BMC Psychiatry · doi:10.1186/s12888-025-07651-0 · Cited by 5 · see citing works
“In addition, current evidence suggests that elevated alexi-thymia levels in adulthood may be due to exposure to dysfunctional emotional environments during emotional and cognitive development, including insecure attachment [13], neglect [14], and abuse [15–17].”
Attention to facial emotions in adult women varies by type and severity of childhood maltreatment experience and emotion regulation strategy
Hoepfel, D., Bila, A., Günther, V., Kersting, A., & Suslow, T. (2025) · Scientific Reports · doi:10.1038/s41598-025-99562-z · Cited by 5 · see citing works
“There is evidence that emotional neglect during childhood is linked to alexithymic personality traits in adulthood 45,46 .”
Assessing autism spectrum disorder in children with a background of maltreatment: challenges and guidance
Wilkinson, S., Evans, S., & DeJong, M. (2022) · Archives of Disease in Childhood · doi:10.1136/archdischild-2022-323986 · Cited by 5 · see citing works
How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD
van Sleeuwen, C., van Zuiden, M., Koch, S. B. J., Frijling, J. L., Veltman, D. J., Olff, M., & Nawijn, L. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2281187 · Cited by 6 · see citing works
“Furthermore, alexithymia might be most strongly associated with emotional neglect in childhood (Frewen et al., 2008a, Kahn & Jaffee, 2022; Terock et al., 2020), which was only partially covered in our measure of childhood trauma (emotional neglect items were combined with emotional abuse items in the emotional abuse s…”
Background
A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress
Fang, J., Qiu, C., Sun, Z., Zhou, J., He, P., Conti, A. A., Lu, Y., Huang, X., Xu, J., & Tang, W. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152505 · Cited by 5 · see citing works
Experiences of childhood emotional maltreatment and emotional intelligence in young women
Suslow, T., Kersting, A., & Hoepfel, D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1583066 · Cited by 3 · see citing works
“Results from recent meta-analyses indicate that emotional and physical neglect but also emotional abuse experienced in childhood are linked to high levels of alexithymia in adulthood (18, 19).”
Childhood matters: How benevolent and adverse childhood experiences shape alexithymia in perpetrators of sex crimes and the community sample
Albuquerque, B. M., & Almeida, T. C. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107754 · Cited by 3 · see citing works
Prevalence of Alexithymia and Internet Addiction Among Students and the Impact of the COVID-19 Pandemic: a Systematic Review and Meta-Analysis of Cross-Sectional Studies
Karaçam, Z., Toker, S., & HASSOY, D. (2025) · Current Addiction Reports · doi:10.1007/s40429-025-00683-2 · Cited by 3 · see citing works
“These results supported the findings of previous studies [ 15 , 30 , 34 – 36 , It was determined that the heterogeneity between the studies was high for the data sets created in this study.”
Interrelationships between childhood trauma, alexithymia, and depressive symptoms: A network analysis and replication
Ye, Q., Zhang, S.-Y., He, X.-L., Yang, Y., Ni, K., Yang, H., Wei, W., Preece, D. A., Chan, R. C. K., Li, B.-M., et al. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107877 · Cited by 3 · see citing works
The relationship between childhood trauma and non-suicidal self-injury in adolescents with depressive disorders: the mediating role of alexithymia and coping strategies
Liu, Y., Liu, Y., Zhou, R., & Hou, C. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1744863 · Cited by 3 · see citing works
Disentangling general and sport-specific risk factors for anxiety and depression in a mixed sample of athletes and non-athletes
Landeghem, C. V., & Jakobson, L. S. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102773 · Cited by 3 · see citing works
An exploratory study of decoding signs of child maltreatment: How case and reporter characteristics shape reporting decisions
Ioku, T., Iwatani, S., Yuyama, Y., Mukai, T., Tanaka, A., Matsuki, Y., Sadamura, M., & Watamura, E. (2025) · Child Protection and Practice · doi:10.1016/j.chipro.2025.100104 · Cited by 3 · see citing works
A network approach to understanding the relationship between childhood maltreatment, suicidal ideation and psychological symptoms among Chinese adolescents
Li, S., He, Y., Zhou, H., Zhang, J., & Tang, Y. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107546 · Cited by 3 · see citing works
Investigating the role of alexithymia in the association between cumulative childhood maltreatment and teen dating violence victimization
Théorêt, V., Hebert, E. B., & Hébert, M. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.03.030 · Cited by 3 · see citing works
Childhood maltreatment and alexithymia: A network analysis
Liu, Y., Liu, S., Preece, D. A., Gross, J. J., Zhao, Z., Qian, J., Gao, M. M., & Han, Z. R. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120876 · Cited by 2 · see citing works
The mediating role of alexithymia and loneliness in the relationship between childhood emotional abuse and nomophobia
Saladino, V., Verrastro, V., Cuzzocrea, F., & Calaresi, D. (2025) · Developmental Child Welfare · doi:10.1177/25161032251388301 · Cited by 3 · see citing works
“These ﬁ ndings align with previous research that has demonstrated the adverse effects of CEA on mental health outcomes such as anxiety, depression, and low self-esteem (Khan & Jaffee, 2022; Paradis & Boucher, 2019; Spinazzola et al., 2014).”
Influential
A network analysis of childhood trauma, perceived social support and alexithymia in Chinese adolescents
Sun, Y., Guo, Y., Niu, X., Chong, X., Li, S., Wang, Y., Zheng, Y., Mu, F., Wang, L., Zhu, G., et al. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108021 · Cited by 2 · see citing works
Impact of alexithymia, attachment styles, and childhood traumas on the severity of body-focused repetitive behavior disorders
Aydın, E. P., Beğenen, A. G., Kenar, J. G., Altunay, İ. K., & Özer, Ö. A. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100438 · Cited by 2 · see citing works
A systematic review of alexithymia in young people and their parents
Davies, R. N., & Griffin, K. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119855 · Cited by 3 · see citing works
Childhood trauma and internalizing problems in youth living in residential care: The mediating role of emotion regulation
Lannes, É. E. M., Couture, S., Laurier, C., & Monette, S. (2026) · Children and Youth Services Review · doi:10.1016/j.childyouth.2026.108892 · Cited by 1 · see citing works
Associations between childhood maltreatment and overt aggression in depressed adolescents: the mediating effect of alexithymia and insomnia
Wang, J., Liu, L., Zhou, S., Zhao, L., Wu, Q., Sun, T., Zhang, N., Wei, X., Xia, L., & Zhao, F. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1619353 · Cited by 1 · see citing works
Relación entre parentalización, alexitimia y competencias parentales de figuras parentales atendidas en un centro de Prevención Focalizada del norte de Chile
Cortés, A., & Cruz, S. G. (2023) · Revista de psicología · doi:10.5354/0719-0581.2023.66416 · Cited by 2 · see citing works
Stress in childhood: clinical implications and therapeutic strategies
Shreiner, E. V., Балакирева, Е. А., Bystrova, V. I., Kovaleva, A. Y., & Хавкин, А. И. (2024) · Archives of Pediatrics and Pediatric Surgery · doi:10.31146/2949-4664-apps-2-1-182-195
Alexithymia: Prevalence and Association with Executive Function among Physiotherapy Students in Karachi, Pakistan
Zakir, N., Saleem, S., Fatima, V., Zulfiqar, B., & Rizvi, S. H. A. (2024) · Pakistan Journal of Rehabilitation · doi:10.36283/pjr.zu.13.2/016
Literaturverzeichnis zu Voderholzer (Hrsg.): Therapie psychischer Erkrankungen, 20. Auflage
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-21224-6.00055-4
The mediator role of alexithymia between childhood traumas and fibromyalgia impact level of patients with fibromyalgia
Çoban, M. C., & FARAJİ, H. (2025) · Interdisciplinary Medical Journal · doi:10.17944/interdiscip.1541885
Prodromal Symptoms of Schizophrenia, Childhood Maltreatment, Attachment Insecurity, and Alexithymia
Sideli, L., Fontana, A., Trani, L., Cuzzocrea, G., Mascanzoni, M., Pecora, R. D., Franquillo, A. C., Cantiano, A., D’Offizi, D., Brogna, P., et al. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001844
The association between childhood maltreatment and personal distress during adulthood in batterers: The moderating role of alexithymia and emotion decoding
Romero‐Martínez, Á., Sarrate‐Costa, C., Lila, M., & Moya‐Albiol, L. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107760
Childhood Trauma Subtypes and Alexithymia
Ateşsönmez, B., & KANDEMİR, F. (2025) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1627449
“Comparative findings show that while all subtypes of childhood trauma are positively associated with alexithymia, emotional abuse and neglect exhibit stronger associations than physical or sexual abuse (Khan and Jaffee 2022).”
Self-Reported Attitudes and Practices Related to Trauma-Informed Care: A Survey of Early Intervention Speech-Language Pathologists
Lord, H., Steele, S. C., & Roepke, E. (2026) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2025_persp-25-00061
Relationship Between Childhood Trauma and Suicidal Behavior in Individuals With Dual Diagnosis: The Mediating Role of Alexithymia and Mental Health
Estévez, A., Diego, G. A., Macía, L., Llanes-Álvarez, C., & Álvarez-Navares, A. I. (2026) · Behavioral Psychology/Psicología Conductual · doi:10.31083/bp51210
“This construct has been studied as a risk factor for suicide (Davey et al., 2018; Greene et al., 2020; Khan and Jaffee, 2022; Norman et al., 2020), both in general population and psychiatric and clinical population (De Berardis et al., 2017; Hemming et al., 2019; Iskric et al., 2020; Norman et al.,…”
Experiences of childhood emotional maltreatment and emotional intelligence in young men
Suslow, T., Rufer, M., Kersting, A., & Hoepfel, D. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1755465
“Recent meta-analyses demonstrate that experiencing emotional abuse, emotional neglect, and physical neglect during childhood is associated with impairments in identifying and describing emotions in adulthood (19, 20).”
Alexithymia in nurses: a context-specific concept analysis using rodgers’s evolutionary methodology
Feng, W., Yiting, L., Yanwen, S., & Jin, Y. (2026) · BMC Psychology · doi:10.1186/s40359-026-04986-5
“Post-traumatic stress and reduced resilience exhibit a bidirectional relationship with affective disorders and traumatic experiences [52].”
Psychological factors mediating/moderating the association between adverse childhood experiences and suicidal ideation in young people: a systematic review
Du, Y., Wan, X., Xu, J., & Feng, H. (2026) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-026-03061-z
“Besides, research has shown that a variety of ACEs are associated with young people’s difficulties in expressing their feelings [99].”
Investigation of Alexithymia Levels and Childhood Trauma in Mothers of Sexually Abused Children
Oksal, H., Büber, Ö., Sarıgedik, E., & Tunagür, M. T. (2026) · Cyprus Turkish Journal of Psychiatry and Psychology · doi:10.35365/ctjpp.26.3.07
Maternal Childhood Maltreatment, Social Support, and Self‐Insight Effects on Psychological Stress
Nakajima, M. (2026) · Japanese Psychological Research · doi:10.1111/jpr.70037
How Childhood Emotional Neglect Becomes Cyberbullying Perpetration: A Structural Model of Alexithymia, Internalized Shame and Self-Compassion
Pirzadeh, M., Azizi, M., Bastami, M., & Bansal, S. (2025) · International Journal of Psychology (IPA) · doi:10.66224/ijpb.19.2.87
Emotional Processing Deficits and PTSD: The Mediating Role of Alexithymia in Childhood Maltreatment Among Veterans
Kopitsky, M., Kozlowski, G. H., Zegel, M., & Taft, C. T. (2026) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2026.2711268
“Previous research has found that childhood maltreatment is positively related to adult alexithymia, with stronger associations for childhood emotional abuse, emotional neglect, and physical neglect compared to physical abuse and sexual abuse (Ditzer et al., 2023; Khan & Jaffee, 2022).”
Associations between childhood trauma and heart rate variability: Serial mediation by alexithymia and anxiety symptoms
Jiang, Z., Yu, C., 李树民, Li, Z., Yin, P., Xiao, Z., & 钟雯 (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.107598
Autistic traits and psychotic experiences in the general population: A moderated mediation model based on 7646 young adults from 12 Arab nations
Fekih-Romdhane, F., Alhuwailah, A., Sakr, F., Chaibi, L., Helmy, M., Shuwiekh, H. A. M., Boudouda, N. E., Zarrouq, B., Naser, A. Y., Taybeh, E. O., et al. (2026) · Personality Neuroscience · doi:10.1017/pen.2026.10009
“Finally, a meta-analytic review encompassing 88 studies and 43,076 participants indicated that the experience of mal-treatment as a child was significantly associated with alexithymia in adulthood (Khan & Jaffee, 2022).”
Influential
The relationship between childhood emotional neglect and emotional eating: the chain mediating role of alexithymia and difficulties in emotion regulation
Guan, Q., Liu, X., Li, C., Yang, Y., & Cui, L. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1895255
“Alexithymia is characterized by dif ﬁ culties in identifying, describing, and understanding emotions (17).”
The role of alexithymia in the association between childhood maltreatment and depressive symptoms in Chinese men with methamphetamine use disorder
Kiyani, A. R. T., Saad, U., Tian, Y., Chen, M., Wang, D.-M., & Zhang, X. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02371-2
The role of alexithymia in the association between adverse childhood experiences and dissociation: a systematic review
Bager-Mariscal, D., Molins, F., Gasch, E. O., & Lacomba‐Trejo, L. (2026) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2026.100761
Interpersonal emotion regulation in daily life: a comparison of individuals with and without depressive disorders
Vu, P. K. L., Ollrogge, K., Daldrup, L., & Köhler, S. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1773706
“These findings suggest a potential pathway whereby childhood maltreatment contributes to elevated alexithymia (Honkalampi et al., 2020; Khan and Jaffee, 2022), which may impair interpersonal ER (Nowicki, 2025), and increase vulnerability to depressive symptoms (Marroquín, 2011).”
Interactive effect of childhood adversity and HPA-axis multilocus genetic variation on alexithymia in adolescents
Zhou, H., & Lü, W. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122593
Factors affecting different aspects of intelligence (A review of the latest articles in this field)
Nateghi, M. R., Saadati, A., & Mohammadian, H. (2025) · Sarem Journal of Medical Research · doi:10.66224/sjrm.10.1.4

Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis
Kick, L., Schleicher, D., Ecker, A., Kandsperger, S., Brunner, R. M., & Jarvers, I. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1412229 · Cited by 41 · see citing works
Childhood maltreatment and alexithymia: The role of immature defence styles
Bontempo, D., Ercoli, A., Giancola, M., Perazzini, M., Cialfi, A., Ceccarelli, M., Vito, L. D., Eibenstein, R., Fatini, S., Fontana, V., et al. (2026) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2026.100741
Childhood maltreatment and somatic symptoms: Examining the role of specific types of childhood maltreatment and alexithymia.
Adamowicz, J. L., Sirotiak, Z., & Thomas, E. B. K. (2022) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001315 · Cited by 24 · see citing works
Childhood maltreatment and alexithymia: A network analysis
Liu, Y., Liu, S., Preece, D. A., Gross, J. J., Zhao, Z., Qian, J., Gao, M. M., & Han, Z. R. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120876 · Cited by 2 · see citing works
Child maltreatment and alexithymia: A meta-analytic review.
Ditzer, J., Wong, E. Y., Modi, R. N., Behnke, M., Gross, J. J., & Talmon, A. (2023) · Psychological Bulletin · doi:10.1037/bul0000391 · Cited by 85 · see citing works

Authors: Khan, A. N., & Jaffee, S. R.
Affiliations: University of Pennsylvania (US)
Corresponding author: Jaffee, Sara R.
ORCID: Khan, Anika N.
Jaffee, Sara R.
Venue: Journal of Child Psychology and Psychiatry
Publisher: Wiley
Published: 2022-04-19
Volume: 63
Issue: 9
Pages: 963-972
ISSN: 0021-9630 (ISSN-L)
1469-7610
DOI: 10.1111/jcpp.13616
OpenAlex: W4224225231
Cited by: 69
References: 65
Citations by year: 2026: 20 · 2025: 20 · 2024: 18 · 2023: 8 · 2022: 3
FWCI: 2.05
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#am (am, 365 d)
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Child Psychology and Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Science Foundation (DGE‐1321851)
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Safety Research › Child Welfare and Adoption
Keywords: alexithymia, child abuse, adolescent maltreatment, emotional awareness, neglect, physical abuse, sexual abuse, transdiagnostic mechanisms, psychopathology, sex differences
MeSH terms: Adolescent, Adult, Affective Symptoms, Mental Disorders, Child, Child Abuse, Emotions, Female, Humans, Psychopathology

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Alexithymia in individuals maltreated as children and adolescents: a meta‐analysis

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