Alexithymia and aggressiveness in old age: Mediation by impulsivity and emotion dysregulation
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Abstract
Aggressiveness is prevalent in old age, and to adapt treatments and diminish the accompanying damage to the self and others, it is important to understand aggressiveness predictors. Poor emotional awareness, impulsivity, and emotion dysregulation are potential mechanisms influencing aggressiveness. The present study examines whether alexithymia, emotion dysregulation, and impulsivity influence aggressiveness in older adults; and whether the effect of alexithymia is conditioned by emotional dysregulation and impulsivity after controlling for probable confounders. The sample consisted of 326 Portuguese older adults (63.2% female) aged 60-96 years from residential care homes and the community. Participants completed report instruments measuring alexithymia, emotional dysregulation, impulsivity, and aggressiveness. Results of the mediation analysis showed that older adults who had more alexithymia tended to report higher levels of emotional dysregulation and impulsivity, which in turn accounted for higher reported aggressiveness. All these effects were independent of cognitive functioning and depressive symptoms. This study suggests the relevance of evaluating and intervening on alexithymia, impulsivity, and emotion dysregulation to reducing aggressiveness in older people.
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References
Bagby, R., Parker, J., & Taylor, G. (1994). The twenty-item Toronto Alexithymia scale – I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23-32. https://doi.org/dp959x
Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9(1), 11-15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816926/
Bjureberg, J., Ljótsson, B., Tull, M., Hedman, E., Sahlin, H., Lundh, L.-G., Bjärehed, J., DiLillo, D., Messman-Moore, T., Gumpert, C., & Gratz, K. (2016). Development and validation of a brief version of the Difficulties in Emotion Regulation Scale: The DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284-296. https://doi.org/10.1007/s10862-015-9514-x
Botngård, A., Eide, A., Mosqueda, L., & Malmedal, W. (2020). Resident-to-resident aggression in Norwegian nursing homes: A cross-sectional exploratory study. BMC Geriatrics, 20(1), 222. https://doi.org/10.1186/s12877-020-01623-7
Brugman, S., Lobbestael, J., Arntz, A., Cima, M., Schuhmann, T., Dambacher, F., & Sack, A. (2015). Identifying cognitive predictors of reactive and proactive aggression. Aggressive Behavior, 41(1), 51-64. https://doi.org/10.1002/ab.21573
Bryant, F., & Smith, B. (2001). Refining the architecture of aggression: A measurement model for the Buss–Perry Aggression Questionnaire. Journal of Research in Personality, 35, 138-167. https://doi.org/dbmdgp
Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63(3), 452-459. https://doi.org/10.1037/0022-3514.63.3.452
Carstensen, L., Pasupathi, M., Mayr, U., & Nesselroade, J. (2000). Emotional experience in everyday life across the adult life span. Journal of Personality and Social Psychology, 79(4), 644-655.
Cohen, P., Cohen, J., Aiken, L., & West, S. (2010). The problem of units and the circumstance for POMP. Multivariate Behavioral Research, 34(3), 315-346. https://doi.org/10.1207/S15327906MBR3403_2
Daniel, F., Fernandes, V., Silva, A., & Espirito-Santo, H. (2019). Cognitive screening for elderly people in long-term care institutions in the Miranda do Corvo municipality, Portugal. Ciência & Saúde Coletiva, 24(11), 4355-4366. https://doi.org/10.1590/1413-812320182411.07422018
Elison, J., Garofalo, C., & Velotti, P. (2014). Shame and aggression: Theoretical considerations. Aggression and Violent Behavior, 19(4), 447-453. https://doi.org/10.1016/j.avb.2014.05.002
Espirito-Santo, H., & Daniel, F. (2018). Optimism and well-being among institutionalized older adults. Journal of Gerontopsychology and Geriatric Psychiatry, 31(1), 5-16. https://doi.org/hd79
Figueiredo-Duarte, C., Espirito-Santo, H., Sério, C., Lemos, L., Marques, M., & Daniel, F. (2021). Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults. Aging and Mental Health, 25(3), 492-498. https://doi.org/hd8b
Folstein, M., Folstein, S., & McHugh, P. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. https://doi.org/b9jhjp
Fonagy, P. (2004). The developmental roots of violence in the failure of mentalization. In F. Pfäfflin & G. Adshead (Eds.), A matter of security: The application of attachment theory to forensic psychiatry and psychotherapy (pp. 13-56). Jessica Kingsley.
Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233-239. https://doi.org/10.1111/j.1467-9280.2007.01882.x
Garofalo, C., Gillespie, S., & Velotti, P. (2020). Emotion regulation mediates relationships between mindfulness facets and aggression dimensions. Aggressive Behavior, 46(1), 60-71. https://doi.org/10.1002/ab.21868
Garofalo, C., Holden, C., Zeigler-Hill, V., & Velotti, P. (2016). Understanding the connection between self-esteem and aggression: The mediating role of emotion dysregulation. Aggressive Behavior, 42(1), 3-15. https://doi.org/10.1002/ab.21601
Garofalo, C., Velotti, P., & Zavattini, G. (2018). Emotion regulation and aggression: The incremental contribution of alexithymia, impulsivity, and emotion dysregulation facets. Psychology of Violence, 8(4), 470-483. https://doi.org/10.1037/vio0000141
Gimm, G., Chowdhury, S., & Castle, N. (2016). Resident aggression and abuse in assisted living. Journal of Applied Gerontology, 37(8), 947-964. https://doi.org/gmzt
Gratz, K., & Roemer, L. (2003). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.
Grover, S., Sahoo, S., Chakrabarti, S., & Avasthi, A. (2019). Anxiety and somatic symptoms among elderly patients with depression. Asian Journal of Psychiatry, 41, 66-72. https://doi.org/10.1016/j.ajp.2018.07.009
Hamilton, K., Littlefield, A., Anastasio, N., Cunningham, K., Fink, L., Wing, V., Mathias, C., Lane, S., Schütz, C., Swann, A., Lejuez, C., Clark, L., Moeller, F., & Potenza, M. (2015). Rapid-response impulsivity: Definitions, measurement issues, and clinical implications. Personality Disorders, 6(2), 168-181. https://doi.org/10.1037/per0000100
Hayes, A. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press.
Hecht, L., & Latzman, R. (2015). Revealing the nuanced associations between facets of trait impulsivity and reactive and proactive aggression. Personality and Individual Differences, 83, 192-197. https://doi.org/10.1016/j.paid.2015.04.021
Kashdan, T., Barrett, L., & McKnight, P. (2015). Unpacking emotion differentiation: Transforming unpleasant experience by perceiving distinctions in negativity. Current Directions in Psychological Science, 24(1), 10-16. https://doi.org/10.1177/0963721414550708
Kishita, N., Takei, Y., & Stewart, I. (2016). A meta-analysis of third wave mindfulness-based cognitive behavioral therapies for older people. International Journal of Geriatric Psychiatry, 21(30), 59-10. https://doi.org/10.1002/gps.4621
Knight, L., & Hester, M. (2016). Domestic violence and mental health in older adults. International Review of Psychiatry, 28(5), 464-474. https://doi.org/10.1080/09540261.2016.1215294
Kolanowski, A. (1995). Aggressive behavior in institutionalized elders: A theoretical framework. American Journal of Alzheimer’s Disease, 10(2), 23-29. https://doi.org/c2685p
Kwon, M.-J. (2015). Convergence study on the relation between cognition, depression and aggression in the elderly. Journal of the Korea Convergence Society, 6(6), 171-176. https://doi.org/10.15207/JKCS.2015.6.6.171
Lambie, J., & Marcel, A. (2002). Consciousness and the varieties of emotion experience: A theoretical framework. Psychological Review, 109(2), 219-259. https://doi.org/10.1037/0033-295x.109.2.219
Leger, J., Moulias, R., Vellas, B., Monfort, J., Chapuy, P., Robert, P., Knellesen, S., & Gerard, D. (2000). Causes and consequences of elderly’s agitated and aggressive behavior. L’Encephale, 26(1), 32-43. https://europepmc.org/article/med/10875060
Luppa, M., Luck, T., Weyerer, S., König, H.-H., Brähler, E., & Riedel-Heller, S. (2010). Prediction of institutionalization in the elderly. A systematic review. Age and Ageing, 39(1), 31-38. https://doi.org/dpxgzx
MacKinnon, D. (2012). Introduction to statistical mediation analysis. Routledge. https://doi.org/10.4324/9780203809556
Maia, P., Ferreira, E., Melo, E., & Vargas, A. (2019). Occurrence of violence in the elderly and its associated factors. Revista Brasileira De Enfermagem, 72(S2), 64-70. https://doi.org/10.1590/0034-7167-2018-0014
Marcinkowska, M., Śniecikowska, J., Fajkis, N., Paśko, P., Franczyk, W., & Kołaczkowski, M. (2020). Management of dementia-related psychosis, agitation and aggression: A review of the pharmacology and clinical effects of potential drug candidates. CNS Drugs, 34(3), 243-268. https://doi.org/10.1007/s40263-020-00707-7
Morales-Vives, F., & Vigil-Colet, A. (2012). Are old people so gentle? Functional and dysfunctional impulsivity in the elderly. International Psychogeriatrics, 24(3), 465-471. https://doi.org/bqt6sg
Onor, M., Trevisiol, M., Spano, M., Aguglia, E., & Paradiso, S. (2010). Alexithymia and aging: A neuropsychological perspective. The Journal of Nervous and Mental Disease, 198(12), 891-895. https://doi.org/c8mb32
Orgeta, V. (2009). Specificity of age differences in emotion regulation. Aging & Mental Health, 13(6), 818-826. https://doi.org/10.1080/13607860902989661
Pereira, A., Marques, M., Simões, S., & Cunha, M. (2016). Relação entre a inteligência espiritual e a saúde mental e física em idosos. Revista Portuguesa de Investigação Comportamental e Social, 2(1), 38-52. https://doi.org/10.7342/ismt.rpics.2016.2.1.18
Preacher, K., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93-115. https://doi.org/10.1037/a0022658
Ramirez-Ruiz, B., Quinn, K., & Ferreira, N. (2019). Emotion-regulation strategies in older people: A systematic review. Working with Older People, 24(1), 1-18. https://doi.org/10.1108/WWOP-09-2019-0026
Sakurai, K., Li, H., Inamura, N., Masuoka, N., & Hisatsune, T. (2020). Relationship between elevated impulsivity and cognitive declines in elderly community-dwelling individuals. Scientific Reports, 10(1), 21032. https://doi.org/10.1038/s41598-020-78124-5
Schmidt, C., Fallon, A., & Coccaro, E. (2004). Assessment of behavioral and cognitive impulsivity: Development and validation of the Lifetime History of Impulsive Behaviors Interview. Psychiatry Research, 126(2), 107-121. https://doi.org/10.1016/j.psychres.2003.12.021
Sifneos, P. (1996). Alexithymia: Past and present. The American Journal of Psychiatry, 153(S7), 137-142. https://doi.org/10.1176/ajp.153.7.137
Spinella, M. (2007). Normative data and a short form of the Barratt Impulsiveness Scale. International Journal of Neuroscience, 117(3), 359-368. https://doi.org/cwxs5f
Templeton, G. F. (2011). A two-step approach for transforming continuous variables to normal: implications and recommendations for IS research. Communications of the Association for Information Systems, 28, 42-58. https://doi.org/10.17705/1CAIS.02804
Velotti, P., Garofalo, C., Petrocchi, C., Cavallo, F., Popolo, R., & Dimaggio, G. (2016). Alexithymia, emotion dysregulation, impulsivity and aggression: A multiple mediation model. Psychiatry Research, 237, 296-303. https://doi.org/bxtz
Vigil-Colet, A., Morales-Vives, F., & Tous, J. (2008). The relationships between functional and dysfunctional impulsivity and aggression across different samples. The Spanish Journal of Psychology, 11(2), 480-487. https://doi.org/10.1017/S1138741600004480
Wang, Y., Cao, S., Zhang, Q., & Xia, L.-X. (2020). The longitudinal relationship between angry rumination and reactive-proactive aggression and the moderation effect of consideration of future consequences-immediate. Aggressive Behavior, 46(6), 476-488. https://doi.org/10.1002/ab.21913
Warburton, W., Williams, K., & Cairns, D. (2006). When ostracism leads to aggression: The moderating effects of control deprivation. Journal of Experimental Social Psychology, 42(2), 213-220. https://doi.org/10.1016/j.jesp.2005.03.005
Wilkinson, S. (1998). Focus group methodology: A review. International Journal of Social Research Methodology, 1(3), 181-203. https://doi.org/10.1080/13645579.1998.10846874