Alexithymia and Suicide Risk in Moroccan Substance Users

[!IMPORTANT] Crisis Disclaimer: If you or someone you know is struggling with substance use or thoughts of self-harm, support is available. Please reach out to a mental health professional, contact local emergency services, or connect with the UHBC team for compassionate guidance.

• Moroccan Study (2022): Co-authored by researchers including Dr. Khaoula Mammad (Ibn Tofaïl University) on 451 consecutively admitted substance users.

• Prevalence: A striking 72.7% of substance users in the study met the criteria for alexithymia (compared to just 6-10% globally).
• The Link to Suicide: The study identifies alexithymia as a primary predictor of suicidal ideation and behaviors.
• Actionable Strategy: Emotion-focused interventions, such as CBT and stress regulation, are vital tools for recovery.

---

What is Alexithymia? The Invisible Emotion Deficit

Alexithymia is a personality construct characterized by the inability to identify, describe, and differentiate emotional states. Literally translating to "no words for emotions," individuals with alexithymia struggle to distinguish between internal emotional feelings and physical bodily sensations.

The Addiction Connection in Morocco

A study published in 2022 in Acta Neuropsychologica evaluated 451 consecutively admitted psychoactive substance users in Morocco. Using the Toronto Alexithymia Scale (TAS-20), researchers examined how this emotional deficit impacts addiction recovery:

• 72.7% of patients met the diagnostic criteria for alexithymia.
• A strong correlation was found between alexithymia and high anxiety levels.
• Surprisingly, no significant difference was found in depression scores between alexithymic and non-alexithymic groups, indicating that the emotional processing deficit itself—rather than depression—is the key issue.

At the Universal Healthy Brain Center (UHBC), we see how emotional blindness complicates addiction therapy. When individuals cannot identify their internal distress, they cannot communicate it, often resorting to substance use to numb their unnamable feelings.

---

The Danger Cascade: How Alexithymia Predicts Suicide Risk

The most critical finding of the 2022 study is that alexithymia is not just associated with substance use—it is a direct predictor of suicidal ideation and behaviors.

Why the Lack of Emotional Language is Dangerous

When individuals cannot find words to express their emotional pain, their internal pressure builds. The study found a highly significant correlation between alexithymia and high scores on the Columbia-Suicide Severity Rating Scale (C-SSRS).

1. The Communication Gap: Without the ability to describe their feelings, patients are less likely to seek professional help or talk to family members about their distress.
2. Impulsive Expressions: Unprocessed emotions are often expressed physically or behaviorally, leading to impulsive acts of self-harm or substance relapse as a coping mechanism.

Moroccan epidemiological data reinforces this risk. A 2023 Marrakech study of students reported a 16.66% prevalence of suicidal ideation, with cannabis use functioning as a major risk amplifier, raising suicide risk by 3.55 times.

---

Why Do Substance Users Struggle with Alexithymia?

Many substance users fall into a cycle where drug use and emotional blindness reinforce each other.

The Self-Medication Cycle

Individuals with underlying alexithymia often feel overwhelmed by physical sensations of stress but cannot label them as "anxiety" or "anger." They may use psychoactive substances to self-medicate these uncomfortable sensations. Over time, chronic substance use further dulls the brain's emotional processing networks, worsening the alexithymia.

Unprocessed feelings can also manifest as interpersonal conflict. When individuals cannot identify their feelings, they may project their internal confusion onto friends and family. Understanding how psychological projection and suppressed emotions impact relationships is a key step in break the cycle.

---

Recovery Pathways: Building Emotional Awareness

Overcoming alexithymia is a core component of sustainable addiction recovery. Patients must build the vocabulary and neural pathways to process their feelings.

1. Cognitive Behavioral Therapy (CBT)

CBT helps individuals label their emotions and connect them to specific thoughts and bodily sensations. For those seeking to rebuild their emotional skills, our comprehensive guide to CBT therapy provides structured exercises to enhance self-awareness and emotional vocabulary.

2. Nervous System Regulation

Since alexithymic individuals experience emotions as raw physical sensations (like chest tightness or stomach pain), regulating the physical body is essential. Practicing heart coherence techniques for emotional regulation helps calm the nervous system and bridges the gap between physical sensations and emotional awareness.

3. Transitioning from Escape to Growth

Addiction often stems from a desire to escape feelings of helplessness. Moving from a victim mindset to active inner growth helps patients take responsibility for their healing and face their emotions with courage.

For those navigating recovery, seeking the right professional support is key. Evaluating your options through coaching vs psychotherapy services helps determine whether clinical psychotherapy is needed to address underlying trauma or if recovery coaching is better suited for rebuilding life goals.

---

Frequently Asked Questions (FAQ)

What are the three components of alexithymia measured by the TAS-20?

The Toronto Alexithymia Scale measures: (1) Difficulty Identifying Feelings (DIF), (2) Difficulty Describing Feelings (DDF), and (3) Externally Oriented Thinking (EOT), where individuals focus on external events rather than internal experiences.

Is alexithymia a form of autism?

No, alexithymia is not a diagnosis or a form of autism. It is a personality trait. While it is highly prevalent in autistic individuals (up to 50%), it can occur independently, particularly in people with trauma or substance use disorders.

Can alexithymia be cured?

Yes. Although it is a stable personality trait, emotional awareness can be trained. Through mindfulness, somatic therapy, and structured emotional labeling in CBT, individuals can significantly improve their emotional processing.

---

References and Citations:

1. Karjouh, K., Azzaoui, F. Z., Ouerchefani, R., Semlali, W. I., Mammad, K., Chtabou, G., Boulbaroud, S., & Ahami, A. (2022). Alexithymia, Suicidal Ideation and Behaviour in Moroccan Psychoactive Substance Users. Acta Neuropsychologica. Dr. Khaoula Mammad on ResearchGate. (Tier 2 Source)
2. World Health Organization. (2023). Addressing Substance Use and Mental Health Comorbidities. WHO Website. (Tier 1 Source)
3. National Institutes of Health. (2023). Alexithymia as a Predictor of Suicide Risk in Clinical Populations. NIH Center. (Tier 1 Source)