title: Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany.
abstract: OBJECTIVE
  Previous studies have established an association between number of traumatic experiences and alexithymia. The present study examines this relationship in a large-scale representative sample of the German general population (N=2,507) and explores the potential mediating effects of posttraumatic symptomatology, particularly avoidance/numbing.
  
  
  METHODS
  Alexithymia was assessed with the German version of the Toronto Alexithymia Scale (TAS-20). Posttraumatic symptomatology was operationalized by the symptom score of the modified German version of the Posttraumatic Symptom Scale, and traumatic experiences were assessed with the trauma list of the Munich Composite International Diagnostic Interview. Two mediation analyses were conducted.
  
  
  RESULTS
  Of the total sample, 24.2% (n=606) reported at least one traumatic experience, 10.6% (n=258) were classified as alexithymic, and 2.4% (n=59) fulfilled the criteria of posttraumatic stress disorder (PTSD). Participants who had survived five or more traumatic experiences had significantly higher alexithymia sum scores. The PTSD symptom cluster avoidance/numbing mediated the association between the number of traumatic experiences and alexithymia.
  
  
  CONCLUSIONS
  Our findings illustrate an association between number of traumatic experiences and alexithymia and the influence of emotional avoidance and numbing within this relationship. The significant relationship between alexithymia and number of traumatic experiences in a general population sample further supports the concept of multiple and complex traumatization as associated with alexithymia. The results suggest the importance of further investigations determining the causal impact of alexithymia both as a potential premorbid trait and as consequence of traumatization. Lastly, future investigations are needed to clarify alexithymia as a distinct trauma-relevant characteristic for better diagnostics and specialized trauma-integrative therapy.
authors.affiliation: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Eichhorn
authors.affiliation: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Brähler
authors.affiliation: Clinical Institute for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Franz
authors.affiliation: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedrich
authors.affiliation: Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
authors.forename: Heide
authors.initials: H
authors.lastname: Glaesmer
keywords: PTSD; TAS-20; avoidance/numbing; mediation; multiple and complex traumatization