Associations of alexithymia and personality traits with symptom severity in patients with depressive and anxiety disorders

Introduction

Depressive and anxiety disorders are highly prevalent and associated with substantial symptom burden. Transdiagnostic factors such as alexithymia and personality traits may influence symptom severity; however, their role in clinical populations remains insufficiently characterized.

Aims

To evaluate associations between alexithymia, personality traits, and severity of depressive and anxiety symptoms in patients with depressive and/or anxiety disorders.

Methods

A cross-sectional study was conducted in psychiatric inpatient settings at the Lithuanian University of Health Sciences, approved by the Lithuanian Biomedical Research Ethics Committee (No. B-2-38). The sample included consecutively hospitalized adult patients (≥18 years) with ICD-10 [1] anxiety and/or mood disorders from April 2025 to September 2026. Data were collected using sociodemographic and clinical questionnaires, the Toronto Alexithymia Scale (TAS-20), Big Five Personality Dimensions questionnaire, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Statistical analysis was performed using SPSS 30.0, applying χ², Mann–Whitney U, Kruskal–Wallis tests, Spearman correlations, and multiple linear regression analyses (p < 0.05).

Results

A total of 60 patients (55% female) with a mean age of 40.8 ± 11.8 years were included. Comorbid anxiety and mood disorders were present in 53.2% of participants, while 23.6% had mood disorders and 23.2% anxiety disorders. High symptom burden was observed: moderate-to-severe depressive symptoms (PHQ-9 > 9) were present in 83.3% (n = 50), and moderate-to-severe anxiety (GAD-7 > 9) in 76.7% (n = 46). These symptoms were more frequent in females (depression: 62.0% vs 38.0%, p = 0.015; anxiety: 67.4% vs 32.6%, p < 0.001). Pronounced alexithymia (TAS-20 > 61) was identified in 76.7% (n = 46) and was associated with greater depressive (ρ = 0.492, p < 0.001) and anxiety severity (ρ = 0.387, p = 0.002). The most common dominant personality traits were conscientiousness (35%) and neuroticism (30%). Conscientiousness was associated with lower symptom severity (depression p = 0.041; anxiety p = 0.002), whereas neuroticism correlated with both depressive (ρ = 0.430, p < 0.001) and anxiety symptoms (ρ = 0.469, p < 0.001). Lower conscientiousness was also associated with higher symptom severity. Female gender was associated with more severe symptoms. Patients with moderate-to-severe depression (PHQ-9 > 9) had higher age (44.5 vs 31.6 years, p = 0.024), alexithymia (61.4 vs 48.3, p = 0.002), and neuroticism (24.2 vs 16.8, p = 0.001), with no differences in other traits. Similarly, moderate-to-severe anxiety (GAD-7 > 9) was associated with higher alexithymia (61.9 vs 50.5, p = 0.002) and neuroticism (24.3 vs 18.4, p = 0.004). Regression analysis showed that depressive severity was independently associated with alexithymia (β = 0.308, p = 0.012), neuroticism (β = 0.297, p = 0.021), and gender (β = –0.275, p = 0.029) (R² = 0.406). Anxiety severity was associated with gender (β = –0.444, p < 0.001) and alexithymia (β = 0.228, p = 0.047), with neuroticism borderline (p = 0.050) (R² = 0.463).

Conclusions

Alexithymia and personality traits are significantly associated with symptom severity. Higher alexithymia and neuroticism and lower conscientiousness were linked to more severe symptoms, supporting their relevance for risk stratification and personalized treatment.

References

1. World Health Organization, 1992. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, Geneva.