Abstract
Alexithymia is an essential predictor of problematic gaming, while the role of internalizing and externalizing problems in their relationship remains unclear. Nine hundred and twenty participants (18–25 yrs., 464 males) were evaluated through an online survey. Alexithymia was assessed with the 20-item Toronto Alexithymia Scale (TAS-20), gaming intensity was evaluated with the Internet Gaming Disorder Scale-Short Form (IGDS9-SF), depression and anxiety symptoms were assessed with the Depression, Anxiety, and Stress Scale (DASS-21), and reactive aggression was evaluated with the Reactive-Proactive Aggression Questionnaire (RPQ). Serial mediation models were performed to examine the potential indirect pathways through which alexithymic is associated with disordered gaming. Multigroup analysis was used to explore the moderating role of gender. It was found that depression/anxiety and reactive aggression mediated the relationship between alexithymia and gaming severity in parallel and serial. Furthermore, the strength of internalizing pathways was more robust than the externalizing ones. Although the multigroup comparison did not reveal significant gender effects, the structure of the mediation models differed trivially between males and females. The present study confirmed the mediating role of depression/anxiety and reactive aggression in the relationship between alexithymia and gaming, which provides intervention studies with important targeting factors.
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Data Availability
The dataset from the present study is available from the Figshare repository database (access link: https://figshare.com/s/43412b6719183c4af256).
References
Adachi, P. J. C., & Willoughby, T. (2013). Demolishing the competition: The longitudinal link between competitive video games, competitive gambling, and aggression. Journal of Youth and Adolescence, 42(7), 1090–1104. https://doi.org/10.1007/s10964-013-9952-2.
Adachi, P. J. C., & Willoughby, T. (2016). The Longitudinal Association between competitive video game play and aggression among adolescents and young adults. Child Development, 87(6), 1877–1892. https://doi.org/10.1111/cdev.12556.
Almaqrami, M. H., & Shuwail, A. Y. (2004). Validity of the self-report version of the strengths and difficulties questionnaire in Yemen. Saudi Medical Journal, 25(5), 592–601.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. https://doi.org/10.1093/jama/9780195176339.022.529.
Ashley, L., O’Connor, D. B., & Jones, F. (2011). Effects of emotional disclosure in caregivers: Moderating role of alexithymia. Stress and Health: Journal of the International Society for the Investigation of Stress, 27(5), 376–387. https://doi.org/10.1002/smi.1388.
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (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/10.1016/0022-3999(94)90005-1.
Bonnaire, C., & Baptista, D. (2019). Internet gaming disorder in male and female young adults: The role of alexithymia, depression, anxiety and gaming type. Psychiatry Research, 272, 521–530. https://doi.org/10.1016/j.psychres.2018.12.158.
Bratis, D., Tselebis, A., Sikaras, C., Moulou, A., Giotakis, K., Zoumakis, E., & Ilias, I. (2009). Alexithymia and its association with burnout, depression and family support among greek nursing staff. Human Resources for Health, 7(1), 1–6. https://doi.org/10.1186/1478-4491-7-72.
Breslau, N., Davis, G. C., Peterson, E. L., & Schultz, L. R. (2000). A second look at comorbidity in victims of trauma: The posttraumatic stress disorder–major depression connection. Biological Psychiatry, 48(9), 902–909. https://doi.org/10.1016/s0006-3223(00)00933-1.
Brody, L. R. (2000). The socialization of gender differences in emotional expression: Display rules, infant temperament, and differentiation. Gender and Emotion: Social Psychological Perspectives, 2(11), 122–137. https://doi.org/10.1017/cbo9780511628191.003.
Brown, S., Fite, P. J., Stone, K., & Bortolato, M. (2016). Accounting for the associations between child maltreatment and internalizing problems: The role of alexithymia. Child Abuse & Neglect, 52, 20–28. https://doi.org/10.1016/j.chiabu.2015.12.008.
Brunborg, G. S., Mentzoni, R. A., Melkevik, O. R., Torsheim, T., Samdal, O., Hetland, J., Andreassen, C. S., & Palleson, S. (2013). Gaming addiction, gaming engagement, and psychological health complaints among norwegian adolescents. Media Psychology, 16(1), 115–128. https://doi.org/10.1080/15213269.2012.756374.
Cabras, C., Cubadda, M. L., & Sechi, C. (2019). Relationships among violent and non-violent video games, anxiety, self-esteem, and aggression in female and male gamers. International Journal of Gaming and Computer-Mediated Simulations (IJGCMS), 11(3), 15–37. https://doi.org/10.4018/ijgcms.2019070102.
Cameron, K., Ogrodniczuk, J., & Hadjipavlou, G. (2014). Changes in alexithymia following psychological intervention: A review. Harvard Review of Psychiatry, 22(3), 162–178. https://doi.org/10.1097/hrp.0000000000000036.
Card, N. A., & Little, T. D. (2006). Proactive and reactive aggression in childhood and adolescence: A meta-analysis of differential relations with psychosocial adjustment. International Journal of Behavioral Development, 30(5), 466–480. https://doi.org/10.1177/0165025406071904.
Casale, S., Musicò, A., & Schimmenti, A. (2021). Beyond internalizing and externalizing symptoms: The association between body disconnection and the symptoms of internet gaming disorder. Addictive Behaviors, 123, 107043. https://doi.org/10.1016/j.addbeh.2021.107043.
Conti, C., Di Francesco, G., Lanzara, R., Severo, M., Fumagalli, L., Guagnano, M. T., & Porcelli, P. (2019). Alexithymia and binge eating in obese outpatients who are starting a weight-loss program: A structural equation analysis. European Eating Disorders Review: The Journal of the Eating Disorders Association, 27(6), 628–640. https://doi.org/10.1002/erv.2696.
Cuijpers, P., Karyotaki, E., de Wit, L., & Ebert, D. D. (2020). The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychotherapy Research, 30(3), 279–293. https://doi.org/10.1080/10503307.2019.1649732.
de Timary, P., Luts, A., Hers, D., & Luminet, O. (2008). Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: Relationship to depression and anxiety. Psychiatry Research, 157(1), 105–113. https://doi.org/10.1016/j.psychres.2006.12.008.
Dorard, G., Bungener, C., Phan, O., Edel, Y., Corcos, M., & Berthoz, S. (2017). Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers. Journal of Psychosomatic Research, 95, 74–80. https://doi.org/10.1016/j.jpsychores.2017.02.012.
Ebert, D. D., Zarski, A. C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. PloS One, 10(3), e0119895. https://doi.org/10.1371/journal.pone.0119895.
Elmas, H. G., Cesur, G., & Oral, E. T. (2017). Alexithymia and pathological gambling: The mediating role of difficulties in emotion regulation. Turkish Journal of Psychiatry, 28(1). 17–24. https://doi.org/10.5080/u13779.
Evren, C., Cinar, O., Evren, B., Umut, G., Can, Y., & Bozkurt, M. (2015). Relationship between alexithymia and aggression in a sample of men with substance dependence. Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 25(3), 233–242. https://doi.org/10.5455/bcp.20130408020445.
Evren, C., Evren, B., Dalbudak, E., Topcu, M., & Kutlu, N. (2019). Relationship of internet gaming disorder severity with symptoms of anxiety, depression, alexithymia, and aggression among university students. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 32(3), 227. https://doi.org/10.14744/dajpns.2019.00032.
Evren, C., Evren, B., Dalbudak, E., Topçu, M., Kutlu, N., & Elhai, J. D. (2020). Relationship between internet gaming disorder symptoms with attention deficit hyperactivity disorder and alexithymia symptoms among university students. Addicta, 7, 1–9. https://doi.org/10.5152/addicta.2020.19076.
Fanti, K. A., Demetriou, C. A., & Kimonis, E. R. (2013). Variants of callous-unemotional conduct problems in a community sample of adolescents. Journal of Youth and Adolescence, 42(7), 964–979. https://doi.org/10.1007/s10964-013-9958-9.
Farah, T., Ling, S., Raine, A., Yang, Y., & Schug, R. (2018). Alexithymia and reactive aggression: The role of the amygdala. Psychiatry Research: Neuroimaging, 281, 85–91. https://doi.org/10.1016/j.pscychresns.2018.09.003.
Fite, P. J., Raine, A., Stouthamer-Loeber, M., Loeber, R., & Pardini, D. A. (2010). Reactive and proactive aggression in adolescent males: Examining differential outcomes 10 years later in early adulthood. Criminal Justice and Behavior, 37(2), 141–157. https://doi.org/10.1177/0093854809353051.
Ford, J. D., Chapman, J., Connor, D. F., & Cruise, K. R. (2012). Complex trauma and aggression in secure juvenile justice settings. Criminal Justice and Behavior, 39(6), 694–724. https://doi.org/10.1177/0093854812436957.
Gaetan, S., Bréjard, V., & Bonnet, A. (2016). Video games in adolescence and emotional functioning: Emotion regulation, emotion intensity, emotion expression, and alexithymia. Computers in Human Behavior, 61, 344–349. https://doi.org/10.1016/j.chb.2016.03.027.
Gao, T., Li, J., Zhang, H., Gao, J., Kong, Y., Hu, Y., & Mei, S. (2018). The influence of alexithymia on mobile phone addiction: The role of depression, anxiety and stress. Journal of Affective Disorders, 225, 761–766. https://doi.org/10.1016/j.jad.2017.08.020.
Gong, X., Xie, X., Xu, R., & Luo, Y. (2010). Psychometric properties of the chinese versions of DASS-21 in chinese college students. Chinese Journal of Clinical Psychology.
González-Bueso, V., Santamaría, J. J., Fernández, D., Merino, L., Montero, E., & Ribas, J. (2018). Association between Internet Gaming disorder or pathological video-game Use and Comorbid psychopathology: A Comprehensive Review. International Journal of Environmental Research and Public Health, 15(4), 668. https://doi.org/10.3390/ijerph15040668.
Granic, I., Lobel, A., & Engels, R. C. M. E. (2014). The benefits of playing video games. American Psychologist, 69(1), 66. https://doi.org/10.1037/a0034857.
Greenwood, D. N., & Long, C. R. (2009). Mood specific media use and emotion regulation: Patterns and individual differences. Personality and Individual Differences, 46(5), 616–621. https://doi.org/10.1016/j.paid.2009.01.002.
Hartley, C. M., Pettit, J. W., & Castellanos, D. (2018). Reactive aggression and suicide-related behaviors in children and adolescents: A review and preliminary meta‐analysis. Suicide and Life‐Threatening Behavior, 48(1), 38–51. https://doi.org/10.1111/sltb.12325.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
Heaven, P. C. L., Ciarrochi, J., & Hurrell, K. (2010). The distinctiveness and utility of a brief measure of alexithymia for adolescents. Personality and Individual Differences, 49(3), 222–227. https://doi.org/10.1016/j.paid.2010.03.039.
Hébert, M., Boisjoli, C., Blais, M., & Oussaïd, E. (2018). Alexithymia as a mediator of the relationship between child sexual abuse and psychological distress in adolescence: A short-term longitudinal study. Psychiatry Research, 260, 468–472. https://doi.org/10.1016/j.psychres.2017.12.022.
Hemming, L., Haddock, G., Shaw, J., & Pratt, D. (2019). Alexithymia and its Associations with Depression, Suicidality, and aggression: An overview of the literature. Frontiers in Psychiatry, 10, 203. https://doi.org/10.3389/fpsyt.2019.00203.
Herbert, B. M., Herbert, C., & Pollatos, O. (2011). On the relationship between interoceptive awareness and alexithymia: Is interoceptive awareness related to emotional awareness? Journal of Personality, 79(5), 1149–1175. https://doi.org/10.1111/j.1467-6494.2011.00717.x.
Hiirola, A., Pirkola, S., Karukivi, M., Markkula, N., Bagby, R. M., Joukamaa, M., Jula, A., Kronholm, E., Saarijärvi, S., & Salminen, J. K. (2017). An evaluation of the absolute and relative stability of alexithymia over 11 years in a finnish general population. Journal of Psychosomatic Research, 95, 81–87. https://doi.org/10.1016/j.jpsychores.2017.02.007.
Honkalampi, K., De Berardis, D., Vellante, F., & Viinamäki, H. (2018). Relations between Alexithymia and depressive and anxiety Disorders and personality. In G. J. Taylor, O. Luminet, & R. M. Bagby (Eds.), Alexithymia: Advances in Research, Theory, and clinical practice (pp. 142–157). Cambridge University Press. https://doi.org/10.1017/9781108241595.011.
Iacono, W. G., Malone, S. M., & McGue, M. (2008). Behavioral disinhibition and the development of early-onset addiction: Common and specific influences. Annu Rev Clin Psychol, 4, 325–348. https://doi.org/10.1146/annurev.clinpsy.4.022007.141157.
Jeong, H., Yim, H. W., Lee, S. Y., Lee, H. K., Potenza, M. N., Jo, S. J., Son, H. J., & Kim, G. (2020). Low self-control and aggression exert serial mediation between inattention/hyperactivity problems and severity of internet gaming disorder features longitudinally among adolescents. Journal of Behavioral Addictions, 9(2), 401–409. https://doi.org/10.1556/2006.2020.00039.
Kandri, T. A., Bonotis, K. S., Floros, G. D., & Zafiropoulou, M. M. (2014). Alexithymia components in excessive internet users: A multi-factorial analysis. Psychiatry Research, 220(1–2), 348–355. https://doi.org/10.1016/j.psychres.2014.07.066.
Kardefelt-Winther, D. (2014). A conceptual and methodological critique of internet addiction research: Towards a model of compensatory internet use. Computers in Human Behavior, 31, 351–354. https://doi.org/10.1016/j.chb.2013.10.059.
Karukivi, M., Hautala, L., Kaleva, O., Haapasalo-Pesu, K. M., Liuksila, P. R., Joukamaa, M., & Saarijärvi, S. (2010). Alexithymia is associated with anxiety among adolescents. Journal of Affective Disorders, 125(1), 383–387. https://doi.org/10.1016/j.jad.2010.02.126.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550.
Kim, H. W., Rim, H. D., Kim, J. H., & Lee, S. J. (2009). Alexithymia and stress response patterns among patients with depressive disorders in Korea. Psychiatry Investigation, 6(1), 13. https://doi.org/10.4306/pi.2009.6.1.13.
Kokkonen, P., Karvonen, J. T., Veijola, J., Läksy, K., Jokelainen, J., Järvelin, M. R., & Joukamaa, M. (2001). Prevalence and sociodemographic correlates of alexithymia in a population sample of young adults. Comprehensive Psychiatry, 42(6), 471–476. https://doi.org/10.1053/comp.2001.27892.
Lane, R. D., Ahern, G. L., Schwartz, G. E., & Kaszniak, A. W. (1997). Is alexithymia the emotional equivalent of blindsight? Biological Psychiatry, 42(9), 834–844. https://doi.org/10.1016/s0006-3223(97)00050-4.
Larrieu, M., Billieux, J., & Decamps, G. (2022). Problematic gaming and quality of life in online competitive videogame players: Identification of motivational profiles. Addictive Behaviors, 133, 107363. https://doi.org/10.1016/j.addbeh.2022.107363.
Leung, H., Pakpour, A. H., Strong, C., Lin, Y. C., Tsai, M. C., Griffiths, M. D., Lin, C. Y., & Chen, I. H. (2020). Measurement invariance across young adults from Hong Kong and Taiwan among three internet-related addiction scales: Bergen social media addiction scale (BSMAS), smartphone application-based addiction scale (SABAS), and internet gaming disorder scale-short. Addictive Behaviors, 101, 105969. https://doi.org/10.1016/j.addbeh.2019.04.027.
Li, X., & Fung, A. L. (2015). Reactive and proactive aggression in mainland chinese secondary school students. Journal of Social Work, 15(3), 297–316. https://doi.org/10.1177/1468017314548119.
Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015). The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry Research, 227(1), 1–9. https://doi.org/10.1016/j.psychres.2015.02.006.
Li, X., Li, B., Lu, J., Jin, L., Xue, J., & Che, X. (2020). The relationship between alexithymia, hostile attribution bias, and aggression. Personality and Individual Differences, 159, 109869. https://doi.org/10.1016/j.paid.2020.109869.
Li, L., Niu, Z., Griffiths, M. D., Wang, W., Chang, C., & Mei, S. (2021). A network perspective on the relationship between gaming disorder, depression, alexithymia, boredom, and loneliness among a sample of chinese university students. Technology in Society, 67, 101740. https://doi.org/10.1016/j.techsoc.2021.101740.
Li, J., Jiang, W., Zhu, R., Fan, F., Fu, F., Wei, D., Tang, S., Tian, Y., Chen, J., & Li, Y. (2022). Depression in Chinese men with methamphetamine dependence: Prevalence, correlates and relationship with alexithymia. Journal of Affective Disorders.https://doi.org/10.1016/j.jad.2022.09.064
Ling, Y., Zeng, Y., Yuan, H., & Zhong, M. (2016). Cross-cultural validation of the 20‐item Toronto Alexithymia Scale in Chinese adolescents. Journal of Psychiatric and Mental Health Nursing, 23(3–4), 179–187. https://doi.org/10.1111/jpm.12298.
Loas, G., Fremaux, D., Otmani, O., Lecercle, C., & Delahousse, J. (1997). Is alexithymia a negative factor for maintaining abstinence? A follow-up study. Comprehensive Psychiatry, 38(5), 296–299. https://doi.org/10.1016/s0010-440x(97)90063-8.
Lovibond, S. H., & Lovibond, P. F. (1996). Manual for the depression anxiety stress scales. Psychology Foundation of Australia.
Lyvers, M., Senturk, C., & Thorberg, F. A. (2021). Alexithymia, impulsivity and negative mood in relation to internet addiction symptoms in female university students. Australian Journal of Psychology, 73(4), 548–556. https://doi.org/10.1080/00049530.2021.1942985.
Maganuco, N. R., Costanzo, A., Midolo, L. R., Santoro, G., & Schimmenti, A. (2019). Impulsivity and alexithymia in virtual worlds: A study on players of World of Warcraft. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 16(3), 127–134.
Mahapatra, A., & Sharma, P. (2018). Association of Internet addiction and alexithymia–A scoping review. Addictive Behaviors, 81, 175–182. https://doi.org/10.1016/j.addbeh.2018.02.004.
Marsee, M. A., Weems, C. F., & Taylor, L. K. (2008). Exploring the association between aggression and anxiety in youth: A look at aggressive subtypes, gender, and social cognition. Journal of Child and Family Studies, 17(1), 154–168. https://doi.org/10.1007/s10826-007-9154-1.
Mattila, A. K., Salminen, J. K., Nummi, T., & Joukamaa, M. (2006). Age is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 61(5), 629–635. https://doi.org/10.1016/j.jpsychores.2006.04.013.
McKenna, K. Y. A., & Bargh, J. A. (2000). Plan 9 from Cyberspace: The implications of the internet for personality and social psychology. Personality and Social Psychology Review, 4(1), 57–75. https://doi.org/10.1207/s15327957pspr0401_6.
Mehroof, M., & Griffiths, M. D. (2010). Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychology Behavior and Social Networking, 13(3), 313–316. https://doi.org/10.1089/cyber.2009.0229.
Mentzoni, R. A., Brunborg, G. S., Molde, H., Myrseth, H., Skouverøe, K. J. M., Hetland, J., & Pallesen, S. (2011). Problematic video game use: Estimated prevalence and associations with mental and physical health. Cyberpsychology Behavior and Social Networking, 14(10), 591–596. https://doi.org/10.1089/cyber.2010.0260.
Milani, L., La Torre, G., Fiore, M., Grumi, S., Gentile, D. A., Ferrante, M., Miccoli, S., & Di Blasio, P. (2018). Internet gaming addiction in adolescence: Risk factors and maladjustment correlates. International Journal of Mental Health and Addiction, 16(4), 888–904. https://doi.org/10.1007/s11469-017-9750-2.
Morie, K. P., Yip, S. W., Nich, C., Hunkele, K., Carroll, K. M., & Potenza, M. N. (2016). Alexithymia and addiction: A review and preliminary data suggesting neurobiological links to reward/loss processing. Current Addiction Reports, 3(2), 239–248. https://doi.org/10.1007/s40429-016-0097-8.
Ohannessian, C. M. (2018). Video game play and anxiety during late adolescence: The moderating effects of gender and social context. Journal of Affective Disorders, 226, 216–219. https://doi.org/10.1016/j.jad.2017.10.009.
Ostinelli, E. G., Zangani, C., Giordano, B., Maestri, D., Gambini, O., D’Agostino, A., Furukawa, T. A., & Purgato, M. (2021). Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 284, 136–142. https://doi.org/10.1016/j.jad.2021.02.014.
Polman, H., Orobio de Castro, B., Koops, W., van Boxtel, H. W., & Merk, W. W. (2007). A Meta-analysis of the distinction between reactive and proactive aggression in children and adolescents. Journal of Abnormal Child Psychology, 35(4), 522–535. https://doi.org/10.1007/s10802-007-9109-4.
Prino, L. E., Longobardi, C., Fabris, M. A., Parada, R. H., & Settanni, M. (2019). Effects of bullying victimization on internalizing and externalizing symptoms: The mediating role of alexithymia. Journal of Child and Family Studies, 28(9), 2586–2593. https://doi.org/10.1007/s10826-019-01484-8.
Qin, L., Cheng, L., Hu, M., Liu, Q., Tong, J., Hao, W., Luo, T., & Liao, Y. (2020). Clarification of the cut-off score for nine-item internet gaming disorder scale–short form (IGDS9-SF) in a chinese context. Frontiers in Psychiatry, 11, 470. https://doi.org/10.3389/fpsyt.2020.00470.
Raine, A., Dodge, K., Loeber, R., Gatzke-Kopp, L., Lynam, D., Reynolds, C., Stouthamer‐Loeber, M., & Liu, J. (2006). The reactive–proactive aggression questionnaire: Differential correlates of reactive and proactive aggression in adolescent boys. Aggressive Behavior, 32(2), 159–171. https://doi.org/10.1002/ab.2115.
Richard, J., Temcheff, C. E., & Derevensky, J. L. (2020). Gaming disorder across the lifespan: A scoping review of longitudinal studies. Current Addiction Reports, 7(4), 561–587. https://doi.org/10.1007/s40429-020-00339-3.
Rosseel, Y. (2012). lavaan: An R Package for Structural equation modeling. Journal of Statistical Software, 48, 1–36. https://doi.org/10.18637/jss.v048.i02.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422. https://doi.org/10.1037/1082-989x.7.4.422.
Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255–262. https://doi.org/10.1159/000286529.
Slater, M. D., Henry, K. L., Swaim, R. C., & Anderson, L. L. (2003). Violent media content and aggressiveness in adolescents: A downward spiral model. Communication Research, 30(6), 713–736. https://doi.org/10.1177/0093650203258281.
Stevens, M. W. R., Dorstyn, D., Delfabbro, P. H., & King, D. L. (2021). Global prevalence of gaming disorder: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 55(6), 553–568. https://doi.org/10.1177/0004867420962851.
Tang, S., Ports, K. A., Zhang, K., & Lin, H. C. (2020). Adverse childhood experiences, internalizing/externalizing symptoms, and associated prescription opioid misuse: A mediation analysis. Preventive Medicine, 134, 106034. https://doi.org/10.1016/j.ypmed.2020.106034.
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1991). The alexithymia construct: A potential paradigm for psychosomatic medicine. Psychosomatics, 32(2), 153–164. https://doi.org/10.1016/s0033-3182(91)72086-0.
Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1999). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press.
Teng, Z., Pontes, H. M., Nie, Q., Griffiths, M. D., & Guo, C. (2021). Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: A longitudinal study. Journal of Behavioral Addictions, 10(1), 169–180. https://doi.org/10.1556/2006.2021.00016.
Thorberg, F. A., Young, R. M., Sullivan, K. A., & Lyvers, M. (2009). Alexithymia and alcohol use disorders: A critical review. Addictive Behaviors, 34(3), 237–245. https://doi.org/10.1016/j.addbeh.2008.10.016.
Tolmunen, T., Heliste, M., Lehto, S. M., Hintikka, J., Honkalampi, K., & Kauhanen, J. (2011). Stability of alexithymia in the general population: An 11-year follow-up. Comprehensive Psychiatry, 52(5), 536–541. https://doi.org/10.1016/j.comppsych.2010.09.007.
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/10.1016/j.psychres.2016.01.025.
Wang, H. Y., & Cheng, C. (2022). The associations between gaming motivation and internet gaming disorder: Systematic review and meta-analysis. JMIR Mental Health, 9(2), e23700. https://doi.org/10.2196/23700.
Willoughby, T., Adachi, P. J. C., & Good, M. (2012). A longitudinal study of the association between violent video game play and aggression among adolescents. Developmental Psychology, 48(4), 1044–1057. https://doi.org/10.1037/a0026046.
Yu, H., & Cho, J. (2016). Prevalence of internet gaming disorder among korean adolescents and associations with non-psychotic psychological symptoms, and physical aggression. American Journal of Health Behavior, 40(6), 705–716. https://doi.org/10.5993/ajhb.40.6.3.
Yu, Y., Mo, P. K. H., Zhang, J., Li, J., & Lau, J. T. F. (2021). Why is internet gaming disorder more prevalent among chinese male than female adolescents? The role of cognitive mediators. Addictive Behaviors, 112, 106637. https://doi.org/10.1016/j.addbeh.2020.106637.
Zhang, W. L., Jia, S. W., Chen, G. H., & Zhang, W. X. (2014). Reliability and validity of reactive-proactive aggression questionnaire in college students. Chinese Journal of Clinical Psychology, 22(2), 260–263.
Zhou, H., Xiao, W., Li, X., & Jiang, H. (2022). The influence of alexithymia on problematic mobile phone use among chinese adolescent students: Multiple mediating roles of social interaction anxiousness and core self-evaluations. Journal of Affective Disorders, 308, 569–576. https://doi.org/10.1016/j.jad.2022.04.051.
Zhu, X., Yi, J., Yao, S., Ryder, A. G., Taylor, G. J., & Bagby, R. M. (2007). Cross-cultural validation of a chinese translation of the 20-item Toronto Alexithymia Scale. Comprehensive Psychiatry, 48(5), 489–496. https://doi.org/10.1016/j.comppsych.2007.04.007.
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Liu, Y., Qiu, Z. & van den Wildenberg, W.P. Alexithymia and internet gaming disorder: The mediating role of internalizing and externalizing problems. Curr Psychol 43, 10567–10577 (2024). https://doi.org/10.1007/s12144-023-05113-y
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DOI: https://doi.org/10.1007/s12144-023-05113-y