A narrative review on alexithymia in adolescents with previous adverse experiences placed for adoption, in foster care, or institutions. Prevalence, gender differences, and relations with internalizing and externalizing symptoms

Alexithymia is a recognized risk factor for psychopathology, showing relationships with internalizing and externalizing symptoms. The prevalence of alexithymia ranges from 7-21% in low-risk community adolescents, especially girls. Further, few retrospective studies suggest a higher incidence in individuals with past traumatic experiences, but they are mostly on clinical adults. Therefore, the current narrative review aimed to examine the state-of-art of literature on alexithymia (in terms of prevalence, gender differences, and relationships with internalizing-externalizing symptoms), in non-clinical adolescents potentially at "high-risk" for alexithymia because placed for adoption, in foster care or institutions due to adverse and potentially traumatic experiences (parental abandonment, neglect, abuse, etc). The review of the literature was computed on documents retrieved through electronic databases (ProQuest, PsycInfo, PsycArticles, PubMed, WOS, Scopus, Google Scholar), included according to their pertinence and type (empirical studies). Of 6379 documents, only 6 studies (0.2%) on institutionalized adolescents met the inclusion criteria, none in adopted and foster care groups. Main results revealed: 1) higher prevalence of alexithymia in institutionalized adolescents (38-85%) compared to community peers; 2) institutionalized girls as more alexithymic, showing more difficulty in identifying and describing feelings than boys, like in community groups; 3) Higher alexithymia was related to more total, internalizing and externalizing problems through similar mechanisms of risk than in community groups. Methodological limits and future directions of research are discussed for each topic, highlighting the need to bridge the research gap on adolescents with adverse backgrounds, potentially at "high-risk" for alexithymia and its negative consequences.