The relationship between aggression and alexithymia in patients with depression

Objective: The aim of this study was to examine the relationship between aggression and alexithymia in individuals diagnosed with major depressive disorder (MDD). Materials and Methods: The study included a total of 210 participants: 105 patients diagnosed with MDD who presented to the Psychiatry Outpatient Clinic of Çukurova University Faculty of Medicine between 2024 and 2025, and 105 healthy control individuals matched for age, gender, and education level. Participants were assessed using the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D), Toronto Alexithymia Scale (TAS-20), and Buss–Perry Aggression Questionnaire (BPAQ). Results: Patients with depression scored significantly higher on both the TAS-20 and BPAQ total scores compared to the control group (p<0.001). GLM (General Linear Model) analysis revealed that the total TAS-20 score had a significant effect on all subdimensions of aggression: physical aggression (F=46.94; p<0.001; η²=0.186), verbal aggression (F=5.21; p=0.023; η²=0.025), anger (F=34.83; p<0.001; η²=0.145), and hostility (F=29.68; p<0.001; η²=0.126). The most prominent diagnostic group difference was observed in anger levels (F=38.01; p<0.001; η²=0.156). Correlation analyses indicated positive associations between the difficulty identifying and describing feelings subscales and anger, hostility, and total aggression (r=0.39–0.51; p<0.001). Regression analysis showed that difficulty identifying feelings increased physical aggression (β=0.50; p<0.001), whereas depression scores reduced it (β=–0.24; p=0.007). Mediation analysis revealed that alexithymia did not play a significant mediating role in the relationship between depression and aggression (p>0.05). Conclusion: Levels of alexithymia and aggression were significantly higher among patients with major depressive disorder. Alexithymia, particularly the difficulty in identifying feelings, was a strong predictor of anger and aggression. The impact of depression on aggression appears to occur indirectly through deficits in emotional awareness rather than directly. These findings highlight the importance of interventions focusing on emotional awareness and anger regulation in the treatment of depression. Keywords: Major depressive disorder, alexithymia, aggression, anger, depression