Objective. - The objective of this study was to support the existence of emotional dimensions like alexithymia and affective intensity and of psychopathological dimensions like anxiety and depressive symptoms in smoking. We think that smoking could be a manifestation of emotional helplessness. Alexithymia and affective intensity associated with anxiety and depressive symptoms could be a model of emotional functioning which is conducive to smoking. Patients and methods. - The study participants consisted of 222 students (37 males and 185 females; mean age = 22.6 + 5.13 years) from 1st to 5th year of Aix-Marseille University. The sample was divided into two groups: smoking (n = 86) and no-smoking (n = 136). We administered a protocol to the subjects consisting of three self-assessment scales to assess emotional and psychopathological dimensions. The alexithymia was assessed by the scale of the Twenty-items Toronto Alexithymia Scale (TAS-20). It allows an overall assessment of the level of alexithymia, as well as three dimensions as represented by specific sub scales: difficulty identifying emotions (DIE), difficulty differentiating emotions (DDE) and externally oriented thinking (EOT). The emotional intensity was assessed by the Affective Intensity Measure (AIM). The AIM is a 40-items questionnaire designed to measure the characteristic strength or weakness with which one experiences emotion. The anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression scale (HAD). The HAD is a 14-items scale used to determine the levels of anxiety and depression, seven of the items relate to anxiety and seven relate to depression. These scales have been validated internationally. Statistical analysis. - We performed descriptive analysis, correlational analysis (Bravais-Pearson's correlation), linear multiple regression and binary logistic regression model using SPSS.17 software. Results. - The results showing that smoking subjects are more anxious (M = 9.10 + 3.94; P < 0.05) and have more difficulty identifying feelings (M = 17.02 + 5.14; P < 0.05) than no-smoking subjects (mean anxiety = 7.95 + 3.58; mean difficulty identifying feelings = 15.54 + 5.25). But smokers are less alexithymics, more specifically in difficulty differentiating emotions (M = 12.7 + 4.73; P < 0.001) and externally oriented thinking (M = 15.27 + 3.85; P < 0.01) dimensions than no-smokers (mean difficulty differentiating emotions = 16 + 3.89; mean externally oriented thinking = 17.22 + 3.38). The analysis of relationships between the different variables shows the existence of several significant connections. We find a moderate and positive correlation between depression/anxiety and alexithymia (r > 25; P < 0.01), and a strong positive correlation between depression/anxiety and emotional dimensions of alexithymia: difficulty identifying feelings (r > 50; P < 0.01). However only with no-smoking subjects, we also find a moderate positive correlation between depression/anxiety and emotional dimensions of alexithymia: differentiating emotions (r > 25; P < 0.01). In smoker group, the regression analysis shows that only emotional dimensions of alexithymia: difficulty identifying feelings and smoking influence positively and significantly anxious and depressive symptoms (P < 0.0001). Anxiety about, the daily consumption of cigarettes (beta = 0.663) is more discriminating than difficulty identifying feeling (beta = 0.225). We find the same observation for depression (mean Cig/day: beta = 0.630; mean difficulty identifying feelings: beta = 0.201). However, we note in no-smoker group that emotional dimensions of alexithymia: difficulty differentiating emotions also contribute significantly anxiety (B = 0.411, P < 0.0001). But in any case, alexithymia is more discriminated to emotional intensity. Moreover, the regression analysis shows the daily consumption of cigarettes about, that the terms of symptomatic expression are more discriminating than other variables (mean anxiety: beta = 0.681; mean depression: beta = 0.641, P < 0.0001). Finally, binary logistic regressions show that anxiety symptoms multiply by 1.5 the probability of smoking. Conclusions. - Our study reveals the role of smoking to emotional regulation. The fact that smokers differentiate more easily their emotions could be understood as an attempt to express emotions which cannot be psychical work out. Because, smokers however are more anxious and have more difficult to identify emotions than no-smokers. We think smoking would be an attempt to release psychological suffering through acting. The difficult to identify emotions would be defense against anxiety situation caused by smoking. The study limitations are discussed. (C) 2016 Elsevier Masson SAS. All rights reserved.
