Relationship between adverse childhood experiences and alexithymia among Patients with Substance Use Disorders in Egypt: A Cross-Sectional Study

Abstract Background Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring before the age of 18, including abuse, neglect, and household dysfunction. These experiences are strongly associated with emotional dysregulation and increased risk of substance use disorders (SUDs). Alexithymia, defined as difficulty in identifying, describing, and processing emotions with a tendency toward externally oriented thinking, is highly prevalent among individuals with SUDs and may serve as a mediating factor between childhood trauma and addictive behaviors. Objectives This study described childhood adversity and alexithymia and examined their association in Egyptian men receiving addiction treatment. Methods In this cross-sectional study, 105 eligible men aged 18–65 years were recruited consecutively from inpatient and outpatient addiction services at Abbasiya Psychiatric Hospital, Cairo, from 15 February to 15 May 2026. Diagnoses were established using the Arabic Structured Clinical Interview for Axis I Disorders under the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Childhood adversity and alexithymia were assessed with the Adverse Childhood Experiences International Questionnaire and the 20-item Toronto Alexithymia Scale. Analyses included Pearson correlation and exploratory multivariable linear regression. Results The mean cumulative adversity score was 6.69 ± 2.74; 87 participants (82.9%) reported four or more adversity domains. The mean alexithymia score was 64.49 ± 8.83. Seventy-two participants were classified as alexithymic (68.6%; 95% confidence interval 59.2–76.7%), 28 as borderline (26.7%), and five as non-alexithymic (4.8%). Cumulative adversity was positively correlated with alexithymia scores ( r = 0.303; 95% confidence interval 0.118 to 0.467; p = 0.002). After adjustment for age, education, marital status, residence, main substance, and route of administration, each additional adversity domain was associated with a 0.93-point higher alexithymia score (95% confidence interval 0.303 to 1.556; p = 0.004). The model explained 21.3% of score variance (adjusted R² = 0.110). Conclusions Greater cumulative childhood adversity was associated with higher alexithymia scores among eligible men receiving addiction treatment at one Egyptian hospital. The findings describe a cross-sectional association and do not establish causality, mediation, or clinical benefit. Independent longitudinal studies incorporating functional and treatment outcomes are needed to assess clinical relevance and applicability to other populations.