Adverse childhood experiences (ACEs) are consistently associated with dissociation in adulthood, yet the psychological mechanisms underlying this relationship remain insufficiently understood. Alexithymia has been proposed as a potential explanatory mechanism because of its role in emotional processing and affect regulation. However, findings across empirical studies remain heterogeneous.

This systematic review aimed to examine the role of alexithymia in the association between ACEs and dissociation in adulthood, with particular attention to its potential mediating function. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science following PRISMA 2020 guidelines. Studies were eligible if they included adults with a history of ACEs, assessed dissociation and alexithymia, and examined their interrelationships. Studies assessing interoceptive processes within the same broader framework were also retained as supplementary exploratory evidence. Eight empirical studies met the eligibility criteria.

Seven studies directly assessed alexithymia, all of which reported significant positive associations with dissociation among adults with histories of childhood adversity. Three studies reported mediation effects, whereas two did not support mediation and two provided correlational or predictive evidence without formal mediation. One additional study assessed body awareness and reported improvements alongside reductions in dissociative symptoms following a body-oriented intervention.

Current evidence indicates that alexithymia is consistently associated with dissociation following childhood adversity and may represent a relevant explanatory pathway between ACEs and dissociative outcomes in some populations. Nevertheless, methodological heterogeneity and the predominance of cross-sectional designs preclude firm causal conclusions. Future longitudinal studies are needed to clarify these pathways, while the possible contribution of interoceptive processes remains an exploratory question for future research.