Social factors in alexithymia

Alexithymia in male alcoholics: study in a Turkish sample

The prevalence of alexithymia among male alcoholic cases in a clinical sample from the Turkish population and the relationship between alexithymia and clinical characteristics of alcoholics were studied. Participants were 56 males with alcohol dependence. Alcohol dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale (TAS-20). Almost 42% of the patients with alcoholism had a score greater than 60 on the TAS-20, and were therefore considered as alexithymic. The alexithymic patients were found to have a lower level of education and poor economic status. In addition, the severity of alcoholism and duration of alcohol use has been shown to be associated with alexithymia. These results suggest that there was a strong connection between alexithymia and alcoholism. However, the prevalence of alexithymia was not different in Turkish alcoholic men compared with Western alcoholic men.

Alexithymia and somatisation: quantitative review of the literature

OBJECTIVE

To present a quantitative review of the empirical literature on somatisation and alexithymia.

METHODS

Medline and PsycLIT searches for relevant studies were conducted. Meta-analytical techniques were applied to quantify the strength of the associations that were found.

RESULTS

A small to moderate relationship was found between general alexithymia and somatic symptom reporting. The alexithymia dimension measuring difficulty in identifying feelings showed the strongest association with symptom reports. The alexithymia dimension measuring externally oriented thinking was virtually unrelated to somatic symptom reports. Compared to healthy control populations, subjects suffering from a somatoform condition were significantly more alexithymic, with effect sizes ranging from moderate to large. The studies comparing somatoform to medical or psychiatric conditions yielded inconclusive results.

CONCLUSIONS

By means of quantitative procedures, an association between general alexithymia and somatic symptom reporting was established. Due to the use of questionnaires that can only check for symptoms, not whether these symptoms are medically explained or not, it is however not possible to draw conclusions on somatisation properly defined. The inconsistent results found when comparing somatoform conditions to medical and psychiatric controls may be attributed to confounding variables. In future studies, these variables should be statistically controlled to establish a more consistent pattern of associations between somatoform conditions and alexithymia. It is, however, equally feasible that this inconsistency reflects the nonspecific character of the association between alexithymia and somatisation. The presence of only one prospective study does not allow to draw conclusions on alexithymia as a predisposing factor for somatisation.

Social situation of expectant mothers and alexithymia 31 years later in their offspring: a prospective study

OBJECTIVE

We studied the association between alexithymia in adulthood and social situation of the child's family at the time of the child's birth.

METHODS

The study forms part of the prospective Northern Finland 1966 Birth Cohort Project. The original material consisted of all 12,058 live-born children in the provinces of Lapland and Oulu in Finland with an expected delivery date during 1966. The material represents 96% of all births in the region. In 1997 a 31-year follow-up study was made on part of the initial sample. The 20-item version of the Toronto Alexithymia Scale (TAS-20) was given to 5983 participants of the field study. Of them, 85% returned the questionnaire properly completed. Factors indicative of the social situation of the child's family were already gathered during pregnancy and the time of birth from the mothers, thus eliminating recall bias.

RESULTS

Alexithymia was more common in subjects from rural than urban dwelling areas. Unwanted children or subjects born into families with many children also exhibited an association with alexithymia in adulthood.

CONCLUSIONS

Maternal social situation and environment predict alexithymia in the offspring.

Association of symptoms of TMD and orofacial pain with alexithymia: an epidemiological study of the Northern Finland 1966 Birth Cohort

Alexithymia is a term denoting a deficit in the ability to differentiate emotional from physical states and to identify and describe one's feelings, as well as a preference for external oriented thinking. Alexithymia has been linked with various somatic and psychosomatic diseases, especially with chronic pain. The aim of this study was to evaluate the association between alexithymia and symptoms of temporomandibular disorders (TMD) as well as oro-lingual and dental pain, in a large representative population sample of young adults. The study was a part of the 31-year follow-up study of the Northern Finland Birth Cohort originally consisting of 12058 live births in the year 1966. In 1997, 4893 subjects living in northern Finland or in the capital area, who participated in a field study of the project and later returned a postal questionnaire, made up the sample of this study. Information concerning symptoms of TMD and oro-lingual and dental pain was collected from the subjects. To assess alexithymia, the Toronto Alexithymia Scale-20 (TAS-20) was used. In addition, information about depression, marital status and self-rated health was collected. The proportion of alexithymics (TAS score over 60) was higher in subjects with the most orofacial symptoms than in asymptomatic subjects. In men, alexithymia associated significantly with facial pain, difficulties in mouth opening, oro-lingual pain and dental pain, and in women with pain on jaw movement and dental pain. After adjusting for depression, marital status, and self-rated health, a significant association remained between alexithymia and the symptoms mentioned, except for facial pain in men. It can be concluded that alexithymia is connected with orofacial symptoms. Clinicians treating these symptoms should be familiar with the concept of alexithymia.

Alexithymia in DSM-IV Disorder: Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression

The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.

Depression is strongly associated with alexithymia in the general population

OBJECTIVE

This study examines how alexithymia and depression are related to each other in men and women in a sample of Finnish general population (n = 2018).

METHODS

Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale. Level of depression was assessed using the 21-item Beck Depression Inventory (BDI). Life satisfaction was estimated with a structured scale.

RESULTS

The prevalence of alexithymia was 12.8% in men and 8.2% in women. However, the prevalence of alexithymia was 32.1% among those having BDI scores of > or = 9, but only 4.3% among the nondepressed subjects (p < 0.001). The BDI scores explained 29.2% of the variation in TAS-20 scores. Alexithymia was associated with several sociodemographic factors if depression was not taken into account. However, after including depression in the logistic regression models, only depression and low life satisfaction were associated with alexithymia, both in men and women.

CONCLUSION

These results suggest that alexithymia has a close relationship to depression in the general population. The impact of social factors on alexithymia may be primarily explained by depression. Depression must be taken into account as a confounding factor when studying alexithymia in general populations due to the strong association between alexithymia and depression.

Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking). but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.

Sociodemographic correlates of alexithymia

The association between alexithymia and sociodemographic variables is not well understood. Previous studies using the current 20-item and previous 26-item versions of the Toronto Alexithymia Scale (TAS) have shown inconsistent associations with age, sex, socioeconomic status, and years of education. We tested 380 subjects from the community stratified equally across sex, five age groups, and three socioeconomic classes. In addition to the TAS-20, we also administered the Levels of Emotional Awareness Scale (LEAS), a behavioral measure of the ability to be aware of and represent emotions in words, a core component of alexithymia. The TAS-20 and LEAS were each correlated with age, sex, socioeconomic status (SES), and years of education (P < .01) in the same direction and to approximately the same degree. Alexithymia (or low emotional awareness) is associated with older age, male sex, lower SES, and fewer years of education. The TAS-20 and LEAS are only slightly correlated (r = -.19, n = 380, P < .001), but their correlation is largely accounted for by their shared variance with these demographic variables. The convergence of findings with these two quite different measures and the nature of their overlap support the validity of these associations between alexithymia and sociodemographic variables.

Alexithymia in chronic pain patients

Prior studies of alexithymia in chronic pain patients have used unvalidated alexithymia measures or have not controlled for treatment-seeking status. In this study, we compared 30 patients with chronic pain and patients seeking treatment for two other problems: nicotine dependence (n = 32) or moderate obesity (n = 25). Alexithymia was assessed with the well-validated Toronto Alexithymia Scale (TAS) and also with the Alexithymia Provoked Response Questionnaire (APRQ). On both alexithymia measures, chronic pain patients were more alexithymic than nicotine-dependent and obese patients; the latter two groups did not differ. Chronic pain patients had greater psychopathology on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and both alexithymia measures correlated positively with certain types of psychopathology. We conclude that alexithymia is increased among patients with chronic pain, that this relationship is not confounded by a treatment-seeking bias, and that alexithymia may contribute to both chronic pain and psychopathology.

Anhedonia and alexithymia: distinct or overlapping constructs

The aim was to examine the relationship between alexithymia, anhedonia, and capacity for displeasure in a group of 133 healthy subjects using principal components analysis. A correlation matrix comprised of items from both the Communication and Identification scale of the 20-item Toronto Alexithymia Scale and the Physical Pleasure-Displeasure Scale yielded a four-factor solution (one Communication-Identification, two Pleasure, and one Displeasure factor) with no overlap of the significant factor loadings for the items from each scale. Moreover, there were no positive significant correlations between the Communication and Identification Scales and the Physical Anhedonia Scale. Our findings support the view that physical anhedonia is a construct distinct and separate from alexithymia.

Alexithymia and risk of death in middle-aged men

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p < 0.001) and a threefold greater risk of death from accidents, injury, or violence (p < 0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity). physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.

How are alexithymia and physical illness linked? A review and critique of pathways

We review the empirical literature and critique four possible pathways linking alexithymia and physical illness; (a) alexithymia leads to organic disease through physiological or behavioral mechanisms: (b) alexithymia leads to illness behavior (physical symptoms, disability, excessive health care use) through cognitive or social mechanisms: (c) physical illness leads to alexithymia; and (d) both alexithymia and physical illness result from sociocultural or biological factors. Our review suggests that alexithymia is associated with tonic physiological hyperarousal, certain types of unhealthy behavior, and a biased perception and reporting of somatic sensations and symptoms. Alexithymia also appears to influence health care use, but in a complex fashion. Although trauma may give rise to alexithymia, whether physical illness such as chronic pain does so is not known, and there is little evidence that sociocultural or biological factors lead to both alexithymia and physical illness. We conclude that alexithymia probably influences illness behavior, but there is little support for the hypothesis that alexithymia leads to chronic organic disease, especially when one distinguishes organic disease from illness behavior.

Alexithymia, social support and health problems

This article presents three studies examining whether alexithymia is associated with less perceived and network social support, whether such relationships are accounted for by reduced social skills associated with alexithymia, and whether limited social support links alexithymia to health problems. The relationships between alexithymia (Toronto Alexithymia Scale), social variables, and physical health and depression were examined in both healthy young adults and patients. Alexithymia (especially deficits in identifying and communicating feelings) was related to less perceived support, fewer close relationships, and less social skill: the social skills deficit accounted fully for the association between alexithymia and a smaller social network. Additionally, alexithymia was related to both somatic complaints and depression, but social support generally was not. It is concluded that alexithymia is associated with reduced perceived and network social support, that these associations are likely due to alexithymia-related deficiencies in social skills but that reduced social support does not account for the relationship between alexithymia and health problems.