What’s in the name ‘alexithymia’? A commentary on “Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud’s legacy.”

Body talk: Sex differences in the influence of alexithymia on physical complaints among psychiatric outpatients

This study investigated the relationship between alexithymia and physical complaints among psychiatric outpatients, and whether sex moderated this relationship. Participants (N = 185) completed measures of physical complaints (bodily symptom burden, pain severity, pain interference), alexithymia, current symptom (depression, anxiety) distress, and somatosensory amplification (i.e., a person's tendency to be bothered by physical sensations). Hierarchical regression analyses were conducted, controlling for the influence of current psychiatric symptom distress and somatosensory amplification. Findings revealed differential relationships between alexithymia and physical complaints (pain interference) for women and men, in addition to main effects for sex and alexithymia. The findings suggest that the negative influence of alexithymia on bodily-related problems may not be universal.

The functional and structural characteristics of the emotion network in alexithymia

BACKGROUND

Alexithymia is a multifaceted personality trait characterized by emotional dysfunction.

METHODS

In this study, the functional and structural features of the emotion network in alexithymia were investigated using resting-state functional MRI (rsfMRI), voxel-based morphometry (VBM), functional connectivity (FC) analysis, and diffusion tensor imaging (DTI). Alexithymic and non-alexithymic students were recruited from the local university. The intrinsic neural activity and gray matter density of the brain regions in the emotion network were measured using rsfMRI and VBM; the FC and structural connectivity of the brain regions in the emotion network were measured using FC analysis and DTI.

RESULTS

The altered intrinsic neural activity in V1, rostral dorsal anterior cingulate cortex, and left amygdala, and the weak FC between V1 and left superior temporal gyrus and V1 and left paracentral lobule in alexithymia subjects were identified. However, no alteration of the structure and structural connectivity of the emotion network was identified.

CONCLUSION

The results indicated that the development of alexithymia might have been caused only by slight alteration of the neural activity. Furthermore, the results suggest that noninvasive treatment technologies for improving the brain activity are suitable for alexithymic individuals.

Characteristics of brain functional and structural connectivity in alexithymic students

BACKGROUND

Alexithymia is a multifaceted personality trait and a risk factor for several mental and physical diseases.

METHODS

In this study, 21 alexithymic students and 21 nonalexithymic students were recruited from the local university and assigned to the alexithymic group and the control group, respectively. Then, the functional connectivity and the structural connectivity among the brain regions of the students were investigated using resting-state functional magnetic resonance imaging (rsfMRI), function connection (FC) analysis, and diffusion tensor imaging (DTI).

RESULTS

The rsfMRI results revealed 14 brain regions showing significant differences in the amplitude of low-frequency fluctuations between the two groups. Comparative analysis of the FC and DTI data in these brain regions between the two groups identified altered levels of functional and structural connectivity between the following four pairs of regions in the alexithymic subjects: the right inferior temporal gyrus and the central posterior gyrus, the left temporal gyrus and the insula, and the bilateral superior frontal gyrus and the anterior cingulate gyrus.

CONCLUSION

Compared with single MRI analysis, the multiple MRI analysis identified more precisely the brain regions that could play a key role in the development of alexithymia.

Alexithymia Components Are Differentially Related to Explicit Negative Affect But Not Associated with Explicit Positive Affect or Implicit Affectivity

Alexithymia represents a multifaceted personality construct defined by difficulties in recognizing and verbalizing emotions and externally oriented thinking. According to clinical observations, experience of negative affects is exacerbated and experience of positive affects is decreased in alexithymia. Findings from research based on self-report indicate that all alexithymia facets are negatively associated with the experience of positive affects, whereas difficulties identifying and describing feelings are related to heightened negative affect. Implicit affectivity, which can be measured using indirect assessment methods, relates to processes of the impulsive system. The aim of the present study was to examine, for the first time, the relations between alexithymia components and implicit and explicit positive and negative affectivity in healthy adults. The 20-item Toronto Alexithymia Scale, the Implicit Positive and Negative Affect Test and the Positive and Negative Affect Schedule (PANAS) were administered to two hundred and forty-one healthy individuals along with measures of depression and trait anxiety. Difficulties identifying feelings were correlated with explicit negative trait affect, depressive mood and trait anxiety. Difficulties describing feelings showed smaller but also significant correlations with depressive mood and trait anxiety but were not correlated with explicit state or trait affect as assessed by the PANAS. Externally oriented thinking was not significantly correlated with any of the implicit and explicit affect measures. According to our findings, an externally oriented, concrete way of thinking appears to be generally unrelated to dispositions to develop positive or negative affects. Difficulties identifying feelings seem to be associated with increased conscious negative affects but not with a heightened disposition to develop negative affects at an automatic response level.

The management of fibromyalgia from a psychosomatic perspective: an overview

Fibromyalgia (FM) is a central sensitization syndrome characterized by chronic widespread pain. FM is often comorbid with psychiatric disorders, as well as psychological distress that worsens the quality-of-life of people affected. The aim was to collect current evidence about the management of FM from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed; review articles, meta-analysis, overview, and guidelines published in the last 10 years written in English were included. Five main topics (Diagnostic criteria of FM; Pathogenesis of chronic widespread pain in FM; Early stress and trauma as predisposing factors for central sensitization; FM and Psychiatric comorbidity; Implications for treatment) were pointed out and discussed. Much evidence underlies the importance of considering and treating the comorbidity of FM with psychiatric disorders and psychological factors that affect pain management. Validation of FM as a central sensitization syndrome by a clinician facilitates therapeutic strategies that involve patients as active participants in the pain management process, likely leading to improved outcomes.

An evaluation of the absolute and relative stability of alexithymia over 11years in a Finnish general population

OBJECTIVE

We investigated if alexithymia, a personality construct with difficulties in emotional processing, is stable in the general population.

METHODS

Altogether 3083 unselected subjects aged 30 and older in Finland completed the 20-item Toronto Alexithymia Scale (TAS-20) in the longitudinal Health 2000 and Health 2011 general population surveys (BRIF8901). The stability of alexithymia at the 11-year follow-up was assessed with t-tests, correlations, and separate linear regression models with base-line and follow-up age, gender, marital status, education, and 12-month depressive and anxiety disorders as confounders.

RESULTS

The mean score (SD) of the TAS-20 for the whole sample was 44.2 (10.4) in 2000 and 44.2 (10.9) in 2011 (p=0.731). The mean score of the TAS-20 subscale Difficulty Identifying Feelings increased by 0.3 points, Difficulty Describing Feelings decreased by 0.6 points and Externally Oriented Thinking increased by 0.3 points. The effect sizes of the changes varied from negligible to small. Age had little effect except for the group of the oldest subjects (75-97years): the TAS-20 mean (SD) score was 49.1 (10.1) in 2000 and 53.1 (10.3) in 2011 (p<0.001), the effect size for the increase was medium. TAS-20 score in 2000 explained a significant proportion of variance in TAS-20 score in 2011. Controlling for all baseline confounders improved the model incrementally; the same applied to controlling for confounders at follow-up. Baseline depression or anxiety disorders were not associated with the TAS-20 scores in 2011, whereas current diagnoses were.

CONCLUSIONS

According to our large longitudinal study both the absolute and relative stability of alexithymia assessed with the TAS-20 are high in the adult general population.

Taxometric Analysis of the Toronto Structured Interview for Alexithymia: Further Evidence That Alexithymia Is a Dimensional Construct

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and describing feelings, externally oriented thinking, and impoverished imaginal processes. Previous taxometric investigations provided evidence that alexithymia is best conceptualized as a continuous dimension rather than a discrete type, at least when assessed with the self-report 20-Item Toronto Alexithymia Scale. The aim of the current study was to test the categorical versus dimensional structure of alexithymia using the recently developed Toronto Structured Interview for Alexithymia. Three nonredundant taxometric procedures (MAXCOV, MAMBAC, and L-Mode) were performed on the Toronto Structured Interview for Alexithymia subscale scores from a multinational sample of 842 adults. All taxometric procedures produced unambiguously dimensional solutions, providing further evidence that the core alexithymia features are continuously distributed in the population. Discussion focuses on the theoretical, assessment, and clinical implications of these findings for the alexithymia construct.

The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome

In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R²=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.