Relationships between alexithymia and psychological characteristics associated with eating disorders

Alexitimia: dificuldade de expressão ou ausência de sentimento? Uma análise teórica

O objetivo deste ensaio é apresentar uma base conceitual para diferenciar emoções de sentimentos, a partir das ideias de LeDoux e Damásio, e usar essa base numa abordagem sobre o conceito e as origens da alexitimia, constructo recentemente desenvolvido para retratar a dificuldade de expressar emoções e sentimentos. Nessa abordagem, é questionado se o alexitímico não expressa ou não tem sentimentos. A conclusão deste ensaio é que no alexitímico as emoções ocorrem normalmente, mas os sentimentos, que requerem circuitos cerebrais adicionais em relação aos acionados pelas emoções, não são desenvolvidos de forma adequada. São apresentadas as limitações do trabalho e sugestões para um programa de pesquisa.

Are treatment options related to alexithymia in eating disorders? Results from a three-year naturalistic longitudinal study

OBJECTIVE

Longitudinal studies have shown that alexithymic features can interfere with treatment response in eating disorders. However, an alternative hypothesis could be that clinicians faced with alexithymic patients chose different treatment options according to their perceptions of these patients. The aim of this investigation was to explore the relationships between alexithymic features and treatment options provided by professionals in a naturalistic prospective study of eating disorders.

METHODS

We conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV Eating Disorder patients with the Toronto Alexithymia Scale (TAS-20). All treatments received during follow-up were recorded and recoded dichotomously, and crossed with the variation of alexithymic categories (cut-off≥56) between inclusion and follow-up.

RESULTS

Patients received different treatments according to their alexithymic profile, in terms both of number and type of treatment received. Patients with high, stable levels of alexithymia received overall more treatments, and significantly more antidepressants, than non-alexithymic patients. Patients who became alexithymics during follow-up were more often rehospitalized and received fewer regular psychotherapies than the non-alexithymic patients.

CONCLUSIONS

Professionals should carefully monitor these personality features and be aware of the potential impact of alexithymic features on treatment compliance and on treatment choice for eating disordered patients.

Implications of Emotional Eating Beliefs and Reactance to Dietary Advice for the Treatment of Emotional Eating and Outcome Following Roux-en-Y Gastric Bypass

This case describes cognitive—behavioral treatment for emotional eating, preceding and following Roux-en-Y gastric bypass, which is associated with 84.52% excess BMI (body mass index) loss 53 months after surgery. It explores the relevance of emotional eating beliefs (EEB; that is, equating food with both alleviation of negative feelings and friendship) and reactance to dietary advice (RDA; that is, rebelling against prescribed nutrition) for the deliberate use of food to feel both better and befriended. EEB and RDA motivate and justify, respectively, the conscious consumption of rich or “forbidden” foods. Simultaneous treatment of EEB and RDA is associated with the utilization of rational thinking and problem solving to cope with emotional discomfort. Remediation of equations of food with friendship engenders amelioration of distress through spousal support. Unrecognized emotional distress fueling reflexive eating and accompanying external eating are found. External eating is decreased coincident with therapy for emotional eating. Implications are discussed.

Alexithymia in healthy women: a brain morphology study

BACKGROUND

Alexithymia relates to difficulty recognizing and describing own feelings. Recent literature shows that specific structures process emotions. Aim of this study was to investigate whether alexithymia is associated with a specific cerebral morphology of candidate structures in healthy adults.

METHODS

Fifty-four female volunteers were enrolled in the study and the 20-item Toronto Alexithymia Scale (TAS-20) was self-administered. Gray matter (GM) volume was assessed with an optimized voxel-based morphometry (VBM) protocol on high-resolution 3D magnetic resonance images. The following three experiments were carried out: 1) contrast between the 14 volunteers with TAS-20 scores > or = 61 (alexithymic) and the 30 with scores < 51 (non-alexithymic), 2) correlation of TAS-20 scores on the whole sample and 3) contrast between the 14 alexithymic and 14 non-alexithymic matched by age. The significant threshold for VBM comparisons and correlation was set at p<0.005 uncorrected.

RESULTS

The alexithymic group showed smaller GM volume in the anterior cingulate cortex (cluster size: 735 voxel no.; z=3.26; stereotaxic coordinates: -12, 22, 30) and middle temporal gyrus (256; 3.21; -60, 2, -20). Of specific biological relevance, smaller clusters were located in the anterior insula, orbitofrontal cortex and superior temporal sulcus. The opposite comparison was negative. The correlation analysis confirmed the pattern of results mainly in the left hemisphere.

CONCLUSIONS

Our findings suggest that the ability to process emotional aspects of the self correlates with morphology of a specific set of cerebral structures known to be involved in decision making and self awareness and rich in neurons subserving social competence.

Alimentary Epigenetics: A Developmental Psychobiological Systems View of the Perception of Hunger, Thirst and Satiety

Hunger, thirst and satiety have an enormous influence on cognition, behavior and development, yet we often take for granted that they are simply inborn or innate. Converging data and theory from both comparative and human domains, however, supports the conclusion that the phenomena hunger, thirst and satiety are not innate but rather emerge probabilistically as a function of experience during individual development. The metatheoretical perspective provided by developmental psychobiological systems theory provides a useful framework for organizing and synthesizing findings related to the development of the perception of hunger, thirst and satiety, or alimentary interoception. It is argued that neither developmental psychology nor the psychology of eating and drinking have adequately dealt with the ontogeny of alimentary interoception and that a more serious consideration of the species-typical developmental system of food and fluid intake and the many modifications that have been made therein is likely necessary for a full understanding of both alimentary and emotional development.

A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with Binge Eating Disorder

Previous studies support the use of selective serotonin reuptake inhibitors (SSRIs), in overweight patients with Binge Eating Disorder (BED), but results are far from conclusive. Sertraline has been studied less extensively, and there have been a few studies concerning SSRIs that report follow-up data at more than 12 weeks of follow-up. The present study assesses the effectiveness of sertraline and fluoxetine over a period of 24 weeks in obese patients with BED (DSM-IV-TR). Forty-two obese outpatients were randomized and assigned to one of two different drug treatments: 22 were treated with sertraline (dose range: 100-200 mg/day) and 20 with fluoxetine (dose range: 40-80 mg/day). Subjects were assessed at baseline and at 8, 12, and 24 weeks of treatment for binge frequency, weight loss, and severity of psychopathology. No significant differences were found between the two treatments. After 8 weeks of treatment a significant improvement in the Binge Eating Scale score and a significant weight loss emerged. These results were maintained by responders (weigh loss of at least 5% of baseline weight) over 24 weeks. The results suggest that a 6-month treatment with SSRI may be an effective option to treat patients with BED.

Is Self-Objectification Related to Interoceptive Awareness? An Examination of Potential Mediating Pathways to Disordered Eating Attitudes

Although there has been considerable empirical support for Objectification Theory ( Fredrickson & Roberts, 1997 ), findings have been mixed regarding self-objectification's relationship to interoceptive awareness, an awareness of one's internal physical and emotional states. We examined whether interoceptive awareness mediated the relationship between self-objectification and disordered eating attitudes, exploring more specifically the relative contributions of difficulties recognizing feelings of hunger and satiety versus emotions. College women ( N = 195) completed measures assessing self-objectification, interoceptive awareness, awareness of emotions, and disordered eating attitudes. Self-objectification correlated significantly more strongly with interoceptive awareness when internal cues about hunger and satiety were assessed. The relationship between self-objectification and disordered eating attitudes was partially mediated by interoceptive awareness. Results revealed that interoceptive awareness may best be captured by a measure that includes lack of awareness of both hunger and satiety and emotional states. Research and clinical implications of these findings are discussed.

Emotional awareness and core beliefs among women with eating disorders

Patients with eating disorders have been shown to experience the emotional components of alexithymia-difficulties in identifying and describing emotions. In keeping with cognitive theories, which stress the role of schema-level beliefs in understanding emotions, this study examined the core beliefs that are associated with this difficulty in women with eating disorders. Seventy eating-disordered women completed standardised measures of core beliefs and alexithymia. There were no differences in alexithymia between diagnostic groups, so the women were treated as a single, transdiagnostic group. Multiple regression analyses showed specific patterns of association between the core beliefs and the emotional elements of alexithymia. Difficulties in identifying emotions were associated with entitlement beliefs, while difficulties in describing emotions were associated with both abandonment and emotional inhibition beliefs. These findings suggest that it may be necessary to work with core beliefs in order to reduce levels of alexithymia, prior to addressing the emotions that drive and maintain pathological eating behaviours.

Dynamics of emotional expression in autobiographic speech of patients with anorexia nervosa

Emotional disturbances in persons with anorexia nervosa have mainly been documented using static descriptions. This study presents the temporal organisation of emotional expression in autobiographical speech of anorexic patients and thereby provides a first attempt to quantify the dynamics of emotions in patients' speech. The temporal pattern of emotional expression for persons with anorexia nervosa was studied after transforming the autobiographical narratives of 14 patients and 13 matched controls into symbolic sequences of positive, negative, and neutral emotional expressions. These symbolic sequences of emotional states and silences were analyzed using static and dynamic indices. Static indices showed that patients with anorexia nervosa expressed more negative emotions and fewer neutral states than control participants. Dynamic indices showed in patients' speech a cycle of negative emotions and silence. These results showed specific dynamics of emotional expression in persons with anorexia nervosa characterised by the presence of negative emotional perseveration. The possible clinical implications of these findings are discussed.

TAS-20 alexithymia in obesity, and its links to personality

We studied the association between alexithymia (20-item Toronto Alexithymia Scale, TAS-20) and obesity, and also assessed the construct validity of the TAS-20 in terms of personality dimensions in obese patients. The TAS-20 and its subscales were analysed for their correlations with the NEO Personality Inventory - Revised (NEO PI-R) in an obese sample of 259 patients. Obesity was associated with higher scores on the TAS-20 than a Swedish reference sample. Obese men furthermore scored higher on Externally Oriented Thinking than the obese women. TAS-20 scores correlated with elevated Neuroticism and lower levels of Extraversion and Openness, in agreement with most previous research, but also somewhat unexpectedly with lower Conscientiousness and for women also with lower Agreeableness. The TAS-20 subscales showed divergent associations with personality variables, largely in accordance with previous findings. The associations were more prominent for the women, and some gender-specific patterns not previously reported were also revealed.

Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study

OBJECTIVE

Several cross-sectional studies have reported high levels of alexithymia in populations with eating disorders. However, only few studies, fraught with multiple methodological biases, have assessed the prognostic value of alexithymic features in these disorders. The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a sample of patients with eating disorders.

METHODS

Within the framework of a European research project on eating disorders (INSERM Network No. 494013), we conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV eating disorder patients using the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory.

RESULTS

At the 3-year assessment, 74% (n=76) of the sample still presented a syndromal or subsyndromal eating disorder (unfavorable outcome: score of > or =3 on the Psychiatric Status Rating Scale for anorexia nervosa or bulimia nervosa). In logistic and hierarchical regression analyses, the Difficulty Identifying Feelings factor of the TAS-20 emerged as a significant predictor of treatment outcome, independent of depressive symptoms and eating disorder severity.

CONCLUSIONS

The results of this study indicate that difficulty in identifying feelings can act as a negative prognostic factor of the long-term outcome of patients with eating disorders. Professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions.

Alexithymia and its relationships with body checking and body image in a non-clinical female sample

The aim of the present study was to evaluate in a non-clinical sample of undergraduate women, the relationships between alexithymia, body checking and body image, identifying predictive factors associated with the possible risk of developing an Eating Disorder (ED). The Toronto Alexithymia Scale (TAS-20), Body Checking Questionnaire (BCQ), Eating Attitudes Test (EAT-26), Body Shape Questionnaire (BSQ), Interaction Anxiousness Scale (IAS), Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI) were completed by 254 undergraduate females. We found that alexithymics had more consistent body checking behaviors and higher body dissatisfaction than nonalexithymics. In addition, alexithymics also reported a higher potential risk for ED (higher scores on EAT-26) when compared to nonalexithymics. Difficulty in identifying and describing feelings subscales of TAS-20, Overall appearance and Specific Body Parts subscales of BCQ as well as lower self-esteem was associated with higher ED risk in a linear regression analysis. Thus, a combination of alexithymia, low self-esteem, body checking behaviors and body dissatisfaction may be a risk factor for symptoms of ED at least in a non-clinical sample of university women.

An evaluation of the absolute and relative stability of alexithymia in women with breast cancer

OBJECTIVES

In the controversy for alexithymia as a state or a trait dimension, recent studies showed that, whereas absolute changes (i.e., extent of alexithymia scores change over time) were observed, alexithymia was relatively stable (i.e., extent to which relative differences among individuals remain the same over time). The present study extended this question by investigating a disease with highly threatening outcomes (breast cancer), by looking at changes in depression and anxiety, and by examining stability for total and factor alexithymia scores.

METHODS

One hundred twenty-two women in treatment for a first instance of breast cancer were assessed for alexithymia (TAS-20), depression, and anxiety (HADS) the day before surgery (T1) and six months later (T2).

RESULTS

Alexithymia scores changed from baseline to follow-up (lack of absolute stability). Strong evidence of relative stability was also demonstrated, as alexithymia scores at baseline correlated significantly with alexithymia scores at follow-up and were also a significant predictor of follow-up alexithymia scores, after partialling the effects of depression and anxiety severity. Changes in alexithymia were explained only to a small extent by changes in depression and anxiety from T1 to T2. Results at the factor level revealed that "difficulty identifying feelings" follow-up and change score accounted for the highest variations in depression and anxiety, and "externally oriented thinking" for the lowest ones.

CONCLUSIONS

The finding of relative stability of alexithymia supports the view that this construct is a stable personality trait rather than a state-dependent phenomenon, even in a context of high threat for physical and psychological integrity.

Effects of distress, alexithymia and impulsivity on eating

OBJECTIVE

To improve our understanding of possible mechanisms underlying emotional overeating this study examined the effects of a distress manipulation on food intake in relation to alexithymia and impulsivity.

METHOD

Participants were 86 females who were subjected to a distress manipulation (the anticipation of a public speaking task) prior to an ad lib taste task and filled out questionnaires on impulsivity and the alexithymia constructs difficulty identifying and describing feelings.

RESULTS

Alexithymia significantly (p<.05) moderated the relationship between food consumption and distress. Instead of eating less in the distress condition, alexithymic females ate the same or even more, this showing a 'biological unnatural' and 'inapt' response.

CONCLUSION

Findings suggest that for the 'natural' distress response (reduction of food intake) good ability to identify and describe feelings to others is required, and that the presence or absence of these abilities may predict which people respond to distress by undereating or by overeating. The results provide empirical support for Bruch's conceptualisation of poor interoceptive awareness as possible predictive factor for emotional overeating.

Emotional processing in eating disorders: specific impairment or general distress related deficiency?

The literature on eating disorders emphasizes the relationship between alexithymia and anorexia nervosa on the one hand, and between bulimia nervosa and affect dysregulation on the other. In our study, two questions are addressed: (1) Are there different patterns of emotional processing deficiencies in anorexia and bulimia? and (2) Is there a unique contribution of eating disorders to emotional processing deficiencies? Participants were women with anorexia nervosa (ANs, n=20), bulimia nervosa (BNs, n=20), and normal controls (NCs, n=20). Three hypotheses were examined: (1) Women with eating disorders will exhibit lower emotional awareness and more deficient emotional regulation than will NCs (emotional deficiency); (2) ANs will be less emotionally aware than BNs, whereas BNs will be less capable of effective emotional regulation than ANs (disorder specificity); and (3) emotional distress will mediate the relationships between emotional processing and eating disorders (emotional distress mediation). Results supported the emotional deficiency and distress mediation hypotheses, and partially supported the disorder specificity hypothesis. The need to move beyond alexithymia in understanding the pattern of emotional processing deficiencies in eating disorders is discussed.

Autobiographical memory deficit in anorexia nervosa: emotion regulation and effect of duration of illness

Emotional deficits in anorexia nervosa can be expressed in autobiographical memory recall. The aim of this study is to test whether deficits in autobiographical memory exist in anorexic patients and concern specifically negative or positive emotional valence. Moreover, it is unclear whether these deficits are dependent upon comorbid aspects (depression, alexithymia, and anxiety) or upon illness duration. Anorexic patients (n=25) were compared to healthy volunteers based on their clinical assessment, explicit memory test score, and autobiographical memory test score. The study makes use of the autobiographical test of Williams and Scott, which involves specific emotional cues to elicit memory. Anorexic patients recalled more general memories than controls in autobiographical memory test, but had no deficit in explicit memory test. This pattern, observed both for negative and positive cues, was neither related to depression or alexithymia, nor to anxiety severity, but increased significantly with illness duration. These results show that anorexic patients are characterized by relative difficulty in the integration of both negative and positive emotional experiences, and that this impairment is reinforced by illness duration.

A new application of sound resonance technology therapy for the treatment of fibromyalgia: A retrospective analysis

OBJECTIVE

Chart review to evaluate the effectiveness of a three-phase sound resonance technology therapy (SRTT) protocol for the treatment of fibromyalgia.

RESULTS

Initial FIQ scores of 159 consecutive patients ranged from 24 to 80 (mean=58). After Phase 1, ( approximately 1 month into the protocol), FIQ scores had decreased on average by 26 points (n=128, 95% CI 23-30, p<.001). After phase 3 of the protocol 53 patients completed an FIQ questionnaire and the mean decrease in FIQ score was 38 points (95% CI 32-44, p=.004).

CONCLUSIONS

This retrospective analysis suggests considerable and rapid relief of the symptoms of fibromyalgia following the use of the three-phase SRTT treatment protocol, which appears to be maintained over several years. Although these results are not conclusive they are remarkable as no other therapy reported in the scientific literature seems as efficacious for fibromyalgia. A follow-up study using an RCT design is warranted.

Mood state effects of chocolate

BACKGROUND

Chocolate consumption has long been associated with enjoyment and pleasure. Popular claims confer on chocolate the properties of being a stimulant, relaxant, euphoriant, aphrodisiac, tonic and antidepressant. The last claim stimulated this review.

METHOD

We review chocolate's properties and the principal hypotheses addressing its claimed mood altering propensities. We distinguish between food craving and emotional eating, consider their psycho-physiological underpinnings, and examine the likely 'positioning' of any effect of chocolate to each concept.

RESULTS

Chocolate can provide its own hedonistic reward by satisfying cravings but, when consumed as a comfort eating or emotional eating strategy, is more likely to be associated with prolongation rather than cessation of a dysphoric mood.

LIMITATIONS

This review focuses primarily on clarifying the possibility that, for some people, chocolate consumption may act as an antidepressant self-medication strategy and the processes by which this may occur.

CONCLUSIONS

Any mood benefits of chocolate consumption are ephemeral.

Alexithymia and body image in adult outpatients with binge eating disorder

OBJECTIVE

The current study elucidates the relations between alexithymia and body image in patients with binge eating disorder (BED).

METHOD

One hundred one patients with BED were evaluated. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). The severity of BED was measured with the Binge Eating Scale (BES). Body concerns were assessed with the Body Shape Questionnaire-Short Version (BSQ-S), the Body Uneasiness Test (BUT), and the Body Attitude Test (BAT). Additional measures were the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI).

RESULTS

The prevalence of alexithymia in our sample was 39.6% (n = 40) and individuals with alexithymia showed higher scores on all rating scales. Higher body dissatisfaction, lower self-esteem, depressive symptoms, and the Difficulty in Identifying Feelings/Difficulty in Describing Feelings subscales of the TAS-20 were predictors of the severity of BED in the linear regression analysis.

CONCLUSION

Alexithymia was associated with more severe BED. Individuals with alexithymia and BED exhibited significantly poorer appearance evaluation and body satisfaction as well as higher depressive symptoms than individuals without alexithymia.

Treatment of eating disorders improves eating symptoms but not alexithymia and dissociation proneness

BACKGROUND

Eating disorders have been reported to increase in frequency, but it is yet unclear what psychological characteristics increase the proneness toward the development of eating disorders. Alexithymia (AL; a difficulty in awareness to one's emotions) and dissociation proneness are 2 such plausible features.

METHOD

In this study, we evaluated the efficacy of a combined intervention (group therapy, individual therapy, and pharmacologic therapy) in a group of soldiers with eating disorders (n = 30) in the Israel Defense Forces. Moreover, we examined whether AL and dissociation proneness were frequent in this group and whether clinical improvement was associated with an improvement in these factors as well.

RESULTS

High scores on the AL and dissociation measures were noted. The intervention was associated with a 50% decrease in the Eating Attitudes Test and Eating Disorders Inventory scores, consistent with our clinical impression of improvement in the eating symptoms. However, the decrease observed on the Dissociative Experiences Scale and Toronto Alexithymia Scale scores was minimal.

CONCLUSIONS

The combined intervention was efficient in our sample of patients with eating disorder despite the small sample size. The aforementioned specific psychometric change may be indicative of the lack of importance of changes in AL or dissociation proneness in the short-term improvement in patients with eating disorder.

Childhood emotional abuse and disordered eating among undergraduate females: mediating influence of alexithymia and distress

OBJECTIVE

Drawing from stress-vulnerability and trauma theory (e.g., Rorty & Yager, 1996), this paper presents a model of associations among child emotional abuse (CEA), alexithymia, general distress (GD), and disordered eating (DE). This study extended previous research on psychological outcomes of child physical and sexual abuse to explore those of CEA using measures of specific emotionally abusive acts.

METHOD

Five hundred and eighty-eight female university students completed self-report surveys consisting of measures of CEA, alexithymia, depression, anxiety, and DE. Structural equation modeling was used to test this conceptual model.

RESULTS

Comparison between measurement models suggested that bulimic behavior is a separate construct from restrictive eating behaviors and body dissatisfaction. In the structural model with the best fit, the association between CEA and DE was mediated by alexithymia and GD (i.e., a component of depression and anxiety). Specifically, CEA was associated with alexithymia, which was further related to GD. Then, restrictive eating behaviors and attitudes mediated the relation between GD and bulimic behaviors. By analyzing a second, nested model, this latter pathway was shown to be important.

CONCLUSION

While the best-fitting model is only one of many possibilities, these results point to a weak-but significant-complex relation between CEA and DE. They are associated through a series of mediating relations in a multivariate model including alexithymia and GD. The current study supports research suggesting that child emotional abuse can have a negative impact on its survivors. Treatment of those survivors manifesting disordered eating should be holistic, as opposed to targeted towards specific symptoms.

Alexithymia in female patients with eating disorders

Previous studies indicate that patients with eating disorders have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS). The aim of the present study was to investigate the role of negative affect (anxiety and depression) in the relationship between eating disorders and alexithymia. In addition, we have evaluated whether the relationship between negative affect and alexithymia varies according to the type of eating disorder (anorexia and bulimia). Eighteen female patients and 16 female patients who met the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnostic criteria for restrictive anorexia nervosa and bulimia nervosa, respectively, and 18 healthy female controls matched by age and education were submitted to Beck Depression Inventory and Spielberger State-Trait Anxiety Inventory to assess depression and anxiety and the Toronto Alexithymia Scale (TAS-20) and the Bermond Vorst Alexithymia Questionnaire (BVAQ) to evaluate alexithymic characteristics. The findings indicated that, although anorexic and bulimic patients showed higher alexithymia scores compared to controls, this result could be mainly related to negative affect. In fact, taking negative affect into account, anorexic and bulimic patients did not show higher TAS-20 and BVAQ scores compared to controls. The only variable useful to discriminate among anorexics, bulimics and controls is the perceived inability to experience emotional feelings, which is higher in anorexic patients compared to the other two groups.

Alexithymia in infertile women

OBJECTIVE

Alexithymia was compared in women with fertility disorders and fertile women who have never been confronted with fertility problems.

METHOD

Self-report instruments (TAS-20 and BVAQ) were used to measure alexithymia in a group of 73 infertile women and in a comparison group of 32 fertile women. Semi-structured interviews were used to assess medical history, current and lifetime diagnosis of psychiatric disorders.

RESULTS

Infertile women showed significantly higher rates of alexithymia than fertile women. The degree of alexithymia does not constitute a discriminating variable between unexplained infertile women and women with an organic aetiology of infertility. The prevalence of psychiatric diagnosis did not differ between the two groups of patients. Lifetime prevalence of depression, obsessive-compulsive disorders, post-traumatic stress disorder were statistically comparable.

CONCLUSION

This result raises the question of secondary alexithymia as a coping strategy in women with fertility troubles. Given the lack of published data on alexithymia in infertile women, there is a need to replicate our results and evaluate other aspects of affect regulation in infertile patients.

Étude des relations entre alexithymie et anhédonie chez des femmes présentant des troubles du comportement alimentaire et chez des témoins

INTRODUCTION

Alexithymia and anhedonia both refer to a deficit in emotion regulation. Although these 2 concepts have been conceptualized to be closely linked, very few studies aimed at examining carefully their interrelations.

OBJECTIVES

Therefore, the purpose of the present study was to investigate the relationships between scores on alexithymia and anhedonia self-reports, and to assess whether the results were influenced by the presence of an emotional disorder.

LITERATURE FINDINGS

The 20-item Toronto Alexithymia Scale is the self-report most frequently used to assess alexithymia. Nevertheless, the results of recent studies comparing the psychometric properties of the TAS-20 and another alexithymia self-report - the Bermond-Vorst Alexithymia Questionnaire (BVAQ) - have recommended the BVAQ over the TAS-20.

DESIGN

Thus, both questionnaires were included in the present study. In addition, since depression and anxiety may influence the correlations between alexithymia and anhedonia scores, we also measured depression and anxiety and these scores were used to control for their potential confounding effect in the analyses. Two groups of participants were included in this study: 46 eating disordered female patients (ED) and 198 female control subjects. All the participants filled up the Bermond-Vorst Alexithymia Questionnaire-form B (BVAQ-B), the 20-item Toronto Alexithymia Scale (TAS-20), the Chapman and Chapman Social Anhedonia Scale (SAS) and Physical Anhedonia Scale (PAS), the 13-item Beck Depression Inventory (BDI) and the Spielberger State and Trait Anxiety Inventory (STAI-Y). The analyses consisted, first, in establishing the matrix of correlations between these self-reports total scores, using Pearson's coefficients of correlation. Then, TAS-20, BVAQ-B, SAS and PAS scores were correlated, adjusting for BDI and STAI scores, using partial correlation analyses. Mean scores comparisons according to the group of participants, and to the presence/absence of alexithymia, as well as to the presence/absence of anhedonia were performed using ANCOVAs or Mann-Whitney tests.

RESULTS

As predicted, BDI and STAI scores were found significantly and positively correlated with alexithymia and anhedonia scores in both participant groups. After controlling for depression and anxiety scores, TAS-20 and PAS scores remained significantly correlated, but not TAS-20 and SAS scores. BVAQ-B scores remained significantly correlated with PAS and SAS scores in the control group, but only with the PAS scores in the ED group. ED patients had higher alexithymia and anhedonia scores than the controls. In total, among the alexithymic individuals, 8.9% were social anhedonics, and 31.1% had a physical anhedonia. Conversely, among the participants with a physical anhedonia, two third were alexithymics. The same proportion of participants with a social anhedonia was alexithymic (66.7%).

CONCLUSION

The results of the present study are informed about the relationships between alexithymia and anhedonia. They also stress the need to rely on several alexithymia measurements, and they further demonstrate the necessity to compare the associations between different affect regulation dimensions in normal and psychopathological disorders.

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Depressive personality dimensions and alexithymia in eating disorders

An association has been reported between high levels of alexithymia and depression in patients with eating disorders. This study has examined alexithymic features and depressive experiences in patients with DSM-IV eating disorder (restricting anorexia, n=105; purging anorexia, n=49; bulimia, n=98) and matched controls (n=279). The subjects were assessed with the Toronto Alexithymia Scale (TAS-20); the Beck Depression Inventory; and the Depressive Experiences Questionnaire, which defines two types of depressive personality style (dependent and self-critical). The patients had high levels of alexithymic features and depressive symptoms. Comparisons of alexithymic features between patients and controls after adjustment for depression showed a significant difference between bulimic patients and controls for the TAS Difficulty Identifying Feelings factor, and between restricting anorexic patients and controls for the TAS Difficulty Describing Feelings factor. With regard to depressive personality styles, only scores on the self-critical dimension were significantly higher in bulimic patients than in restricting anorexic patients and controls. In the entire group of eating disorders, dependency was associated with the TAS Difficulty Identifying Feelings factor only in anorexic patients. Self-criticism, on the other hand, was associated with the TAS Difficulty Identifying Feelings factor in all subtypes of eating disorders, although the relationship was significantly stronger in restricting anorexic than in bulimic patients. The results of this study suggest that people with restricting anorexia and bulimia show specific clinical profiles associating alexithymic features and depressive dimensions.

Emotional awareness deficits in inpatients of a psychosomatic ward: a comparison of two different measures of alexithymia

OBJECTIVE

The TAS 20 has demonstrated strong psychometric properties in a broad variety of studies in healthy populations. Much less work has been done in clinical contexts exploring the validity of the TAS 20 as a measure of the cognitive processing of emotions. The TAS 20, a self-report scale, tends to correlate with self-reported negative affect, but in a clinical context it is important to be able to differentiate between negative affect and the cognitive processing of emotion. We therefore used the TAS 20 and a performance measure, the Levels of Emotional Awareness Scale (LEAS), which in previous studies demonstrated no overlap with measures of negative affect, to explore the ability of the two measures to detect deficits in emotional awareness in a clinical sample.

METHODS

Data from inpatients of a psychosomatic ward were collected at onset (N = 394) and at the end of multimodal psychodynamic treatment (N = 249). The sample consisted of six diagnostic groups (depression; anxiety and compulsive-obsessive disorders, adjustment disorders, somatoform disorders, psychological factors related to somatic disorders, eating disorders). Changes in the TAS 20 and LEAS were compared at the two time points controlling for the effects of gender, age, educational level, and associations with self-reported negative affect.

RESULTS

In contrast to the LEAS, the TAS 20 correlated with negative affect at the onset and the end of treatment. The scores of the TAS 20 decreased with treatment in all diagnostic groups but the change in the TAS 20 was not statistically significant when negative affect was controlled. In contrast, LEAS scores increased with treatment in the groups with somatoform disorders and psychological factors related to somatic disorders, and this change was independent of negative affect.

CONCLUSION

The LEAS captured a change in emotional awareness due to treatment, whereas the TAS 20 captured a change in negative affect. The LEAS appears to be a more specific measure of change in emotional awareness in clinical contexts than the TAS 20.

Emotion-processing deficits in eating disorders

OBJECTIVE

First, we measured both emotional awareness and alexithymia to understand better emotion-processing deficits in eating disorder patients (EDs). Second, we increased the reliability of the measures by limiting the influence of confounding factors (negative affects).

METHOD

Seventy females with eating disorders were compared with 70 female controls. Participants completed the Beck Depression Inventory (BDI; depression), the Hospital and Anxiety Depression Scale (HADS; anxiety), the Toronto Alexithymia Scale (TAS; alexithymia), and the Level of Emotional Awareness Scale (LEAS).

RESULTS

EDs exhibited higher alexithymia scores and lower LEAS scores, with an inability to identify and describe their own emotions, as well as an impairment in mentalizing others' emotional experience. Whereas alexithymia scores were related to depression scores, LEAS scores were not. After controlling for depression, alexithymia scores were similar in EDs and controls.

DISCUSSION

The marked impairment in emotion processing found in EDs is independent of affective disorders. Thus, the joint use of TAS and LEAS suggests a global emotion-processing deficit in EDs.

Alexithymia in young adulthood: a risk factor for pathological gambling

BACKGROUND

Pathological gambling is more prevalent among postsecondary students than among the general adult population. While the prevalence of pathological gambling in this group has risen over the past decade, factors underlying the development of problem gambling among university students remain largely unexplored. One early study found alexithymia to be associated with pathological gambling. The aim of the present study was to further examine the relationship between alexithymia and gambling among postsecondary students.

METHODS

The relationship between alexithymia and pathological gambling was examined in 562 postsecondary students who completed the South Oaks Gambling Screen (SOGS) and the 20-item Toronto Alexithymia Scale (TAS-20).

RESULTS

Approximately 12% of the sample was classified as alexithymic according to the TAS-20. These individuals were found to have significantly more gambling problems, as measured by the SOGS, than nonalexithymic individuals. Approximately 9% of the sample was classified as pathological gamblers according to the SOGS. These individuals were found to have significantly higher levels of alexithymia, as measured by the TAS-20, than nonproblem gamblers.

CONCLUSIONS

Alexithymia is associated with pathological gambling and may be a risk factor among postsecondary students for developing severe gambling problems.

Validité du questionnaire d’alexithymie de Bermond et Vorst : étude chez des sujets présentant des troubles du comportement alimentaire et chez des témoins

Alexithymia core features are the difficulties in identifying and describing feelings; the difficulties in distinguishing feelings from the bodily sensations of emotional arousal; an impaired symbolization, as evidenced by a paucity of fantasies and other imaginative activity; and a tendency to focus on external events rather than inner experience. Several measures of alexithymia have been developed, including interviewer-rated questionnaires and self-report questionnaires. Among the self-report questionnaires, the 20-item Toronto Alexithymia scale (TAS-20) is the most commonly used, but it fails to measure all the core features of alexithymia. A recently developed instrument, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), allows the measurement of the alexithymia core features, as well as an additional one. It appeared to present good psychometric properties, notably the abbreviated BVAQ-form B. The results of recent studies comparing the psychometric properties of the TAS-20 and the BVAQ have recommended the BVAQ over the TAS-20. However, this questionnaire needed further validation.

OBJECTIVES

Thus, the aim of the present study was to determine the convergent, discriminant and concurrent validity of the Bermond-Vorst Alexithymia Questionnaire -- form B (BVAQ-B) in a clinical sample of 59 eating disorder patients, as well as in 191 controls. The TAS-20 constituted the gold standard for the assessment of the BVAQ-B' convergent validity. To compare the concurrent validity of the BVAQ-B and the TAS-20, participants also completed several self-reports investigating different dimensions of emotion regulation capacities: the 13-item Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI-form Y), as well as the Chapman and Chapman Physical and Social Anhedonia Scales (PAS and SAS). One way analyses of variance were used for mean scores comparisons. Convergent validity was determined using Pearson coefficients of correlation.

RESULTS

Results of the analyses suggested the BVAQ-B has a satisfying convergent and discriminant validity. This was observed in both the clinical and control samples. Moreover, the comparison of the convergent validity of the BVAQ-B and the TAS-20 revealed several differences between these two alexithymia self-report questionnaires. The BVAQ-B appeared less sensitive to the subjective emotional state of the participants than the TAS-20. Whereas it was argued the TAS-20 overlaps with other emotional state scores, the BVAQ-B would allow to measure alexithymia more specifically. In addition, the present results allowed to further determine the relations between alexithymia and other dimensions of emotion regulation capacities. The analyses confirmed that alexithymia is linked to other emotion regulation dimensions such as depression and anxiety. Moreover, alexithymia was associated with physical and social anhedonia, two dimensions that received less interest in the alexithymia literature to date. This study also showed that control and clinical sample have different emotion regulation capacities. Eating disorder patients were not only more alexithymic and more depressed, but also more anxious and more anhedonic than the controls. Finally, this study revealed that alexithymia differs whether the alexithymic individuals are patients or controls. Healthy alexithymic individuals (ie, individuals categorized as alexithymic in the control group) seemed characterised by a selective deficit of emotional cognition, with sparing of emotional experience (Bermond's type II alexithymia). Alexithymics individuals of the eating -disorder group seemed particularly unabled to experience affect. This pattern could correspond to Bermond's type I alexithymia, which is characterised by the absence of emotional experience and, consequently, by the absence of the cognition accompanying the emotion. In summary, results of the present study add to the literature debating on whether alexithymia is similar in different types of population.

Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity

OBJECTIVE

To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA.

SAMPLING AND METHODS

Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded.

RESULTS

In all patients, the levels of IA were higher than the 'normal' ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence.

CONCLUSIONS

The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety.

Alexithymia in parents of daughters with eating disorders: its relationships with psychopathological and personality variables

OBJECTIVES

The purpose of this research was to investigate alexithymia among parents of a daughter with eating disorders (EDs) and to relate alexithymia to personality and psychopathology characteristics.

METHODS

Parents of 73 women with ED (20 with anorexia nervosa, restrictive subtype (ANR), 23 with anorexia nervosa, bulimic subtype (ANB) and 30 with bulimia nervosa (BN)) and parents of 72 normal women were evaluated with the Toronto Alexithymia Scale (TAS-20), the Eysenck Personality Questionnaire, the Beck Depression Inventory and the Self-Rating Anxiety Scale.

RESULTS

The parents of daughters with ED show higher scores in the TAS-20 and its factors than the controls. TAS-20 scores of parents are associated with neuroticism, anxiety and depression.

CONCLUSIONS

Alexithymia in parents of daughters with an ED could be a trait of personality, but it could also be a state due to distress. Alexithymia should be taken into account in order to help these parents express emotions.

Emotional eating, alexithymia, and binge-eating disorder in obese women

OBJECTIVE

To investigate the relationships between alexithymia and emotional eating in obese women with or without Binge Eating Disorder (BED).

RESEARCH METHODS AND PROCEDURES

One hundred sixty-nine obese women completed self-report questionnaires, including the Beck Depression Inventory, the State Trait Anxiety Inventory, the Stress Perceived Scale, the Dutch Eating Behaviour Questionnaire, and the Toronto Alexithymia Scale. The presence of BED, screened using the Questionnaire of Eating and Weight Patterns, was confirmed by interview.

RESULTS

Forty obese women were identified as having BED. BED subjects and non-BED subjects were comparable in age, body mass index, educational level, and socioeconomic class. According to the Dutch Eating Behaviour Questionnaire, BED subjects exhibited higher depression, anxiety, perceived stress, alexithymia scores, and emotional and external eating scores than non-BED subjects. Emotional eating and perceived stress emerged as significant predictors of BED. The relationships between alexithymia and emotional eating in obese subjects differed between the two groups according to the presence of BED. Alexithymia was the predictor of emotional eating in BED subjects, whereas perceived stress and depression were the predictors in non-BED subjects.

DISCUSSION

This study pointed out different relationships among mood, alexithymia, and emotional eating in obese subjects with or without BED. Alexithymia was linked to emotional eating in BED. These data suggest the involvement of alexithymia in eating disorders among obese women.