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Isoardo G, Adenzato M, Ciullo S, Fontana E, Stura I, Migliaretti G, Titolo P, Matteoni E, Calvo A, Laino F, Palumbo F, Ardito RB. Emotion Processing in Peripheral Neuropathic Pain: An Observational Study. Med Sci (Basel) 2024; 12:27. [PMID: 38804383 PMCID: PMC11130802 DOI: 10.3390/medsci12020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In clinical practice, the implementation of tailored treatment is crucial for assessing the patient's emotional processing profile. Here, we investigate all three levels of analysis characterizing emotion processing, i.e., recognition, representation, and regulation, in patients with peripheral neuropathic pain (PNP). METHODS Sixty-two patients and forty-eight healthy controls underwent quantitative sensory testing, i.e., psychophysical tests to assess somatosensory functions such as perception of cold (CDT), heat-induced pain (HPT), and vibration (VDT), as well as three standardized tasks to assess emotional processing: (1) the Ekman 60-Faces Test (EK-60F) to assess recognition of basic facial emotions, (2) the Reading the Mind in the Eyes Test (RME) to assess the ability to represent the feelings of another person by observing their eyes, and (3) the 20-item Toronto Alexithymia Scale (TAS-20) to assess emotional dysregulation, i.e., alexithymia. RESULTS General Linear Model analysis revealed a significant relationship between left index finger VDT z-scores in PNP patients with alexithymia. The RME correlated with VDT z-scores of the left little finger and overall score for the EK-60F. CONCLUSIONS In patients with PNP, emotion processing is impaired, which emphasizes the importance of assessing these abilities appropriately in these patients. In this way, clinicians can tailor treatment to the needs of individual patients.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Stefano Ciullo
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Elena Fontana
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
| | - Ilaria Stura
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Giuseppe Migliaretti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Torino, Italy;
| | - Paolo Titolo
- UOD Reconstructive Microsurgery, Department of Orthopedics & Traumatology, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Enrico Matteoni
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Andrea Calvo
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
- 1st Neurology Unit, Department of Neurosciences & Mental Health, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
| | - Federica Laino
- Unit of Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Hospital “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy;
| | - Francesca Palumbo
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (I.S.); (E.M.); (A.C.); (F.P.)
| | - Rita B. Ardito
- Department of Psychology, University of Turin, 10124 Turin, Italy; (M.A.); (S.C.); (E.F.)
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Habibi Asgarabad M, Salehi Yegaei P, Jafari F, Azami-Aghdash S, Lumley MA. The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis. Eur J Pain 2023; 27:321-337. [PMID: 36471652 DOI: 10.1002/ejp.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM. DATABASES AND DATA TREATMENT Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses. RESULTS The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM. CONCLUSIONS Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended.
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Affiliation(s)
- Mojtaba Habibi Asgarabad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute), Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Salehi Yegaei
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
| | - Fatemeh Jafari
- Department of Psychology, Faculty of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Michigan, Detroit, USA
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Vicario CM, Scavone V, Lucifora C, Falzone A, Pioggia G, Gangemi S, Craparo G, Martino G. Evidence of abnormal scalar timing property in alexithymia. PLoS One 2023; 18:e0278881. [PMID: 36689490 PMCID: PMC9870170 DOI: 10.1371/journal.pone.0278881] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/26/2022] [Indexed: 01/24/2023] Open
Abstract
Evidence suggests that incidental modulation of affective states affects the ability to keep track of time. Alexithymia represents an ideal condition to further address the emotion-time processing link, as it refers to a trait characterized by a deficit of affective processing. 31 healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and a time reproduction task of visual stimuli related to positive (i.e., happiness) and negative (i.e., anger) facial expressions. Results documented a positive correlation between TAS-20 score and the variability in reproducing sub-second durations of the anger expression stimuli We also found an overestimation of sub-second durations of non-affective expressions in borderline/alexithymic participants. Finally, in line with the literature, we confirmed the overall tendency to overestimate the duration of anger expression stimuli. These findings, which can be interpreted in terms of abnormal scalar timing property in alexithymia, expand previous investigations linking this personality trait with abnormal processing of negative emotions. The evidence that alexithymia predicts the reproduction variability of sub-second durations of negative affective stimuli corroborates previous neuroimaging studies documenting cerebellar deficits in these individuals.
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Affiliation(s)
- Carmelo Mario Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Vito Scavone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | | | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Sebastiano Gangemi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna, Cittadella Universitaria, Enna, Italy
| | - Gabriella Martino
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
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Coping and Beliefs as Predictors of Functioning and Psychological Adjustment in Fibromyalgia Subgroups. Pain Res Manag 2022; 2022:1066192. [PMID: 35463626 PMCID: PMC9023200 DOI: 10.1155/2022/1066192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
Abstract
Objectives Research has pointed to two profiles of persons with fibromyalgia according to differences in functionality, thus distinguishing between functional and dysfunctional patients. The role of psychological factors underlying such clusters is unclear. This study aims to explore the contribution of pain beliefs and coping on fibromyalgia clustering. Methods A cluster analysis was performed to classify 238 women with fibromyalgia using the Fibromyalgia Impact Questionnaire and the Beck Depression Inventory as clustering variables. Cluster differences in physical functioning, depression, pain beliefs, coping, and age were then calculated (Student's t-test). Finally, a binary logistic regression was conducted to study the unique contribution of age, beliefs, and coping on cluster classification. Results Two clusters were revealed. Cluster 1 had a poor adaptation to fibromyalgia regarding physical functioning and depression. They generally embraced less adaptive beliefs (i.e., disability, harm, emotion, and requests) and coping strategies (i.e., guarding, resting, and asking for assistance). Cluster 2 showed a better adaptation to fibromyalgia and adopted more favorable beliefs (i.e., control) and coping strategies (i.e., exercise and task persistence). Cluster differences in age were significant but small. The backward binary logistic regression suggested a final model with six predictors (guarding, task persistence, harm, emotion, solicitude, and age) that explained 31% of the variance of group membership. Discussion. These results suggest that only a subset of psychological variables uniquely and independently contribute to functional/dysfunctional group membership. The results support the need to address psychological components in the management of fibromyalgia and point to a subset of preferred target beliefs and coping strategies.
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The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps. J Clin Med 2022; 11:jcm11030844. [PMID: 35160295 PMCID: PMC8836473 DOI: 10.3390/jcm11030844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/19/2022] Open
Abstract
Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.
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Abstract
Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.
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Di Tella M, Perutelli V, Miele G, Lavorgna L, Bonavita S, De Mercanti SF, Streito LM, Clerico M, Castelli L. Family Functioning and Multiple Sclerosis: Study Protocol of a Multicentric Italian Project. Front Psychol 2021; 12:668010. [PMID: 34177727 PMCID: PMC8219871 DOI: 10.3389/fpsyg.2021.668010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple Sclerosis (MS) is a chronic inflammatory and neurodegenerative disease, which not only affects physical functioning, but is also associated with cognitive impairments and great psychological distress. The combination of those symptoms may have negative consequences on the family functioning of patients with MS, with detrimental effects on both marital relationships and parental bonding. Furthermore, the presence of individual characteristics and of an adequate social support may also contribute to the quality and endurance of family relationships. Particularly, high levels of alexithymia, a personality trait that affects the recognition of a person's own emotions, have been associated with reduced interpersonal communication skills and enhanced anxiety/depressive symptoms. Therefore, the main aim of the present study is to provide an in-depth evaluation of family functioning and related factors in patients with MS and their families. In order to reach this goal, the perceived quality of family functioning, dyadic relationships, and parental bonding will be first investigated. Secondly, the possible associations between the quality of family relationships and the presence of alexithymia, psychological distress, and perceived social support will be examined. Patients with MS and their families who will consent to take part in the study will be asked to provide sociodemographic and clinical information, and to complete a series of questionnaires, presented and uploaded on an online dedicated platform. The final sample will be made up of 300 families, consecutively recruited from the Italian medical centers involved in the project. The results of the present study will shed light on the family functioning of patients with MS, through a comprehensive assessment of the main factors that are associated with family dynamics. A holistic evaluation of those aspects can help clinicians and researchers understand family dynamics in MS population better.
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Affiliation(s)
| | - Virginia Perutelli
- Department of Clinical and Biological Sciences, School of Medicine, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Federica De Mercanti
- Department of Clinical and Biological Sciences, School of Medicine, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Lidia Mislin Streito
- Department of Clinical and Biological Sciences, School of Medicine, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, School of Medicine, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Fresán A, González-Castro TB, Pool-García S, Tovilla-Zárate CA, Castellanos-Narvaéz E, Cruz JPSDL, Juárez-Rojop IE, López-Narváez ML, Lopez AM. Evaluation of alexithymia in individuals with chronic pain in a Mexican population: Alexithymia in a Mexican population. Int J Psychiatry Med 2021; 56:177-188. [PMID: 33327844 DOI: 10.1177/0091217420982086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Alexithymia is the difficulty in identifying and describing feelings. Several studies have suggested that chronic pain can be linked to alexithymia. The aims of this study were to determine the presence of alexithymia in a sample of Mexican individuals who attended public health services, to assess if alexithymia is higher in medically ill individuals with pain than in those without pain, and to determine which alexithymia dimensions are more affected by the presence of pain. METHODS Demographic and clinical features were evaluated in 250 Mexican outpatients of the General Hospital of Comalcalco, Tabasco. Pain was evaluated using the Visual Analogue Scale for Pain Assessment (VAS-P) and alexithymia was evaluated using the Toronto Alexithymia Scale (TAS-20). RESULTS 38.8% of the sample was identified with probable/definite alexithymia and up to 61.2% of individuals were currently experiencing pain. Individuals with pain exhibited higher scores in the TAS-20 dimensions: difficulty describing feelings (p = 0.02), difficulty identifying feelings (p < 0.001) and higher total TAS-20 score (p < 0.001). Also, Probable/definite alexithymia was more frequently reported in individuals with pain (49% vs. 21.6%, p < 0.001). CONCLUSIONS Our results show that a large proportion of individuals who attend public health services in a Mexican population present pain. We also identified that pain could be associated with alexithymia, in particular with a difficulty in describing and identifying feelings. An early identification and treatment of alexithymia could help in reducing the clinical burden of chronic pain in Mexican outpatients.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México
| | - Sherezada Pool-García
- Hospital General de Comalcalco "Dr. Desiderio G Rosado Carbajal", Secretaría de Salud, Comalcalco, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Eduardo Castellanos-Narvaéz
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Juan Pablo Sánchez de la Cruz
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. José Manuel Velasco Silez", Secretaría de Salud, Yajalón, Chiapas, México
| | - Alejandro Molina Lopez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
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Isoardo G, Ciullo S, Titolo P, Fontana E, Battiston B, Stella M, Luxardo N, Laino F, Migliaretti G, Stura I, Ardito RB, Adenzato M. The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy. J Neural Transm (Vienna) 2021; 128:61-71. [PMID: 33315145 PMCID: PMC7815565 DOI: 10.1007/s00702-020-02282-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences and Mental Health, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Stefano Ciullo
- Department of Psychology, University of Turin, Turin, Italy
| | - Paolo Titolo
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Elena Fontana
- Department of Psychology, University of Turin, Turin, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maurizio Stella
- Department of Plastic Surgery Burn Center, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Nicola Luxardo
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Federica Laino
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Rita B Ardito
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy
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Di Tella M, Adenzato M, Catmur C, Miti F, Castelli L, Ardito RB. The role of alexithymia in social cognition: Evidence from a non-clinical population. J Affect Disord 2020; 273:482-492. [PMID: 32560944 DOI: 10.1016/j.jad.2020.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment. METHODS We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills. RESULTS Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states. LIMITATIONS The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships. CONCLUSIONS These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.
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Affiliation(s)
- Marialaura Di Tella
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy
| | - Mauro Adenzato
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy.
| | | | - Francesca Miti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy
| | - Rita B Ardito
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia. PLoS One 2020; 15:e0231674. [PMID: 32287311 PMCID: PMC7156042 DOI: 10.1371/journal.pone.0231674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Fibromyalgia (FM) is a chronic pain syndrome, and alexithymia, which is a condition that is characterised by deficits in emotional self-awareness, is highly prevalent among individuals with FM. Insecure attachment styles and inadequate parental care appear to play an important role in the onset and maintenance of both alexithymia and chronic pain. Therefore, the present study aimed to examine the associations between attachment styles, parental bonding, and alexithymia among patients with FM and healthy controls (HC). Methods All participants completed a battery of tests that assessed alexithymia, attachment styles, and parental bonding. Two logistic regression models were tested to examine whether these variables predict (a) group membership (i.e. patients with FM vs. HC) and (b) the likelihood of having alexithymia (i.e. among patients with FM and HC). Results Alexithymia (i.e. difficulty identifying and describing feelings subscales of the 20-item Toronto Alexithymia Scale) significantly predicted group membership (i.e. the likelihood of having FM). On the other hand, educational level and dismissive attachment (i.e. the discomfort with closeness and relationships as secondary subscales of the Attachment Style Questionnaire) were the only significant predictors of the likelihood of having alexithymia. Conclusions These findings highlight both the relevance of alexithymic traits to the definition of FM and centrality of an insecure attachment style to the manifestation of alexithymia.
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Orrù G, Gemignani A, Ciacchini R, Bazzichi L, Conversano C. Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia. Front Med (Lausanne) 2020; 6:319. [PMID: 31998737 PMCID: PMC6970411 DOI: 10.3389/fmed.2019.00319] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
Here, we report an investigation on the accuracy of the Toronto Alexithymia Scale, a measure to assess alexithymia, a multidimensional construct often associate to fibromyalgia. Two groups of participants, patients with fibromyalgia (n = 38), healthy controls (n = 38) were administered the Toronto Alexithymia Scale and background tests. Machine learning models achieved an overall accuracy higher than 80% in detecting both patients with fibromyalgia and healthy controls. The parameter which alone has demonstrated maximum efficiency in classifying the single subject within the two groups has been the item 3 of the alexithymia scale. The analysis of the most informative features, based on all scales administered, revealed that item 3 and 13 of the alexithymia questionnaire and the visual analog scale scores were the most informative attributes in correctly classifying participants (accuracy above 85%). An additional analyses using only the alexithymia scale subset of items and the visual analog scale scores has shown that the predictors which efficiently classified patients with fibromyalgia and controls were the item 3 and 7 (accuracy = 85.53%). Our findings suggest that machine learning models analysis based on the Toronto Alexithymia Scale subset of items scores accurately distinguish patients with fibromyalgia from healthy controls.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Laura Bazzichi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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Vucurovic K, Dupont-Gaudin C, Raucher-Chéné D, Kaladjian A, Cuervo-Lombard CV. Fibromyalgia patients make scarce reference to pain in self-defining memories. Compr Psychiatry 2019; 90:30-36. [PMID: 30684830 DOI: 10.1016/j.comppsych.2018.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Self-defining memories (SDMs) are vivid, emotionally intense and well-rehearsed autobiographical memories that provide fundamental information about one's cognitive affective motivational representation of self. Exploring SDMs in fibromyalgia (FM) is of interest for understanding the psychopathology of this disorder and improving clinical interventions. Our aim was to compare patients and healthy controls (HC) on SDM characteristics. METHOD We included 25 patients with FM and 24 HC matched for age, sex and education level. Each participant described five SDMs, which were coded for content, specificity, integration, tension, redemption, contamination, affective response, date, and reference to pain. We statistically controlled our results for the most plausible confounding factors related to FM that could affect SDM recall, namely depression, anxiety, cognitive inhibition, pain severity and medication. RESULTS Compared with HC, patients retrieved less specific SDMs with a more negative emotional valence but less tension. They reported more relationship-related memories, and fewer redemptive ones, with less meaning-making. The number of memories referring to physical or psychological pain did not differ between groups. None of the confounding factors we analysed could explain (either alone or in combination) the statistical differences between groups for SDMs characteristics. CONCLUSION We discuss functional avoidance and alexithymia as two main factors for poor reference to pain in patients' SDMs that further reveal affective dysregulation in FM. In clinical practice, remediating the way in which pain is integrated into SDMs in FM may help to mitigate its negative impact on everyday life.
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Affiliation(s)
- Ksenija Vucurovic
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France.
| | | | - Delphine Raucher-Chéné
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France
| | - Arthur Kaladjian
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France
| | - Christine-Vanessa Cuervo-Lombard
- Department of Psychiatry, University Hospital, Reims, France; Centre for Studies and Research on Health Psychology and Psychopathology (CERPPS), Department of Psychology, Toulouse 2 Jean Jaurès University, Toulouse, France
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Conversano C, Marchi L, Rebecca C, Carmassi C, Contena B, Bazzichi LM, Gemignani A. Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review. Clin Pract Epidemiol Ment Health 2018; 14:223-232. [PMID: 30294356 PMCID: PMC6166394 DOI: 10.2174/1745017901814010223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/10/2018] [Accepted: 07/28/2018] [Indexed: 01/25/2023]
Abstract
Introduction: Fibromyalgia (FM) is the second most common rheumatic disease with many effects on patient's quality of life. It has been described as a chronic condition characterized by widespread musculo-skeletal pain, sleep disorders and prominent fatigue. Regarding the role of personality factors in fibromyalgia, researchers have focused both on personality traits and psychopathological aspects showing inconsistent results. In particular, several studies have examined the role of alexithymia in FM patients, a trait of personality characterized by difficulty in identification, recognition and description of emotions and feelings, while others have focused on a specific type of personality, such as type D personality (distressed personality). Other studies investigated personality in FM patients referring to Cloninger’s model, a psychobiological model of personality that includes both temperamental and character dimensions of personality. Analyzing scientific literature on this subject seems well suited to provide a critical review of the latest studies and their results. Methods: The method used for this review satisfies the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). We identified PsycInfo and PubMed as databases for our research. Results: Personality is studied under many aspects and a reference model is not always present. Many studies underline high levels of alexithymia and type D personality in FM patients but when depression is controlled, these results do not differ from those of healthy controls. Conclusion: Studies that use a comprehensive model of personality present a different theoretical approach and use alternatively the Big-Five model, Eysenck’s and Cloninger’s models. The use of a comprehensive model of personality and the control of psychopathological disorders, such as anxiety and depression, seem to be very relevant for a better understanding of a specific personality profile associated with fibromyalgia.
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Affiliation(s)
- Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Marchi
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ciacchini Rebecca
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | | | - Laura Maria Bazzichi
- Department of Clinical and Experimental Medicine, Rheumatologic Clinic, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Han D, Li M, Mei M, Sun X. The functional and structural characteristics of the emotion network in alexithymia. Neuropsychiatr Dis Treat 2018; 14:991-998. [PMID: 29695908 PMCID: PMC5905825 DOI: 10.2147/ndt.s154601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Dai Han
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Mei Li
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Minjun Mei
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xiaofei Sun
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Fang Y, Li M, Mei M, Sun X, Han D. Characteristics of brain functional and structural connectivity in alexithymic students. Neuropsychiatr Dis Treat 2018; 14:2609-2615. [PMID: 30349259 PMCID: PMC6186308 DOI: 10.2147/ndt.s174015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Yantong Fang
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China,
| | - Mei Li
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Minjun Mei
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaofei Sun
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Dai Han
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China, .,Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China, .,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, People's Republic of China,
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