The status of alexithymia as a risk factor in medically unexplained physical symptoms

What is the relationship between alexithymia and experiential avoidance? A latent analysis using three alexithymia questionnaires

Alexithymia is a clinically relevant personality trait characterized by poor emotional awareness and associated with several psychological and physical health concerns. Individuals with high alexithymia tend to engage in experiential avoidance and this may mediate psychological distress. However, little is known about what specific processes of experiential avoidance are involved, and the nature of the relation between alexithymia, experiential avoidance, and psychological distress remains unclear at a latent construct level. To examine this relationship at the latent construct level, a representative sample of 693 U.S. adults completed alexithymia (TAS-20, BVAQ, PAQ), general distress (DASS-21), multi-dimensional experiential avoidance (MEAQ), and general health (PROMIS-G-10) questionnaires. Structural equation modeling revealed that alexithymia significantly predicted experiential avoidance (β = 0.966, t = 82.383, p < .01), experiential avoidance significantly predicted general distress (β = 0.810, t = 2.017, p < .05), and experiential avoidance fully mediated the relationship between alexithymia and general distress (βindirect = -0.159, t = -0.398, p > .05). Correlations between alexithymia and experiential avoidance subfactors revealed a strong relationship to the repression and denial subfactor. Experiential avoidance is a promising target for clinical interventions, though longitudinal research is necessary to elucidate how the relationship between alexithymia and experiential avoidance unfolds over time.

M.U.P.S (Medically Unexplained Physical Symptoms): Is the Accurate Diagnosis Necessary for the Rehab-Team?

Background: Physiatrists often treat patients with medically unexplained symptoms (MUPS), which suggest various psychiatric, psychosomatic or physical diagnoses. Some patients are finally diagnosed with somatoform, dissociative or factitious disorders, while some experience psychological factors affecting physical conditions. It happens that patients are admitted to rehabilitative medical facilities without a clear diagnosis. Apparently, there are overlapping symptoms between chronic fatigue syndrome, PTSD (post-traumatic stress disorder), "Gulf War syndrome", fibromyalgia, CRPS, and others.Aims: To assess recognition of medically unexplained physical symptoms (MUPS) by physicians, mostly specialists in physical and rehabilitative medicine are engaged.Methods: All information was collected from scientific database site, and derived from the authors' nearly 50 years of clinical experience.Results: Cognitive-affective disturbance, chronic muscle and joint pain, panic disorder, chronic fatigue syndrome, malingering, and others can be described in the medical literature as unexplained physical symptoms.Conclusions: Treatment should comprise a multidisciplinary-integrative approach, by practitioners from medicine, psychology, allied health professionals and social work. MUPS is not a "non-disease" entity, but rather, an unexplained clinical phenomenon. Patients are entitled to benefit from the rehabilitative medicine model of treatment even if their clinical diagnosis is not accurate or clear.

Prevalence of Alexithymia in Patients with Medically Unexplained Physical Symptoms: A Cross-sectional Study in Egypt

BACKGROUND

There is a high incidence of alexithymia in people who report medically unexplained symptoms. There have been limited studies on the prevalence of alexithymia in patients with medically unexplained physical symptoms (MUPS) in various ethnic and cultural backgrounds.

OBJECTIVE

This study aimed to estimate the prevalence of alexithymia in patients with MUPS and examine their socio-demographic data.

METHODS

In this cross-sectional study, 196 patients with MUPS were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. Patients completed a structured interview; socio-demographic and medical history data were collected. Somatic symptom severity was assessed using the Arabic version of the Patient Health Questionnaire (PHQ-15). Alexithymia was assessed using the Arabic version of the Toronto Alexithymia Scale.

RESULTS

General fatigue was the most common complaint observed, followed by headache and dyspepsia. In addition, 73.5% of patients had a high Patient Health Questionnaire score, 17.9% had somatic symptoms of medium severity, while 8% and 0.5% had low and marginal somatic symptoms, respectively. Alexithymia was presented in 49.5%, 22.9% had no alexithymia, and 27.6% had borderline/intermediate alexithymia.A weak positive correlation (r<0.4) was found between somatic symptom severity and alexithymic psychopathology (r=0.277;p<0.05). Only the 'difficulty identifying feelings' dimension of alexithymic psychopathology was positively correlated with the severity of somatic symptoms (r=0.271;p<0.05).

CONCLUSION

Alexithymia is associated with the development of MUPS.

How to improve healthcare for autistic people: A qualitative study of the views of autistic people and clinicians

LAY ABSTRACT

Research has shown that on average, autistic people are more likely to die earlier than non-autistic people, and barriers can stop autistic people accessing healthcare. We carried out a study where we interviewed healthcare professionals (including doctors and nurses), and held discussion groups of autistic people. Our results highlighted several key points: seeing the same professional is important for autistic people and clinicians; both clinicians and autistic people think making adjustments to healthcare is important (and often possible); autistic people process information in a different way and so may need extra support in appointments; and that clinicians are often constrained by time pressures or targets.

The role of attachment in medically unexplained symptoms and long-term illness

In this article, we explore the role of attachment in the development of medically unexplained symptoms (MUS) and response to physical illness. We review the evidence that attachment insecurity is common in people with different forms of MUS and certain long-term physical conditions. We discuss a possible developmental model for understanding how MUS develop. We conclude with discussion of potential therapies and implications for services.

Alexithymia Has No Clinically Relevant Association With Outcome of Multimodal Treatment Tailored to Needs of Patients Suffering From Somatic Symptom and Related Disorders. A Clinical Prospective Study

Introduction: Alexithymia may moderate the effectiveness of treatment and may predict impaired general functioning of patients suffering from somatic symptom and related disorders (SSRD). Aim: We compared alexithymia levels in a clinical prospective study with 234 consecutive patients suffering from SSRD from the Centre of Excellence for Body, Mind, and Health, Tilburg using the Bermond-Vorst Alexithymia Questionnaire, with general population norm scores. Second, we explored treatment outcomes of a multimodal treatment tailored to patient needs by Shared Decision Making (SDM) and Patient Related Outcome Monitoring (PROM) in patients with SSRD. Third, we explored whether alexithymia is associated with treatment outcome. Fourth, we explored if the presence of a chronic medical condition (e.g., diabetes mellitus, cardiovascular diseases) affects the association of alexithymia with treatment outcomes. Results: Compared to norm scores, SSRD patients showed elevated scores on the subscales identifying, verbalizing, and fantasizing, and on the cognitive dimension. All patients benefited from treatment in terms of anxiety, depression, and physical symptoms. The association of alexithymia with treatment outcome was significant, but the effect size was negligible (range odds ratios 1.02-1.25). The association between alexithymia and treatment outcome was stronger in patients suffering from chronic medical conditions compared to patients without chronic medical conditions. However, the effect size of this association was negligible (range odds ratio 0.94-1.12). Discussion: Alexithymia scores are elevated in patients with SSRD compared to general population scores, but the level of alexithymia has no clinically relevant association with treatment outcome both in SSRD patients with and without comorbid chronic medical conditions.

Alexithymia and anesthetic bladder capacity in interstitial cystitis/bladder pain syndrome

OBJECTIVE

In contrast to the inconsistent results of organic causes, it has been found that psychological risk factors are reliably related to functional somatic syndromes (FSSs), including interstitial cystitis/bladder pain syndrome (IC/BPS). Compared to patients with acute cystitis, a subgroup of IC/BPS patients with a history of childhood relational trauma reported intensified unregulated affective states (i.e., anxiety and depression) and trauma-related psychopathology (i.e., dissociation). Nevertheless, it remains unknown whether psychosocial risk factors can be separated from bladder-centric factors. This study aimed to verify whether psychosocial factors such as alexithymia, which is a key psychological factor of FSSs, are less likely to be linked to a low bladder capacity in patients with IC/BPS.

METHODS

Ninety-four female IC/BPS patients were recruited from the outpatient departments of urology, obstetrics, and gynecology. Anxiety, depression, dissociation, childhood relational trauma, and alexithymia were assessed using standardized scales, and anesthetic bladder capacity was examined by cystoscopic hydrodistention.

RESULTS

Positive correlations were found between anesthetic bladder capacity and the psychosocial variables, including alexithymia. An increased bladder capacity was associated with anxiety, dissociation, and childhood relational trauma, and a combination of high cognitive and low affective alexithymia mediated the correlations between bladder capacity and the psychosocial variables.

CONCLUSIONS

Psychosocial variables that are associated with an aversive childhood relational environment and affect dysregulation may constitute a pathogenic trajectory that differs from bladder-centric defects such as a lower bladder capacity. The findings of this study support the notion that IC/BPS in some patients may be due to an FSS.

Links among emotional awareness, somatic awareness and autonomic homeostatic processing

Emotional awareness and somatic interoceptive awareness are essential processes for human psychosomatic health. A typical trait of lacking emotional awareness related to psychosomatic symptoms is alexithymia. In contrast, alexisomia refers to the trait of lacking somatic awareness. Links between emotional and somatic awareness and homeostatic processing are also significant for the psychosomatic health. The purpose of the present paper is to review the links among emotional awareness, somatic interoceptive awareness and autonomic homeostatic processing. On the basis of the collected evidence, the following arguments were presented¹: (1) The main subcortical neural substrates for these processes are limbic-related systems, which are also responsible for autonomic functions for optimization of homeostatic efficiency. (2) Considerable studies have shown that autonomic activity and/or reactivity to stress correlate with both emotional and interoceptive awareness. A hypothesis was advocated about the links between the two types of awareness and autonomic function: Autonomic dysfunction, especially high sympathetic tone at baseline and/or attenuated reactivity or variability to stress, appears to be involved in disturbance of emotional and interoceptive awareness. (3) Several studies suggest that a link or a cooperative relationship exists between emotional and somatic awareness, and that somatic awareness is the more fundamental of the two types of awareness. Emotional awareness, somatic awareness and autonomic homeostatic processing generally occur in parallel or concurrently. However, some complex features of pathologies include coexistence of reduced interoceptive awareness and somatosensory amplification. The autonomic homeostatic process is fundamentally involved in emotional and somatic awareness. Investigation of these types of awareness with both neuroimaging evaluations and estimation of peripheral autonomic function are required as next steps for exploration of the relationship between awareness and human somatic states including somatic symptoms as well as general psychosomatic health.

Insecure attachment strategies are associated with cognitive alexithymia in patients with severe somatoform disorder

OBJECTIVE

In light of interpersonal difficulties and their relation to alexithymia in patients with somatoform disorder, the primary aim of this study was to explore the association between two insecure attachment strategies (deactivation and hyperactivation strategies), and affective and cognitive alexithymia in a sample of 128 patients with severe somatoform disorder, over and above the levels of negative affectivity and personality pathology.

METHOD

In a cross-sectional study among patients with somatoform disorder, self-report data were obtained using measures for alexithymia (Bermond-Vorst Alexithymia Questionnaire), attachment (Experiences in Close Relationships Questionnaire), personality pathology (Inventory of Personality Organization), and negative affectivity (Dutch Short Form of the MMPI). We used hierarchical regression analyses to test main effects of attachment deactivation and hyperactivation strategies in the prediction of both cognitive and affective alexithymia, while controlling for the levels of negative affectivity and personality pathology.

RESULTS

Only cognitive alexithymia, i.e., the inability to analyze, identify, and verbalize emotions, was associated with personality dysfunction, in particular insecure attachment strategies. Affective alexithymia, i.e., the inability to fantasize and to experience emotions, was associated (negatively) with negative affectivity but not with the personality variables.

CONCLUSIONS

This study, therefore, indicates that both types of alexithymia are relevant for the assessment and treatment of severe somatoform disorder, yet each type may tap into different features of somatoform disorder.

A Comparative Study on Alexithymia in Depressive, Somatoform, Anxiety, and Psychotic Disorders among Koreans

OBJECTIVE

Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388).

METHODS

Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68).

RESULTS

We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables.

CONCLUSION

These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.

Influence of alexithymia on health-related quality of life in inflammatory bowel disease: are there any related factors?

OBJECTIVE

Alexithymia is a personality trait characterized by difficulty to perceive and express emotions. Previous studies have indicated a high prevalence of alexithymia in patients with inflammatory bowel disease (IBD) but results have been inconsistent. The aim of the present study was to investigate the prevalence of alexithymia in a large IBD cohort and to establish the impact of alexithymia on health-related quality of life (HRQOL) in these patients.

MATERIAL AND METHODS

A cross-sectional prospective study was undertaken including 534 consecutive IBD patients. Independent variables were measured using one socio-demographic and clinical questionnaire, the hospital anxiety and depression scale (HADS) and the Toronto alexithymia scale (TAS-26). Dependent variables were measured using the short form 36 health survey (SF-36) and the inflammatory bowel disease questionnaire (IBDQ-36). Multiple linear regression and logistic regression were performed to identify factors associated with HRQOL.

RESULTS

Participation rate was 91.3%. The overall prevalence of alexithymia was 30.2% (95% CI: 26.0-35.0), with no difference between Crohn's disease and ulcerative colitis. The most affected scales in quality of life were general health (mean = 48.35, 95% CI: 46.43-50.27), vitality (mean = 55.81, 95% CI: 53.59-58.04) and systemic symptoms (mean = 5.19, 95% CI: 5.08-5.29). Alexithymia was significantly associated with an impaired quality of life (OR = 3.34, 95% CI: 1.98-5.65). "Difficulty identifying feelings" and "externally oriented thinking" were the alexithymia factors related to the impaired HRQOL.

CONCLUSIONS

Alexithymia is highly prevalent in IBD and represents a significant determinant of HRQOL. Alexithymia and its components need to be taken into consideration in the management of IBD patients.

Leadership coaching experiences of clients with Alexithymia

Orientation: Leaders who find it difficult to connect emotionally with colleagues are often seen as incompetent, the idea that they may suffer from alexithymia – an inability to feel – is not taken into account. This coaching model seemed to be not successful in changing this behaviour pattern.Research purpose: The purpose of the research was to describe the coaching experiences of leaders with symptoms of alexithymia and to formulate hypotheses around their leadership experiences.Motivation for the study: Effective leadership is strongly associated with emotional connections with colleagues. Leaders suffering from alexithymia, struggle with making these connections. It was thought that coaching might help them bridge the gap towards building effective relationships.Research design, approach and method: A qualitative research design using case studies was used. Three participants underwent 10 months of systems psychodynamic leadership coaching, including role analysis. Researcher’s field notes and participant essays were discourse analysed. The researcher’s unconscious experiences were included in the interpretations.Main findings: Five themes manifested themselves namely, leaders’ difficult experiences with coaching, the dynamics underlying their normative, experiential and phenomenal roles and the coach’s unconscious experiences affecting the relationship. The research hypothesis referred to the differences between the role parts and the resulting anxiety.Practical/managerial implications: This coaching model did not provide sufficient opportunities for the participating leaders with regard to emotional reactivity and regulation. Contribution/value-add: The research created awareness of how alexithymia amongst leaders manifests in organisations. Unfortunately the coaching was unsuccessful in addressing the emotional task. Other ways need to be explored.

The role of alexithymia in quality of life and health care use in asthma

BACKGROUND

Alexithymia is a personality trait characterized by difficulties in perceiving and expressing emotions. The relationship between alexithymia and health outcomes in asthma has been shown in a scarce number of studies, in which alexithymia has been considered as an homogeneous construct and the confounding potential effect of anxiety and depression has not been controlled for.

OBJECTIVES

To determine the relationship between each of the three dimensions of alexithymia as assessed with the Twenty-Item Toronto Alexithymia Scale--Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking--and health-related quality of life and utilization of health care services, controlling anxiety and depression.

METHODS

Patients with moderate to severe asthma between 18 and 65 years old filled in the Twenty-Item Toronto Alexithymia Scale, the Short-Form 36 Health Survey, the St. George's Respiratory Questionnaire, the Trait Anxiety Inventory, and the Cognitive Depression Index. Sociodemographic and clinical data were collected and the frequency of emergency room visits and hospitalizations due to asthma during the following 24 months was recorded. Data were analyzed using the ?2 test, the Mann-Whitney U test, Spearman correlations and multiple linear regression analyses.

RESULTS

A total of 76 patients took part in the study (42.67 ± 15.33 years; 59.2% female; 81.6% severe asthma). Data on emergency room visits during the 24-month follow-up were collected for 42 patients; 13 of them (30.95%) with at least one emergency room visit during the follow-up. After controlling for sociodemographic variables, clinical variables, anxiety, and depression, the Difficulty Describing Feelings factor was related to dimensions of the Short-Form 36 Health Survey: Physical Functioning (p = .021), Role-Physical (p = 0.025), and the Physical Component Score (p = .012). The Difficulty Identifying Feelings factor was associated with a higher frequency of emergency room visits (p = .005). The Externally Oriented Thinking factor was not related to any of the dependent measures.

CONCLUSIONS

Two dimensions of alexithymia, Difficulty Identifying Feelings and Difficulty Describing Feelings, are complicating factors in the management of asthma, but they operate via different mechanisms and over different outcomes and the effects of alexithymia remain even while controlling for the confounding effect of anxiety and depression.

Alexithymia and somatization in general population

OBJECTIVE

Even though the association between alexithymia and somatization seems plausible according to several studies with selected populations, it has not been verified in carefully controlled and nationally representative population studies. We conducted such a study to find out whether alexithymia is associated with somatization at population level.

METHODS

This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 5129 subjects aged 30 to 97 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and somatic symptom reporting with the 12-item somatization scale derived from the Hopkins Symptom Checklist. Sociodemographic and health-related variables, including depressive and anxiety disorders, and physician verified somatic diagnoses, were treated as confounders in multivariate analyses.

RESULTS

Alexithymia was associated with somatization independently of somatic diseases, depression and anxiety and confounding sociodemographic variables. The TAS-20 factor scale "Difficulties Identifying Feelings" was the strongest common denominator between alexithymia and somatization.

CONCLUSIONS

This was the first time the independent association between alexithymia and somatization was established in a large, nationally representative nonclinical sample of both young and old adults with and without mental disorders and somatic diseases.

Maternity blues in Athens, Greece: a study during the first 3 days after delivery

BACKGROUND

Although maternity blues have been studied in many countries worldwide the factors that influence the occurrence of this clinical entity are not well understood. The purpose of this study was to investigate the prevalence, time course and symptomatology of maternity blues in a Greek urban environment as well as the relation of maternity blues with certain clinical and sociodemographic factors.

METHOD

A study of a sample of 402 women that were recruited during the first day after delivery. Each woman completed the Kennerley's Blues Questionnaire on a daily basis for the first 3 days of puerpartum. Clinical and sociodemographic data were obtained through questionnaires and personal interview.

RESULTS

179 (44.5%) women experienced severe maternity blues during the first 3 days after delivery. Delivery by caesarian section (P=0.006), stressful events during pregnancy (P=0.02), depressive feelings the last month prior to delivery (P=0.002), anxiety on the day of delivery (P=0.001) and hypochondriasis (P=0.001) were the factors that were found to relate significantly to maternity blues.

CONCLUSION

The women's emotional condition prior and after delivery, delivery via caesarotomy, as well as fears concerning somatic health had strong impact on the occurrence of maternity blues.

Reliability and factorial validity of the Observer Alexithymia Scale-Chinese translation

The purpose of the present study was to develop a Chinese translation of the Observer Alexithymia Scale (OAS-C) and evaluate its reliability and factorial validity. The original English-version of the Observer Alexithymia Scale (OAS) was translated into Chinese and given to 468 Chinese undergraduate students. Students were asked to rate a person (other than themselves) whom they knew well (e.g., a parent, sibling, another relative, or friend). We evaluated internal consistency, test-retest and inter-rater reliability, and factorial validity. Average OAS-C scores were slightly higher than, but comparable to, OAS scores in the normative samples (English-speaking/nonclinical). The OAS-C showed adequate internal consistency (Cronbach's alpha coefficient was 0.84, and the mean inter-item correlation coefficient was 0.14), good stability (test-retest reliability with a 2-week interval was 0.90), and inter-rater reliability (intra-class correlation coefficient was 0.78). Moreover, the OAS five-factor model (Distant, Uninsightful, Somatizing, Humorless, and Rigid) was confirmed: incremental fit index=0.905, comparative fit index=0.904, and root mean square error of approximation=0.086; each represented an adequate model fit. The OAS-C appears to be a reliable and valid observer-rated alexithymia measure. We recommend that researchers collect both self- and observer-rated alexithymia data and, when possible, obtain observer reports from more than one person.

Adult attachment, alexithymia, and symptom reporting: an extension to the four category model of attachment

OBJECTIVE

A previous study using a three-category attachment model found that avoidant attachment was associated with increased symptom reporting, and that this relationship was largely mediated by negative affectivity and alexithymia. The present study aimed to advance on these findings by using a four-category model of attachment to determine which aspect of avoidant attachment (fearful or dismissing) is related to symptom reporting, and via which mediating variables.

METHOD

One hundred and forty-two male and female undergraduates, aged 17-44, completed questionnaire measures of attachment style, alexithymia, self-esteem, positive and negative affectivity, and symptom reporting.

RESULTS

Fearful and preoccupied attachment styles, negative affectivity, and alexithymia were all significantly associated with increased symptom reporting, while the dismissing attachment style was not. Regression analyses showed that the relationship between fearful attachment and symptom reporting was partly, but not fully, mediated by alexithymia and negative affectivity, while that between preoccupied attachment and symptom reporting was mediated mainly by negative affectivity. Low self-esteem was associated with symptom reporting only via its association with negative affectivity.

CONCLUSIONS

Fearful and preoccupied attachment styles are both associated with symptom reporting via a negative model of the self and increased negative affectivity, but alexithymia is an additional predictor of symptom reporting in individuals with fearful attachment. This difference is thought to be linked to the model of others developed in early interactions with caregivers.

Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia

OBJECTIVE

To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia.

METHODS

Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status.

RESULTS

Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA.

CONCLUSION

The findings highlight the important role of impaired affect regulation and NA in the process of somatization.

Somatization and conversion disorder

Somatization is the psychological mechanism whereby psychological distress is expressed in the form of physical symptoms. The psychological distress in somatization is most commonly caused by a mood disorder that threatens mental stability. Conversion disorder occurs when the somatic presentation involves any aspect of the central nervous system over which voluntary control is exercised. Conversion reactions represent fixed ideas about neurologic malfunction that are consciously enacted, resulting in psychogenic neurologic deficits. Treatment is complex and lengthy; it includes recovery of neurologic function aided by narcoanalysis and identification and treatment of the primary psychiatric disorder, usually a mood disorder.

Personality and affect as determinants of medically unexplained symptoms in primary care; A follow-up study

OBJECTIVE

To examine whether the personality dimensions, neuroticism and alexithymia, and the affective state dimensions measuring negative and positive affect significantly contributed to changes over time in the number of medically unexplained symptoms (MUS) reported.

METHODS

A total of 318 patients, presenting to their primary care physician with MUS, participated in the study. Logistic regression analyses were conducted to assess to what extent neuroticism, alexithymia, negative affect and positive affect independently contributed to (1) increase vs. decrease in the number of symptoms reported, and (2) the presence of a consistently high number of MUS over a 6-month follow-up period.

RESULTS

Negative affect was the strongest determinant of changes in the number of symptoms reported. In addition, low positive affect significantly contributed to changes in the number of symptoms over time. Next to negative affect, the dimension of alexithymia measuring difficulty in identifying feelings (DIF) was found to be an independent predictor of a consistently high number of MUS. Neither neuroticism nor general alexithymia independently contributed to changes in the number of symptoms over time or to symptom persistence.

CONCLUSIONS

Negative affect is an important determinant of MUS, because it contributes both to symptom evolution and symptom persistence. Positive affect has a beneficial effect on somatic symptom evolution, whereas the alexithymia dimension measuring DIF clearly contributes to the prediction of symptom persistence.

Alexithymia does not predict the persistence of medically unexplained physical symptoms

BACKGROUND

Alexithymia is thought to be associated with the development of medically unexplained physical symptoms (UPS). So far little research has been published on alexithymia as a risk factor for the persistence of UPS.

OBJECTIVE

To determine the clinical outcome in UPS patients and to study the relative importance of alexithymia in predicting that outcome.

METHODS

A follow-up study was conducted among general medical outpatients with UPS. Patients underwent extensive examinations at baseline and were reassessed after a mean 61-week interval. Outcome of the UPS and general health perception at follow-up were used as major outcome variables.

RESULTS

Outcome of the UPS and general health perception at follow-up were not strongly associated with each other. More than half (63%) of the patients reported improvement of their initial symptoms, but only 38% of the patients considered themselves at follow-up to be in good health. UPS outcome was predominantly predicted by the duration of the UPS and the number of additional physical symptoms at baseline. General health perception at follow-up was predominantly predicted by the general health perception at baseline and the number of additional physical symptoms and pain experience at baseline. The explained variance of the general health perception was three times as high as the explained variance for the UPS outcome. Alexithymia was not associated with any of the two outcome variables.

CONCLUSIONS

Outcome of the UPS and general health perception at follow-up are not strongly associated and are predicted by different variables. Alexithymia, however, is not an important predictor for the outcome in the majority of UPS patients.

Adult attachment, alexithymia, symptom reporting, and health-related coping

OBJECTIVE

The objective of this study was to test a hypothesised model of associations between adult attachment style and two health-related outcomes, symptom reporting and coping with health problems. Alexithymia, a construct involving a deficit in the ability to identify and describe emotions, is thought to develop as a result of childhood interactions with caregivers. We wished to determine whether alexithymia acted as a mediating variable between attachment and health outcomes.

METHOD

Two hundred and one female undergraduates, aged 18-34, completed questionnaire measures of attachment style, alexithymia, positive and negative affectivity, symptom reporting, and coping with health problems.

RESULTS

Insecure attachment (both avoidant and anxious), alexithymia, and negative affectivity were all weakly intercorrelated. However, insecure attachment was associated with alexithymia independent of its association with negative affectivity. Avoidant attachment was weakly predictive of symptom reporting and emotional preoccupation as a way of coping with health problems. Regression analyses showed that the association between avoidant attachment and these health-related outcomes was mediated by alexithymia and negative affectivity, both of which made significant independent contributions to the health outcomes.

CONCLUSIONS

Our results are consistent with the proposition that alexithymia develops in response to interactions with primary caregivers that also influence infant and adult attachment. Associations between adult attachment and health outcomes may be due in part to disturbances in affect regulation.

Alexithymie: Kompetenzdefizit oder (motivierte) Hemmung?

Zusammenfassung. Theoretischer Hintergrund: Alexithymie bezeichnet eine eingeschränkte Fähigkeit, Affekte zu identifizieren und zu beschreiben. Auf konstruktheoretischer Ebene ist ungeklärt, ob alexithyme Phänomene auf einer defizitären oder auf einer gehemmten Affektregulation beruhen. Fragestellung: Um eine Entscheidung zu ermöglichen, wurden aus jeder der beiden theoretischen Perspektiven Hypothesen formuliert und überprüft. (1) Alexithyme Patienten verfügen über einen weniger differenzierten semantischen Raum für die Unterscheidung von Emotionen. (2) Alexithyme Patienten akzeptieren ihre eigene Emotionalität in geringerem Maße als nichtalexithyme Patienten und/oder erwarten in stärkerem Ausmaß, daß ihre Emotionalität von anderen abgelehnt wird. Methode: Bei 39 Patienten mit DSM-III-R Angststörungen wurde der Differenzierungsgrad der Emotionswahrnehmung individuell für jeden Patienten mit einer Variante der Repertory-Grid-Technik, dem “Emotions-Grid“, bestimmt. Die Emotionsakzeptanz wurde mittels Ratings für diverse Grundemotionen bestimmt. Mit der Toronto Alexithymia Scale (TAS-20) wurden alexithyme Merkmale psychometrisch erfasst. Ergebnisse: Eine emotionale Differenzierungsschwäche alexithymer Patienten kann belegt werden. Schlussfolgerungen: Die Befunde stützen ein “Defizitkonzept“ der Alexithymie.

Alexithymia in patients with major depressive disorder and comorbid cluster C personality disorders: a 6-month follow-up study

The authors examined the association between alexithymia, cluster C personality disorders (CPD), and severity of depression among 121 outpatients with major depressive disorder (MDD) in a 6-month, follow-up study. Diagnosis of depression and CPD was confirmed by means of the Structured Clinical Interviews for DSM-III-R (SCID I and SCID II). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale and severity of depression was assessed using the 21-item Beck Depression Inventory. Results indicated that alexithymic features are common in patients with MDD but often alleviated during recovery from depression. Moreover, comorbid CPD and severity of depression seemed to be associated with poorer recovery from alexithymia. The implications of these findings are discussed.

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

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

Alexithymia in patients with coronary heart disease

OBJECTIVE

The aim of this study was to investigate factors associated with alexithymia in patients (n=153) with coronary heart disease (CHD) verified by coronary angiography.

METHOD

Self-rated depression was assessed using 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with Symptom Check List-90 (SCL-90). Life satisfaction was assessed using a separate scale. The Structured Clinical Interview (SCID I and II) for DSM-III-R was used to identify mental disorders. Assessments took place 1 day before angiography.

RESULTS

Twenty-one percent of CHD patients (n=32) were assessed as being alexithymic according to the Toronto Alexithymia Scale (TAS-20). Alexithymics were more often blue-collar workers, incapable of working, dissatisfied with life, and depressed than the other CHD patients. Occurrences of mental disorders were not associated with alexithymia. Logistic regression analysis revealed that factors independently associated with alexithymia were currently or previously being a blue-collar worker (adjusted odds ratio, AOR: 4.8), self-rated depression (AOR: 3.2), and dissatisfaction with life (AOR: 2.9).

CONCLUSION

In CHD patients alexithymia was unrelated to cardiovascular risk factors or exercise capacity but was related to self-rated depression and decreased life satisfaction. Alexithymia is associated with the enhanced psychosocial burden of suffering CHD. This patient group may need more individual support and attention than other CHD patients.

Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients?

OBJECTIVE

Alexithymia is presumed to play an important predisposing role in the pathogenesis of medically unexplained physical symptoms. However, no research on alexithymia has been done among general medical outpatients who present with medically unexplained physical symptoms as their main problem and in which anxiety and depression have been considered as possible confounding factors. This study investigated whether patients with medically unexplained physical symptoms are more alexithymic than those with explained symptoms and whether, in patients with unexplained symptoms, alexithymia is associated with subjective health experience and use of medical services.

METHODS

We conducted a cross-sectional study among patients attending an internal medicine outpatient clinic. All patients were given a standardized interview and completed a number of questionnaires.

RESULTS

After complete physical examinations, 169 of 321 patients had unexplained physical symptoms according to two independent raters. Patients with medically unexplained symptoms more often had a mental disorder, but overall they were not more alexithymic. In patients with unexplained physical symptoms, alexithymia was not associated with subjective health experience or use of medical services. However, patients with both unexplained symptoms and a mental disorder who also denied any possible connection between emotional problems and their physical symptoms did have more alexithymic traits.

CONCLUSIONS

In the majority of patients with medically unexplained physical symptoms, alexithymia does not play a role of clinical significance. Patients with unexplained physical symptoms are heterogeneous with respect to psychiatric syndrome pathology and probably also with respect to personality pathology.