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Dubé V, Amédée LM, Raza H, Hébert M. Somatic Problems in Children Disclosing Sexual Abuse: The Mediating Role of Alexithymia and Dissociation. JOURNAL OF CHILD SEXUAL ABUSE 2024:1-19. [PMID: 39291891 DOI: 10.1080/10538712.2024.2403999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 06/03/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024]
Abstract
Child sexual abuse (CSA) is linked to heightened levels of medically unexplained symptoms. Research indicates that victims of CSA display alexithymia and dissociation symptoms. Alexithymia and dissociation may potentially contribute to developing somatic complaints in CSA victims. They represent mechanisms through which psychological distress is avoided and could then manifest as physical symptoms like somatic problems (e.g. headaches, nausea, stomachache, etc.). This study aimed to investigate if alexithymia and dissociation are mechanisms explaining the link between CSA and somatic complaints. The sample included 245 children who had disclosed child sexual abuse and 100 non-abused children aged 6-12 years old. Results of a sequential mediation model revealed that the CSA-somatic complaints relationship was mediated by alexithymia and dissociation. This study suggests that intense negative emotion leads children to focus on external stimuli to reduce psychological suffering. To mitigate somatic problems in victims of CSA, treatment should target overregulation of affect, namely alexithymia, and dissociation. In the long term, this could prevent unnecessary diagnostic testing and delay in appropriate interventions.
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Affiliation(s)
- Valéry Dubé
- Université du Québec à Montréal, Montréal, Canada
| | | | - Hina Raza
- Brown University, Providence, RI, USA
| | - Martine Hébert
- Université du Québec à Montréal, Montréal, Canada
- Canada Research Chair in Interpersonal Traumas and Resilience, Montréal, Canada
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Tan Y, An X, Cao M, Van den Bergh O. Somatosensory Amplification Scale-Chinese version: psychometric properties and its mediating role in the relationship between alexithymia and somatization. Front Psychol 2024; 15:1392351. [PMID: 39100552 PMCID: PMC11294251 DOI: 10.3389/fpsyg.2024.1392351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
The Somatosensory Amplification Scale (SSAS) was designed to measure individual's tendency to experience visceral and somatic sensations as unusually intense, disturbing and alarming. In this study, we aimed to investigate the reliability and validity of the SSAS in the Chinese general population, as well as the mediating effect of somatosensory amplification in the relationship between alexithymia and somatization. A total of 386 healthy adults were enrolled in this study. Participants completed the Chinese versions of the Somatosensory Amplification Scale (SSAS-C), the somatization subscale of the Symptom Check List 90 (SCL-90 som), the Toronto Alexithymia Scale (TAS-20), and the Short form Health Anxiety Inventory (SHAI). One hundred and thirty-three participants were randomly selected to complete the SSAS-C again two weeks after the initial assessment. The reliability and validity of the SSAS-C were analyzed. Confirmatory factor analysis showed that the one-factor model achieved adequate model fits; one item was deleted due to low factor loading. The revised SSAS-C showed good internal consistency and test-retest reliability. The SSAS-C scores correlated positively with the scores of SCL-90 som, TAS-20 and the SHAI, showing good convergent validity. In addition, somatosensory amplification mediated the association between alexithymia and somatization. The Chinese version of SSAS has acceptable reliability and validity for the general population. In addition, alexithymia may increase somatization through higher somatosensory amplification.
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Affiliation(s)
- Yafei Tan
- School of Psychology, Central China Normal University, Wuhan, China
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Xiaoran An
- School of Psychology, Central China Normal University, Wuhan, China
| | - Menglu Cao
- Faculty of Psychology, Southwest University, Chongqing, China
- Center of Students’ Mental Health, Sichuan Technology and Business University, Chengdu, China
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Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, Levenson JL, Henningsen P. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403:2649-2662. [PMID: 38879263 DOI: 10.1016/s0140-6736(24)00623-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 08/29/2024]
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Christopher Burton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
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Petzke TM, Elspaß L, Köteles F, Van den Bergh O, Witthöft M. "And how did that make you feel?" - Repeated symptom queries enhance symptom reports elicited by negative affect. J Psychosom Res 2024; 181:111634. [PMID: 38453590 DOI: 10.1016/j.jpsychores.2024.111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Negative affect, alexithymia, and other predisposing traits (such as health anxiety) can influence an individual's symptom perception. In this study, we used the affective picture paradigm (APP, Bogaerts et al., 2010) to induce symptoms using affective picture stimuli. We aimed to cross-sectionally test the effect of high vs low-frequency symptom queries and analyze the time course of the APP, including interactions with health anxiety and somatic symptom distress. METHODS Participants (N = 124) completed a modified APP and filled out various questionnaires. In the APP, participants were randomized to either a highly-frequent-query condition (18 symptom checklists) or a less-frequent-query condition (6 checklists). Data were analyzed using ANOVAs, cross-lagged panel models, moderation models, and multilevel models. RESULTS Both groups had comparable symptom baseline values, but people in the highly frequent as opposed to less frequent condition reported significantly higher symptom levels once the experiment started (F (1,120) = 14.319, p < .001, η2=.107). Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment (β = 0.43 and β = 0.68, both p < .001). Health anxiety levels significantly predicted symptom levels (F(1,121) = 10.054, p = .002, η2=.077) and moderated the relation between condition and symptom levels (F(2,121) = 16.253, p < .001, η2=.212). CONCLUSION In terms of the predictive processing model (e.g.,[1]), repeated symptom queries following negative affective cues may activate prior beliefs about symptoms, resulting in elevated levels of symptom reports in interaction with health anxiety.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Lina Elspaß
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Ferenc Köteles
- Department of General Psychology and Methodology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
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Smakowski A, Hüsing P, Völcker S, Löwe B, Rosmalen JGM, Shedden-Mora M, Toussaint A. Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies. J Psychosom Res 2024; 181:111608. [PMID: 38365462 DOI: 10.1016/j.jpsychores.2024.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment. METHODS Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included. RESULTS Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning. CONCLUSION This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.
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Affiliation(s)
- Abigail Smakowski
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Paul Hüsing
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Sophia Völcker
- Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Bernd Löwe
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Netherlands
| | - Meike Shedden-Mora
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany; Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Anne Toussaint
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
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Merlo EM, Tutino R, Myles LAM, Lia MC, Minasi D. Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus. Ital J Pediatr 2024; 50:99. [PMID: 38755698 PMCID: PMC11100042 DOI: 10.1186/s13052-024-01647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM. METHODS 105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively. RESULTS A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM. CONCLUSIONS Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
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Yavrum F, Ezerbolat Ozates M, Ozates S. An important contributing factor in dry eye disease: somatization. Int Ophthalmol 2024; 44:190. [PMID: 38652333 DOI: 10.1007/s10792-024-03133-6] [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: 09/10/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Somatization is an important mental process that may causes medically unexplained and treatment-resistant somatic symptoms. The aim of the study is assess the presence of somatization in patients with dry eye disease (DED). METHODS Eighty-eight patients with no objective DED finding and ongoing DED treatment were included in this prospective and observational study. Patients with subjective symptoms formed the symptom group and patients without subjective symptoms formed the control group. All patients were scored with the Turkish version of the Ocular Surface Disease Index (OSDI), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Symptom Checklist-90-R (SCL-90R) somatization subscale, Toronto Alexithymia Scale (TAS), Pain Catastrophizing Scale (PCS), and Symptom Interpretation Questionnaire (SIQ). RESULTS Mean OSDI score was significantly higher in the symptom group than in the control group. The mean HAM-D and HAM-A outcomes did not differ between the groups. The mean SCL-90R somatization subscale, TAS, and PCS scores were significantly higher in the symptom group than in the control group. In the SIQ, somatic attributional style score was significantly higher in the symptom group than in the control group. The SCL-90R somatization subscale, PCS, and somatic attributional style scores had positive and mild-moderate correlation with OSDI scores in the symptom group. The TAS score had positive and moderate correlation with OSDI scores in all sample analyses. CONCLUSION Somatization should be considered in patients with DED with chronic ocular surface symptoms. Presence of subjective symptoms resistant to treatment may be an indicator of somatization.
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Affiliation(s)
- Fuat Yavrum
- Ophthalmology Department, Faculty of Medicine, Alanya Alaaddin Keykubat University, st. no: 80, Kestel, 07425, Antalya, Turkey.
| | | | - Serdar Ozates
- Ophthalmology Department, Faculty of Medicine, Okan University, Istanbul, Turkey
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Zhang B, Li X, Deng H, Tan P, He W, Huang S, Wang L, Xu H, Cao L, Nie G. The relationship of personality, alexithymia, anxiety symptoms, and odor awareness: a mediation analysis. BMC Psychiatry 2024; 24:185. [PMID: 38448836 PMCID: PMC10916267 DOI: 10.1186/s12888-024-05653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/01/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Personality, emotions, and olfaction exhibit partial anatomical overlap in the limbic system structure, establishing potential mechanisms between personality, affective disorders, and olfactory-related aspects. Thus, this study aims to investigate the associations among the Big Five personality traits, alexithymia, anxiety symptoms, and odor awareness. METHODS A total of 863 college participants were recruited for this study. All participants completed the Chinese Big Five Personality Inventory-15, the Odor Awareness Scale (OAS), the Toronto Alexithymia Scale-20, and the Generalized Anxiety Disorder Screener-7. Structural equation modeling was employed to examine the hypothesized mediated model. RESULTS The findings revealed the majority of significant intercorrelations among the dimensions of the Big Five personality traits, alexithymia, anxiety symptoms, and OAS (|r| = 0.072-0.567, p < 0.05). Alexithymia and anxiety symptoms exhibited a serial mediation effect between neuroticism and OAS (95%CI[0.001, 0.014]), conscientiousness and OAS (95%CI[-0.008, -0.001]), and extraversion and OAS (95%CI[-0.006, -0.001]). Anxiety symptoms mediated the relationship between agreeableness and OAS (95%CI[-0.023, -0.001]) and between openness and OAS (95%CI [0.004, 0.024]). CONCLUSION The mediating roles of alexithymia and anxiety symptoms between the Big Five personality traits and odor awareness support the idea of a certain level of association among personality, emotions, and olfaction, with the underlying role of the limbic system structure. This enhances our understanding of personality, emotions, and olfaction and provides insights for future intervention measures for affective disorders and olfactory dysfunctions.
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Affiliation(s)
- Binfeng Zhang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Xiuxia Li
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Hongzhen Deng
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Peixuan Tan
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Wanyong He
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Shuling Huang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Lu Wang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Hao Xu
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Lei Cao
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Guanghui Nie
- Department of Psychology, Guangxi Medical University, Nanning, China.
- School of Public Health, Guangxi Medical University, Shuangyong Road 22, 530021, Nanning, Guangxi, China.
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Boecking B, Brueggemann P, Rose M, Mazurek B. [Chronic tinnitus: An interplay between somatic and psychological factors]. HNO 2023; 71:719-730. [PMID: 37702794 DOI: 10.1007/s00106-023-01370-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.
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Affiliation(s)
- Benjamin Boecking
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Petra Brueggemann
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Matthias Rose
- Medizinische Klinik mit Schwerpunkt für Psychosomatik und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland.
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Torunsky NT, Knauz S, Vilares I, Marcoulides KM, Koutstaal W. What is the relationship between alexithymia and experiential avoidance? A latent analysis using three alexithymia questionnaires. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023; 214:112308. [PMID: 37637074 PMCID: PMC10455047 DOI: 10.1016/j.paid.2023.112308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
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.
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Affiliation(s)
| | - Sara Knauz
- Department of Psychology, University of Minnesota – Twin Cities, USA
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Freiherr von Schoenhueb D, Boecking B, Mazurek B. Alexithymia in Patients with Somatization Difficulties and Tinnitus-Related Distress: A Systematic Review. J Clin Med 2023; 12:6828. [PMID: 37959295 PMCID: PMC10649228 DOI: 10.3390/jcm12216828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom, chronic tinnitus can present as a "somatoform" or "functional" difficulty. Some evidence has pointed to alexithymia as a transdiagnostically relevant risk factor for both symptom clusters. Using a two-part rapid review-searching within EBSCO, Embase by Ovid, PubMed, Web of Science-we summarize psychological studies regarding alexithymia, i.e., difficulties in recognizing and expressing emotions and (1) somatoform conditions and (2) chronic tinnitus. For the former (inclusion criteria: (1) adult human beings with different kinds of somatization, (2) longitudinal study designs, (3) publication between 2001 and 2021, (4) full-text in English or German) we identified eight studies that revealed significant links between alexithymia and somatoform conditions. Psychotherapy improved alexithymia in most studies. Additionally, alexithymia was associated with broader treatment outcomes such as improvements in pain intensity, gastrointestinal symptoms, and patient-therapist alliance. The 'Risk Of Bias In Non-randomized Studies-of Interventions' tool (ROBINS-I) and 'Revised Cochrane risk-of-bias tool for randomized trials' (RoB 2) were used for risk of bias assessment. Summarizing all available studies on alexithymia and chronic tinnitus, we identified three studies. Inclusion criteria were: (1) adult human beings with chronic tinnitus, (2) publication between 2001 and 2021, (3) full-text in English or German. Risk of bias was assessed by the 'JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies'. The available studies suggested a high rate of alexithymia (65.7%) in patients with chronic tinnitus. Tinnitus-related distress was significantly associated with alexithymia in two studies, one of which, however, found no differences in alexithymia between patients with bothersome versus non-bothersome tinnitus. Conversely, one study reported high levels of alexithymia in patients with low levels of tinnitus-related distress. Overall, alexithymia may be a transdiagnostic psychological indicator of somatization phenomena, which might include some chronic tinnitus presentations. Psychotherapy likely improves alexithymia as well as somatoform symptom presentations.
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Affiliation(s)
| | | | - Birgit Mazurek
- Tinnitus Center, Charité—Universitatsmedizin Berlin, 10117 Berlin, Germany; (D.F.v.S.); (B.B.)
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Tanemoto Y, Yamada U, Nakayama M, Takeuchi T, Tanemoto F, Ito Y, Kobayashi D, Ohta D, Hashizume M. Association of illness perception and alexithymia with fatigue in hemodialysis recipients: a single-center, cross-sectional study. Sci Rep 2023; 13:16592. [PMID: 37789052 PMCID: PMC10547682 DOI: 10.1038/s41598-023-43935-9] [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: 04/19/2023] [Accepted: 09/30/2023] [Indexed: 10/05/2023] Open
Abstract
Fatigue in hemodialysis recipients interferes with daily activities and renal rehabilitation, and its underlying causes and treatment remain unclear. Psychological factors, like illness perceptions and alexithymia, cause fatigue in other diseases; however, their contribution to hemodialysis-related fatigue is unknown. This cross-sectional study included 53 hemodialysis recipients. To assess participants' fatigue, we used a self-administered patient-reported outcome questionnaire whose items have shown correlation with those of established scales, such as the Profile of Mood States and Visual Analogue Scales. The associations among the scores of the revised Illness Perceptions Questionnaire (IPQ-R), Toronto Alexithymia Scale (TAS-20), and Hospital Anxiety and Depression Scale and fatigue were analyzed using bivariable and multivariable analyses. Patients with fatigue had significantly higher median scores for the IPQ-R subscales "Identity" and "Negative emotional representation about illness" than those without fatigue, suggesting the association of specific illness perception with fatigue. Median scores for the TAS-20 subscale "Difficulty identifying feelings" were also significantly higher among fatigued patients, suggesting the association of alexithymia with fatigue. Depression was not associated with fatigue. Multivariable logistic regression revealed the association of a high "Identity" score with the risk of fatigue (adjusted odds ratio, 1.32; 95% confidence interval, 1.00-1.73; P = 0.04), while there were no significant association between a high "Difficulty identifying feelings" score and the risk of fatigue (adjusted odds ratio, 1.09; 95% confidence interval, 0.95-1.24). Specific illness perception and alexithymia were slightly associated with hemodialysis-related fatigue. Cognitive-behavioral therapy for these conditions could reduce fatigue and promote renal rehabilitation.
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Affiliation(s)
- Yoko Tanemoto
- Department of Psychosomatic Medicine, Toho University Graduate School of Medicine, Omori Nishi 5-21-16, Ota-Ku, Tokyo, 143-0015, Japan.
- Department of Psychosomatic Medicine, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan.
| | - Ui Yamada
- Department of Psychosomatic Medicine, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan
| | - Masaaki Nakayama
- Department of Nephrology, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan
| | - Takeaki Takeuchi
- Department of Psychosomatic Medicine, Toho University School of Medicine, Omori Nishi 5-21-16, Ota-Ku, Tokyo, 143-0015, Japan
| | - Fumiaki Tanemoto
- Department of Nephrology, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan
| | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Amicho Chuo 3-20-1, Inashiki-Gun, Ibaraki, 300-0332, Japan
| | - Daisuke Ohta
- Department of Psychosomatic Medicine, St. Luke's International Hospital, Akashicho 9-1, Chuo-Ku, Tokyo, 104-0044, Japan
| | - Masahiro Hashizume
- Department of Psychosomatic Medicine, Toho University Graduate School of Medicine, Omori Nishi 5-21-16, Ota-Ku, Tokyo, 143-0015, Japan
- Department of Psychosomatic Medicine, Toho University School of Medicine, Omori Nishi 5-21-16, Ota-Ku, Tokyo, 143-0015, Japan
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Levantini V, Camodeca M, Iannello NM. The Contribution of Bullying Involvement and Alexithymia to Somatic Complaints in Preadolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050905. [PMID: 37238453 DOI: 10.3390/children10050905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Somatic complaints during preadolescence are connected to individual and contextual factors, and extant research highlights the relevance of alexithymia and bullying involvement. In this cross-sectional study, we explored the joint and unique influence of bullying involvement-as perpetrators, victims, or outsiders-and alexithymia on somatic complaints in a sample of 179 Italian middle-school students (aged 11-15). Findings revealed an indirect association between bullying perpetration and victimization complaints through alexithymia. We also found a significant direct association between victimization and somatic complaints. No significant association between outsider behavior and somatization was found. Our results revealed that bullying perpetration and victimization could increase youths' risk for somatic complaints and clarify one of the processes underlying this association. The current findings further emphasize the relevance of emotional awareness for youths' well-being and propose that implementing social-emotional skills might prevent some of the adverse consequences of being involved in bullying episodes.
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Affiliation(s)
- Valentina Levantini
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56128 Pisa, Italy
| | - Marina Camodeca
- Department of Languages and Literatures, Communication, Education, and Society, University of Udine, 33100 Udine, Italy
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De Gucht V, Wilderjans TF, Garcia FK, Maes S. Dimensionality and Validation of the Highly Sensitive Person Scale (HSPS) in a Dutch General Population Sample and Two Clinical Samples. JOURNAL OF INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1027/1614-0001/a000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Abstract: Previous studies on the Highly Sensitive Person Scale (HSPS) were primarily conducted in highly selective, mostly student populations. The objective of the present study was to examine the factor structure of the Dutch HSPS in the general population ( n = 998), prolonged fatigue ( n = 340), and chronic pain samples ( n = 283), and investigate its psychometric properties. The factorial structure of the HSPS was assessed by an exploratory factor analysis, followed by a confirmatory factor analysis. To this end, the overall sample consisting of 1,621 subjects was randomly split into two subsamples. The factor structure was subsequently confirmed in the general population, fatigue, and chronic pain samples separately. A bi-factor model, consisting of a general factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labeled “Ease of Excitation” (11 items), “Sensory and Aesthetic Sensitivity” (5 items), and “Low Sensory Threshold” (5 items). Internal consistency was satisfactory. Distinct patterns of associations were found between these factors and (un)related personality constructs.
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Affiliation(s)
- Véronique De Gucht
- Research Group of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, The Netherlands
| | - Tom F. Wilderjans
- Methodology and Statistics Research Unit, Institute of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Leiden Institute for Brain and Cognition (LIBC), Leids Universitair Medisch Centrum (LUMC), The Netherlands
| | - Franshelis K. Garcia
- Research Group of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, The Netherlands
| | - Stan Maes
- Research Group of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, The Netherlands
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15
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Čevelíček M, Roubal J, Hytych R, Řiháček T. What works in the treatment of medically unexplained physical symptoms? The psychotherapist perspective. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2022.2123785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Jan Roubal
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Roman Hytych
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
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16
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Bonazza F, Politi G, Leone D, Vegni E, Borghi L. Psychological factors in functional hypothalamic amenorrhea: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:981491. [PMID: 36777338 PMCID: PMC9911452 DOI: 10.3389/fendo.2023.981491] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Psychological factors have been found to be associated with functional hypothalamic amenorrhea (FHA); however, their role in the onset or persistence of FHA is still understudied. The study aims to assess the associations of psychological factors with the presence vs the absence of FHA. METHODS A systematic literature search has been conducted across the major databases (PubMed, PsycINFO, Scopus, and Embase) to explore the psychological factors associated with FHA. The search was limited to English-written articles published from 2000 onwards. Articles were selected based on stringent inclusion/exclusion criteria. After data extraction, meta-analysis and meta-synthesis were conducted. RESULTS Of 349 retrieved articles, eight studies were included. Findings indicate that the main psychological factors associated to FHA seem to be depression and eating attitudes, especially drive for thinness. FHA women present higher levels of anxiety, sleep disorders, dysfunctional attitudes, and alexithymia. The meta-analysis on drive for thinness revealed that the pooled MD across the studies was statistically significant both in the fixed 0.63 (95% CI: 0.31-0.95) and random model 0.70 (95% CI: 0.13-1.26). Likewise, as for depression, the pooled MD across the studies was statistically significant both in the fixed 0.60 (95% CI: 0.36-0.84) and random model 0.61 (95% CI: 0.20-1.01). DISCUSSION Findings showed the association of psychological factors and FHA and recognized their involvement in the persistence of the disorder. A multidisciplinary approach should involve a collaborative process between gynecologists, clinical psychologists, and psychiatrists, from diagnosis to treatment. Longitudinal studies should be implemented with a comparison/control group or by including clinical psychologists in the psychological assessment and study design.
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Affiliation(s)
- Federica Bonazza
- Department of Health Sciences, University of Milan, Milan, Italy
- *Correspondence: Federica Bonazza,
| | - Giuliana Politi
- Azienda Socio-Sanitaria Territoriale (ASST) Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Daniela Leone
- Department of Health Sciences, University of Milan, Milan, Italy
- Azienda Socio-Sanitaria Territoriale (ASST) Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
- Azienda Socio-Sanitaria Territoriale (ASST) Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
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Ballespí S, Nonweiler J, Sharp C, Vives J, Barrantes‐Vidal N. Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents. Psychol Psychother 2022; 95:905-920. [PMID: 35746823 PMCID: PMC9795931 DOI: 10.1111/papt.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. DESIGN This is a cross-sectional, general population study evaluating adolescents (n = 162, 61.3% female; ages 12-18, M = 14.63, SD = 1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. METHODS One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. RESULTS The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b = -0.019, 95% CI = -0.0379 to -0.0002, p = .0476), but not other-mentalizing (b = 0.027, 95% CI = 0.000 to 0.053, p = .051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. CONCLUSIONS Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.
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Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Jacqueline Nonweiler
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Carla Sharp
- Department of PsychologyUniversity of HoustonHoustonTexasUSA
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health SciencesUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Neus Barrantes‐Vidal
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of Mental HealthFundació Sanitària Sant Pere ClaverBarcelonaSpain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
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18
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Kang Y, Kim A, Kang W, Han KM, Ham B. The Association of White Matter Tracts with Alexithymia among Individuals with Major Depressive Disorder. Exp Neurobiol 2022; 31:343-352. [PMID: 36351844 PMCID: PMC9659491 DOI: 10.5607/en22030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 04/20/2024] Open
Abstract
Alexithymia is characterized by impairments in the processing of emotions. Although the disruptions in the white matter (WM) integrity in Major depressive disorder (MDD) has frequently been reported, the underlying relationship with alexithymia remains unclear. In the present study, we investigated WM tracts with Tracts Constrained by UnderLying Anatomy approach to discover potential associations between alexithymia and WM integrity to identify the neural basis of impaired emotional self-awareness in MDD. 101 patients with MDD and 99 healthy sex- and age-matched individuals underwent diffusion-weighted imaging. All participants were assessed with the 20-item Toronto Alexithymia Scale (TAS). TAS scores were significantly higher in MDD patients than in controls. Patients with MDD exhibited significantly lower FA values in the left inferior longitudinal fasciculus and it also showed negative associations with TAS. These results contribute to the neurobiological evidence on the association between MDD and alexithymia. Additionally, they suggest that reduced white matter integrity in the regions constitutes a principal pathophysiology underlying impaired emotional recognition and description in MDD.
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Affiliation(s)
- Youbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Byoungjoo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
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19
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Renzi A, Conte G, Tambelli R. Somatic, Emotional and Behavioral Symptomatology in Children during COVID-19 Pandemic: The Role of Children's and Parents' Alexithymia. Healthcare (Basel) 2022; 10:2171. [PMID: 36360512 PMCID: PMC9691013 DOI: 10.3390/healthcare10112171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 09/29/2023] Open
Abstract
The COVID-19 pandemic has deeply affected the psychophysical wellbeing of children worldwide. Alexithymia, a personality trait involving difficulties in identifying and expressing feelings represents a vulnerability factor for stress-related disorders. Under pandemic stress exposure, we aimed to investigate the role of parents' and children's alexithymia in the psychophysical symptomatology shown by children and to evaluate possible differences according to age, gender and history of COVID-19 infections. The perception of parents and children about the impact of the pandemic on children's emotional, social and physiological wellbeing was also explored. Sixty-five familial triads were surveyed in the period from March to May 2022: children (n = 33 males; mean age = 9.53, sd = 1.55), mothers (mean age = 44.12; sd = 6.10) and fathers (mean age = 47.10; sd = 7.8). Both parental and children's alexithymia scores were significantly associated with somatic and externalizing symptomatology in children. Self-reported anger and externally oriented thinking scores were higher in younger children (age 8-9.9 years) than in older ones (10-12 years). Girls scored higher than boys in somatic complaints, as reported by parents. No difference emerged between children affected/not affected by COVID-19. Notably, children reported a greater negative impact of the pandemic on their emotional and psychosocial well-being than their parents. The findings emphasize the role of alexithymia in the occurrence of psychophysical symptoms in children during the COVID-19 pandemic. The reduced parental awareness of the emotional burden imposed by the pandemic on children indicates the need to better consider how epidemics affect children's mental health and to develop adequate preventive strategies to support them in these exceptional times.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Giulia Conte
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy
| | - Renata Tambelli
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy
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20
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Windgassen SS, Sutherland S, Finn MTM, Bonnet KR, Schlundt DG, Reynolds WS, Dmochowski RR, McKernan LC. Gender differences in the experience of interstitial cystitis/bladder pain syndrome. FRONTIERS IN PAIN RESEARCH 2022; 3:954967. [PMID: 36034752 PMCID: PMC9404297 DOI: 10.3389/fpain.2022.954967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Aims This study assessed gender differences in a debilitating urologic pain condition, interstitial cystitis/bladder pain syndrome (IC/BPS). We aimed to (1) evaluate how pain, symptom, and distress profiles of IC/BPS may differ between genders and (2) obtain in-depth firsthand accounts from patients to provide additional insight into their experiences that may explain potential gender differences. Methods A mixed methods approach combined validated patient-reported outcome measures with a single timepoint 90-min focus group. Tests of summary score group differences between men and women were assessed across questionnaires measuring urologic symptoms, pain, emotional functioning, and diagnostic timeline. Qualitative analysis applied an inductive-deductive approach to evaluate and compare experiences of living with IC/BPS Group narratives were coded and evaluated thematically by gender using the biopsychosocial model, providing insight into the different context of biopsychosocial domains characterizing the male and female experience of IC/BPS. Results Thirty-seven participants [women (n = 27) and men (n = 10)] completed measures and structured focus group interviews across eight group cohorts conducted from 8/2017 to 3/2019. Women reported greater pain intensity (p = 0.043) and extent (p = 0.018), but not significantly greater impairment from pain (p = 0.160). Levels of psychological distress were significantly elevated across both genders. Further, the duration between time of pain symptom onset and time to diagnosis was significantly greater for women than men (p = 0.012). Qualitative findings demonstrated key distinctions in experiences between genders. Men appeared not to recognize or to deter emotional distress while women felt overwhelmed by it. Men emphasized needing more physiological treatment options whilst women emphasized needing more social and emotional support. Interactions with medical providers and the healthcare system differed substantially between genders. While men reported feeling supported and involved in treatment decisions, women reported feeling dismissed and disbelieved. Conclusion The findings indicate different pain experiences and treatment needs between genders in persons experiencing urologic pain and urinary symptoms, with potential intervention implications. Results suggest gender health inequality in medical interactions in this urologic population needing further investigation.
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Affiliation(s)
- Sula S. Windgassen
- Department of Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Susanna Sutherland
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Michael T. M. Finn
- Helen DeVos Children's Hospital, Grand Rapids, MI, United States
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, United States
| | - Kemberlee R. Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Lindsey C. McKernan
- Department of Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
- *Correspondence: Lindsey C. McKernan
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21
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Ma X, Jiang X, Jiang Y. Increased spontaneous fronto-central oscillatory power during eye closing in patients with multiple somatic symptoms. Psychiatry Res Neuroimaging 2022; 324:111489. [PMID: 35537300 DOI: 10.1016/j.pscychresns.2022.111489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/20/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Functional somatic symptoms (FSS) are typically associated with excessive thoughts, feelings and behaviors related to the physical symptoms whether these symptoms are unequivocally associated with a diagnosed medical condition. However, less evidence is available concerning the neurocognitive deficits underlying these features of FSS. This study aimed to examine the resting-state oscillatory activities during both eye-opening and eye-closure states in individuals with FSS. Sixty-six FSS patients screened with PHQ-15 received two 10-minute sessions of EEG assessments. All completed clinical measurements on depression, anxiety, and psychological measurements on personality traits and alexithymia. Patients scoring high on PHQ-15 (the multiple somatic symptom (MSS) or SS-high group) demonstrated increased powers in central channels (C3 and C4) in low-beta band and in the left-frontal channel (F3) in high-gamma band, during eye-closure states. Patients with higher scores in depression were more likely to be classified as the SS-high group. SS-high patients demonstrated increased difficulties in describing and identifying emotions, and less reduced day-dreaming. The combined findings in increased fronto-central high-frequency activities and alexithymia measures suggest MSS patients are associated with enhanced internally-oriented thinking and cognitive simulation which may lead to intensified feelings of simulated events and misattribution of symptoms. Future treatments should focus on eliminating cognitive bias and enhancing accuracy in interoceptive awareness.
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Affiliation(s)
- Xiquan Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoming Jiang
- Institute of Linguistics, Shanghai International Studies University, Shanghai, China.
| | - Yu Jiang
- Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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22
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Schnabel K, Petzke TM, Witthöft M. The emotion regulation process in somatic symptom disorders and related conditions - A systematic narrative review. Clin Psychol Rev 2022; 97:102196. [DOI: 10.1016/j.cpr.2022.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/31/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
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23
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Role of Alexithymia in Predicting Internet Novel Addiction through Boredom Proneness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148708. [PMID: 35886561 PMCID: PMC9319492 DOI: 10.3390/ijerph19148708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022]
Abstract
With the development of the internet, people’s pursuit of reading entertainment has enriched internet novels, but the relevant influencing factors are still unclear. Therefore, we recruited 344 Chinese college students and employed a questionnaire survey to explore the relationship between alexithymia, boredom proneness, and internet novel addiction. The results showed that (1) there was no significant difference between female and male college students in terms of alexithymia and boredom proneness, whereas male college students had a higher total score of internet novel addiction than females. (2) There were significant positive correlations between alexithymia, boredom proneness, and internet novel addiction. (3) Boredom proneness played a partial mediating role in the impact of alexithymia on the internet novel addiction. Taken together, alexithymia may directly and indirectly predict internet novel addiction through boredom proneness.
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24
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Elrassas H, Saad A, Fekry M, Elkholy H, Mansour O, Azzam L. Psychiatric comorbidity in a sample of Egyptian women with vaginismus. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vaginismus is a female sexual dysfunction affecting the quality of women and the couple’s relationship. It is considered the main feminine cause of unconsummated marriage in Egypt. The study aims in assessment of comorbid psychiatric disorders, personality disorders, and levels of alexithymia among a sample of women with vaginismus. It is a case-control study where 30 women diagnosed with vaginismus following up in the psychosexual clinic in Ain Shams University Hospitals were enrolled in the study in comparison to 30 controls. Assessment was done based on the socio-demographic data, Toronto Alexithymia scale (TAS-20), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II).
Results
It was found that women having vaginismus had significant below university level of education (P = 0.026) together with their partners (P = 0.006). It was also found that women having vaginismus are showing high levels of alexithymia (p < 0.001), more than one anxiety and/or depressive disorder (P = 0.032) in comparison to the control group. Also, borderline personality disorder/traits and avoidant personality traits were significantly more frequent among cases (P = 0.026, P = 0.001, and P = 0.045 respectively). Moreover, it was found that having two or more of either of rigidity, perfectionism, dramatization, mood swings, and impulsivity was significantly more frequent among cases (P < 0.001) showing a unique personality pattern of women with vaginismus.
Conclusions
Women with vaginismus were having higher levels of alexithymia, more developing anxiety, and depressive disorders than controls and they have specific personality characteristics.
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Řiháček T, Čevelíček M, Boehnke JR, Pourová M, Roubal J. Mechanisms of change in multicomponent group-based treatment for patients suffering from medically unexplained physical symptoms. Psychother Res 2022; 32:1016-1033. [PMID: 35436163 DOI: 10.1080/10503307.2022.2061874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Understanding psychological mechanisms of change is essential to advance treatments for patients suffering from medically unexplained physical symptoms (MUPS). This study aimed to test the role of selected change mechanisms (incl. interoceptive awareness, emotional regulation skills, symptom acceptance, relational needs satisfaction, clarification of meaning, working alliance, and group cohesion) in the modification of patients' somatic symptom intensity and well-being. N = 290 patients suffering from MUPS participated in a multi-component group-based treatment at seven clinical sites. Data were collected weekly. Multi-level modeling was used to test cross-lagged relationships between the hypothesized mechanisms and outcomes in terms of Granger causality (with lags of 1, 2, and 3 weeks). None of the mechanisms predicted a time-lagged change in outcomes in the expected direction. In fact, there was a consistent pattern of negative time-lagged relationships (i.e., an increase in a mechanism predicted worsening of the outcome). Findings consistent with the hypothesized role of the mechanisms were found only in concurrent relationships between mechanisms and outcomes. This study did not support time-lagged relationships under the condition of weekly measurement and many methodological factors remain to be considered (e.g., a finer time resolution).
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Affiliation(s)
- Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Martina Pourová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan Roubal
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Abstract
AbstractAre personality traits related to symptom overreporting and/or symptom underreporting? With this question in mind, we evaluated studies from 1979 to 2020 (k = 55), in which personality traits were linked to scores on stand-alone validity tests, including symptom validity tests (SVTs) and measures of socially desirable responding (SDR) and/or supernormality. As to symptom overreporting (k = 14), associations with depression, alexithymia, apathy, dissociation, and fantasy proneness varied widely from weak to strong (rs .27 to .79). For underreporting (k = 41), inconsistent links (rs − .43 to .63) were found with narcissism, whereas alexithymia and dissociation were often associated with lower SDR tendencies, although effect sizes were small. Taken together, the extant literature mainly consists of cross-sectional studies on single traits and contexts, mostly offering weak correlations that do not necessarily reflect causation. What this field lacks is an overarching theory relating traits to symptom reporting. Longitudinal studies involving a broad range of traits, samples, and incentives would be informative. Until such studies have been done, traits are best viewed as modest concomitants of symptom distortion.
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Okur Güney ZE, Cardone D, Sattel H, Ariens S, Witthöft M, Merla A, Kuppens P, Henningsen P. Interpersonal Emotion Dynamics in Couples With Somatic Symptom Disorder: Dyadic Coherence in Facial Temperature During Emotional Interactions. Psychosom Med 2022; 84:188-198. [PMID: 34654022 DOI: 10.1097/psy.0000000000001032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Disturbances in emotional processes are commonly reported in patients with a somatic symptom disorder (SSD). Although emotions usually occur in social interactions, little is known about interpersonal emotion dynamics of SSD patients during their actual emotional encounters. This study examined physiological coherence (linkage) between SSD patients and their partners, and in healthy couples during their emotional interactions. Secondarily, we explored group-level relationships between participants' and their partners' subjective affect. METHODS Twenty-nine romantic couples (16 healthy and 13 SSD patient-couples) underwent a dyadic conversation task with neutral and anger-eliciting topics followed by a guided relaxation. Partners' cutaneous facial temperature was recorded simultaneously by functional infrared thermal imaging. Immediately after each condition, participants reported on their pain intensity, self-affect, and perceived partner-affect. RESULTS Emotional conditions and having a partner with an SSD significantly affected coherence amplitude on the forehead (F(2,54) = 4.95, p = .011) and nose tip temperature (F(2,54) = 3.75, p = .030). From baseline to anger condition, coherence amplitude significantly increased in the patient-couples, whereas it decreased in the healthy couples. Correlation changes between partners' subjective affect comparably accompanied the changes in physiological coherence in healthy and patient-couples. CONCLUSIONS Inability to reduce emotional interdependence in sympathetic activity and subjective affect during a mutual conflict observed in SSD patient-couples seems to capture emotion co-dysregulation. Interventions should frame patients' emotional experiences as embodied and social. Functional infrared thermal imaging confirms to be an ecological and reliable method for examining autonomic changes in interpersonal contexts.Registration Page: https://osf.io/8eyjr.
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Affiliation(s)
- Zeynep Emine Okur Güney
- From the Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology (Okur Güney, Witthöft), Johannes Gutenberg University of Mainz, Mainz; Department of Psychosomatic Medicine and Psychotherapy (Okur Güney, Sattel, Henningsen), Technical University of Munich, Munich, Germany; Department of Neurosciences, Imaging and Clinical Sciences (Cardone, Merla), University G. d'Annunzio of Chieti-Pescara, Pescara, Italy; and Faculty of Psychology and Educational Sciences, Quantitative Psychology and Individual Differences (Ariens, Kuppens), KU Leuven, Leuven, Belgium
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Löwe B, Andresen V, Van den Bergh O, Huber TB, von dem Knesebeck O, Lohse AW, Nestoriuc Y, Schneider G, Schneider SW, Schramm C, Ständer S, Vettorazzi E, Zapf A, Shedden-Mora M, Toussaint A. Persistent SOMAtic symptoms ACROSS diseases - from risk factors to modification: scientific framework and overarching protocol of the interdisciplinary SOMACROSS research unit (RU 5211). BMJ Open 2022; 12:e057596. [PMID: 35063961 PMCID: PMC8785206 DOI: 10.1136/bmjopen-2021-057596] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Persistent somatic symptoms (PSS) are highly prevalent in all areas of medicine; they are disabling for patients and costly for society. The subjective symptom burden often correlates poorly with the underlying disease severity, and patients' needs for effective treatment are far from being met. Initial evidence indicates that, in addition to disease-specific pathophysiological processes, psychological factors such as expectations, somatosensory amplification and prior illness experiences contribute to symptom persistence in functional as well as in somatic diseases. However, prospective studies investigating the transition from acute to chronic somatic symptoms, integrating pathophysiological, psychological and social factors, are scarce. A better understanding of the multifactorial mechanisms of symptom persistence is crucial for developing targeted mechanism-based interventions for effective prevention and treatment of PSS. Thus, the overall aim of the interdisciplinary SOMACROSS research unit is to identify generic and disease-specific risk factors and aetiological mechanisms of symptom persistence across a range of diseases. METHODS AND ANALYSIS Seven projects will investigate risk factors and mechanisms of symptom persistence in a total of 3916 patients across 10 medical conditions. All study designs are prospective and share common assessment points, core instruments and outcome variables to allow comparison and validation of results across projects and conditions. Research will focus on the identification of generic and disease-specific mechanisms associated with unfavourable symptom course. The development of a multivariate prediction model will facilitate the understanding of the course of PSS across diseases. ETHICS AND DISSEMINATION All individual SOMACROSS studies were approved by the ethics committees of the Medical Chambers Hamburg and Münster, Germany. Findings will be disseminated through peer-reviewed publications, scientific conferences and the involvement of relevant stakeholders, patients and the lay public. This interdisciplinary research unit will fundamentally contribute to earlier recognition of patients at risk, and to the development of prevention and tailored treatment concepts for PSS.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viola Andresen
- Department of Gastroenterology, Israelitic Hospital, Hamburg, Germany
| | - Omer Van den Bergh
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Münster, Münster, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sonja Ständer
- Department of Dermatology, Medical University Center Münster, Münster, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Zdankiewicz-Ścigała E, Ścigała D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation. PLoS One 2021; 16:e0255460. [PMID: 34428238 PMCID: PMC8384168 DOI: 10.1371/journal.pone.0255460] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The purpose of the study is to analyses the relationship between interoceptive sensibility and somatoform disorders among persons with Autism Spectrum Disorder (ASD). It has been assumed that the interoceptive sensibility is accompanied by a high level of alexithymia and emotion dysregulation in somatoform disorders. METHODS Persons under the care of the foundation helping people with ASD were asked to participate in the study. In total, 205 people took part in the research. The participants aged from 18 to 63 (M = 34.91; SD = 8.44). The ASD group comprised 79 persons (38.5% of subjects). The control group comprised 126 individuals (61.5% of subjects). Participants completed self-report questionnaires measuring autism (AQ), interoceptive sensibility (BPQ), alexithymia (TAS20), emotional dysregulation (DERS), and somatoform disorder (SDQ). RESULTS The analyses showed a moderation effect of the group, which indicates the existence of a relationship between interoceptive sensibility and somatoform disorders to the greater extent in the clinical group than in the control group. In addition, the serial multiple mediation model analysis allowed to verify the mediating effect of emotion dysregulation and alexithymia on the abovementioned relationship. The indirect effect, which assumed the mediating role of alexithymia turned out to be significant, contrary to the indirect effect where emotion dysregulation was a mediator in a situation where both variables were applied simultaneously. CONCLUSIONS Interoceptive sensibility correlated with level of alexithymia, in particular, difficulties in identifying and verbalizing emotions and emotion dysregulation in the lack of emotional awareness and lack of emotional clarity and is associated with somatoform disorders in the investigated group regardless of participants' belonging to the ASD or control group.
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Affiliation(s)
| | - Dawid Ścigała
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Joanna Sikora
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Wanda Kwaterniak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Williams ZJ, Gotham KO. Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory. Mol Autism 2021; 12:56. [PMID: 34376227 PMCID: PMC8353782 DOI: 10.1186/s13229-021-00463-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/31/2021] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. METHODS This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a "general alexithymia" factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. RESULTS The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with "TAS" no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. LIMITATIONS Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. CONCLUSIONS These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN 37232 USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN USA
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Williams ZJ, Gotham KO. Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale. Mol Autism 2021; 12:20. [PMID: 33653400 PMCID: PMC7971146 DOI: 10.1186/s13229-021-00427-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alexithymia, a personality trait characterized by difficulties interpreting one's own emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies a number of cognitive and emotional differences previously attributed to autism, such as difficulties in facial emotion recognition and reduced empathy. Although questionnaires such as the twenty-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have attempted to determine the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. METHODS We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 verbal autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study (the Human Penguin Project). The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to further refine the scale based on local model misfit and I-DIF between the groups. Correlations between alexithymia and other clinical outcomes such as autistic traits, anxiety, and quality-of-life were used to assess the nomological validity of the revised alexithymia scale in the SPARK sample. RESULTS The TAS-20 did not exhibit adequate global model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an eight-item unidimensional scale (TAS-8) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that TAS-8 scores meaningfully predict autistic trait levels, anxiety and depression symptoms, and quality of life, even after controlling for trait neuroticism. LIMITATIONS Limitations of the current study include a sample of autistic adults that was overwhelmingly female, later-diagnosed, and well-educated; clinical and control groups drawn from different studies with variable measures; and an inability to test several other important psychometric characteristics of the TAS-8, including sensitivity to change and I-DIF across multiple administrations. CONCLUSIONS These results indicate the potential of the TAS-8 as a psychometrically robust tool to measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced TAS-8 latent trait scores in research applications (available at http://asdmeasures.shinyapps.io/TAS8_Score ).
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN 37232 USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN USA
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Çolak B, Eken A, Kuşman A, Sayar Akaslan D, Kızılpınar SÇ, Çakmak IB, Bal NB, Münir K, Öner Ö, Baskak B. The relationship of cortical activity induced by pain stimulation with clinical and cognitive features of somatic symptom disorder: A controlled functional near infrared spectroscopy study. J Psychosom Res 2021; 140:110300. [PMID: 33248397 DOI: 10.1016/j.jpsychores.2020.110300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The neurobiological correlates of Somatic Symptom Disorder (SSD) introduced in the DSM-5 has been the focus of a limited investigation. We aimed to examine the cortical response to painful stimuli and its relationship to symptom severity as well as cognitive and psychological characteristics in proposed models of somatoform disorders. METHODS We measured hemodynamic responses by 52-channel functional near-infrared spectroscopy. We compared the cortical response to painful stimuli in index patients with SSD (N = 21) versus age, and gender matched healthy control subjects (N = 21). We used brush stimulation as the control condition. We analyzed the relationship of cortical activity with SSD symptom severity as well as somatosensory amplification (SSA), alexithymia, dysfunctional illness behaviour, worry, and neuroticism. RESULTS Patients with SSD had higher somatic symptom severity, SSA, alexithymia, neuroticism, illness-related worry, and behaviour. Somatic symptom severity was predicted by a model including SSA and subjective feeling of pain in the index patients. Activity in the left-angular and right-middle temporal gyri was higher in the SSD subjects than the controls during pain stimulation. Positive correlations were detected between mean pain threshold levels and left middle occipital gyrus activity, as well as between SSA-scores and right-angular gyrus activity during pain condition in the index patients with SSD. CONCLUSION We present the first evidence that representation of pain in terms of cortical activity is different in subjects with SSD than healthy controls. SSA has functional neuroanatomic correlates and predicts symptom severity in SSD and therefore is involved as a valid intermediate phenotype in SSD pathophysiology.
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Affiliation(s)
- Burçin Çolak
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Aykut Eken
- Pompeu Fabra University, Center for Brain and Cognition, Barcelona, Spain
| | - Adnan Kuşman
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | - Damla Sayar Akaslan
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
| | | | - Işık Batuhan Çakmak
- University of Health Sciences, Ankara City Hospital, Department of Psychiatry, Ankara, Turkey
| | - Neşe Burcu Bal
- University of Health Sciences, Ankara Oncology Hospital, Department of Psychiatry, Ankara, Turkey
| | - Kerim Münir
- Harvard Medical School, Developmental Medicine Center, Boston Children's Hospital, Boston, USA
| | - Özgür Öner
- Bahçeşehir University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Bora Baskak
- Ankara University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey; Ankara University Brain Research Center (AUBAUM), Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey.
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Lanzara R, Conti C, Camelio M, Cannizzaro P, Lalli V, Bellomo RG, Saggini R, Porcelli P. Alexithymia and Somatization in Chronic Pain Patients: A Sequential Mediation Model. Front Psychol 2020; 11:545881. [PMID: 33192791 PMCID: PMC7655126 DOI: 10.3389/fpsyg.2020.545881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate whether chronic pain (CP) patients with somatization reported higher alexithymic traits than those without somatization and to study the different relationships between psychological characteristics, pain, health-related quality of life (HRQL), and somatization. METHOD A consecutive sample of 134 CP treatment-seeking outpatients were evaluated for alexithymia (TAS-20), somatization (PHQ-15), distress (HADS), HRQL (SF-12), and pain (BPI). RESULTS Patients with somatization (37.04%) reported significantly higher TAS-20 total scores (p < 0.001) and difficulty in identifying feelings (DIF) (p < 0.001) than those without somatization. The somatizer group had also a significantly higher disease duration, severity and interference of pain, distress, and lower HRQL than the non-somatizer group. Hierarchical regression analysis showed that although distress, pain interference and the mental HRQL component are closely related to somatization (R 2 = 0.55), DIF was the strongest predictor of severity of somatization (β = 0.31). A sequential indirect effect from DIF to somatization via distress symptoms and pain interference turned out to be significant [95% CI (0.01, 0.09)]. Support was also found for sequential mediation paths from DIF to somatization via distress and mental HRQL [95% CI (0.01, 0.11)]. CONCLUSIONS Our results pointed-out that alexithymia, particularly DIF, may be major factor for somatization risk in CP patients. Longitudinal observations are needed for evaluating the role of alexithymia in clinical outcomes.
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Affiliation(s)
- Roberta Lanzara
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Chiara Conti
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Martina Camelio
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Paolo Cannizzaro
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Vittorio Lalli
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Raoul Saggini
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
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Fábián B, Csiki Z, Bugán A. Alexithymia and emotion regulation in patients with Raynaud's disease. J Clin Psychol 2020; 76:1696-1704. [DOI: 10.1002/jclp.22947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Balázs Fábián
- Faculty of Public Health, Institute of Behavioural SciencesUniversity of Debrecen Debrecen Hungary
- Doctoral School of Health SciencesUniversity of Debrecen Debrecen Hungary
| | - Zoltán Csiki
- Department of Internal Medicine, Faculty of MedicineUniversity of Debrecen Debrecen Hungary
| | - Antal Bugán
- Faculty of Public Health, Institute of Behavioural SciencesUniversity of Debrecen Debrecen Hungary
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Akiyama Y, Hanno P. Phenotyping of interstitial cystitis/bladder pain syndrome. Int J Urol 2020; 26 Suppl 1:17-19. [PMID: 31144756 DOI: 10.1111/iju.13969] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Abstract
Interstitial cystitis/bladder pain syndrome is a chronic, potentially debilitating condition characterized by pain perceived to be related to the bladder in conjunction with lower urinary tract symptoms, and includes a wide variety of clinical phenotypes with diverse etiologies. Currently the only clinically relevant proven phenotype of interstitial cystitis/bladder pain syndrome is the Hunner lesion. Whether the presence of Hunner lesions is a hallmark of a distinct disease cohort or a potentially transient feature of non-Hunner lesion phenotype has been debated but remains controversial. There are few documented examples of a patient converting between the two forms. Growing clinical and basic evidence supports eliminating the Hunner lesion phenotype from the bladder pain syndrome umbrella and considering it a distinct disease. The Hunner lesion phenotype is characterized by distinct bladder histology, including subepithelial chronic inflammatory changes and epithelial denudation, and specific clinical characteristics (older onset age, severe bladder-centric symptoms, reduced bladder capacity, and favorable response to the lesion-targeted therapies). To define the Hunner lesion phenotype, it is necessary to develop an atlas of standardized images of cystoscopic (and, if possible, pathological) appearances of Hunner lesions. A true potential and clinically relevant phenotype of interstitial cystitis/bladder pain syndrome may be patients with non-bladder-centric symptoms, characterized by the affect dysregulation and somatic symptoms, and a greater bladder capacity in absence of Hunner lesions. In the present workshop, we concluded that the Hunner lesion is a valid phenotype and can reasonably be considered a disease in its own right. Assessment of bladder capacity and the extent of symptoms (bladder beyond or bladder centric) may help phenotyping of interstitial cystitis/bladder pain syndrome. Proper phenotyping is essential for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome, and for facilitating research.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Philip Hanno
- Urology, Stanford University School of Medicine, Stanford, California, USA
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Connolly HL, Young AW, Lewis GJ. Consistent evidence of a link between Alexithymia and general intelligence. Cogn Emot 2020; 34:1621-1631. [PMID: 32623969 DOI: 10.1080/02699931.2020.1789850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alexithymia is a personality construct characterised most notably by a difficulty in identifying and expressing feelings. Although the emotional difficulties in alexithymia are well established, to date little work has examined its relationship to broader cognitive abilities, such as general intelligence. Across three independent, healthy adult samples (Ns = 389, 318, & 273), we examined whether alexithymia was associated with general intelligence. In all three samples, we observed a significant negative association between alexithymia and general intelligence. In two of the samples, general intelligence was a significant predictor of alexithymia even when accounting for performance on tests of facial emotion recognition ability and supramodal emotion recognition ability (measured with faces, bodies, and voices). From a theoretical perspective, these results suggest that models of alexithymia need to incorporate a role for more generalised cognitive functioning. From a practical perspective, studies examining links between alexithymia and clinical disorders, many of which have known links to general intelligence, should consider including a measure of general intelligence in order to adjust for this potentially confounding factor.
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Affiliation(s)
- Hannah L Connolly
- Department of Psychology, Royal Holloway, University of London, Egham
| | - Andrew W Young
- Department of Psychology, University of York, Heslington
| | - Gary J Lewis
- Department of Psychology, Royal Holloway, University of London, Egham
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Kleinstäuber M, Allwang C, Bailer J, Berking M, Brünahl C, Erkic M, Gitzen H, Gollwitzer M, Gottschalk JM, Heider J, Hermann A, Lahmann C, Löwe B, Martin A, Rau J, Schröder A, Schwabe J, Schwarz J, Stark R, Weiss FD, Rief W. Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:287-299. [PMID: 31430755 DOI: 10.1159/000501621] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. METHODS In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. RESULTS Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: -0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. DISCUSSION/CONCLUSIONS Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany,
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University, Erlangen, Germany
| | - Christian Brünahl
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Harald Gitzen
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Mario Gollwitzer
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | | | - Jens Heider
- Outpatient Clinic for Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Martin
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Jörn Rau
- Coordinating Centre for Clinical Trials, Philipps University, Marburg, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Johannes Schwabe
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | - Jeanine Schwarz
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Frauke Dorothee Weiss
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
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Empathy, social and emotional competencies, bullying perpetration and victimization as longitudinal predictors of somatic symptoms in adolescence. J Affect Disord 2020; 271:145-151. [PMID: 32479310 DOI: 10.1016/j.jad.2020.03.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/20/2020] [Accepted: 03/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Somatic symptoms are an important adolescent health problem that affects individuals and the society as a whole. Although research focused on somatic symptoms has been very fruitful, studies about their longitudinal predictors are still in their early stages. The present study focuses on the relations between social and emotional competencies, empathy and bullying, and the presence of somatic symptoms concurrently and one year later. METHOD The sample consisted of 384 Spanish adolescents, who participated in a longitudinal study with a one-year follow-up. Validated questionnaires were used to assess social and emotional competencies, bullying, empathy and somatic complaints. RESULTS High scores in social and emotional competencies were related to low scores in somatic symptoms one year later. High affective empathy predicted more somatic symptoms concurrently and one year later. Bullying victimization was related to more somatic symptoms concurrently and one year later. LIMITATIONS Other-reports could be useful to further validate the results obtained with self-reports. Non-linear relations could be tested. Representative samples could be used in future studies. CONCLUSIONS These results suggest that it may be important to promote social and emotional competencies and reduce bullying to decrease somatic symptoms. More studies are needed to understand the impact of high affective empathy on somatic symptoms.
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The effect of alexithymia and depressive feelings on pain perception in somatoform pain disorder. J Psychosom Res 2020; 133:110101. [PMID: 32224345 DOI: 10.1016/j.jpsychores.2020.110101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/08/2020] [Accepted: 03/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between alexithymia and depression and their influence on the subjective versus experimental pain perception in somatoform pain disorder. METHODS Three groups consisting of 40 patients with somatoform pain disorder, 40 patients with depression, and 40 healthy controls were matched. They completed questionnaires regarding alexithymia (TAS26) and depressive feelings (BDI-II). In addition, pain patients rated their subjective pain intensity (NRS). Quantitative sensory testings were conducted in all participants examining temperature (CPT, HPT) and mechanical (MPT, PPT) thresholds. RESULTS Analysis of variance showed that alexithymia was significantly increased in both patient groups compared to healthy controls, but with the highest amount in somatoform pain. Regression analyses confirmed that this finding was in part due to a high comorbidity of depressive feelings in both patient groups. We found a discrepancy between increased clinical pain ratings and elevated pressure pain thresholds, indicating a less intense mechanical pain perception in somatoform pain. Correlation analyses demonstrated a significant connection of subjective pain ratings and pressure pain thresholds with depressive feelings. CONCLUSION Contrary to the results of other experimental pain studies on chronic muskuloskeletal pain syndromes, we could not confirm central sensitization in somatoform pain disorder. Our findings place the somatoform pain disorder more in the direction of affective disorder such as depression. These findings may improve a better understanding of the disease and also have direct therapeutic implications. The high occurrence of alexithymia and depressive feelings in somatoform pain should be considered in diagnostic and therapeutic regimens of these patients.
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Yang Y. Aggression and Somatic Symptoms: the Role of Emotion Regulation and Distress Tolerance. Int J Behav Med 2020; 27:466-474. [DOI: 10.1007/s12529-020-09885-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Update on the Pathophysiology of Interstitial Cystitis /Bladder Pain Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-019-00569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vesterling C, Koglin U. The relationship between attachment and somatoform symptoms in children and adolescents: A systematic review and meta-analysis. J Psychosom Res 2020; 130:109932. [PMID: 31981896 DOI: 10.1016/j.jpsychores.2020.109932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Problems in childhood and adolescence are often present with recurring physical signs of illness, called somatoform symptoms. These symptoms are a common reason for consultation at both paediatric care and psychotherapeutic/psychiatric praxis. We propose that attachment is a possible predictive factor. This article provides a systematic overview of the existing research literature concerning the relationship between attachment and somatoform symptoms in children and adolescents. METHODS A systematic search for empirical articles from 1990 up to August 2018 focusing on this association was conducted. Out of six databases, 4994 studies were detected by using defined keywords. One study was added identified by checking reference lists. Finally, 15 studies were selected, which were the bases for the narrative review. Ten studies were included in meta-analysis. RESULTS Combining study results, we found that attachment cannot solely predict somatoform symptoms. Mixed results are shown. The quantitative analysis substantiated these narrative results, revealing a small but significant combined effect size of Δ ≈ .12 (95% CI .04 - .19). CONCLUSIONS The findings suggest that a relationship exists, but further investigations need to demonstrate that these are not only superficial. There are many developmental factors that affect the relationship between attachment and somatoform symptoms in children and adolescents. Further research should explore this interplay in order to gain a holistic and comprehensive understanding of the underlying mechanisms that lead to these correlations and to discover possible predicting factors.
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Affiliation(s)
- Christina Vesterling
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Ammerleander Heerstr. 114-118, 26129 Oldenburg, Germany.
| | - Ute Koglin
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Ammerleander Heerstr. 114-118, 26129 Oldenburg, Germany.
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Hadji-Michael M, McAllister E, Reilly C, Heyman I, Bennett S. Alexithymia in children with medically unexplained symptoms: a systematic review. J Psychosom Res 2019; 123:109736. [PMID: 31376873 DOI: 10.1016/j.jpsychores.2019.109736] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adult research investigating the link between alexithymia and medically unexplained symptoms (MUS) has found a significant relationship between increased alexithymia and MUS. This difficulty in expressing emotions is likely to begin in childhood so the objective of this paper is to present a quantitative review of studies focussing on the association between MUS and alexithymia in children. METHODS Databases were searched with predefined terms relating to alexithymia and MUS in children (0-17 years). Two reviewers independently assessed abstracts, extracted data and undertook quality analyses. Systematic review methods were used in accordance with Cochrane guidelines. RESULTS Ten studies met the criteria for inclusion in the review. Seven of the eight studies which focused on a comparison between children with MUS and healthy controls, found higher levels of self-reported alexithymia in the children with MUS. However, in the two studies where children were asked to complete tasks that objectively measure alexithymia, significant differences were not found. Results of studies comparing alexithymia in children with MUS and children with medical/psychiatric controls were inconsistent; there was some evidence of increased anxiety and depression in young people with alexithymia and MUS but inconsistency of measures across studies makes drawing conclusions difficult. CONCLUSION There is preliminary evidence that children with MUS have significantly higher levels of alexithymia than controls based on self-report measures; however, this finding was not replicated in objective tasks of alexithymia. Future studies should include validated tasks that objectively measure emotion recognition abilities and focus on possible mediating factors such as neurodevelopmental and mental health difficulties.
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Affiliation(s)
- Maria Hadji-Michael
- UCL Great Ormond Street Institute of Child Health (ICH),30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
| | - Eve McAllister
- UCL Great Ormond Street Institute of Child Health (ICH),30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Colin Reilly
- UCL Great Ormond Street Institute of Child Health (ICH),30 Guilford Street, London WC1N 1EH, UK; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health (ICH),30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health (ICH),30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
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Řiháček T, Čevelíček M. Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms. Psychother Res 2019; 30:532-545. [PMID: 31345126 DOI: 10.1080/10503307.2019.1645370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, further progress may be achieved by a synthesis of clinical strategies used in diverse treatment models. The aim of this study was to identify clinical strategies shared across multiple psychological treatments intended for the treatment of adult patients with MUSS. Method: Descriptions of psychological treatments for patients with MUSS were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. N = 135 resources met inclusion criteria and were subjected to qualitative analysis. Results: Similarities across treatments were captured in 8 broad categories and 18 subcategories that covered aspects of the therapeutic relationship, specific skills (bodily, emotional, and relational) for patients to develop, search for the meaning of symptoms, and the orientation on life beyond symptoms. Conclusions: Despite the differences in technique, it was possible to identify common therapeutic strategies in psychological treatments for patients with MUSS. These overarching treatment strategies, many of which have already obtained empirical support, may inspire further research and the development of comprehensive treatments with enhanced efficacy. Limitations of the present study include the lack of focus on specific syndromes.
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Affiliation(s)
- Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
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Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
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Linhartová P, Látalová A, Kóša B, Kašpárek T, Schmahl C, Paret C. fMRI neurofeedback in emotion regulation: A literature review. Neuroimage 2019; 193:75-92. [DOI: 10.1016/j.neuroimage.2019.03.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/23/2022] Open
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Hobson H, Brewer R, Catmur C, Bird G. The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. EMOTION REVIEW 2019. [DOI: 10.1177/1754073919838528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work & Counselling, University of Greenwich, UK
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway University of London, UK
| | - Caroline Catmur
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Ballespí S, Vives J, Alonso N, Sharp C, Ramírez MS, Fonagy P, Barrantes-Vidal N. To know or not to know? Mentalization as protection from somatic complaints. PLoS One 2019; 14:e0215308. [PMID: 31048857 PMCID: PMC6497236 DOI: 10.1371/journal.pone.0215308] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/29/2019] [Indexed: 01/29/2023] Open
Abstract
Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.
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Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Naida Alonso
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, United States of America
| | - María Salvadora Ramírez
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Peter Fonagy
- Department of Psychology & Lang Sciences, University College London, London, United Kingdom
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Department of Mental Health, Fundació Sanitària Sant Pere Claver, Barcelona, Catalonia, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Peng W, Meng J, Lou Y, Li X, Lei Y, Yan D. Reduced empathic pain processing in patients with somatoform pain disorder: Evidence from behavioral and neurophysiological measures. Int J Psychophysiol 2019; 139:40-47. [DOI: 10.1016/j.ijpsycho.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 01/09/2023]
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