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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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Şahin O, Güneş M, Şahin EHK, Dönmez R. The effect of greater occipital nerve block on amplification of somatic symptoms and anxiety and depression levels in chronic migraine. Acta Neurol Belg 2024:10.1007/s13760-024-02585-y. [PMID: 38814378 DOI: 10.1007/s13760-024-02585-y] [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: 12/08/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES It is known that chronic migraine (CM) is often accompanied by anxiety, depression, and psychosomatic complaints. We designed this study with the assumption that greater occipital nerve (GON) block treatment could potentially improve not only pain symptoms but also psychosomatic complaints. This study aimed to evaluate the changes in the visual analog scale (VAS), somatosensory amplification scale (SSAS), beck depression ınventory (BDI), and beck anxiety ınventory (BAI) with GON block treatment in patients with CM. METHODS This study was conducted retrospectively on 164 patients with CM between December 2018 and January 2023. Patients underwent six sessions of GON block treatment at weeks 0, 1, 2, 3, 5, and 7. VAS, SSAS, BAI, and BDI scores; number of attacks per month (NAM); attack pain duration (APD); and monthly use of analgesics (UA) were compared before the start and at week 8 of GON block treatment. RESULTS The mean age of the subjects was 38 ± 9 years. Statistical analysis revealed that VAS, SSAS, BAI, and BDI scores; NAM; APD; and monthly UA were statistically significantly lower following GON block treatment than before GON block treatment (p < 0.001 each). CONCLUSION GON block treatment was effective for pain and somatic complaints (amplification of physical symptoms), anxiety, and depressive symptoms accompanying CM in patients with CM.
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Affiliation(s)
- Oruç Şahin
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey.
| | - Muzaffer Güneş
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | | | - Recep Dönmez
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
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Influence of Catechol-O-Methyltransferase Gene Polymorphism on the Correlation between Alexithymia and Hypervigilance to Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413265. [PMID: 34948872 PMCID: PMC8704340 DOI: 10.3390/ijerph182413265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
The psychological characteristic of having difficulty expressing emotions, known as alexithymia, is associated with hypervigilance to pain and is considered one of the risk factors for chronic pain. The correlation between alexithymia and hypervigilance to pain can be observed even in healthy individuals. However, the factors influencing this correlation remain unknown. We explored the dopamine system, which is known to be involved in emotion and pain. The dopamine-degrading enzyme catechol-O-methyltransferase (COMT) has a genetic polymorphism known to influence dopamine metabolism in the prefrontal cortex. COMT polymorphism reportedly affects various aspects of pain and increases pain sensitivity in Met allele carriers. Therefore, we investigated whether the correlation between alexithymia and hypervigilance to pain is influenced by COMT polymorphism in healthy individuals. The results revealed a significant positive correlation between the "difficulty describing feelings" of the 20-item Toronto Alexithymia Scale and the "attention to changes in pain" of the pain vigilance and awareness questionnaire in COMT Met carriers but not in Val/Val individuals. This finding suggests that the correlation between alexithymia and hypervigilance to pain is influenced by COMT polymorphism.
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Kealy D, Rice SM, Chartier GB, Cox DW. Investigating Attachment Insecurity and Somatosensory Amplification, and the Mediating Role of Interpersonal Problems. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Somatosensory amplification involves perceptual sensitivity to and cognitive-affective interpretation of bodily sensations and external stimuli, contributing to heightened experiences of somatic symptoms. However, little is known about somatosensory amplification in relation to vulnerabilities such as attachment insecurity. Aims: The present study investigated the link between attachment insecurity and somatosensory amplification, including the mediating role of dysfunctional interpersonal behaviors. Method: A sample of 245 adult community members completed the Somatosensory Amplification Scale, Generalized Anxiety Disorder Scale, and abbreviated versions of the Experiences in Close Relationships scale and Inventory of Interpersonal Problems. Correlational and regression analyses were used to examine relations among study variables, including a hypothesized parallel mediation model. Results: Somatosensory amplification was significantly associated with attachment anxiety, but not attachment avoidance. Regression analyses, controlling for general anxiety symptoms and gender, found that interpersonal sensitivity (but not aggression or ambivalence) mediated the link between attachment anxiety and somatosensory amplification. Limitations: Study limitations include the use of cross-sectional data and a non-clinical sample. Conclusion: The findings indicate that somatosensory amplification may be related to individuals’ attachment anxiety, through the mediating effect of interpersonal sensitivity problems.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Simon M. Rice
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Australia
| | | | - Daniel W. Cox
- Counselling Psychology Program, University of British Columbia, Vancouver, BC, Canada
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ÜSTÜNDAĞ M, ŞEN GÖKÇEİMAM P. An investigation of Temperament, Character, and Alexithymia in Patients with Obsessive-Compulsive Disorder. FAMILY PRACTICE AND PALLIATIVE CARE 2020. [DOI: 10.22391/fppc.756632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Brown TT, Lee W. The FUTUREPAIN study: Validating a questionnaire to predict the probability of having chronic pain 7-10 years into the future. PLoS One 2020; 15:e0237508. [PMID: 32817710 PMCID: PMC7440636 DOI: 10.1371/journal.pone.0237508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The FUTUREPAIN study develops a short general-purpose questionnaire, based on the biopsychosocial model, to predict the probability of developing or maintaining moderate-to-severe chronic pain 7-10 years into the future. METHODS This is a retrospective cohort study. Two-thirds of participants in the National Survey of Midlife Development in the United States were randomly assigned to a training cohort used to train a predictive machine learning model based on the least absolute shrinkage and selection operator (LASSO) algorithm, which produces a model with minimal covariates. Out-of-sample predictions from this model were then estimated using the remaining one-third testing cohort to determine the area under the receiver operating characteristic curve (AUROC). An optimal cut-point that maximized sensitivity and specificity was determined. RESULTS The LASSO model using 82 variables in the training cohort, yielded an 18-variable model with an out-of-sample AUROC of 0.85 (95% Confidence Interval (CI): 0.80, 0.91) in the testing cohort. The sum of sensitivity (0.88) and specificity (0.76) was maximized at a cut-point of 17 (95% CI: 15, 18) on a 0-100 scale where the AUROC was 0.82. DISCUSSION We developed a short general-purpose questionnaire that predicts the probability of an adult having moderate-to-severe chronic pain in 7-to-10 years. It has diagnostic ability greater than 80% and can be used regardless of whether a patient is currently experiencing chronic pain. Knowing which patients are likely to have moderate-to-severe chronic pain in the future allows clinicians to target preventive treatment.
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Affiliation(s)
- Timothy T. Brown
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America
| | - Woojung Lee
- School of Pharmacy, University of Washington, Washington, DC, United States of America
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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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Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis. Pain 2020; 160:994-1006. [PMID: 31009416 DOI: 10.1097/j.pain.0000000000001487] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non-self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
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Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. Int J Behav Med 2019; 26:427-436. [DOI: 10.1007/s12529-019-09799-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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El bèze Rimasson D, Bouvet C, Hamdi H. La gestion des émotions et ses déficits, chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping. PSYCHOLOGIE FRANCAISE 2018. [DOI: 10.1016/j.psfr.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Vroege L, Emons WHM, Sijtsma K, van der Feltz-Cornelis CM. Alexithymia Has No Clinically Relevant Association With Outcome of Multimodal Treatment Tailored to Needs of Patients Suffering From Somatic Symptom and Related Disorders. A Clinical Prospective Study. Front Psychiatry 2018; 9:292. [PMID: 30087625 PMCID: PMC6066688 DOI: 10.3389/fpsyt.2018.00292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 06/12/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Alexithymia may moderate the effectiveness of treatment and may predict impaired general functioning of patients suffering from somatic symptom and related disorders (SSRD). Aim: We compared alexithymia levels in a clinical prospective study with 234 consecutive patients suffering from SSRD from the Centre of Excellence for Body, Mind, and Health, Tilburg using the Bermond-Vorst Alexithymia Questionnaire, with general population norm scores. Second, we explored treatment outcomes of a multimodal treatment tailored to patient needs by Shared Decision Making (SDM) and Patient Related Outcome Monitoring (PROM) in patients with SSRD. Third, we explored whether alexithymia is associated with treatment outcome. Fourth, we explored if the presence of a chronic medical condition (e.g., diabetes mellitus, cardiovascular diseases) affects the association of alexithymia with treatment outcomes. Results: Compared to norm scores, SSRD patients showed elevated scores on the subscales identifying, verbalizing, and fantasizing, and on the cognitive dimension. All patients benefited from treatment in terms of anxiety, depression, and physical symptoms. The association of alexithymia with treatment outcome was significant, but the effect size was negligible (range odds ratios 1.02-1.25). The association between alexithymia and treatment outcome was stronger in patients suffering from chronic medical conditions compared to patients without chronic medical conditions. However, the effect size of this association was negligible (range odds ratio 0.94-1.12). Discussion: Alexithymia scores are elevated in patients with SSRD compared to general population scores, but the level of alexithymia has no clinically relevant association with treatment outcome both in SSRD patients with and without comorbid chronic medical conditions.
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Affiliation(s)
- Lars de Vroege
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands
| | - Wilco H M Emons
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Klaas Sijtsma
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Christina M van der Feltz-Cornelis
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
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Köteles F, Witthöft M. Somatosensory amplification - An old construct from a new perspective. J Psychosom Res 2017; 101:1-9. [PMID: 28867412 DOI: 10.1016/j.jpsychores.2017.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed.
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Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy Ödön u. 10, H-1117 Budapest, Hungary.
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Borhani K, Làdavas E, Fotopoulou A, Haggard P. "Lacking warmth": Alexithymia trait is related to warm-specific thermal somatosensory processing. Biol Psychol 2017; 128:132-140. [PMID: 28735971 PMCID: PMC5595273 DOI: 10.1016/j.biopsycho.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 01/24/2023]
Abstract
Alexithymia is a personality trait involving deficits in emotional processing. The personality construct has been extensively validated, but the underlying neural and physiological systems remain controversial. One theory suggests that low-level somatosensory mechanisms act as somatic markers of emotion, underpinning cognitive and affective impairments in alexithymia. In two separate samples (total N=100), we used an established Quantitative Sensory Testing (QST) battery to probe multiple neurophysiological submodalities of somatosensation, and investigated their associations with the widely-used Toronto Alexithymia Scale (TAS-20). Experiment one found reduced sensitivity to warmth in people with higher alexithymia scores, compared to individuals with lower scores, without deficits in other somatosensory submodalities. Experiment two replicated this result in a new group of participants using a full-sample correlation between threshold for warm detection and TAS-20 scores. We discuss the relations between low-level thermoceptive function and cognitive processing of emotion.
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Affiliation(s)
- Khatereh Borhani
- Institute of Cognitive Neuroscience, University College London, London, UK; Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; CSRNC, Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Viale Europa 980, 47521 Cesena, Italy; Institute of Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Elisabetta Làdavas
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; CSRNC, Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Viale Europa 980, 47521 Cesena, Italy
| | | | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK.
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Abbas OL, Kurkcuoglu A, Aytop CD, Uysal C, Pelin C. Perception of Symmetry in Aesthetic Rhinoplasty Patients: Anthropometric, Demographic, and Psychological Analysis. Perception 2017; 46:1151-1170. [DOI: 10.1177/0301006617714214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Visual perception of symmetry is a major determinant of satisfaction after aesthetic rhinoplasty. In this study, we sought to investigate the existence of any relationship between anthropometric characteristics of the face and visual perceptions of asymmetry among rhinoplasty patients and to evaluate tools that can shed light on patients who appear at high risk for exaggerating potential asymmetries. In the first part, 168 rhinoplasty patients were asked to fill out the demographic questionnaire, nasal shape evaluation scale, and the somatosensory amplification scale. In the second part, we examined the relationship between anthropometric characteristics of the face and visual perceptions of asymmetry using standardized photographs of 100 medical students. In the third part, patients answered the rhinoplasty outcome evaluation questionnaire 6 months after the surgery. Objectively, no symmetrical face was observed in the anthropometric evaluation. Subjectively, only 73% and 54% of the faces were considered asymmetrical by the rhinoplasty and the control groups, respectively. The rate of asymmetry perception was significantly greater in revision patients when compared with primary rhinoplasty patients. The relationship between the rate of subjective perception of asymmetry and the somatosensory amplification scale scores was statistically significant. We found a significant inverse relationship between the rate of asymmetry perception and the rhinoplasty outcome evaluation scores. Plastic surgeons should be aware of this high selectivity in asymmetry perception, which is associated with poor postoperative satisfaction. Somatosensory amplification scale may help identify rhinoplasty patients at a high risk for exaggerating potential asymmetries. Level of Evidence: III.
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Affiliation(s)
- Ozan Luay Abbas
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ahi Evran University, Kırşehir, Turkey
| | - Ayla Kurkcuoglu
- Faculty of Medicine, Department of Anatomy, Başkent University, Ankara, Turkey
| | - Cigdem Derya Aytop
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Ahi Evran University, Kırşehir, Turkey
| | - Cengiz Uysal
- Faculty of Medicine, Department of Psychiatry, Ahi Evran University, Kırşehir, Turkey
| | - Can Pelin
- Faculty of Medicine, Department of Anatomy, Başkent University, Ankara, Turkey
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Taycan O, Özdemir A, Erdoğan Taycan S. Alexithymia and Somatization in Depressed Patients: The Role of the Type of Somatic Symptom Attribution. Noro Psikiyatr Ars 2017; 54:99-104. [PMID: 28680305 DOI: 10.5152/npa.2016.12385] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/11/2015] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION This study aimed to establish the association between alexithymia and various factors, mainly somatization, and to determine the predictors of alexithymia in depressed patients. METHODS A total of 90 patients with major depressive disorder who met The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnostic criteria were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Symptom Checklist-90 (SCL-90), Somatosensory Amplification Scale, and Symptom Interpretation Questionnaire. The patients were classified into two groups as alexithymic and non-alexithymic with respect to the TAS cut-off points (≥59=alexithymic). Predictors of alexithymia were tested by multiple linear regression analysis. RESULTS Of all patients, 36 (40%) were in the alexithymic group. The percentage of women, depression severity, level of general psychopathology and distress, and somatic symptom reporting (SCL-90), as well as the tendency to somatosensory amplification and three forms of somatic symptom attributions, were significantly higher in alexithymic patients than in non-alexithymic patients. Furthermore, age, depression severity, somatic symptom reporting, and the tendency to attribute physical symptoms to somatic causes were predictors of alexithymia. CONCLUSION The results indicated an intimate association between alexithymia and somatization in depressed patients. Therefore, when evaluating depressed patients with alexithymia, their tendency for somatization should be considered, and alexithymic individuals should be assessed with particular attention, considering that somatization can mask the underlying depressive condition.
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Affiliation(s)
- Okan Taycan
- Clinic of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Armağan Özdemir
- Clinic of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey
| | - Serap Erdoğan Taycan
- Clinic of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Aghayousefi A, Oraki M, Mohammadi N, Farzad V, Daghaghzadeh H. Reliability and Validity of the Farsi Version of the Somatosensory Amplification Scale. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e233. [PMID: 26576173 PMCID: PMC4644620 DOI: 10.17795/ijpbs-233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/15/2014] [Accepted: 12/20/2014] [Indexed: 01/12/2023]
Abstract
Background: The somatosensory amplification scale (SSAS) is a 10-item self-report instrument designed to assess a tendency to experience normal somatic and visceral sensations as intense, noxious, and disturbing. Objectives: The present study investigated the reliability and validity of the SSAS, developed by Barsky et al. (1988), in the Iranian population. Materials and Methods: The study was carried out on 240 patients with functional gastrointestinal disorders and 30 healthy persons selected by convenience sampling from 2013 to 2014. The patients completed the SSAS, the somatization subscale of the symptom checklist-90-revised (SCL-90-R som), and the modified somatic perception questionnaire (MSPQ), whereas the healthy persons completed just the SSAS. Results: Exploratory factor analysis indicated that the one-factor solution, accounting for 29.42% of the variance, explained that the SSAS items were represented by one global dimension. The SSAS had acceptable internal consistency (α = 0.78) and good test-retest reliability (r = 0.80). The item-to-scale correlations varied from 0.17 to 0.55. Item 2 had the lowest item-total score correlation (r = 0.17), and the α coefficient for the SSAS exceeded when this item was deleted. The convergent validity of the SSAS with somatization was shown with a significant correlation between the SSAS, SCL-90-R som (r = 0.36), and MSPQ scores (r = 0.52). Discriminant validity analysis showed no significant difference in the SSAS between the patient and control groups (P > 0.05) and non-specificity of the SSAS for patients. Conclusions: In sum, the SSAS has acceptable reliability and validity for the Iranian population and the scale measures the same the original scale, namely somatosensory amplification.
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Affiliation(s)
| | - Mohammad Oraki
- Department of Psychology, Payame Noor University, Tehran, IR Iran
| | - Narges Mohammadi
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | | | - Hammed Daghaghzadeh
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Margalit D, Ben Har L, Brill S, Vatine JJ. Complex regional pain syndrome, alexithymia, and psychological distress. J Psychosom Res 2014; 77:273-7. [PMID: 25280824 DOI: 10.1016/j.jpsychores.2014.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/18/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to elucidate the relationships between alexithymia, psychological distress, and pain in persons with complex regional pain syndrome (CRPS). METHODS Participants were 60 Israeli adults ages 19-65. This is a cross sectional study with a comparison group. Alexithymia, psychological distress, and pain were assessed in 30 individuals with CRPS in comparison to 30 gender- and age-matched persons with lower back pain (LBP). Assessments included the Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and two subscales of the McGill Pain Questionnaire. RESULTS Persons with CRPS had significantly higher ratings of psychological distress and of alexithymia when compared to LBP controls. Pain severity was significantly associated with higher levels of alexithymia and psychological distress among persons with CRPS, but not among controls. Alexithymia and pain severity correlations were significantly different between the two groups. In persons with CRPS, the relationships between alexithymia and pain severity and between difficulty identifying feelings and pain were not confounded by psychological distress. CONCLUSIONS To our knowledge, this is the first cross sectional study providing empirical evidence on the relationship between alexithymia and CRPS. From the perspective of conceptualizing alexithymia as an outcome of CRPS, findings highlight the importance of early CRPS diagnosis and support the provision of care that addresses pain-related psychological distress and alexithymia among CRPS patients. Also, findings underscore the need to generate alternative, non-physical avenues, such as learning to identify feelings for processing pain, in order to reduce pain among persons with CRPS.
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Affiliation(s)
| | - Laura Ben Har
- Department of Behavioral Sciences, Ariel University, Israel; Reuth Rehabilitation Hospital, Tel Aviv, Israel.
| | - Silviu Brill
- Institute for Pain Medicine, Sourasky Medical Center, Tel Aviv, Israel
| | - Jean-Jacques Vatine
- Reuth Rehabilitation Hospital, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S, Iwaki R, Yamashiro K, Yoshida T, Imada Y, Kubo C, Kiyohara Y, Sudo N, Hosoi M. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PLoS One 2014; 9:e90984. [PMID: 24621785 PMCID: PMC3951296 DOI: 10.1371/journal.pone.0090984] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic pain is a significant health problem worldwide, with a prevalence in the general population of approximately 40%. Alexithymia -- the personality trait of having difficulties with emotional awareness and self-regulation -- has been reported to contribute to an increased risk of several chronic diseases and health conditions, and limited research indicates a potential role for alexithymia in the development and maintenance of chronic pain. However, no study has yet examined the associations between alexithymia and chronic pain in the general population. METHODS We administered measures assessing alexithymia, pain, disability, anxiety, depression, and life satisfaction to 927 adults in Hisayama, Japan. We classified the participants into four groups (low-normal alexithymia, middle-normal alexithymia, high-normal alexithymia, and alexithymic) based on their responses to the alexithymia measure. We calculated the risk estimates for the criterion measures by a logistic regression analysis. RESULTS Controlling for demographic variables, the odds ratio (OR) for having chronic pain was significantly higher in the high-normal (OR: 1.49, 95% CI: 1.07-2.09) and alexithymic groups (OR: 2.56, 95% CI: 1.47-4.45) compared to the low-normal group. Approximately 40% of the participants belonged to these two high-risk groups. In the subanalyses of the 439 participants with chronic pain, the levels of pain intensity, disability, depression, and anxiety were significantly increased and the degree of life satisfaction was decreased with elevating alexithymia categories. CONCLUSIONS The findings demonstrate that, in the general population, higher levels of alexithymia are associated with a higher risk of having chronic pain. The early identification and treatment of alexithymia and negative affect may be beneficial in preventing chronic pain and reducing the clinical and economic burdens of chronic pain. Further research is needed to determine if this association is due to a causal effect of alexithymia on the prevalence and severity of chronic pain.
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Affiliation(s)
- Mao Shibata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kozo Anno
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yonemoto
- Biostatistics Center, Kurume University, Fukuoka, Japan
| | - Seiko Makino
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Iwaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashiro
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiyuki Yoshida
- Department of Speech and Hearing Sciences, International University of Health and Welfare, School of Health Sciences at Fukuoka, Fukuoka, Japan
| | - Yuko Imada
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chiharu Kubo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- * E-mail:
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Ak I, Sayar K, Yontem T. Alexithymia, somatosensory amplification and counter-dependency in patients with chronic pain. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856904322858693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Evren B, Evren C, Guler MH. Clinical correlates of alexithymia in patients with fibromyalgia. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856906775249857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bridou M, Aguerre C. Validity of the French form of the Somatosensory Amplification Scale in a Non-Clinical Sample. Health Psychol Res 2013; 1:e11. [PMID: 26973888 PMCID: PMC4768601 DOI: 10.4081/hpr.2013.e11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 12/02/2022] Open
Abstract
The SomatoSensory Amplification Scale (SSAS) is a 10-item self-report instrument designed to assess the tendency to detect somatic and visceral sensations and experience them as unusually intense, toxic and alarming. This study examines the psychometric properties of a French version of the SSAS in a non-clinical population and, more specifically, explores its construct, convergent and discriminant validities. The SSAS was completed by 375 university students, together with measures of somatization propensity (SCL-90-R somatization subscale) and trait anxiety (STAI Y form). The results of principal component and confirmatory factor analyses suggest that the French version of the SSAS evaluates essentially a single, robust factor (Somatosensory amplification) and two kinds of somatic sensitivity (Exteroceptive sensitivity and Interoceptive sensitivity). Somatosensory amplification correlated with somatization tendency and anxiety propensity. These results encourage further investigations in French of the determinants and consequences of somatosensory amplification, and its use as a therapeutic strategy.
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Affiliation(s)
- Morgiane Bridou
- Department of Psychology, François Rabelais University , France
| | - Colette Aguerre
- Department of Psychology, François Rabelais University , France
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22
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Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. J Behav Ther Exp Psychiatry 2011; 42:432-9. [PMID: 21570932 PMCID: PMC3152650 DOI: 10.1016/j.jbtep.2011.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 03/28/2011] [Accepted: 04/05/2011] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% females, M age=50 years) with chest pain seeking cardiac evaluation, who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18-month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.
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NIKOLAOU ALEXANDRA, SCHIZA SOFIAE, CHATZI LEDA, KOUDAS VASSILIS, FOKOS STEFANOS, SOLIDAKI ELENI, BITSIOS PANOS. Evidence of dysregulated affect indicated by high alexithymia in obstructive sleep apnea. J Sleep Res 2011; 20:92-100. [DOI: 10.1111/j.1365-2869.2010.00865.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hosoi M, Molton IR, Jensen MP, Ehde DM, Amtmann S, O'Brien S, Arimura T, Kubo C. Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: Considering the effect of negative affectivity. Pain 2010; 149:273-277. [PMID: 20207082 DOI: 10.1016/j.pain.2010.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 01/28/2010] [Accepted: 02/08/2010] [Indexed: 01/22/2023]
Abstract
Alexithymia, the inability to identify or label emotions, has been shown to be associated with pain in patients with a number of chronic pain conditions. We sought to: (1) replicate this association in samples of persons with chronic pain secondary to neuromuscular disease, (2) extend this finding to other important pain-related measures, and (3) to determine whether relationships among alexithymia and study variables existed after controlling for negative affect. One hundred and twenty-nine individuals with muscular dystrophy and chronic pain were administered measures of alexithymia (Toronto Alexithymia Scale, TAS-20), pain intensity (0-10 NRS), pain interference (Brief Pain Inventory Interference scale), mental health (SF-36 Mental Health scale; as a proxy measure of negative affect) and vitality (SF-36 Vitality scale). Higher TAS scores were associated significantly with higher pain intensity and interference, and less vitality. Although the strengths of these associations were reduced when mental health was used as a control, the associations between the Difficulty Identifying Feelings scale and vitality, and the Externally Oriented Thinking and Total TAS scales and pain intensity remained statistically significant. The findings replicate and extend previous findings concerning the associations between alexithymia and important pain-related variables in a sample of persons with chronic pain and neuromuscular disease. Future research is needed to determine the extent to which the associations are due to (1) a possible causal effect of alexithymia on patient functioning that is mediated via its effects on negative affect or (2) the possibility that alexithymia/outcome relationships reflect response bias caused by general negative affectivity.
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Affiliation(s)
- Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 356490, Seattle, WA, USA Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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Chatzi L, Bitsios P, Solidaki E, Christou I, Kyrlaki E, Sfakianaki M, Kogevinas M, Kefalogiannis N, Pappas A. Type 1 diabetes is associated with alexithymia in nondepressed, non-mentally ill diabetic patients: a case-control study. J Psychosom Res 2009; 67:307-13. [PMID: 19773023 DOI: 10.1016/j.jpsychores.2009.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Alexithymia refers to difficulty in identifying and expressing emotions, and it is a characteristic common to several psychiatric and medical conditions, including autoimmune disorders. Type 1 diabetes (T1D) is an autoimmune disorder with increased psychiatric comorbidity. Previously reported associations between alexithymia and T1D may have been confounded by the presence of depression. The central aim of this study was to examine alexithymia levels in psychiatrically uncomplicated T1D outpatients with that of nondiabetic controls. METHODS Ninety-six T1D patients without any DSM-IV Axis I diagnoses and 105 age- and sex-matched healthy controls entered the study. Alexithymia and depressive symptoms were assessed with the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory (BDI-21), respectively. Multivariate regression models were used to evaluate the association of alexithymia with the presence of diabetes, duration of diabetes, diabetes control, parameters of treatment intensification, and diabetic complications. RESULTS T1D was positively associated with the TAS-20 "identifying feelings" (beta coefficient=2.64, P=.003) and "externally oriented thinking" (beta coefficient=1.73, P=.011) subscales. The prevalence of overall alexithymia (TAS-20 total score, > or =60) was 22.2% in T1D patients and 7.6% in the controls (OR, 4.6; 95% CI, 1.7-12.8). TAS-20 scores were positively associated with diabetes duration and negatively with treatment intensification parameters. CONCLUSIONS Alexithymia is higher in psychiatrically uncomplicated T1D patients than in healthy controls even after adjustment for confounding depressive symptoms; it is greater with longer diabetes duration and is associated with some reduced parameters of treatment intensification but not with worse outcome in terms of glycemic control or somatic complications.
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Affiliation(s)
- Leda Chatzi
- Faculty of Medicine, Department of Social Medicine, University of Crete, Crete, Greece.
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Fishbain DA, Lewis JE, Gao J, Cole B, Steele Rosomoff R. Is chronic pain associated with somatization/hypochondriasis? An evidence-based structured review. Pain Pract 2009; 9:449-67. [PMID: 19735366 DOI: 10.1111/j.1533-2500.2009.00309.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This is an evidence-based structured review. OBJECTIVES The objectives of this review were to answer the following questions: (1) Are somatization/hypochondriasis associated with chronic pain? (2) Is the degree of somatization/hypochondriasis related to pain levels? (3) Does pain treatment improve somatization/hypochondriasis? (4) Are some pain diagnoses differentially associated with somatization/hypochondriasis? METHODS Fifty-seven studies which fulfilled inclusion criteria and had high quality scores were sorted by the above-mentioned objectives. Agency for health care policy and research guidelines were utilized to type and characterize the strength/consistency of the study evidence within each objective. RESULTS Somatization and hypochondriasis were both consistently associated with chronic pain (consistency ratings B and A, respectively). Study evidence indicated a correlation between pain intensity and presence of somatization and hypochondriasis (consistency rating A and B, respectively). Pain treatment improved somatization and hypochondriasis (consistency rating B and A, respectively). Some chronic pain diagnostic groups somatized more (consistency rating B). CONCLUSIONS Somatization is commonly associated with chronic pain and may relate to pain levels.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Rose S, Cottencin O, Chouraki V, Wattier JM, Houvenagel É, Vallet B, Goudemand M. Réponse des auteurs à la correspondance à propos de l’article : « Importance des troubles de la personnalité et des comorbidités psychiatriques chez 30 patients atteints de fibromyalgie ». Presse Med 2009. [DOI: 10.1016/j.lpm.2009.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Valdés M, Bernardo M, Segarra N, Parramón G, Teresa Plana M, Rami L, Salamero M, Bargalló N. La amplificación somatosensorial en la esquizofrenia está relacionada con la preservación del rendimiento neuropsicológico. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2008; 1:3-9. [DOI: 10.1016/s1888-9891(08)72510-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/16/2008] [Indexed: 11/29/2022]
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Nakao M, Barsky AJ. Clinical application of somatosensory amplification in psychosomatic medicine. Biopsychosoc Med 2007; 1:17. [PMID: 17925010 PMCID: PMC2089063 DOI: 10.1186/1751-0759-1-17] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Accepted: 10/09/2007] [Indexed: 12/01/2022] Open
Abstract
Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well. Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity. The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same. The specific role of somatosensory amplification with regard to both neurological and psychological function should be clarified in future studies. In this paper, we will explain the concept of amplification and describe its role in psychosomatic illness.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
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Mehling WE, Krause N. Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators. J Psychosom Res 2007; 62:667-74. [PMID: 17540224 PMCID: PMC1955468 DOI: 10.1016/j.jpsychores.2007.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Alexithymia, a lack of emotional awareness, was positively associated with self-reported low back pain (LBP) in cross-sectional studies. We assessed the association of alexithymia with 7.5-year incidence of LBP prospectively in a cohort study of 1207 San Francisco transit operators. METHODS Alexithymia was measured by the 20-item Toronto Alexithymia Scale (TAS-20). LBP was assessed by physician-confirmed diagnoses from administrative workers' compensation data. Cox proportional hazards analyses controlled for demographic, behavioral, and physical and psychosocial job factors measured by questionnaire and interview. RESULTS Of all drivers, 27.7% (n=334) filed compensated claims for LBP injuries with workers' compensation insurance during the 7.5-year observation time. The hazard ratios from the fully adjusted model were 0.73 (0.56-0.96) for the TAS-20 scale and 0.82 (0.69-0.98) for the subscale "difficulty describing feelings." Alexithymia scores did not predict the duration of compensated work disability. CONCLUSION In contrast to previous cross-sectional positive associations between alexithymia and LBP, alexithymia is negatively associated with compensated LBP claims. We hypothesize that shame and reporting behavior may explain these inconsistent results.
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Affiliation(s)
- Wolf E Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA
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Abstract
In this study, the authors aimed to investigate the reliability and validity of the Somatosensory Amplification Scale (SSAS) that was developed by Barsky et al. in the Turkish population. The study was carried out with 42 patients with Fibromyalgia Syndrome and Asthma Diseases attending to outpatient Physical Therapy and Rehabilitation and Chest Diseases clinics and 86 healthy students from Karadeniz Technical University. SSAS scores were normally distributed, and had acceptable test-retest reliability (r: 0.73) and internal consistency (alpha, 0.62-0.76). Item to scale correlations varied from 0.10 to 0.72, and most were highly significant. Whereas, one item (item 1) in the control group and one item (item 2) in the patients group had low item-total score correlation (r < 0.15). Criterion related validity of the SSAS was shown with significant correlation between the Symptom Interpretation Questionnaire, the Toronto Alexithymia Scale and the Symptom Check List 90 Revised somatization subscale. The validity analysis of the scale resulted in a very high significant difference (P < 0.01) between the mean SSAS scores of the control and patient's group. Test-retest, internal reliability, and item-total score correlation, discriminating power for specific groups and criterion related validity of the SSAS show that the scale has acceptable reliability and validity for the Turkish population.
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Affiliation(s)
- Hüseyin Güleç
- Istanbul Erenkoy Psychiatry Hospital, Istanbul, Turkey.
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Porcelli P, Tulipani C, Maiello E, Cilenti G, Todarello O. Alexithymia, coping, and illness behavior correlates of pain experience in cancer patients. Psychooncology 2007; 16:644-50. [PMID: 17094162 DOI: 10.1002/pon.1115] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper aimed to investigate the role played by key psychological factors in the experience of pain in cancer. One hundred and eight consecutive cancer patients were administered validated scales for pain, alexithymia, coping with cancer, and illness behavior. Two groups of patients with (n=45, 42%) and without (n=63, 58%) current pain were compared. Pain was associated to tumor sites and status, poor adjustment to cancer, and higher disease conviction and perception, but not to global alexithymia. However, the component of difficulty identifying feelings (DIF) of the alexithymia construct was significantly higher in pain patients compared to pain-free patients (t=2.88, p<0.01), constituted one of the independent predictors of pain (r=0.37; beta=0.27, p<0.01), and correlated with quality descriptors of pain (r=0.33, p<0.05). The present findings showed for the first time that although alexithymia was not globally related to cancer pain, the DIF component was however associated to pain dimensions, thus suggesting it might be involved in the way patients describe their pain experience, together with maladaptive coping and abnormal illness behavior. Cancer patients experiencing pain should be helped to adopt a more adaptive coping with the disease by identifying more accurately the source of their feelings.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy.
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Abstract
This paper considers the role of disturbances in affect regulation in the development and course of somatoform disorders. We first give an overview of contemporary theories in the field of psychosomatic medicine that links deficits in emotion regulation to the process of somatization, and then review recent empirical research that focuses on the association between affect regulation and somatoform disorders, with an emphasis on studies investigating the alexithymia construct. Overall, the findings suggest that somatoform disorders are linked to a diminished capacity to consciously experience and differentiate affects and express them in an adequate or healthy way. It must be noted, however, that this result has not been obtained exclusively for somatoform disorders. A promising approach to further our understanding of the developmental roots of impaired affect regulation in somatoform disorders is attachment research. The attachment research reviewed in this paper indicates that a dismissing status of attachment is linked to defensive forms of processing and expressing emotions. We present some new data that not only provide empirical support of a high proportion of dismissing attachment in somatoform disorders but also suggest that the degree to which somatoform disorder patients employ dismissing attachment strategies is strongly related to affect dysregulation. Finally, some implications for psychotherapeutic interventions in patients with somatoform disorders are considered.
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Affiliation(s)
- Elisabeth Waller
- Department of Psychosomatic and Psychotherapeutic Medicine, University Hospital of Freiburg, D-79104 Freiburg, Germany.
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Nakao M, Tamiya N, Yano E. Gender and Somatosensory Amplification in Relation to Perceived Work Stress and Social Support in Japanese Workers. Women Health 2005; 42:41-54. [PMID: 16418121 DOI: 10.1300/j013v42n01_03] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To examine gender-related differences in somatization among workers, 490 Japanese municipal office employees (248 women) completed the Medical Symptom Checklist, Somatosensory Amplification Scale (SSAS), and Profile of Mood States (POMS), along with questionnaires on their working environment. In women, SSAS scores were positively associated with perceived work stress, and negatively with social support levels (both p < 0.01). Female sex was significantly associated with SSAS scores (p < 0.01), controlling for the effects of total somatic symptom count, POMS tension-anxiety and depression scores, perceived working stress, and social support. The phenomenon of somatosensory amplification might be essential in estimating gender-specific symptoms in a working population.
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Affiliation(s)
- Mutsuhiro Nakao
- Dept. of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan.
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Abstract
BACKGROUND Previous research has yielded inconsistent findings on the relationship between personality characteristics and chronic pain. The present study examines measures of alexithymia, somatosensory amplification, attachment, counterdependency, and emotional distress in 140 consecutive general medical outpatients seen in psychiatric consultation. METHODS Forty-five subjects having no chronic pain (NP) were compared to 49 subjects with chronic pain restricted to their back and/or extremities (BE) and with 46 subjects having pain involving other regions of the body (OP). RESULTS Findings demonstrated marked counterdependency traits in the BE group relative to the other two groups. By contrast, traits of alexithymia and somatosensory amplification, insecure attachment, and a high level of emotional distress characterized the OP group. A multiple logistic regression model combining counterdependency and secure attachment was 86% accurate in predicting BE (c = 0.86). CONCLUSIONS The study's findings suggest that personality traits vary according to chronic pain location, although the nature of the relationship still needs to be determined.
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Affiliation(s)
- Robert J Gregory
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Mehling WE, Krause N. Are difficulties perceiving and expressing emotions associated with low-back pain? The relationship between lack of emotional awareness (alexithymia) and 12-month prevalence of low-back pain in 1180 urban public transit operators. J Psychosom Res 2005; 58:73-81. [PMID: 15771873 DOI: 10.1016/j.jpsychores.2004.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 05/26/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the association of alexithymia (deficit in emotional awareness) with 12-month prevalence of low back pain (LBP) cross-sectionally in a cohort study of 1180 San Francisco transit operators. METHODS Alexithymia was measured by the Toronto Alexithymia Scale (TAS-20). LBP was assessed in medical histories during drivers relicensing exams. Multivariate logistic regression analyses controlled for demographic, behavioral (smoking, alcohol, coping style), and physical and psychosocial job factors measured by questionnaire and interview. RESULTS Of all the drivers, 31.4% suffered from LBP. Scoring in the upper quartile of alexithymia summary scores was associated with twofold higher odds of LBP (adjusted odds ratio=2.00, 95% confidence interval: 1.31-3.00). The association was stronger in women (adj. OR=4.35) than in men (adj. OR=1.83). The factor "difficulty identifying feelings" showed the strongest association with LBP (adj. OR=2.23). CONCLUSION The results support an association between alexithymia and LBP.
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Affiliation(s)
- Wolf E Mehling
- Department of Family and Community Medicine, University of California-San Francisco, Campus Box 1726, 1701 Divisadero, #150, San Francisco, CA 94143-1726, USA
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Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia. J Psychosom Res 2004; 57:239-47. [PMID: 15507250 DOI: 10.1016/s0022-3999(03)00613-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Accepted: 10/21/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia. METHODS Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status. RESULTS Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA. CONCLUSION The findings highlight the important role of impaired affect regulation and NA in the process of somatization.
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Affiliation(s)
- Elisabeth Waller
- Department of Psychosomatic and Psychotherapeutic Medicine, University Hospital of Freiburg, Hauptstr. 8, D-79104, Freiburg, Germany.
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Portincasa P, Moschetta A, Baldassarre G, Altomare DF, Palasciano G. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. World J Gastroenterol 2003; 9:2293-9. [PMID: 14562396 PMCID: PMC4656481 DOI: 10.3748/wjg.v9.i10.2293] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Psychological factors, altered motility and sensation disorders of the intestine can be variably associated with irritable bowel syndrome (IBS). Such aspects have not been investigated simultaneously. The aim of this paper was to evaluate gastrointestinal motility and symptoms, psychological spectrum and quality of life in a large group of IBS patients in southern Italy.
METHODS: One hundred IBS patients (F:M = 73:27, age 48 ± 2 years, mean ± SE) fulfilling ROME II criteria matched with 100 healthy subjects (F:M = 70:30, 45 ± 2 years). Dyspepsia, bowel habit, alexithymia, psycho-affective profile and quality of life were assessed using specific questionnaires. Basally and postprandially, changes in gallbladder volumes and antral areas after liquid meal and orocaecal transit time (OCTT) were measured respectively by ultrasonography and H2-breath test. Appetite, satiety, fullness, nausea, and epigastric pain/discomfort were monitored using visual-analogue scales.
RESULTS: Compared with controls, IBS patients had increased dyspepsia (score 12.6 ± 0.7 vs 5.1 ± 0.2, P < 0.0001), weekly bowel movements (12.3 ± 0.4 vs 5.5 ± 0.2, P < 0.00001, comparable stool shape), alexithymia (score 59.1 ± 1.1 vs 40.5 ± 1.0, P = 0.001), poor quality of life and psycho-affective profile. IBS patients had normal gallbladder emptying, but delayed gastric emptying (T50: 35.5 ± 1.0 vs 26.1 ± 0.6 min, P = 0.00001) and OCTT (163.0 ± 5.4 vs 96.6 ± 1.8 min, P = 0.00001). Fullness, nausea, and epigastric pain/discomfort were greater in IBS than in controls.
CONCLUSION: ROME II IBS patients have a pan-enteric dysmotility with frequent dyspepsia, associated with psychological morbidity and greatly impaired quality of life. The presence of alexithymia, a stable trait, is a novel finding of potential interest to detect subgroups of IBS patients with different patterns recoveed after therapy.
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Affiliation(s)
- Piero Portincasa
- Section of Internal Medicine, Department of Internal and Public Medicine (DIMIMP), University of Bari Medical School, Bari, Italy.
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Friedman S, Vila G, Even C, Timsit J, Boitard C, Dardennes R, Guelfi JD, Mouren-Simeoni MC. Alexithymia in insulin-dependent diabetes mellitus is related to depression and not to somatic variables or compliance. J Psychosom Res 2003; 55:285-7. [PMID: 12932804 DOI: 10.1016/s0022-3999(02)00636-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the prevalence of alexithymia in insulin-dependent diabetic mellitus (IDDM) outpatients. To examine whether alexithymia is associated with diabetic somatic variables, depression, and compliance. METHOD Our sample comprised 69 diabetic outpatients followed in a university hospital. We assessed the prevalence of alexithymia (26-item Toronto Alexithymia Scale, TAS-26) and the relationships among alexithymia, depression (13-item Beck Depression Inventory, BDI-13), somatic diabetic variables (glycosylated hemoglobin, number of mild or severe hypoglycemia, somatic complications), and compliance (observer-rater scale completed by diabetologist). RESULTS The prevalence of alexithymia in IDDM patients was low (14.4%). Alexithymia and depression, as measured by TAS-26 and BDI-13 scores, respectively, correlated with each other. Alexithymia was not correlated with glycemic control, somatic complications, or compliance. CONCLUSION In our sample, alexithymia was related to depression and not to somatic factors or compliance.
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Affiliation(s)
- S Friedman
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Centre Hospitalier Sainte-Anne, Universi;té René Descartes Paris V, UFR Cochin Port-Royal, 1 rue Cabanis, 75674 Paris Cedex 14, France.
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Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res 2002; 53:823-30. [PMID: 12217458 DOI: 10.1016/s0022-3999(02)00337-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Alexithymia is elevated among patients with chronic pain, but the relationship of alexithymia to the severity of pain among chronic pain patients is unclear. Also, studies have rarely examined whether alexithymia is unique from other, more widely studied constructs in the chronic pain literature (i.e., self-efficacy, catastrophizing, and depression), and research has not examined how alexithymia relates to the sensory versus affective dimensions of pain. METHODS Among 80 patients with chronic myofascial pain, we tested how alexithymia (Toronto Alexithymia Scale-20) was related to three competing constructs--self-efficacy, catastrophizing, and depression--and to the sensory and affective dimensions of pain as well as physical impairment. We then determined whether alexithymia remained correlated with pain and impairment when tested simultaneously with each of the three competing constructs. RESULTS Analyses controlled for patients' sex, age, marital status, and duration of pain. Alexithymia was moderately correlated with less self-efficacy and greater catastrophizing, and substantially correlated with greater depression. Alexithymia was positively related to both affective pain and physical impairment, but was unrelated to sensory pain, whereas all three of the competing constructs were related to both types of pain as well as physical impairment. Regression analyses indicated that alexithymia remained a significant and independent correlate of affective pain severity while controlling for either self-efficacy or catastrophizing, but depression accounted for alexithymia's relationship with affective pain. Also, alexithymia was no longer related to physical impairment, after controlling for any of the other three constructs. CONCLUSION Although alexithymia is not related to the sensory component of pain, it is correlated positively with the affective or unpleasantness component of pain, independent of self-efficacy or catastrophizing. The emotional regulation deficits of alexithymia may lead to depression, which appears to mediate alexithymia's relationship to affective pain. Alexithymia's relationship with physical impairment appears to be better accounted for by self-efficacy or catastrophizing.
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Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, 71 West Warren Avenue, Detroit, MI 48202, USA.
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Nakao M, Barsky AJ, Kumano H, Kuboki T. Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic. PSYCHOSOMATICS 2002; 43:55-60. [PMID: 11927759 DOI: 10.1176/appi.psy.43.1.55] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P<0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P<0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.
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Affiliation(s)
- Mutsuhiro Nakao
- Center for Evidence-Based Medicine, Department of Hygiene and Public Health, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan.
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Aronson KR, Barrett LF, Quigley KS. Feeling your body or feeling badly: evidence for the limited validity of the Somatosensory Amplification Scale as an index of somatic sensitivity. J Psychosom Res 2001; 51:387-94. [PMID: 11448707 DOI: 10.1016/s0022-3999(01)00216-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Somatosensory Amplification Scale (SSAS) purports to measure the extent to which individuals are sensitive to their bodies. The present study examined the psychometric properties of the SSAS in two studies with university students. METHODS Participants completed the SSAS, various cross-sectional measures of somatic and psychological distress, longitudinal measures of somatic symptoms, daily hassles and mood, and participated in a heartbeat detection task (Study 2 only). RESULTS The SSAS was correlated with cross-sectional measures of somatic symptom reporting, but not with somatic symptoms reported on a daily basis nor with an index of interoceptive sensitivity. The SSAS was also correlated with several indices of general distress including anxious and depressive symptoms, daily hassles, and negative emotionality. CONCLUSION Taken together, the results suggest that the SSAS is more likely an index of negative emotionality and general distress than a valid measure of somatic sensitivity per se.
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Affiliation(s)
- K R Aronson
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA.
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Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamäki H. Alexithymia and Depression: A Prospective Study of Patients With Major Depressive Disorder. PSYCHOSOMATICS 2001; 42:229-34. [PMID: 11351111 DOI: 10.1176/appi.psy.42.3.229] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors conducted a 12-month follow-up study to determine the association between alexithymia and depression in 116 outpatients with major depressive disorder (MDD) and 540 control subjects from the general population. Alexithymia was screened using the Toronto Alexithymia Scale (TAS-20), and depression was assessed using the Beck Depression Inventory (BDI). The results show that the severity of depression was significantly associated with alexithymia. In addition, the BDI scores increased or decreased proportionately with the change in TAS-20 score in both groups. These results lend further support to the idea that alexithymia may be a state-dependent phenomenon.
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Affiliation(s)
- K Honkalampi
- Department of Psychiatry, Kuopio University Hospital, Finland.
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Bankier B, Aigner M, Bach M. Alexithymia in DSM-IV Disorder: Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression. PSYCHOSOMATICS 2001; 42:235-40. [PMID: 11351112 DOI: 10.1176/appi.psy.42.3.235] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.
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Affiliation(s)
- B Bankier
- Department of Psychiatry, University of Vienna, Austria.
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Gregory RJ, Manring J, Berry SL. Pain location and psychological characteristics of patients with chronic pain. PSYCHOSOMATICS 2000; 41:216-20. [PMID: 10849453 DOI: 10.1176/appi.psy.41.3.216] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors assessed psychological characteristics of 140 medical outpatients with chronic non-malignant pain referred for psychiatric consultation. Subjects completed the Toronto Alexithymia Scale, Somatosensory Amplification Scale (SSAS), and Counter-dependency Scale (CDS). The only psychological measure able to differentiate the chronic pain group from the control subjects was the CDS. However, SSAS scores were significantly higher in subjects having pain involving the head, chest, abdomen, or pelvis than in subjects having pain only in their backs or extremities. The latter subgroup had significantly higher CDS scores. The findings suggest that there are discrete subgroups within the chronic pain population defined by pain location and specific psychological characteristics.
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Affiliation(s)
- R J Gregory
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse 13210, USA
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Ernst H, Key JD, Koval MS. Alexithymia in an adolescent with agenesis of the corpus callosum and chronic pain. J Am Acad Child Adolesc Psychiatry 1999; 38:1212-3. [PMID: 10517052 DOI: 10.1097/00004583-199910000-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE Some reports have characterized patients with chronic pain as counterdependent, that is, having emotional suppression, idealization of relationships, strong work ethic, a caregiver role-identity, and self-reliance. However, research has been hampered because formal measures of these traits have been lacking. In this article, we describe a five-item self-report questionnaire, the Counterdependency Scale (CDS), designed to elicit each of these traits on a Likert scale. METHODS The CDS was administered to 150 consecutive patients evaluated in an outpatient psychiatry consultation program. RESULTS CDS scores were normally distributed and had significant interitem correlations and test-retest reliability (r = 0.68). As expected, subjects with chronic pain (N = 100) had higher mean CDS scores than those without chronic pain (t = 5.6, p = .000). CDS scores were independent of demographic variables and measures of anxiety, depression, alexithymia, and somatic amplification. CONCLUSIONS These results suggest that counterdependency can be described by a distinct and measurable cluster of traits associated with chronic pain.
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Affiliation(s)
- R J Gregory
- Outpatient Psychiatry Consultation Program, SUNY Health Science Center, Syracuse, New York 13210, USA
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