Stability in alexithymia levels: A longitudinal analysis on various emotional answers

Perceived stress and severity of depression mediate the association between alexithymia and suicidal ideation in patients with major depressive disorder

Introduction

Alexithymia and perceived stress have been recognized as risk factors for suicide in patients with major depressive disorder (MDD). However, few studies have been conducted to examine the relationship between these factors.

Methods

A cross-sectional study was conducted on 105 MDD patients. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale (TAS), perceived stress was assessed by the Perceived Stress Scale (PSS), severity of depression was assessed by the 17-item Hamilton Depression Rating Scale (HAMD), and suicidal ideation was assessed by the self-report Beck Scale for Suicide Ideation (SSI). A sequential mediation model was established to test the mediating effects of perceived stress and severity of depression on the association between alexithymia and suicidal ideation.

Results

81 of the 105 participants (77.14 %) had suicidal ideation. Patients with suicidal ideation had greater difficulty in identifying feelings (DIF) (p = 0.046), higher severity of depression (p = 0.005) and perceived stress (p = 0.003). DIF subscale score of TAS was associated with perceived stress (r = 0.292, p = 0.003), severity of depression (r = 0.349, p < 0.001) and suicidal ideation (r = 0.229, p = 0.012). Sequential mediation model showed that perceived stress and severity of depression mediated the effect of DIF on suicidal ideation.

Conclusions

This study suggests that perceived stress and severity of depression fully mediate the relationship between difficulty in identifying feelings and suicidal ideation in MDD patients.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.

Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts

INTRODUCTION

Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI).

METHODS

A literature search was conducted for original articles examining the general and psychiatric populations.

RESULTS

There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts.

CONCLUSION

The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.

The Prospective Influence of Trait Alexithymia on Intrusive Memories: What Is the Role of Emotional Recognition Memory?

Posttraumatic stress disorder (PTSD) is often considered to be a disorder of memory as patients suffer from fragmented uncontrollable memories (intrusions) whilst experiencing difficulties in intentionally retrieving details of the traumatic event. Recent research suggests that trait-related deficits in the identification of emotional states (alexithymia) may impact emotional memory processes in a way that promotes intrusion formation in PTSD. Therefore, we investigated the influence of alexithymia on intrusive re-experiencing and emotional recognition memory in a prospective analog study. Twenty-six healthy participants took part in a laboratory experiment, which combined two independent paradigms. Participants were exposed to a traumatic film (first session) and completed an episodic memory task comprising neutral and emotional stimuli (second session). In between sessions, participants recorded intrusive memories of the film. Individuals with higher trait alexithymia (HTA) reported an increased number of intrusions on the day of film presentation. Moreover, analyses of memory performance revealed a negative correlation between alexithymia and emotional recognition memory. Further analyses suggest that reduced emotional recognition memory, as evident in individuals with HTA, may, in turn, be associated with enhanced intrusive re-experiencing. As such, the current findings provide first indications regarding the role of alexithymia in emotional learning and PTSD. Future studies should further investigate these associations as well as potential implications for the treatment of PTSD.

Alexithymia and Its Associations With Depression, Suicidality, and Aggression: An Overview of the Literature

Depression affects around 4-10% of the general population in England. Depression can often lead to behaviors and thoughts related to suicide and aggression, which have a social and economic burden to the United Kingdom. One construct that has been theorized as having an association with these behaviors is alexithymia. People with alexithymia have difficulties identifying and describing their emotional experiences. To date, there is no consensus on types or causes of alexithymia. Whilst the literature evidences a strong relationship between alexithymia and suicidality and aggression, little is known about the nature of this relationship. The present article will attempt to describe the extant literature on this relationship, drawing out some of the contentions and unanswered questions.

The neurocognition of alexithymia: evidence from neuropsychological and neuroimaging studies

OBJECTIVE

Alexithymia refers to an ineffective regulation and expression of emotions. It constitutes a major risk factor for a range of medical and psychiatric problems, including chronic pain, somatisation, anxiety and depression. Alexithymia is a multi-faceted concept, described in terms of cognitive and affective aspects. From a neuropsychological perspective, alexithymia can be defined as a disturbance in affective information processing and social cognition. As the growing literature on brain structures involved in alexithymia is fragmented and sometimes even contradictory, the aim of this article was to review findings on neural substrates with regard to their convergence.

METHODS

A narrative review was performed, including both early neuropsychological and more recent imaging studies, in order to achieve a better understanding of the aetiology of alexithymia.

RESULTS

Corpus callosum, cingulate cortex and insula are clearly involved in alexithymia. The amygdala and the orbitofrontal part of the cortex appear to be implicated as mediators, because of their broader involvement in emotional processing and executive control.

CONCLUSION

Notwithstanding the diffuse neural representation, the alexithymia construct can be usefully applied in the clinical and empirical studies of social cognition, particularly when adopting a dimensional neuropsychological approach.

Direct and indirect effects of the temperament and character on alexithymia: a pathway analysis with mood and anxiety

OBJECTIVE

We aimed to assess the pathway from personality to alexithymia through mood and anxiety as mediators.

METHOD

Three hundred thirty-four subjects (130 male), whose psychiatric health was verified by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders, completed the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory, the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression scale (CES-D). The schematic models for the pathway analysis from Temperament and Character Inventory (TCI) to TAS-20 scores were made.

RESULTS

Low reward dependence (RD), low self-directedness (S-D), and high cooperativeness (CO) had paths to TAS-20 total (P = .000, P = .000, and P = .042, respectively). S-D had also an indirect path via STAI-state to TAS total. On TAS-20 factor 1, low RD, low S-D, and high self-transcendence (ST) had direct effects (P = .004, P = .000, and P = .000, respectively). S-D had also an indirect path via STAI-state and (CES-D) on TAS-20 factor 1. On TAS factor 2, low novelty seeking (NS), high harm avoidance (HA), low RD, low S-D, and high cooperativeness (CO) had direct effects (P = .005, P = .011, P = .000, P = .000, and P = .004, respectively). On TAS-20 factor 3, low RD and S-D had direct effects (P = .002 and P = .000, respectively).

CONCLUSION

Current results suggest that although alexithymia is affected by the personality, state-dependent mood and anxiety may mediate the relationship between alexithymia and personality.

The stability of alexithymia during work in a high-stress environment: a prospective study of Swedish peacekeepers serving in Kosovo

We applied a prospective design to reinvestigate the issue whether the sub-domains of alexithymia could be considered stable traits or distress-related states. Assessments of alexithymia and subjective distress were conducted before deployment to Kosovo in a sample of male peacekeepers. A second assessment was conducted approximately six months later during the final phase of service. The results showed evidence of moderate to high relative stability in all alexithymic sub-domains. It was also found that a relative change in subjective distress predicted a relative change in difficulty identifying feelings and difficulty describing feelings but not in externally oriented thinking. We suggest therefore that the alexithymic sub-domains could be considered relatively stable traits but that the level of difficulty identifying and describing feeling varies with the level of subjective distress.

Alexithymia and health-related quality of life in a general population

BACKGROUND

Alexithymia is thought to reflect a deficit in the cognitive processing of emotion, and, therefore, it may predispose individuals to both psychological and somatic symptoms.

OBJECTIVE

The authors investigated the relationship between alexithymia and health-related quality of life (HRQoL) in a nationally representative population sample of 5,418 subjects, age 30 to 97 years.

METHOD

Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and HRQoL measured with the 15D, a generic HRQoL measure.

RESULTS

Alexithymia was significantly associated with lower HRQoL independently of other variables. The TAS-20 subfactor Difficulties Identifying Feelings was the strongest common denominator between alexithymia and HRQoL.

CONCLUSION

Alexithymia may be a predisposing factor to poorer HRQoL.

Cortical augmenting in alexithymic subjects after unpleasant acoustic stimulation

OBJECTIVE

Alexithymia has a high prevalence in patients with chronic or somatoform pain disorders. Various investigations demonstrated a hypersensitivity and low tolerance of alexithymics to touch and painful stimulation. It was argued that alexithymic characteristics may lead an individual to augment stimuli in order to prevent ignoring stimuli that might be dangerous. Therefore, there may be a relation to the reducer-augmenter construct. To test this hypothesis, cortical reactivity in response to unpleasant acoustical stimulation was measured.

METHODS

Nineteen high alexithymics and 18 low alexithymics were stimulated with five series of acoustic stimuli (white noise) of different intensity levels. Evoked potentials were recorded at electroencephalogram electrodes Fz, Cz, and Pz.

RESULTS

With ascending stimulus intensities, both groups showed increasing P1-N1 and N1-P2 peak-to-peak amplitudes. High alexithymics had higher P1-N1 amplitudes and a stronger intensity-dependent slope of P1-N1 amplitude. In contrast to that, N1-P2 amplitude of low alexithymics tended to decrease in response to the highest stimulus intensity level.

CONCLUSION

High alexithymic subjects seem to behave like cortical augmenters. This may be due to a disturbed transmarginal inhibition, which may normally serve as a protective physiological mechanism.

Alexithymia and occupational burnout are strongly associated in working population

OBJECTIVE

The relationship between alexithymia and occupational burnout has not previously been studied. We investigated the association between alexithymia and occupational burnout in a representative nationwide population health study.

METHODS

This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 3322 employees aged 30-64 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and occupational burnout with the Maslach Burnout Inventory-General Survey. Sociodemographic and health-related variables including depression were treated as confounders in the logistic regression analyses, which were performed alternately with TAS-20 total score and the scores of the three TAS-20 factor scales as alexithymia variables.

RESULTS

Alexithymia and its three facets were significantly associated with occupational burnout even when controlled for confounding factors.

CONCLUSIONS

Even though both alexithymia and depression are associated with burnout, alexithymia may be an independent risk factor for occupational burnout.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Age is strongly associated with alexithymia in the general population

OBJECTIVE

We studied the prevalence of alexithymia, its distribution in different age groups in a wide age range, its association with sociodemographic and health-related variables, and its co-occurrence with depression.

METHODS

The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue.

RESULTS

The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression.

CONCLUSIONS

The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed.

Stability of alexithymia and its relationships with the 'big five' factors, temperament, character, and attachment style

BACKGROUND

Controversy still exists concerning the stability of the alexithymia construct. Also, although alexithymia has been found to be related in a theoretically meaningful way to other personality constructs such as the 'Big Five' factors, few studies have investigated its relationship with influential constructs such as temperament and character, and attachment security.

METHODS

Two hundred twenty-one undergraduate and graduate students were administered the Toronto Alexithymia Scale (TAS-20), the State-Trait Anxiety Inventory (STAI), the Zung Depression Scale (ZDS), the Temperament and Character Inventory (TCI-125), the Big Five Questionnaire (BFQ), and the Experiences in Close Relationships (ECR) questionnaire. After 1 month, 115 participants completed again the TAS-20, STAI, and ZDS.

RESULTS

Alexithymia was only moderately correlated with depression and anxiety. Both the absolute and relative stability of TAS-20 total and subscale scores was high, and a negligible portion of their change over time was accounted for by changes in depression or anxiety. In separate multiple regression models including also gender, age, depression and anxiety, TAS-20 total and subscale scores were correlated with low energy/extraversion, low emotional stability, openness, low friendliness/agreeableness; harm avoidance, low self-directedness, low cooperativeness, low reward dependence; attachment-related avoidance and anxiety.

CONCLUSIONS

Our findings lend support for both absolute and relative stability of alexithymia, corroborate an association between alexithymia and insecure attachment, and contribute to a coherent placing of alexithymia in the broader theoretical network of personality constructs.

Alexithymia: its prevalence and correlates in a British undergraduate sample

INTRODUCTION

Alexithymia is characterized by a difficulty identifying and describing emotional states, as well as an externally oriented thinking style. This study investigated the prevalence of alexithymia in a British undergraduate sample and assesses its relationship to both parental bonding and dissociation.

METHOD

The Toronto alexithymia scale (TAS-20), the Parental Bonding Instrument (PBI), and the Dissociative Experience Scale (DES) were administered to a sample of 181 male and 190 female undergraduate students from both arts and science subjects.

RESULTS

Rates of alexithymia were comparable with those observed in some other countries. Contrary to predictions, females were found to have higher rates than males, and the highest presence of alexithymia was in female science students. As in previous studies, alexithymia was linked to both dissociation and perceptions of a lack of maternal care, though the degree of association to the latter was small. Dissociative experiences were predicted by both maternal overprotection and difficulties identifying feelings.

DISCUSSION

Some qualified support was found for the relevance of early maternal bonding to later difficulties processing emotions. The presence of greater alexithymia in females, and female science students in particular, was discussed in reference to similar observations elsewhere. There was also an understandable relationship between 'difficulty identifying feelings' (TAS) and both depersonalization/derealization and absorption (DES).

Temporal stability and differential relationships with neuroticism and extraversion of the three subscales of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples

OBJECTIVES

To examine the cross-sample and temporal stability of the three subscales of the 20-item Toronto Alexithymia Scale (TAS-20) and to study the pattern of associations between the TAS-20 scales, neuroticism, and alexithymia.

METHODS

Two clinical and three nonclinical samples were included in the cross-sectional part of the study. One clinical and one nonclinical sample also participated in the 6-month follow-up study. To test the replicability of the three-factor structure of the TAS-20 across samples, a principal component analysis was conducted, followed by a Procrustes rotation. Linear regression analyses were conducted to examine temporal stability and to determine the specificity of the associations among the TAS-20 scales, neuroticism, and extraversion.

RESULTS

The three-factor structure of the TAS-20 was confirmed across all five samples. With a few exceptions, neuroticism and extraversion attained a higher level of temporal stability than the alexithymia scales. The TAS-subscale measuring difficulty identifying feelings (DIF) was less stable in the clinical than in the nonclinical sample. Neuroticism was most strongly associated with DIF, whereas extraversion was mainly related to externally oriented thinking (EOT). A combination of both neuroticism and extraversion was the best predictor of difficulty describing feelings (DDF).

CONCLUSIONS

Future studies on the psychometric properties and the clinical value of the TAS-20 should pay more attention to its subscales. Especially the EOT facet needs further examination.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Stability of neuroticism and alexithymia in somatization

The personality traits neuroticism and alexithymia have been hypothesized as predisposing factors for somatization. Stability over time is a basic assumption underlying any trait construct. Although there are considerable (and sometimes conflicting) data relevant to this issue, the stability of neuroticism and alexithymia has not been assessed in somatization. The main purpose of this study was to examine the temporal stability of neuroticism and alexithymia in patients presenting to their primary care physician with medically unexplained symptoms, and compare this to the stability of negative and positive affect, anxiety, and depression. A total number of 318 patients were assessed at baseline and at 6-months follow-up. Whereas the affective state dimensions changed significantly over the follow-up period, neuroticism and alexithymia were substantially stable.

Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies

OBJECTIVE

To review neurobiological studies of alexithymia in order to achieve a better understanding of the relationship between alexithymia and psychosomatic diseases and psychiatric illnesses.

METHODS

Neurobiological studies of alexithymia were reviewed with a special focus on how emotional and cognitive elements of alexithymia are reflected in earlier research.

RESULTS

Studies that have correlated alexithymia to corpus callosum dysfunctioning have mainly found impairments in cognitive characteristics of alexithymia, whereas from studies of right hemisphere and frontal lobe deficits, it may be concluded that both cognitive and emotional characteristics of alexithymia are impaired.

CONCLUSION

The fact that there is no general agreement on how to define alexithymia seems to have hampered theoretical and empirical progress on the neurobiology of alexithymia and related psychosomatic diseases and psychiatric illnesses. Alexithymia should no longer be approached as one distinct categorical phenomenon and follow-up studies should monitor subjects according to both the cognitive and emotional characteristics of alexithymia.

Alexithymia--state or trait?

Alexithymia refers to a specific disturbance in emotional processing that is manifested by difficulties in identifying and verbalizing feelings and a tendency to focus on and amplify the somatic sensations that accompany emotional arousal. Alexithymia is conceptualized both as an affect-deficit disorder and a continuous personality variable. The main purpose of the present study was to investigate the stability levels of alexithymia with regard to changes in emotional distress levels caused by university exams. We tested 20 university students at four different times, before and after the exams. Alexithymic features and self-reported emotional distress (trait anxiety and physical symptoms) were measured. Whereas emotional distress measures changed significantly during the diverse phases, the level of alexithymia remained unchanged. We therefore conclude that alexithymia represents a constant trait.

Psychophysiological Response Patterns of High and Low Alexithymics Under Mental and Emotional Load Conditions

Abstract Compared to normals or low alexithymics, high alexithymic subjects show a modified psychophysiological reactivity under experimental stress. This study aims to differentiate these effects under different load conditions (mental vs. emotional load, 5min each). High (N = 33) and low (N = 33) alexithymic subjects were identified by the German version of the Toronto-Alexithymia-Scale (TAS-20). Subjects were exposed to two tasks of the continuous performance test as a mental load condition and two unpleasant movie sequences as an emotional load condition. Heart rate and electrodermal activity (nonspecific skin conductance reactions) were continuously recorded during stimuli presentation. High alexithymic subjects showed a decreased number of nonspecific skin conductance reactions under all load conditions compared to low alexithymics. Initial heart rate acceleration of high alexithymic subjects under mental load was stronger, whereas under emotional load high alexithymic subjects showed a stronger initial heart rate deceleration. Results are discussed with respect to a modified processing of emotionally qualified information in alexithymics.

Recent developments in alexithymia theory and research

OBJECTIVE

To review recent developments in alexithymia theory and research that are relevant to the field of psychosomatic medicine.

METHOD

Articles were selected from the alexithymia literature published over the past decade that describe advances in the theoretical understanding of alexithymia or report empirical investigations of the relationships of the construct with emotion regulation and with somatic illness and disease. Empirical investigations of the neural correlates of alexithymia were reviewed also, as were studies that explore therapeutic attempts to modify alexithymic characteristics.

RESULTS

The salient features of the alexithymia construct are now thought to reflect deficits in the cognitive processing and regulation of emotions. This is supported by studies showing that alexithymia is associated with maladaptive styles of emotion regulation, low emotional intelligence, a bidirectional interhemispheric transfer deficit, and reduced rapid eye movement (REM) density (number of eye movements divided by number of REM periods). Although empirical evidence demonstrates that alexithymia is associated with several somatic disorders, more prospective studies are required to establish the direction of causality. Preliminary data suggest that psychotherapies involving specific techniques to enhance emotional awareness and integrate symbolic and subsymbolic elements of emotion schemas may be effective in reducing alexithymic characteristics.

CONCLUSION

Alexithymia is proving to be a heuristically useful construct for exploring the role of personality and emotions in the pathogenesis of certain somatic illnesses and diseases.