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Kick L, Schleicher D, Ecker A, Kandsperger S, Brunner R, Jarvers I. Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Front Psychiatry 2024; 15:1412229. [PMID: 39011338 PMCID: PMC11246998 DOI: 10.3389/fpsyt.2024.1412229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions. Methods In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated. Results The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse. Discussion These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.
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Affiliation(s)
- Lorenz Kick
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stephanie Kandsperger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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2
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Kindermann D, Rollmann I, Orth M, Friederich HC, Nikendei C. Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy. Psychother Res 2024; 34:774-789. [PMID: 37706484 DOI: 10.1080/10503307.2023.2254917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy. We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor. The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate. Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.
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Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Orth
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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3
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Craparo G, La Rosa VL, Commodari E, Marino G, Vezzoli M, Faraci P, Vicario CM, Cinà GS, Colombi M, Arcoleo G, Severino M, Costanzo G, Gori A, Mangiapane E. What Is the Role of Psychological Factors in Long COVID Syndrome? Latent Class Analysis in a Sample of Patients Recovered from COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010494. [PMID: 36612816 PMCID: PMC9819212 DOI: 10.3390/ijerph20010494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 05/24/2023]
Abstract
Background: This study aimed to identify clusters of long COVID-19 symptoms using latent class analysis and investigate the psychological factors involved in the onset of this syndrome. Method: Five hundred and six subjects recovering from COVID-19 completed a series of standardized questionnaires to evaluate the personality traits, alexithymia, and post-traumatic stress. Results: Five classes were identified: Brain fog (31.82%), No symptoms (20.95%), Sensory disorders (18.77%), Breath impairment (17.59%), and Multiple disorders (10.87%). Women reported post-COVID-19 respiratory symptoms and multiple disorders to a greater extent than men. Hospitalized subjects were more likely to report persistent symptoms after COVID-19 than asymptomatic or home-treated subjects. Antagonism, hyperarousal, and difficulty identifying emotions significantly predicted post COVID-19 symptoms. Conclusions: These findings open new questions for research on long COVID-19 and how states of emotional dysregulation can alter the physiological processes of the body and contribute to the onset of organic pathologies.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | | | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Graziella Marino
- IRCCS—Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Michela Vezzoli
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Palmira Faraci
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98122 Messina, Italy
| | - Gabriella Serena Cinà
- Department of Psychology, U.O.C., Azienda Sanitaria Provinciale Trapani, 91100 Trapani, Italy
| | | | | | | | - Giulia Costanzo
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | - Alessio Gori
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
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4
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Porcelli P, De Carne M, Leandro G. Distinct associations of DSM-5 Somatic Symptom Disorder, the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) and symptom severity in patients with irritable bowel syndrome. Gen Hosp Psychiatry 2020; 64:56-62. [PMID: 32199282 DOI: 10.1016/j.genhosppsych.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/26/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The clinical management of high symptom severity is a challenging task with patients with functional somatic disorders. We investigated the extent to which DCPR-revised (DCPR-R) syndromes and the DSM-5 category of Somatic Symptom Disorder (SSD) were able to predict symptom severity in 203 consecutive tertiary care patients with irritable bowel syndrome (IBS). METHOD Semistructured interview were used for assessing DCPR-R and validated scales for SSD (combining PHQ-12 and WI-7), severity of symptoms (IBS-SSS), psychological distress (HADS), and psychosocial functioning (SF-12). RESULTS Compared to moderate severity (IBS-SSS = 175-300), patients in the high range of severity (IBS-SSS > 300) had significantly more DCPR-R syndromes (particularly alexithymia and persistent somatization), higher psychological distress, and poorer psychosocial functioning, but showed no difference for SSD. DCPR-R, particularly alexithymia and persistent somatization, significantly and independently predicted IBS severity by explaining 18.5% of the IBS-SSS variance with large effect size (d = 1.18), after controlling for covariables. Conversely, SSD was not able to significantly predict IBS severity. CONCLUSIONS This study highlights the need of an integrative approach in the medical setting. Psychosomatic factors play a relevant role in the individual perception of symptom severity and should be carefully evaluated for clinical management of functional syndromes.
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Affiliation(s)
- Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University of Chieti, Italy.
| | - Massimo De Carne
- Department of Gastroenterology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy
| | - Gioacchino Leandro
- Department of Gastroenterology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy
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5
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Fournier A, Mondillon L, Dantzer C, Gauchez AS, Ducros V, Mathieu N, Faure P, Canini F, Bonaz B, Pellissier S. Emotional overactivity in patients with irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13387. [PMID: 29856118 DOI: 10.1111/nmo.13387] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients' vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters. METHODS We assessed the emotional facial expressions (EMFACS), psychological (anxiety, depression, alexithymia), and neurophysiological (cortisol, heart rate variability (HRV)) parameters of 25 IBS patients and 26 healthy controls (HC) while they watched fear-eliciting movie extracts. KEY RESULTS Overall, the task elicited an increase in state anxiety and consistent HRV responses. However, IBS patients differed from HC as they displayed more sadness and tended to display more rage. Contrary to HC, IBS patients showed an increase in heart rate and a decrease in parasympathetic regulation, reflecting an enhanced responsiveness corroborated by higher scores in depression and state anxiety. Consistent with their higher difficulty in identifying feelings, a component of alexithymia positively correlated with their expressions of rage, they were not aware of their increase in anxiety during the task, whereas HC were. No linear relationship between patients' expressions and their neurophysiological responses was found. CONCLUSIONS & INFERENCES Irritable bowel syndrome patients displayed greater emotional expressiveness with negative prevalence. This reflects an emotional vulnerability potentially related to low regulation skills and underscores the importance of considering the central dysregulation hypothesis in IBS as a promising avenue of research.
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Affiliation(s)
- A Fournier
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - L Mondillon
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - C Dantzer
- Laboratory of Psychology, Bordeaux University, Bordeaux, France
| | - A-S Gauchez
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - V Ducros
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - N Mathieu
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France
| | - P Faure
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France
| | - F Canini
- Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France
| | - B Bonaz
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France.,Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France.,Grenoble Institute of Neurosciences (GIN), INSERM, University Grenoble Alpes, Grenoble, France
| | - S Pellissier
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
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6
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Kano M, Endo Y, Fukudo S. Association Between Alexithymia and Functional Gastrointestinal Disorders. Front Psychol 2018; 9:599. [PMID: 29922191 PMCID: PMC5996925 DOI: 10.3389/fpsyg.2018.00599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/10/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Michiko Kano
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
- Behavioral Medicine, Graduated School of Medicine, Tohoku University, Sendai, Japan
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Yuka Endo
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Behavioral Medicine, Graduated School of Medicine, Tohoku University, Sendai, Japan
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
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7
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Carrozzino D, Porcelli P. Alexithymia in Gastroenterology and Hepatology: A Systematic Review. Front Psychol 2018; 9:470. [PMID: 29681874 PMCID: PMC5897673 DOI: 10.3389/fpsyg.2018.00470] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation. Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies. Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10-15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings. Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University “G.d'Annunzio” of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, University “G.d'Annunzio” of Chieti-Pescara, Chieti, Italy
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8
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Eiroa-Orosa FJ, Rodriguez-Urrutia A, Accarino A, Santamarina-Perez P, Parramon G, Azpiroz F. An exploratory study comparing psychological profiles and its congruence with clinical performance among patients with functional or motility digestive disorders. J Health Psychol 2016; 21:2590-2599. [PMID: 25921480 DOI: 10.1177/1359105315581069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Functional gastrointestinal disorders have been related with different psychological conditions. On the contrary, the role of psychological factors within gastrointestinal motor disorders remains unclear. The objective of this study was to explore the differences and congruence with clinical performance of the psychological profile and subjective functionality among patients diagnosed with functional gastrointestinal disorders and gastrointestinal motor disorders. Using a double-blind design, 56 inpatients from a Gastroenterology Department were included in the study. No major differences were detected between the two groups. However, clinical performance was coherent with subjective physical functioning only among patients diagnosed with gastrointestinal motor disorders. These results may provide useful information for gastroenterologists dealing with patients' complaints not consistent with their clinical profile.
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Affiliation(s)
| | | | - Anna Accarino
- 2 Universitat Autònoma de Barcelona, Spain.,3 CIBEREHD, Spain
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9
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Craparo G, Gori A, Dell'Aera S, Costanzo G, Fasciano S, Tomasello A, Vicario CM. Impaired emotion recognition is linked to alexithymia in heroin addicts. PeerJ 2016; 4:e1864. [PMID: 27069803 PMCID: PMC4824882 DOI: 10.7717/peerj.1864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/09/2016] [Indexed: 11/20/2022] Open
Abstract
Several investigations document altered emotion processing in opiate addiction. Nevertheless, the origin of this phenomenon remains unclear. Here we examined the role of alexithymia in the ability (i.e., number of errors—accuracy and reaction times—RTs) of thirty-one heroin addicts and thirty-one healthy controls to detect several affective expressions. Results show generally lower accuracy and higher RTs in the recognition of facial expressions of emotions for patients, compared to controls. The hierarchical multivariate regression analysis shows that alexithymia might be responsible of the between groups difference with respect to the RTs in emotion detection. Overall, we provide new insights in the clinical interpretation of affective deficits in heroin addicts suggesting a role of alexithymia in their ability to recognize emotions.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Alessio Gori
- Department of Human Sciences-Lumsa University of Rome, Italy; Department of Education and Psychology-University of Florence, Italy
| | | | - Giulia Costanzo
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Silvia Fasciano
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Antonia Tomasello
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Carmelo M Vicario
- Wolfson Centre for Clinical and Cognitive Neuroscience, School of Psychology, Bangor University, Bangor, United Kingdom; School of Psychology, University of Tasmania, Tasmania, Australia
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10
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Alkan Härtwig E, Crayen C, Heuser I, Eid M. It's in the mix: psychological distress differs between combinations of alexithymic facets. Front Psychol 2014; 5:1259. [PMID: 25429275 PMCID: PMC4228974 DOI: 10.3389/fpsyg.2014.01259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/17/2014] [Indexed: 11/25/2022] Open
Abstract
Alexithymia is a personality trait characterized by difficulties in identifying, describing, and communicating one's emotions. The aim of the present study is to examine the usefulness of a typological approach considering the interaction between distinct alexithymic features within a population of high-alexithymic German adults (N = 217). Latent profile analysis (LPA) was employed to test for possible underlying profiles. A 3-profile solution showed the best fit: The profiles can be described as (1) "low": lower load on all facets of alexithymia, (2) "mixed": specific problems on identifying emotions, and (3) "high": higher load on all facets of alexithymia. Moreover, this study tested how these profiles differed in psychological distress. "Mixed" profile, with specific problems on identifying emotions showed the highest levels of psychological distress. The present study suggests the importance of a specific combination of alexithymic features, rather than total alexithymia scores, as a risk factor for psychological distress.
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Affiliation(s)
- Elif Alkan Härtwig
- Cluster of Excellence “Languages of Emotion,” Freie Universität BerlinBerlin, Germany
- Department of Psychiatry, Charitè University MedicineBerlin, Germany
| | - Claudia Crayen
- Department of Education and Psychology, Freie Universität BerlinBerlin, Germany
| | - Isabella Heuser
- Cluster of Excellence “Languages of Emotion,” Freie Universität BerlinBerlin, Germany
- Department of Psychiatry, Charitè University MedicineBerlin, Germany
| | - Michael Eid
- Cluster of Excellence “Languages of Emotion,” Freie Universität BerlinBerlin, Germany
- Department of Education and Psychology, Freie Universität BerlinBerlin, Germany
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11
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Bahmani M, Zargaran A, Rafieian-Kopaei M. Identification of medicinal plants of Urmia for treatment of gastrointestinal disorders. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2014. [DOI: 10.1016/j.bjp.2014.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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12
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Phillips K, Wright BJ, Kent S. Psychosocial predictors of irritable bowel syndrome diagnosis and symptom severity. J Psychosom Res 2013; 75:467-74. [PMID: 24182637 DOI: 10.1016/j.jpsychores.2013.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study explored the role of psychosocial factors in predicting both membership to either an irritable bowel syndrome (IBS) or control group, and the severity of IBS symptoms. METHODS A total of 149 participants (82 IBS and 67 controls) completed a battery of self-report inventories assessing disposition and environment, cognitive processes, and psychological distress. Logistic regression analyses were used to assess predictive contribution of psychosocial variables to IBS diagnosis. Hierarchical linear regression was then used to assess the relationship of psychosocial variables with the severity of IBS symptoms. RESULTS Significant predictors of IBS were found to be alexithymia, the defectiveness/shame schema, and four coping dimensions (active coping, instrumental support, self-blame, and positive reframing), χ(2) (6, N=130)=46.99, p<.001, with predictive accuracy of 72%. Significant predictors of IBS symptom severity were two of the alexithymia subscales (difficulty identifying feelings, and difficulty describing feelings), gender, the schemas of defectiveness/shame and entitlement, and global psychological distress. This model predicted IBS severity F (6, 64)=16.94, p<.001 and accounted for 61.3% of the variability in IBS severity scores. CONCLUSION Psychosocial variables account for a large percentage of the differences between an IBS and control group, as well as the variance of symptoms experienced within the IBS group. Alexithymia and the defectiveness schema appear to be related to both IBS and symptom severity.
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Affiliation(s)
- Kristy Phillips
- School of Psychological Science, La Trobe University, Melbourne, Australia
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13
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Jones MP, Coppens E, Vos R, Holvoet L, Luyten P, Tack J, Van Oudenhove L. A multidimensional model of psychobiological interactions in functional dyspepsia: a structural equation modelling approach. Gut 2013; 62:1573-80. [PMID: 22917658 DOI: 10.1136/gutjnl-2012-302634] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Gastric sensorimotor function, abuse history, 'trait' and 'state' psychological factors and 'somatisation' all play a role in functional dyspepsia (FD) and its associated impaired quality of life (QoL), but their interplay remains poorly understood. We aimed to test a comprehensive, a priori hypothesised model of interactions between these dimensions in FD. DESIGN In 259 FD patients, we studied gastric sensitivity with a barostat. We measured abuse history (sexual/physical, childhood/adulthood), 'trait' (alexithymia, trait anxiety) and 'state' (positive/negative affect, depression, panic disorder) psychological factors, somatic symptom reporting (somatic symptom count, dyspepsia, irritable bowel syndrome and fatigue symptoms) and QoL (physical, mental) using validated questionnaires. Confirmatory factor analysis (CFA) was used to assess whether four a priori hypothesised latent variables ('abuse', 'trait affectivity', 'state affect' and 'somatic symptom reporting') were adequately supported by the data. Structural equation modelling (SEM) was used to test the a priori hypothesised relationships between these latent variables and the observed variables gastric sensitivity and QoL. RESULTS Both the CFA and SEM models fitted the data adequately. Abuse exerted its effect directly on 'somatic symptom reporting', rather than indirectly through psychological factors. A reciprocal relationship between 'somatic symptom reporting' and 'state affect' was found. Gastric sensitivity influences 'somatic symptom reporting' but not vice versa. 'Somatic symptom reporting' and 'trait affectivity' are the main determinants of physical and mental QoL, respectively. CONCLUSIONS We present the first comprehensive model elucidating the complex interactions between multiple dimensions (gastric sensitivity, abuse history, 'state' and 'trait' psychological factors, somatic symptom reporting and QoL) in FD.
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Affiliation(s)
- Michael P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
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14
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Ogrodniczuk JS, Sochting I, Piper WE, Joyce AS. A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program. Psychol Psychother 2012; 85:278-91. [PMID: 22903919 DOI: 10.1111/j.2044-8341.2011.02032.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning. DESIGN AND METHODS Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms. RESULTS Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period. CONCLUSIONS The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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van der Veek SM, Derkx H, de Haan E, Benninga MA, Boer F. Emotion awareness and coping in children with functional abdominal pain: A controlled study. Soc Sci Med 2012; 74:112-9. [DOI: 10.1016/j.socscimed.2011.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/28/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022]
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Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res 2011; 190:43-8. [PMID: 20471096 DOI: 10.1016/j.psychres.2010.04.026] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 03/18/2010] [Accepted: 04/18/2010] [Indexed: 10/19/2022]
Abstract
Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Suite 420 - 5950 University Boulevard, Vancouver, BC, Canada.
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Kent LK, Blumenfield M. Psychodynamic psychiatry in the general medical setting. ACTA ACUST UNITED AC 2011; 39:41-62. [PMID: 21434742 DOI: 10.1521/jaap.2011.39.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For more than half a century analytically trained psychiatrists have been making observations about psychodynamic factors impacting on medical illness and treatment. Some of these reports have been subsequently supported by evidence-based research while others have been found to be clinically useful to varying degrees even if not substantiated by research. In this article we have presented some of the highlights of the application of psychodynamics to the treatment of physical illness in the general medical setting. It is not meant to be a comprehensive review but we hope it will demonstrate how psychodynamic thinking has permeated many aspects of care in the general medical setting. Topics considered include onset of disease (giving up complex, specificity, role of stress, anniversary reactions), reactions to illness (psychological defenses, fantasies, role of psychotherapy), specific conditions (pregnancy, cancer, human immunodeficiency virus, conversion and alexithymia, heart disease, death and dying), and the doctor-patient relationship.
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Affiliation(s)
- Laura K Kent
- Columbia Presbyterian Medical Center/New York State Psychiatric Institute, New York, NY 10032, USA.
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Der Einfluss von Alexithymie auf Behandlungsverlauf und -ergebnis von Psychotherapie: Eine programmatische Überprüfung. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2011. [DOI: 10.13109/grup.2011.47.2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thorberg FA, Young RM, Sullivan KA, Lyvers M, Connor JP, Feeney GF. A psychometric comparison of the Toronto Alexithymia Scale (TAS-20) and the Observer Alexithymia Scale (OAS) in an alcohol-dependent sample. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2010.03.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leweke F, Bausch S, Leichsenring F, Walter B, Stingl M. Alexithymia as a predictor of outcome of psychodynamically oriented inpatient treatment. Psychother Res 2010; 19:323-31. [PMID: 20183393 DOI: 10.1080/10503300902870554] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This naturalistic study aimed to determine whether the initial degree of alexithymia can predict treatment outcome of psychodynamically oriented multimodal therapy. The Toronto Alexithymia Scale-26, the Global Severity Index (GSI), and the Depression subscale of the Symptom Checklist-90-Revised were administered at hospital admission and at discharge to 480 inpatients with various psychological disorders. GSI and depressive symptoms decreased significantly during treatment. High initial alexithymia total scores significantly predicted treatment outcome, especially in patients with somatoform disorders. Difficulties in verbalizing feelings had the strongest association with less favourable symptom improvement. Although significant, the predictive values were relatively small, and patients with alexithymia indeed benefited from therapy. Implications of these results are discussed for the specificity of disorders and therapeutic approach.
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Affiliation(s)
- Frank Leweke
- Clinic for Psychosomatic Medicine and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
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Banovic I, Gilibert D, Olivier M, Cosnes J. L’observance et certains de ses déterminants dans les maladies inflammatoires chroniques de l’intestin (MICI). PRAT PSYCHOL 2010. [DOI: 10.1016/j.prps.2009.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults. DESIGN Cross-sectional. PARTICIPANTS One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment. MEASURES Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II). RESULTS Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores. CONCLUSION The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.
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Thorberg FA, Young RM, Sullivan KA, Lyvers M. Alexithymia and alcohol use disorders: a critical review. Addict Behav 2009; 34:237-45. [PMID: 19010601 DOI: 10.1016/j.addbeh.2008.10.016] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 09/03/2008] [Accepted: 10/15/2008] [Indexed: 01/18/2023]
Abstract
All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional "deficits' is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed.
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Affiliation(s)
- Fred Arne Thorberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
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Bodini B, Mandarelli G, Tomassini V, Tarsitani L, Pestalozza I, Gasperini C, Lenzi GL, Pancheri P, Pozzilli C. Alexithymia in multiple sclerosis: relationship with fatigue and depression. Acta Neurol Scand 2008; 118:18-23. [PMID: 18162056 DOI: 10.1111/j.1600-0404.2007.00969.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of alexithymia in a sample of patients with multiple sclerosis (MS) and to further evaluate the association between alexithymia and the occurrence of common disabling MS-related symptoms such as fatigue and depression. METHODS Fifty-eight relapsing-remitting MS patients treated with interferon (IFN)-beta-1a underwent a complete neurological evaluation, including Expanded Disability Status Scale score assessment. Alexithymia, depressive symptoms and fatigue were assessed using the 20-item Toronto Alexithymia Scale, Beck Depression Inventory and Fatigue Severity Scale. RESULTS Prevalence of alexithymia was 13.8%, with 27.6% of patients presenting borderline alexithymia. Sixty-seven per cent of the patients complained of fatigue while 29.3% of them were depressed. Higher levels of fatigue and depression were found in alexithymic patients when compared with non-alexithymic patients. Results from logistic regressions showed that alexithymia significantly contributes to the severity of fatigue and depression. CONCLUSIONS Alexithymia was associated with increased severity of fatigue and depression.
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Affiliation(s)
- B Bodini
- Department of Neurological Sciences, Sapienza University of Rome, Italy
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Farinelli M, Ercolani M, Trombini G, Bortolotti M. Gastroesophageal reflux disease: alexithymia and attachment style. Percept Mot Skills 2007; 105:347-50. [PMID: 17918582 DOI: 10.2466/pms.105.1.347-350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Alexithymia and its relation with attachment style were evaluated in a group of 69 patients (men, M age = 46.4 yr., SD = 12.6; women, M age = 44.2 yr., SD = 14.4) affected by Gastroesophageal Reflux Disease. Two self-evaluation questionnaires were used for psychological evaluation, the 20 item Toronto Alexithymia Scale (TAS-20) and the Attachment Style Questionnaire (ASQ). The TAS-20 analysis showed that the clinical sample taken as a whole did not score in the alexithymic range. The inverse correlations between the Confidence ASQ subscale and the Difficulty Communicating Feelings TAS-20 subscale showed that communication of emotions could develop more easily within the framework of a relational context characterized by safety and confidence. In this group of patients this was represented by the referent caregiver.
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26
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Kano M, Hamaguchi T, Itoh M, Yanai K, Fukudo S. Correlation between alexithymia and hypersensitivity to visceral stimulation in human. Pain 2007; 132:252-263. [PMID: 17360119 DOI: 10.1016/j.pain.2007.01.032] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 01/23/2007] [Accepted: 01/23/2007] [Indexed: 01/21/2023]
Abstract
Empirical studies indicate that alexithymia exacerbates physical illness. However, direct evidence to explain the mechanism of this exacerbation has not been provided. One hypothesis is that alexithymics amplify unpleasant internal signals. In the present study, we investigated how alexithymia influences sensitivity to visceral stimulation in human. In 45 non-clinical healthy subjects (34 males and 11 females), brain processing of visceral sensation induced by colonic distension was examined using H(2)(15)O positron emission tomography (PET). Subjective feeling evaluated on an ordinate scale and neuroendocrine response to stimuli were also measured. The degree of alexithymia was determined using the 20-item of Toronto alexithymia scale (TAS-20), and the correlation between reaction to stimuli and the scores of TAS-20 and its three subscales [difficulty to identify feelings (DIF), difficulty to describe feelings (DDF) and external oriented thinking (EOT)] was evaluated. Greater activation was observed during colonic distension in the pregenual anterior cingulate cortex, right insula and midbrain in the 10 (out of 45) subjects that were identified as alexithymic by TAS-20 scores larger than 61. TAS-20 scores positively correlated with both activity in the right insula and orbital gyrus and adrenaline levels in the blood in response to stimulation. Subjects with high scores of DIF perceived strong pain, urgency for defecation, stress, anxiety, and slight sleepiness. The present study demonstrates that alexithymia is associated with hypersensitivity to visceral stimulation. This finding supports the somatosensory amplification hypothesized in alexithymics and is important to elucidate the influence of alexithymia on brain-gut function, particularly to understand the pathophysiology of FGIDs (functional gastrointestinal disorders).
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Affiliation(s)
- Michiko Kano
- Behavioral Medicine, Tohoku University School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan Department of Psychosomatic Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan Cyclotron Radioisotope Center, Tohoku University, Sendai, Japan Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan
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Abstract
Visceral hypersensitivity (perception of gastrointestinal sensory events at a lower-than-normal threshold) is considered to be an important pathophysiological mechanism in the development of functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, non-cardiac chest pain and functional dyspepsia. These disorders are associated with significant health care and socioeconomic costs due to factors such as repeated visits to consultants, hospitalizations and work absenteeism. Despite the presence of extensive evidence linking visceral hypersensitivity and FGIDs, the mechanism(s) underlying visceral hypersensitivity has not been fully elucidated. Suggested hypotheses include sensitization of afferent neurones, both at the level of the enteric and the (afferent) autonomic nervous system (peripheral sensitization), sensitization of spinal cord dorsal horn neurones (central sensitization) and psychosocial factors/psychiatric comorbidity influencing the processing of afferent signals at the level of the brain. Importantly, these hypotheses may be complementary rather than mutually exclusive. However, the degree to which each of these mechanisms contributes to the overall perception of visceral pain, and therefore the generation of symptoms, still remains unclear. This article discusses the mechanisms that may underlie visceral hypersensitivity, with reference to FGIDs. Understanding these mechanisms is essential in order to improve the diagnosis and treatment of patients with these disorders.
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Affiliation(s)
- P Anand
- Peripheral Neuropathy Unit, Department of Clinical Neuroscience, Imperial College London, London, UK
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Saarijarvi S, Salminen JK, Toikka T. Temporal stability of alexithymia over a five-year period in outpatients with major depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:107-12. [PMID: 16508346 DOI: 10.1159/000090895] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous research on alexithymia and depression has led to a controversy over whether alexithymia should be viewed as a state-dependent phenomenon or as a stable personality trait. The aim of this 5-year follow-up study was to examine the temporal stability of alexithymia in outpatients suffering from major depression. METHODS The study population comprised 116 (49 male and 67 female) outpatients with major depression. Alexithymic features were assessed with the Toronto Alexithymia Scale (TAS-20) and the degree of depression with the Beck Depression Inventory. The patients were retested after a period of 5 years. RESULTS Mean alexithymia and depression scores decreased significantly over the 5-year period. Alexithymia and depression were associated with each other, but the high test-retest correlations in the TAS-20 scores indicate relative stability of alexithymia. The three factors of alexithymia behaved differently. Difficulty in identifying feelings and difficulty in describing feelings were associated with alleviation of depressive symptoms, whereas externally oriented thinking was not. CONCLUSIONS Alexithymia seems to be related with the severity of depression in outpatients with major depression, but it also shows relative stability over 5 years. Our findings support the view that the alexithymia construct represents a stable personality trait, but is also a state-dependent phenomenon.
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Affiliation(s)
- S Saarijarvi
- Department of Psychiatry, Turku University Hospital, Turku, Finland.
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Spitzer C, Siebel-Jurges U, Barnow S, Grabe HJ, Freyberger HJ. Alexithymia and interpersonal problems. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:240-6. [PMID: 15947514 DOI: 10.1159/000085148] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Interpersonal relationships are substantially codetermined by nonverbal communication, e.g. facial affect. Given the deficits of nonverbal affect recognition and expression in alexithymia, we hypothesized that alexithymics had more interpersonal problems than nonalexithymic individuals, and that the various facets of the alexithymia construct are differentially related to interpersonal problems. METHOD 149 subjects participating in an inpatient group psychotherapy program completed the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-C) at the beginning of the treatment. The IIP-C was also administered to a subgroup at the end of the treatment. RESULTS Based on the alexithymia scores, patients were classified as low- (TAS-20 score </=51), moderate- or high-alexithymic (TAS-20 score >/=61). High-alexithymic patients had significantly more interpersonal problems than low alexithymics, particularly in the IIP-C scales indicating hostility and social avoidance. The TAS-20 subscale difficulty describing feelings showed the highest correlations with interpersonal problems (r between 0.23 and 0.55). At the end of the treatment, the high alexithymics still scored highest on the IIP-C, but the magnitude of change in interpersonal problems did not differ across the groups. CONCLUSIONS Our findings suggest that the interpersonal style of alexithymic individuals is characterized by a cold and socially avoidant behavior, corresponding to the predominantly insecure attachment pattern found in alexithymia. Additionally, our results indicate that group psychotherapy is as helpful for alexithymic as for nonalexithymic subjects with respect to interpersonal problems. Finally, we propose that alexithymia involves a reduced capacity to use social interactions for affect regulation.
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Affiliation(s)
- Carsten Spitzer
- Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University, Greifswald/Stralsund, Germany.
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Ehlert U, Nater UM, Böhmelt A. High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders. J Psychosom Res 2005; 59:7-10. [PMID: 16126090 DOI: 10.1016/j.jpsychores.2005.03.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2004] [Revised: 03/01/2005] [Accepted: 03/15/2005] [Indexed: 12/14/2022]
Abstract
OBJECTIVE It was examined whether unstimulated salivary cortisol levels as a psychobiological marker of stress reactivity correspond to psychological assessments of pain perception, depressive mood, and anxiety in patients with functional gastrointestinal disorder (FGD). METHODS A total of 30 patients was diagnosed according to the Rome diagnostic criteria for irritable bowel syndrome, nonulcer dyspepsia, or both conditions. Psychometric data were assessed by questionnaires, and salivary samples were collected for the measurement of cortisol levels after awakening and during the day. Patients were grouped by their awakening cortisol levels into low (G1), medium (G2), and high cortisol group (G3). RESULTS Psychiatric comorbidity did not differ between the groups. Analysis of variance (ANOVA) showed significant group differences with respect to pain perception and depressive mood, with the highest pain in G1 and the highest depression in G3. CONCLUSION The reported results are in line with prior research on hypothalamus-pituitary-adrenal (HPA) axis dysregulation in patients suffering from somatoform disorders on the one hand (low cortisol levels) and high cortisol levels in depression on the other. It is remarkable that our sample of patients of whom all received the same diagnosis, i.e., FGD, can be subdivided according to functional gastrointestinal symptoms, which correspond to the two types of cortisol alterations. The data provide evidence for psychobiological subgroups in FGD patients. As a consequence, the predominant symptoms reported by patients with FGD should carefully be taken into account to specify (psychotherapeutic) treatment.
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Affiliation(s)
- Ulrike Ehlert
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Zürich, CH-8044 Zürich, Switzerland.
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Parisi G, Bottona E, Carrara M, Cardin F, Faedo A, Goldin D, Marino M, Pantalena M, Tafner G, Verdianelli G, Zilli M, Leandro G. Treatment effects of partially hydrolyzed guar gum on symptoms and quality of life of patients with irritable bowel syndrome. A multicenter randomized open trial. Dig Dis Sci 2005; 50:1107-12. [PMID: 15986863 DOI: 10.1007/s10620-005-2713-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The effects of partially hydrolyzed guar gum (PHGG) were compared in patients with irritable bowel syndrome, at 10 g/day (N = 40) and 5 g/day (N = 46) for 12 weeks. Gastrointestinal symptoms (GSRS), quality of life (SF-36), and psychological symptoms (HADS) were evaluated at baseline, during treatment (months 1 and 3), and at follow-up (month 6). In both groups symptoms and quality of life improved significantly after the first month of administration until follow-up compared to those at baseline. However, the improvement was significantly reduced at follow-up compared to the end of treatment. PHGG was effective for improving somatic (gastrointestinal symptoms) and psychological (quality of life and psychological distress) symptoms over the short term. Since the improvement tended to decrease after the end of the treatment period, further studies should evaluate the benefits of PHGG at a maintenance dosage.
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Affiliation(s)
- Giancarlo Parisi
- Servizio di Gastroenterologia, Casa di Cura Abano Terme, ULSS 16, Padova, Italy
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Balon R. Reflections on relevance: Psychotherapy and Psychosomatics in 2004. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:3-9. [PMID: 15627850 DOI: 10.1159/000082020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Relevance of an article is a highly desirable yet hardly predictable quality at the time of its publication. Article relevance is frequently measured by the impact factor of the journal where the article is published. Furthermore, impact factor, citation index and citation analysis are used as a measure of research progress and scientific wealth of a nation. The wisdom and significance of this approach to relevance is debatable and thus discussed here. In 2004, Psychotherapy and Psychosomatics published a variety of articles which, in the author's view, are clinically relevant. Several selected clinically relevant issues reviewed in this article include: the conceptualization of fibromyalgia as a stress disorder; the psychosocial impact and psychosocial interventions in cancer; the impact of alexithymia on patient care; the possible relationship between depression and nutrition (namely intake of folate and pyridoxal phosphate); the significance of hypercoagulability in panic-like anxiety; the questionable value of single isomer drugs, and the relevance and adequacy of clinimetrics versus psychometrics in clinical research. The reviewed issues seem to be relevant to clinical practice, research or both, but also to our critical thinking, and the critical review of the developments in psychiatry and psychology.
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Affiliation(s)
- Richard Balon
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.
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