Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic

Interoceptive sensibility and alcohol craving in Polish prisoners: the role of alexithymia and emotional dysregulation

Introduction

Alcohol craving, characterized by a strong desire or compulsion to consume alcohol, is a prominent symptom of substance dependence syndrome. Research indicates that alcohol craving is a significant factor leading to the termination of abstinence. The mechanisms underlying the activation of alcohol craving remain not fully understood. The urge to reach for alcohol may be stimulated by emotions, memories, thoughts, or bodily sensations, as well as external factors. It has been postulated that individuals with high levels of interoceptive sensibility tend to exhibit a high degree of alexithymia and emotion dysregulation in the context of alcohol craving. Deficits in identifying and verbalizing emotions, along with an operational thinking style, facilitate alcohol consumption by impeding accurate insight into one's mental state, thereby hindering the comprehension of bodily states, emotions, and the regulation of self.

Method

This study involved 160 inmates incarcerated in a prison in Poland, awaiting participation in therapy for individuals with substance dependence following psychiatric diagnosis. Four questionnaires were used in the study: multidimensional Assessment of Interoceptive Sensibility (MAIA) for interoceptive sensibility, Toronto Alexithymia Scale (TAS-20) for alexithymia, Difficulties in Emotion Regulation Scale (DERS) for emotional dysregulation, and the Penn Alcohol Craving Scale (PACS) for alcohol craving assessment.

Results

The results of the study are as follows: the study findings indicated that alexithymia and emotional dysregulation significantly mediates the relationship between interoceptive sensibility and alcohol craving. The indirect effect for both factors was found to be significant, similar to the indirect effect observed for alexithymia as an mediator. However, in the case of emotional dysregulation, no significant indirect effect was observed.

Conclusion

Our study provides insights into the potential contribution of interoceptive sensibility to the heightened risk of alcohol dependence. Specifically, impaired interoceptive sensibility may be associated with the development of alexithymia and emotional dysregulation, potentially rendering individuals more susceptible to alcohol craving. Interoceptive sensibility could serve as a prerequisite for the cultivation of positive emotional processing skills.

Emotions in search of words: Does alexithymia predict treatment outcome in chronic musculoskeletal pain?

Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.

Somatosensory Amplification Scale-Chinese version: psychometric properties and its mediating role in the relationship between alexithymia and somatization

The Somatosensory Amplification Scale (SSAS) was designed to measure individual's tendency to experience visceral and somatic sensations as unusually intense, disturbing and alarming. In this study, we aimed to investigate the reliability and validity of the SSAS in the Chinese general population, as well as the mediating effect of somatosensory amplification in the relationship between alexithymia and somatization. A total of 386 healthy adults were enrolled in this study. Participants completed the Chinese versions of the Somatosensory Amplification Scale (SSAS-C), the somatization subscale of the Symptom Check List 90 (SCL-90 som), the Toronto Alexithymia Scale (TAS-20), and the Short form Health Anxiety Inventory (SHAI). One hundred and thirty-three participants were randomly selected to complete the SSAS-C again two weeks after the initial assessment. The reliability and validity of the SSAS-C were analyzed. Confirmatory factor analysis showed that the one-factor model achieved adequate model fits; one item was deleted due to low factor loading. The revised SSAS-C showed good internal consistency and test-retest reliability. The SSAS-C scores correlated positively with the scores of SCL-90 som, TAS-20 and the SHAI, showing good convergent validity. In addition, somatosensory amplification mediated the association between alexithymia and somatization. The Chinese version of SSAS has acceptable reliability and validity for the general population. In addition, alexithymia may increase somatization through higher somatosensory amplification.

Prefrontal contributions to the stability and variability of thought and conscious experience

The human prefrontal cortex is a structurally and functionally heterogenous brain region, including multiple subregions that have been linked to different large-scale brain networks. It contributes to a broad range of mental phenomena, from goal-directed thought and executive functions to mind-wandering and psychedelic experience. Here we review what is known about the functions of different prefrontal subregions and their affiliations with large-scale brain networks to examine how they may differentially contribute to the diversity of mental phenomena associated with prefrontal function. An important dimension that distinguishes across different kinds of conscious experience is the stability or variability of mental states across time. This dimension is a central feature of two recently introduced theoretical frameworks-the dynamic framework of thought (DFT) and the relaxed beliefs under psychedelics (REBUS) model-that treat neurocognitive dynamics as central to understanding and distinguishing between different mental phenomena. Here, we bring these two frameworks together to provide a synthesis of how prefrontal subregions may differentially contribute to the stability and variability of thought and conscious experience. We close by considering future directions for this work.

Alexithymia and facial emotion recognition in patients with craniofacial pain and association of alexithymia with anxiety and depression: a systematic review with meta-analysis

Background

We aimed to determine the presence of alexithymia in patients with craniofacial pain (CFP) compared with asymptomatic individuals. Our secondary aims were to assess the relationship of alexithymia with anxiety and depression levels, as well as to assess the presence of facial emotion recognition deficit.

Methods

Medline, Scielo and Google Scholar were searched, with the last search performed in 8 September 2021. Standardized mean differences (SMDs) and 95% CIs were calculated for relevant outcomes and were pooled in a meta-analysis using the random effects model. In addition, meta-analyses of correlations and a meta-regression of alexithymia with depression and anxiety were performed.

Results

Regarding alexithymia, assessed through the Toronto Alexithymia Scale (TAS), the results showed significant differences, with higher values in patients compared with asymptomatic individuals, with a large clinical effect (SMD 0.46; 95% CI [0.22–0.71]; heterogeneity-Q 66.86; p < 0.001; inconsistency (I²) = 81%). We found statistically significant correlations with a small clinical effect of alexithymia with anxiety and depression. The meta-regression showed no significant association between the TAS and anxiety or depression. With respect to facial emotion recognition, the results showed statistically significant differences, with greater recognition difficulty in patients compared with asymptomatic individuals, with a large clinical effect (SMD −1.17; 95% CI [−2.01 to −0.33]; heterogeneity-Q 2.97; p = 0.080; I² = 66%).

Conclusions

Patients with CFP showed alexithymia with moderate evidence. There was also moderate evidence indicating that these patients had significant deficits in facial emotion recognition compared with asymptomatic individuals. Furthermore, alexithymia showed statistically significant correlations with anxiety and depression levels.

Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation

OBJECTIVE

The purpose of the study is to analyses the relationship between interoceptive sensibility and somatoform disorders among persons with Autism Spectrum Disorder (ASD). It has been assumed that the interoceptive sensibility is accompanied by a high level of alexithymia and emotion dysregulation in somatoform disorders.

METHODS

Persons under the care of the foundation helping people with ASD were asked to participate in the study. In total, 205 people took part in the research. The participants aged from 18 to 63 (M = 34.91; SD = 8.44). The ASD group comprised 79 persons (38.5% of subjects). The control group comprised 126 individuals (61.5% of subjects). Participants completed self-report questionnaires measuring autism (AQ), interoceptive sensibility (BPQ), alexithymia (TAS20), emotional dysregulation (DERS), and somatoform disorder (SDQ).

RESULTS

The analyses showed a moderation effect of the group, which indicates the existence of a relationship between interoceptive sensibility and somatoform disorders to the greater extent in the clinical group than in the control group. In addition, the serial multiple mediation model analysis allowed to verify the mediating effect of emotion dysregulation and alexithymia on the abovementioned relationship. The indirect effect, which assumed the mediating role of alexithymia turned out to be significant, contrary to the indirect effect where emotion dysregulation was a mediator in a situation where both variables were applied simultaneously.

CONCLUSIONS

Interoceptive sensibility correlated with level of alexithymia, in particular, difficulties in identifying and verbalizing emotions and emotion dysregulation in the lack of emotional awareness and lack of emotional clarity and is associated with somatoform disorders in the investigated group regardless of participants' belonging to the ASD or control group.

What do alexithymia items measure? A discriminant content validity study of the Toronto-alexithymia-scale-20

Background

Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the (discriminant) content validity of the most widely used alexithymia scale, i.e., the Toronto Alexithymia Scale (TAS-20).

Methods

Participants (n = 81) rated to what extent TAS-20 items and items of related constructs were relevant for assessing the constructs ‘alexithymia’, ‘difficulty identifying feelings’, ‘difficulty describing feelings’, ‘externally-oriented thinking’, ‘limited imaginal capacity’, ‘anxiety’, ‘depression’, and ‘health anxiety’.

Results

Results revealed that, overall, the TAS-20 did only partly measure ‘alexithymia’. Only the subscales ‘difficulty identifying feelings’ and ‘difficulty describing feelings’ represented ‘alexithymia’ and their intended construct, although some content overlap between these subscales was found. In addition, some items assessed (health) anxiety equally well or even better.

Conclusions

Revision of the TAS-20 is recommended to adequately assess all key features of alexithymia. Findings with the TAS-20 need to be interpreted with caution in people suffering from medical conditions.

Interoceptive Sensibility, Alexithymia, and Emotion Regulation in Individuals Suffering from Fibromyalgia

INTRODUCTION

People suffering from fibromyalgia syndrome report various difficulties in emotional processing, possibly resulting from changes in bodily perception (interoception). In our study, we investigated the relationships between interoceptive sensibility (IS) and two disease-relevant emotional components (alexithymia and emotion regulation) in fibromyalgia sufferers compared to healthy individuals.

METHODS

Fifty-five fibromyalgia sufferers and 55 healthy individuals, matched with regard to age and gender, participated in our cross-sectional study. All participants completed the following self-report measures: the Multidimensional Assessment of Interoceptive Awareness, the Toronto Alexithymia Scale, and the Emotion Regulation Skills Questionnaire. Depression and anxiety scores served as confounding variables.

RESULTS

Fibromyalgia sufferers reported a stronger tendency to note as well as to avoid (unpleasant) body sensations. IS and psychopathology each explained about thirty percent of the variance in emotion regulation in fibromyalgia sufferers. Alexithymia was related to IS and emotion regulation in controls but not in fibromyalgia sufferers.

CONCLUSION

Disturbances in interoception could be seen as the starting point of emotional difficulties in people with fibromyalgia. Following the fear-avoidance-model, experiential avoidance may restrict patients' ability to adaptively regulate emotional states, possibly initiating a vicious cycle of psychological distress and pain.

A retrospective observational study comparing somatosensory amplification in fibromyalgia, chronic pain, psychiatric disorders and healthy subjects

OBJECTIVES

Somatosensory amplification (SA) has been described as an important feature of somatoform disorders, and an "amplifying somatic style" has been reported as a negative connotation of body perception. As widespread pain (WSP) in fibromyalgia (FM) is due to a central sensitization (CS) rather than organic alterations, there has been discussion as to whether FM is equivalent to or distinct from somatization disorder (SD). Assuming SD and FM are two distinct entities, an increase in somatic amplification should be expected only in subjects who have SD, regardless of the type of pain they experience. Purpose of the study was to explore the magnitude of SA in FM, and whether this depends on the association with SD.

METHODS

FM (n=159) other forms of chronic pain (OCP, n=582), psychiatric (Psy, n=53) and healthy (H, n=55) subjects were investigated using the Somatosensory Amplification Scale (SSAS), Illness Behavior Questionnaire, (IBQ), Italian Pain Questionnaire (IPQ), and Cold Pressor Test (CPT) in a retrospective observational study.

RESULTS

FM subjects displayed higher SSAS scores than the other groups. High SSAS score was associated with FM (OR=8.39; 95%CI: 5.43-12.46) but not OCP. Although FM has the highest prevalence of SD (x²=14.07; p=.007), high SSAS scores were associated with SD in OCP but not in FM.

CONCLUSIONS

Unlike in OCP, in FM high SSAS scores were independent of the presence of SD. From a biopsychosocial perspective, SSAS may be a factor associated with the onset of FM.

Shitsu-taikan-sho (alexisomia): a historical review and its clinical importance

“Shitsu-taikan-sho” is a clinical concept that refers to characteristics of having difficulty in the awareness and expression of somatic feelings or sensations. This concept was first proposed in 1979 by Dr. Yujiro Ikemi, the founder of psychosomatic medicine in Japan, as a characteristic observed in patients with psychosomatic diseases, i.e. physical diseases in which psychosocial factors are closely involved in their onset and progress. Soon after Dr. Ikemi introduced to Japan the concept of alexithymia, coined by P. E. Sifneos in 1973, he noticed that patients with psychosomatic diseases have difficulty in describing not only their emotions, but also somatic feelings and sensations. Dr. Ikemi proposed naming the concept of the trait of lacking somatic awareness “shitsu-taikan-sho” in Japanese (“alexisomia” in English), meaning “shitsu” a lack, “taikan” bodily feelings/sensations, and “sho” condition/symptoms. Dr. Ikemi observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases, but considered alexisomia to have a more fundamental pathophysiological role in the understanding of psychosomatic diseases. He also emphasized the importance of treating alexisomia when treating psychosomatic diseases.

Recently, alexisomia has again come into focus for various reasons. One is the availability of the Shitsu-taikan-sho Scale (STSS), a self-rating questionnaire to evaluate alexisomic tendency. Another is recent advances in basic research on interoception. The former will facilitate clinical studies on alexisomia, and the latter will enable a deeper understanding of alexisomia.

This article is an overview of the historical development of the concept of alexisomia which was conceptualized by Dr. Ikemi, introduces the STSS, and discusses the current understanding and clinical importance of alexisomia in psychosomatic medicine.

Management of supragastric belching with cognitive behavioural therapy: factors determining success and follow-up outcomes at 6-12 months post-therapy

BACKGROUND

Supragastric belching (SGB) has a significant behavioural component. We recently used cognitive behavioural therapy (CBT) to treat SGB. We demonstrated that CBT significantly reduces symptoms and improves quality of life in 50% of patients who had completed treatment.

AIMS

To investigate factors associated with successful CBT for SGB and to assess symptoms 6-12 months after completion of CBT METHODS: Records of 39 patients who had completed the CBT protocol were analysed. Per cent pre- to post-treatment change in symptoms was assessed using a visual analogue scale (VAS) score. We evaluated the association between 'pre-treatment' factors and 'during-treatment' factors, and symptomatic outcomes. Symptoms were also assessed 6-12 months after treatment.

RESULTS

From 'pre-treatment factors', a lower number of SGBs (P < .01) and lower hypervigilance score (P < .04) were significantly associated with a better outcome. From 'during-treatment factors' a higher CBT 'proficiency score' ([a] acceptance of the explanation that SGB is a behavioural phenomenon [b] detection of a warning signal before belching [c] adherence to the exercises treatment) was associated with a better outcome (P = .001). Multiple regression analysis found that number of SGBs, hypervigilance score and CBT proficiency score were independently associated with outcome (P < .01, P = .01, P < .01). VAS score before CBT (267 ± 79) decreased to 151 ± 88 soon after CBT (P < .001), and the effect persisted at 6-12 months follow-up (153 ± 82).

CONCLUSIONS

Lower number of SGBs, lower hypervigilance score and higher proficiency during CBT were associated with better CBT outcome. CBT positive effect lasted for at least 6-12 months post-treatment.

Emotional Dysregulation as a Factor of Psychosomatic Disturbances in Depression and Cardiovascular Pathology (Analytical Review of Foreign Literature)

The review presents data on cognitive processes of emotional regulation, which are the result of the interaction of the activity of the prefrontal cortex and emotional centers, as the most important pathogenetic link in the psychosomatic relations of depressive and cardiovascular diseases. The neuroanatomical substrate of emotional regulation is the connection between emotional and cognitive processes, which are carried out through bidirectional neuronal interactions between the neocortex and emotional centers. This connection allows emotional centers to modulate cortical activity, and cognitive centers, through descending cortical influences, to modulate the processing of emotions. At present, direct and indirect connections of the frontal cortex with the centers of the autonomic nervous system and its stimulating sympathetic and inhibitory parasympathetic influences have been confirmed. Pathogenetic links of emotional dysregulation include neurobiological and cognitive (rumination, fixation on negative information) processes. The pathophysiological mechanisms of depression and cardiovascular diseases have common links - the dysregulation of the metabolic, immunological and hypothalamus-pituitary-adrenal systems. The tendency to negative emotional response, the prevalence of negative emotions and alexithymia (low awareness of emotions) stand out as predictors of the development of both cardiovascular diseases and depression. Studies aimed at studying the typology and meaning of emotional dysregulation in various forms of psychopathological disorders in the aspect of comorbidity and psychosomatic relationships with somatic diseases can be fruitful in terms of finding new approaches to diagnosis and therapy.

Alexithymia mediates the relationship between interoceptive sensibility and anxiety

A number of empirical and theoretical reports link altered interoceptive processing to anxiety. However, the mechanistic understanding of the relationship between the two remains poor. We propose that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, increases an individual’s vulnerability to anxiety. In order to investigate this, a large sample of general population adults were recruited and completed self-report measures of interoceptive sensibility, trait anxiety and alexithymia. Results confirmed that the positive association between interoceptive sensibility and trait anxiety was partially mediated by alexithymia, such that those most at risk for clinically significant levels of trait anxiety have both significantly higher levels of interoceptive sensibility and alexithymia. A subsequent factor analysis confirmed the independence of the three measures. Altered interoceptive processing in combination with alexithymia, increased the risk for anxiety above and beyond altered interoceptive processing alone. We suggest that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, leaves these sensations vulnerable to catastrophizing interpretation. Interventions that target the attribution of bodily sensations may prove valuable in reducing anxiety.

Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness

BACKGROUND

Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms.

METHODS

We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic symptoms, and the candidate clinical predictors were perceived psychosocial stress, alexithymia, somatosensory amplification, adaptation, anxiety, and depression. All participants completed questionnaires assessing the outcome and the predictors.

RESULTS

The average number of reported somatic symptoms was 4.8; the most frequent was fatigue (75.3%), followed by insomnia (56.1%), low-back pain (49.5%), headache (44.7%), and palpitations (43.1%). Multiple regression analysis showed that the total number of somatic symptoms was significantly associated with the degree of perceived psychosocial stress, alexithymia, somatosensory amplification, and depression. Also, structural equation models indicated links between excessive adaptation (via perceived psychosocial stress, alexithymia, and somatosensory amplification) and the total number of somatic symptoms.

CONCLUSION

The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients.

Alexithymia in Gastroenterology and Hepatology: A Systematic Review

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.

Somatosensory amplification - An old construct from a new perspective

The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed.

"Lacking warmth": Alexithymia trait is related to warm-specific thermal somatosensory processing

Alexithymia is a personality trait involving deficits in emotional processing. The personality construct has been extensively validated, but the underlying neural and physiological systems remain controversial. One theory suggests that low-level somatosensory mechanisms act as somatic markers of emotion, underpinning cognitive and affective impairments in alexithymia. In two separate samples (total N=100), we used an established Quantitative Sensory Testing (QST) battery to probe multiple neurophysiological submodalities of somatosensation, and investigated their associations with the widely-used Toronto Alexithymia Scale (TAS-20). Experiment one found reduced sensitivity to warmth in people with higher alexithymia scores, compared to individuals with lower scores, without deficits in other somatosensory submodalities. Experiment two replicated this result in a new group of participants using a full-sample correlation between threshold for warm detection and TAS-20 scores. We discuss the relations between low-level thermoceptive function and cognitive processing of emotion.

Alexithymia and depression in the recovery of chronic pain patients: a follow-up study

BACKGROUND

Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare.

AIMS

The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied.

METHODS

The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided.

RESULTS

At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome.

CONCLUSIONS

Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.

Now or not-now? The influence of alexithymia on intertemporal decision-making

Optimal intertemporal decisions arise from the balance between an emotional-visceral component, signaling the need for immediate gratification, and a rational, long-term oriented component. Alexithymia, a personality construct characterized by amplified sensitivity to internal bodily signals of arousal, may result in enhanced activation of the emotional-visceral component over the cognitive-rational one. To test this hypothesis, participants with high- and low-alexithymia level were compared at an intertemporal decision-making task, and their choice behavior correlated with their interoceptive sensitivity. We show that high-alexithymic tend to behave more impatiently than low-alexithymic in intertemporal decisions, particularly when the sooner reward is immediately available. Moreover, the greater their sensitivity to their own visceral sensations, the greater the impatience. Together, these results suggest a disproportionate valuation of reward available immediately in high alexithymia, possibly reflecting heightened perception of bodily physiological signals, which ultimately would bias their intertemporal decision-making.

Differences in psychological and somatic symptom cluster score profiles between subjects with Idiopathic environmental intolerance, major depression and schizophrenia

Idiopathic Environmental Intolerance (IEI) has been associated with psychogenic factors and an increased number of comorbid psychiatric disorders such as depression and anxiety disorder. The purpose of the current study was to examine a possible overlap of psychological and somatic symptoms between subjects with IEI and patients with major depression and schizophrenia as well as to specify characteristic differences. The different symptom clusters included symptoms of chemical intolerance, neurotoxicity and psychological distress as well as measurements of mental health such as anxiety, depression, somatoform symptoms, and schizophrenia-specific disturbances in cognitive domains. IEI patients reported higher overall levels in physical symptoms such as chemical intolerance, neurotoxicity and somatic symptoms not attributable to an organic cause. Schizophrenia patients showed higher overall levels in self-experienced disturbances in several schizophrenia-specific cognitive domains, whereas general psychological distress, anxiety and depression were rated highest by patients with major depression. Importantly, the groups markedly differed in the shapes of profiles of various symptom clusters. Our results provide evidence that IEI patients can be distinguished on the phenomenological level from patients with major depression or schizophrenia, and that distinct domains of psychological and somatic symptoms are particularly problematic in specific diagnostic groups.

Alexithymia and Somatization in Depressed Patients: The Role of the Type of Somatic Symptom Attribution

INTRODUCTION

This study aimed to establish the association between alexithymia and various factors, mainly somatization, and to determine the predictors of alexithymia in depressed patients.

METHODS

A total of 90 patients with major depressive disorder who met The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnostic criteria were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Symptom Checklist-90 (SCL-90), Somatosensory Amplification Scale, and Symptom Interpretation Questionnaire. The patients were classified into two groups as alexithymic and non-alexithymic with respect to the TAS cut-off points (≥59=alexithymic). Predictors of alexithymia were tested by multiple linear regression analysis.

RESULTS

Of all patients, 36 (40%) were in the alexithymic group. The percentage of women, depression severity, level of general psychopathology and distress, and somatic symptom reporting (SCL-90), as well as the tendency to somatosensory amplification and three forms of somatic symptom attributions, were significantly higher in alexithymic patients than in non-alexithymic patients. Furthermore, age, depression severity, somatic symptom reporting, and the tendency to attribute physical symptoms to somatic causes were predictors of alexithymia.

CONCLUSION

The results indicated an intimate association between alexithymia and somatization in depressed patients. Therefore, when evaluating depressed patients with alexithymia, their tendency for somatization should be considered, and alexithymic individuals should be assessed with particular attention, considering that somatization can mask the underlying depressive condition.

Analyzing the Aesthetic Impressions of Alexithymic Japanese Students

We investigated the association between alexithymic tendencies as measured by the 20-item Toronto Alexithymia Scale and the characteristics of aesthetic impressions for words and drawings. Impressions were measured using the semantic differential technique in three groups of Japanese students (High scores n = 31, Moderate scores n = 40, and a Control group n = 182) who were presented only words (Word condition), only drawings (Drawing condition), or pairs comprising one word plus one drawing that represented the same emotional categories (Drawing/Word condition). In a factor analysis on the data from participants, three factors (Evaluation, Activity, and Potency) were extracted. Based on the factor scores, the distances among the three conditions were calculated for each of the groups. For Potency, significant group differences were found between the Drawing/Word and other conditions. In the High-scoring alexithymia group, in particular, the Potency impressions based on tactile sensation, e.g., soft–hard, blunt–sharp, were amplified regardless of stimulus condition. These results are discussed in the context of somatosensory amplification associated with alexithymia and the difficulty of distinguishing between emotion and somatic sensations.

The role of alexithymia: An 8-year follow-up study of chronic pain patients

OBJECTIVE

The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome.

METHODS

Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability.

RESULTS

In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period.

CONCLUSION

Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.

Is somatosensory amplification a risk factor for an increased report of side effects? Reference data from the German general population

OBJECTIVE

The study investigates the association between somatosensory amplification and the reporting of side effects. It establishes a German version of the Somatosensory Amplification Scale and examines its psychometric properties in a representative sample of the German population.

METHODS

Sample size was 2.469, with 51% taking any medication. Participants answered the Somatosensory Amplification Scale, Generic Assessment of Side Effects Scale, and indicated whether they were taking any medication and the type of medication. Correlational analysis and binary logistic regression were performed.

RESULTS

When examining a subsample reporting both medication intake and general bodily symptoms, participants higher in somatosensory amplification rated more of their general bodily symptoms as medication-attributed side effects. However, somatosensory amplification scores were not associated with the intake of any type of medication. In the overall sample, higher somatosensory amplification scores were associated with an increased report of bodily symptoms. Additionally, participants with higher somatosensory amplification reported intake of a greater number of different medications. The psychometric properties of the translated scale were good, and previously established associations of somatosensory amplification with demographic variables (age, sex) were replicated.

CONCLUSION

Results suggest a possible attributional bias concomitant to somatosensory amplification which in turn may increase the reporting of side effects after medication intake.

Dissociation between Emotional Remapping of Fear and Disgust in Alexithymia

There is growing evidence that individuals are able to understand others' emotions because they "embody" them, i.e., re-experience them by activating a representation of the observed emotion within their own body. One way to study emotion embodiment is provided by a multisensory stimulation paradigm called emotional visual remapping of touch (eVRT), in which the degree of embodiment/remapping of emotions is measured as enhanced detection of near-threshold tactile stimuli on one's own face while viewing different emotional facial expressions. Here, we measured remapping of fear and disgust in participants with low (LA) and high (HA) levels of alexithymia, a personality trait characterized by a difficulty in recognizing emotions. The results showed that fear is remapped in LA but not in HA participants, while disgust is remapped in HA but not in LA participants. To investigate the hypothesis that HA might exhibit increased responses to emotional stimuli producing a heightened physical and visceral sensations, i.e., disgust, in a second experiment we investigated participants' interoceptive abilities and the link between interoception and emotional modulations of VRT. The results showed that participants' disgust modulations of VRT correlated with their ability to perceive bodily signals. We suggest that the emotional profile of HA individuals on the eVRT task could be related to their abnormal tendency to be focalized on their internal bodily signals, and to experience emotions in a "physical" way. Finally, we speculated that these results in HA could be due to a enhancement of insular activity during the perception of disgusted faces.

The many faces of somatosensory amplification: The relative contribution of body awareness, symptom labeling, and anxiety

The questionnaire study aimed to evaluate the relative contribution of body awareness, subjective symptoms, and anxiety to the construct of somatosensory amplification in both healthy controls (n = 475) and patients visiting their general practitioner (n = 236). Regression analysis explained 52.0 percent of total variance of the somatosensory amplification scale scores. Body awareness was the most influential predictor (β = 0.489, p < 0.001) when considering all predictors simultaneously. The results suggest that dispositional interoceptive focus, as indicated by body awareness, may be an important aspect of somatosensory amplification, over and above dispositional anxiety or subjective symptom report.

Neural activity during interoceptive awareness and its associations with alexithymia-An fMRI study in major depressive disorder and non-psychiatric controls

OBJECTIVE

Alexithymia relates to difficulties recognizing and describing emotions. It has been linked to subjectively increased interoceptive awareness (IA) and to psychiatric illnesses such as major depressive disorder (MDD) and somatization. MDD in turn is characterized by aberrant emotion processing and IA on the subjective as well as on the neural level. However, a link between neural activity in response to IA and alexithymic traits in health and depression remains unclear.

METHODS

A well-established fMRI task was used to investigate neural activity during IA (heartbeat counting) and exteroceptive awareness (tone counting) in non-psychiatric controls (NC) and MDD. Firstly, comparing MDD and NC, a linear relationship between IA-related activity and scores of the Toronto Alexithymia Scale (TAS) was investigated through whole-brain regression. Secondly, NC were divided by median-split of TAS scores into groups showing low (NC-low) or high (NC-high) alexithymia. MDD and NC-high showed equally high TAS scores. Subsequently, IA-related neural activity was compared on a whole-brain level between the three independent samples (MDD, NC-low, NC-high).

RESULTS

Whole-brain regressions between MDD and NC revealed neural differences during IA as a function of TAS-DD (subscale difficulty describing feelings) in the supragenual anterior cingulate cortex (sACC; BA 24/32), which were due to negative associations between TAS-DD and IA-related activity in NC. Contrasting NC subgroups after median-split on a whole-brain level, high TAS scores were associated with decreased neural activity during IA in the sACC and increased insula activity. Though having equally high alexithymia scores, NC-high showed increased insula activity during IA compared to MDD, whilst both groups showed decreased activity in the sACC.

CONCLUSIONS

Within the context of decreased sACC activity during IA in alexithymia (NC-high and MDD), increased insula activity might mirror a compensatory mechanism in NC-high, which is disrupted in MDD.

Depression's influence on the Asthma Control Test, Japanese version

BACKGROUND

Depression has been linked to poorer asthma control in asthmatic patients. Although the Japanese version of the Asthma Control Test (ACT-J) is frequently used as a simple, practical evaluation tool in clinical care settings in Japan, knowledge regarding its efficacy for assessing asthma control in asthmatic patients with depression is limited. Thus, we retrospectively investigated cut-off values of the ACT-J for well-controlled asthma, and explored depression's influence on the test with a questionnaire survey.

METHODS

Data were analyzed on 1,962 adult asthmatic patients who had completed both the ACT-J and the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) in 2008 questionnaire survey conducted by the Niigata Asthma Treatment Study Group. Patients were classified into low (LD: J-PHQ-9 score of 0-4) or high depression (HD: J-PHQ-9 score of 5-27) groups. In both groups, the efficacy of the ACT-J was confirmed. We then compared the optimal cut-off points for uncontrolled asthma in both groups by performing a receiver operating characteristic (ROC) analysis, using the original classification referred to the GINA classification as the "true" classification.

RESULTS

Cronbach's alpha in the LD and HD group was 0.808 and 0.740 respectively. In both groups, the sub-group with existence of work absenteeism or frequent attacks during the previous 12 months scored lower on the ACT-J. The area under the curve and optimal cut-off point for patients with LD and HD were 0.821 and 0.846, and 23 and 20 respectively.

CONCLUSIONS

The efficacy of the ACT-J was confirmed in depressive patients with asthma. Because asthma control as evaluated with the ACT-J can be worse than actual control under depressive states, physicians should also pay attention to a patient's depressive state at evaluation. Further investigations focus on the association between the ACT-J and depression are required.

Alexithymia and gastrointestinal-specific anxiety in moderate to severe irritable bowel syndrome

OBJECTIVE

Gastrointestinal-specific anxiety (GSA) and alexithymia are two psychological constructs that may contribute to severity of irritable bowel syndrome (IBS). We aimed to investigate their independent contribution in predicting the level of severity in a group of patients with moderate to severe IBS.

METHOD

A sample of 177 consecutive IBS patients (49.2% with moderate and 50.8% with severe IBS), diagnosed with Rome III criteria, were evaluated for IBS symptoms, alexithymia, GSA, psychological distress, and psychosocial functioning with validated scales.

RESULTS

IBS severity was highly associated to both alexithymia (r=0.61) and GSA (r=0.66), that were also associated to each other (r=0.64). Severe IBS patients scored significantly different than moderate IBS patients to all scales in the expected direction. Multiple and hierarchical regression analyses showed that IBS severity was predicted at a similar degree by alexithymia and GSA, controlled for IBS symptoms, psychological distress, and psychosocial functioning. Effect sizes showed that the highest IBS severity scores were obtained by patients with high alexithymia alone (d=1.16) or combined with higher GSA (d=1.45).

CONCLUSION

Alexithymia and GSA were closely related to each other and associated to IBS severity, thus suggesting a common basis of emotional dysregulation. However, alexithymia (particularly the facets of difficulty identifying and describing feelings) resulted to be a stronger predictor of IBS severity than GSA, thus suggesting that impaired affective awareness may reflect on the clinical manifestations of IBS.

The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan

Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind-body relationship.

Schizophrenia as a self-disorder due to perceptual incoherence

The aim of this review is to describe the potential relationship between multisensory disintegration and self-disorders in schizophrenia spectrum disorders. Sensory processing impairments affecting multisensory integration have been demonstrated in schizophrenia. From a developmental perspective multisensory integration is considered to be crucial for normal self-experience. An impairment of multisensory integration is called 'perceptual incoherence'. We theorize that perceptual incoherence may evoke incoherent self-experiences including depersonalization, ambivalence, diminished sense of agency, and 'loosening of associations' between thoughts, feelings and actions that lie within the framework of 'self-disorders' as described by Sass and Parnas (2003). We postulate that subconscious attempts to restore perceptual coherence may induce hallucinations and delusions. Increased insight into mechanisms underlying 'self-disorders' may enhance our understanding of schizophrenia, improve recognition of early psychosis, and extend the range of therapeutic possibilities.

Relationship between alexithymia and coping strategies in patients with somatoform disorder

PURPOSE

A multidimensional intervention integrating alexithymia, negative affect, and type of coping strategy is needed for the effective treatment of somatoform disorder; however, few studies have applied this approach to the three different dimensions of alexithymia in patients with somatoform disorder. The purpose of this study was to determine the relationship between type of coping strategy and three different dimensions of alexithymia expressed in patients.

PATIENTS AND METHODS

A total of 196 patients with somatoform disorder completed the 20-item Toronto Alexithymia Scale, the Zung Self-Rating Depression Scale, the Spielberger State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, and the Lazarus Stress Coping Inventory. The relationships between alexithymia (Toronto Alexithymia Scale - 20 score and subscales), demographic variables, and psychological inventory scores were analyzed using Pearson's correlation coefficients and stepwise multiple regression analysis.

RESULTS

The mean Toronto Alexithymia Scale - 20 total score (56.1±10.57) was positively correlated with the number of physical symptoms as well as with psychopathology scores (Self-Rating Depression Scale, State-Trait Anxiety Inventory trait, state, and Somatosensory Amplification Scale), but negatively correlated with planful problem solving, confrontive coping, seeking social support, and positive reappraisal coping scores. With respect to coping strategy, multiple regression analyses revealed that "difficulty in identifying feelings" was positively associated with an escape-avoidance strategy, "difficulty in describing feelings" was negatively associated with a seeking social support strategy, and "externally oriented thinking" was negatively associated with a confrontive coping strategy.

CONCLUSION

Alexithymia was strongly associated with the number of somatic symptoms and negative affect. Patients with high "difficulty in describing feelings" tend to rely less on seeking social support, and patients with high "externally oriented thinking" tend to rely less on confrontive coping strategies. The coping skills intervention implemented should differ across individuals and should be based on the alexithymia dimension of each patient.

Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology

OBJECTIVE

To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria.

METHOD

Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis.

RESULTS

Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%).

CONCLUSIONS

The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.

The Asthma Control Test, Japanese version (ACT-J) as a predictor of Global Initiative for Asthma (GINA) guideline-defined asthma control: analysis of a questionnaire-based survey

BACKGROUND

The 2006 Global Initiative for Asthma (GINA 2006) guidelines emphasize the importance of evaluating the control rather than the severity of asthma. The Asthma Control Test (ACT) is well known to be an excellent tool for evaluating asthma control in the clinical setting. This study aimed to evaluate the ACT, Japanese version (ACT-J) as a predictor of asthma control as defined by the GINA 2006 guidelines in actual clinical practice.

METHODS

A cross-sectional analysis comparing the ACT-J score and GINA classification of asthma control among 419 patients of primary care physicians and specialists was performed using the data from a 2010 questionnaire-based survey conducted by the Niigata Asthma Treatment Study Group.

RESULTS

The optimal cut-off point of the ACT-J score for predicting GINA-defined asthma control was 23, with ACT-J scores of ≥23 and ≤22 predicting controlled and uncontrolled asthma with area under the receiver operating characteristics curve values of 0.76 [95% confidence interval (CI): 0.72-0.81] and 0.93 [95% CI: 0.90-0.97], respectively.

CONCLUSIONS

ACT scores of ≥23 and ≤22 are useful for identifying patients with controlled and uncontrolled asthma, respectively, as defined by GINA 2006, and the latter is more strongly predictive than the former. The reason for the higher cut-off point of the ACT-J relative to other versions of the ACT is unclear and warrants further investigation.

Alexithymia and depression in a chronic pain patient sample

OBJECTIVE

The aim of the present study was to assess the prevalence of alexithymia in a sample of general chronic pain patients, to explore possible differences in depression and pain variables between alexithymic and nonalexithymic chronic pain patients and to analyze if depression is a mediator between alexithymia and pain disability.

METHODS

Two hundred and seventy-one patients making their first visit to a pain clinic completed the study questionnaire including various pain measures, the Beck Depression Inventory-II (BDI-II) and the 20-item Toronto Alexithymia Scale (TAS-20). The sample was dichotomized to alexithymic and nonalexithymic groups. The means of the study variables were compared between the groups. The correlation analysis of the variables was carried out separately in both groups. Path analysis was done to ascertain the mediation effect of BDI-II between the TAS-20 and pain disability.

RESULTS

Every fifth chronic pain patient was alexithymic. The BDI-II and pain variable scores were significantly higher in the alexithymic group than in the nonalexithymic group. Pain variables were not associated with alexithymia when BDI-II was controlled for. BDI-II worked as a full mediator between TAS-20 and pain disability.

CONCLUSION

The alexithymic patient group was more morbid than the nonalexithymic group. The results suggest that depression is the main factor in pain conditions of alexithymic chronic pain patients. The authors recommend screening and treatment of depression in alexithymic chronic pain patients.

The alexithymic brain: the neural pathways linking alexithymia to physical disorders

Alexithymia is a personality trait characterized by difficulties in identifying and describing feelings and is associated with psychiatric and psychosomatic disorders. The mechanisms underlying the link between emotional dysregulation and psychosomatic disorders are unclear. Recent progress in neuroimaging has provided important information regarding emotional experience in alexithymia. We have conducted three brain imaging studies on alexithymia, which we describe herein. This article considers the role of emotion in the development of physical symptoms and discusses a possible pathway that we have identified in our neuroimaging studies linking alexithymia with psychosomatic disorders. In terms of socio-affective processing, alexithymics demonstrate lower reactivity in brain regions associated with emotion. Many studies have reported reduced activation in limbic areas (e.g., cingulate cortex, anterior insula, amygdala) and the prefrontal cortex when alexithymics attempt to feel other people's feelings or retrieve their own emotional episodes, compared to nonalexithymics. With respect to primitive emotional reactions such as the response to pain, alexithymics show amplified activity in areas considered to be involved in physical sensation. In addition to greater hormonal arousal responses in alexithymics during visceral pain, increased activity has been reported in the insula, anterior cingulate cortex, and midbrain. Moreover, in complex social situations, alexithymics may not be able to use feelings to guide their behavior appropriately. The Iowa gambling task (IGT) was developed to assess decision-making processes based on emotion-guided evaluation. When alexithymics perform the IGT, they fail to learn an advantageous decision-making strategy and show reduced activity in the medial prefrontal cortex, a key area for successful performance of the IGT, and increased activity in the caudate, a region associated with impulsive choice. The neural machinery in alexithymia is therefore activated more on the physiologic, motor-expressive level and less in the cognitive-experiential domains of the emotional response system. Affects may play an important role in alleviating intrinsic physiologic reactions and adapting to the environment. Deficient development of emotional neural structures may lead to hypersensitivity to bodily sensations and unhealthy behaviors, a possible mechanism linking alexithymia to psychosomatic disorders.

Validity of the French form of the Somatosensory Amplification Scale in a Non-Clinical Sample

The SomatoSensory Amplification Scale (SSAS) is a 10-item self-report instrument designed to assess the tendency to detect somatic and visceral sensations and experience them as unusually intense, toxic and alarming. This study examines the psychometric properties of a French version of the SSAS in a non-clinical population and, more specifically, explores its construct, convergent and discriminant validities. The SSAS was completed by 375 university students, together with measures of somatization propensity (SCL-90-R somatization subscale) and trait anxiety (STAI Y form). The results of principal component and confirmatory factor analyses suggest that the French version of the SSAS evaluates essentially a single, robust factor (Somatosensory amplification) and two kinds of somatic sensitivity (Exteroceptive sensitivity and Interoceptive sensitivity). Somatosensory amplification correlated with somatization tendency and anxiety propensity. These results encourage further investigations in French of the determinants and consequences of somatosensory amplification, and its use as a therapeutic strategy.

Serotonin transporter gene promoter polymorphism and alexithymia

BACKGROUND

Recent neurobiological studies have reported that alexithymia may result from altered brain function related to emotional processing. Serotonin (5-hydroxytryptamine, 5-HT) has been shown to regulate central nervous system development associated with psychological processing. We investigated the possibility that polymorphism of the 5-HT transporter-linked promoter region (5-HTTLPR) is associated with alexithymia.

METHODS

This study included 304 healthy Japanese volunteers (148 males, 156 females). The subjects were categorized according to genotype (L/L, L/S, S/S) and results of the 20-item Toronto Alexithymia Scale (TAS-20), State-Trait Anxiety Inventory (STAI) and Self-Rating Depression Scale (SDS).

RESULTS

Subjects with the L/L genotype showed significantly higher TAS-20 scores, as well as significantly higher scores on the difficulty identifying feeling (DIF) subscale, than those with the L/S or S/S genotype (p < 0.05). There was a gender difference in the association between 5-HTTLPR genotype and DIF score. Female subjects with the L/L genotype showed significantly higher DIF scores than those with the L/S or S/S genotype (p ≤ 0.001). Neither STAI nor SDS was significantly associated with the 5-HTTLPR genotype.

CONCLUSION

These results suggest a link between low synaptic 5-HT and alexithymia.

Association between psychopathological factors and joint hypermobility syndrome in a group of undergraduates from a French university

OBJECTIVE

To explore the frequency of Joint Hypermobility Syndrome (JHS) among university students and assess whether a relationship exists between this collagen condition and certain psychological variables.

METHOD

A cross-sectional sample of 365 undergraduates at a French university was assessed with the Brighton's criteria for JHS, Somatosensory Amplification Scale (SSAS), Liebowitz Social Anxiety Scale (LSAS), and Hospital Anxiety and Depression Scale (HADS).

RESULTS

39.5% of the participants met Brighton's criteria for JHS. Scores of somatosensory amplification were higher among participants with JHS (t = -2.98; p = 0.03) independent of gender. Female participants with JHS had higher scores in depression (t = -2.01; p = 0.04) and general anxiety (t = -2.35; p = 0.01) than women without JHS. The percentage of males with a medium/high level of social anxiety was greater among participants with JHS (78.6% vs. 41.7%; chi2 = 6.18;p = 0.01). Logistic regression demonstrated that male sex and low level of somatosensory amplification are variables contrary to the presence of JHS.

CONCLUSION

JHS is a frequent condition among young people evaluated. JHS is associated with psychological distress and higher levels of somatosensory amplification.