Alexithymia and somatic complaints in psychiatric out-patients

Correlation Analyses Between Childhood Behavioral Disturbance and Maternal Alexithymia: An Observational Study

Purpose

Caregivers' responses have an impact on children's emotional and behavioral development. The inability of caregivers to perceive their own emotions affects their responses to children. This study aims to examine the relationship between a mother's difficulties in emotional expression and children's emotional and behavioral disorders.

Patient and Methods

A total of 78 cases, aged between 3 and 15 years old, were included in this study. The mothers completed the Taiwan version of the "Toronto Alexithymia Scale" (TAS) and "Children's Behavior Checklist" (CBCL) questionnaires, which served as research tools. TAS consists of three factors: difficulty in distinguishing emotions (Factor 1, F1), difficulty in expressing feelings (Factor 2, F2), and an externally oriented thinking style (Factor 3, F3). CBCL represents a child's behavior profile. The Mann-Whitney test and correlation analyses were used for follow-up analysis.

Results

Our analysis revealed that F1, F2, F3, and total scores of TAS (TAS-Total) correlate positively with the somatic complaint subscale of CBCL (F1: p = 0.003; F2: p = 0.002; F3: p = 0.034, TAS-Total p=0.002). Additionally, TAS-F1 was positively correlated with the internalizing problems subscale of CBCL (p = 0.020) and the withdrawn (WD) subscale of CBCL (p = 0.044). We also found a significant association between TAS-F1 and WD of CBCL in boys alone (p = 0.022). However, we observed a negative association between TAS-F3 and the social problems subscale of CBCL in boys alone (p = 0.038).

Conclusion

Mothers with alexithymic features are more likely to have children who internalize emotions, leading to withdrawal and somatic expression. Boys tend to exhibit withdrawal traits associated with internalization. This study provides initial evidence of a partial correlation between maternal alexithymia and children's emotional and behavioral disorders, emphasizing the importance of investigating caregivers' emotional traits for a better understanding of children's development in the future.

The Contribution of Bullying Involvement and Alexithymia to Somatic Complaints in Preadolescents

Somatic complaints during preadolescence are connected to individual and contextual factors, and extant research highlights the relevance of alexithymia and bullying involvement. In this cross-sectional study, we explored the joint and unique influence of bullying involvement-as perpetrators, victims, or outsiders-and alexithymia on somatic complaints in a sample of 179 Italian middle-school students (aged 11-15). Findings revealed an indirect association between bullying perpetration and victimization complaints through alexithymia. We also found a significant direct association between victimization and somatic complaints. No significant association between outsider behavior and somatization was found. Our results revealed that bullying perpetration and victimization could increase youths' risk for somatic complaints and clarify one of the processes underlying this association. The current findings further emphasize the relevance of emotional awareness for youths' well-being and propose that implementing social-emotional skills might prevent some of the adverse consequences of being involved in bullying episodes.

Mood regulation, alexithymia, and personality disorders in female patients with opioid use disorders

Background

Opioid use disorders are rising among females. So, there is a need for more recognition of the various factors contributing to this trend in women, to help us to plan effective interventions to this group of patients. Hence, we conducted this research to identify risk factors associated with opioid use in females including mood regulation, alexithymia, and personality disorders. The study included 60 females ranging from 18 to 45 years [30 females diagnosed with opioid use disorder according DSM-IV (case group), and 30 females with no mental illness diagnosis according to general health questionnaire (control group)]. The subjects were recruited from inpatients and outpatient clinic of Al-Abbassia Hospital, Cairo, Egypt. Both groups were assessed by the Structured Clinical Interview for DSM-IV axis II disorders (SCID II) for personality, Trait Meta-Mood Scale (TMMS) for emotional regulation and Toronto Alexithymia Scale-20 (TAS-20) for alexithymia.

Results

Regarding sociodemographic data, cases were significantly different from controls as they are less educated (P < 0.001), more 73% (22) unemployed (P <0.001) and 56.7% (17) of cases had positive family history of first degree relatives with drug use (P = 0.001).

SCID II showed more significant personality disorders diagnosis among cases as (borderline, antisocial, paranoid, schizotypal, and schizoid personality disorder) (P < 0.001, < 0.001, 0.01, 0.003, and 0.005, respectively) and also multiple personality disorders (P < 0.001) diagnosis. As regards alexithymia all cases were classified as having alexithymia 100% versus 56.7% among controls. Meanwhile, cases showed more difficulty in identifying (P < 0.001) and describing feelings (P = 0.001) and more externally oriented thinking (P = 0.010). Results of TMMS showed cases had lower total score on TMMS (p = 0.016). Signifying their inability to regulate their emotions in comparison to controls. There was no significant association between alexithymia, sociodemographic data, TMMS, and SCID II among cases group.

Conclusions

The present study found that females with opioid use disorders tend to be less educated, unemployed with positive family history of substance abuse, and diagnosed mainly with cluster A and B personality disorders. Moreover, had difficulty in identifying, describing, and regulating their emotions.

A new science of emotion: implications for functional neurological disorder

Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms. In doing so, we address several themes for the functional neurological disorder field including: (i) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, 'panic attack without panic', dissociation, insecure attachment and the influential role of life experiences; (ii) re-interpret select neurobiological research findings in functional neurological disorder cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and (iii) discuss therapeutic implications. While we continue to support that functional neurological disorder is mechanistically and aetiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience.

Psychopathology and Alexithymia in Patients with Moderate-to-Severe Psoriasis: Development of a Novel Index with Prognostic Value

BACKGROUND

Psoriasis is a chronic, relapsing, inflammatory disease with a high risk of developing mental health difficulties.

OBJECTIVE

The purposes of the study were to evaluate in moderate-to-severe psoriasis (a) the prevalence of depression and psychopathology, (b) the relationship between depression, psychopathology symptoms, and alexithymia, including its three dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT), and (c) to establish a novel index for the development of depression according to patients' psychopathological profile.

METHODS

In 104 patients, alexithymia was evaluated with the Toronto Alexithymia Scale (TAS-20), depression with the Beck Depression Inventory (BDI), and psychopathology with the Brief Symptom Inventory SCL-90 (SCL90). A psychopathology index that combines information from the BDI and SCL90 scales was constructed and the performance of the index with alexithymia was examined.

RESULTS

Female patients and active smokers score higher on BDI and SCL90 scales. Overweight patients tend to score arithmetically higher. The psychopathology index developed correlates significantly with age, DIF, DDF, and TAS-20. DIF, DDF, and TAS-20 are significant predictors of the psychopathology index. Patients with alexithymia/possible alexithymia are six times as likely to score higher in one of the psychopathology scales.

CONCLUSIONS

Alexithymia is a significant factor in the development of psychopathology in psoriasis patients. The use of the proposed novel psychopathology index could be essential in order to identify patients with moderate-to-severe psoriasis who are more likely to experience depression and psychopathology. This could have an impact on the decision-making of psoriasis treatment and monitoring of the patient.

Psychopathological and Interactive-Relational Characteristics in Non-Suicidal Self-Injury Adolescent Outpatients

Non-suicidal self-injury (NSSI) is described as behaviors that directly and intentionally inflict damage to body tissue without suicidal intent and for reasons not linked to cultural expectations or norms. Literature has confirmed several “specific risk factors” related to NSSI behaviors; emotional reactivity, internalizing problems, alexithymia traits, and maladaptive family functioning can predispose an individual to intrapersonal and interpersonal vulnerabilities related to difficulties in regulating one’s own cognitive-emotional experience. The present study aims to analyze and define the psychopathological and family interactive-relational characteristics of adolescents with NSSI through a case-control study. Thirty-one patients with NSSI and thirty-one patients without NSSI paired for sex, age, and psychiatric diagnosis (ICD-10) were recruited in Padua among two Child Neuropsychiatry Units before the COVID-19 pandemic. Results show a higher prevalence of internalizing problems, alexithymia trait related to “difficulty identifying feelings”, and lower quality of family functioning related to inclusion of partners, child involvement, and child self-regulation. These results carry significant implications for the clinical management and therapeutic care of non-suicidal self-injury patients and further confirm the need for an in-depth investigation of internalizing problems, alexithymia, and quality of family interactions.

Objective and Subjective Measurement of Alexithymia in Adults with Autism

High rates of alexithymia, a condition characterised by difficulties identifying and describing emotions, are frequently reported in both children and adults with autism spectrum disorder (ASD). However, the dilemma of measuring alexithymia via self-report has rarely been addressed. In this study, we compared objective and subjective measures of alexithymia in adults with ASD and typically developing adults. We found significantly higher levels of alexithymia in the ASD sample as measured by both self-report on the Toronto Alexithymia Scale (TAS-20) and by the observer rated Alexithymia Provoked Response Scale (APRQ). However, the two measures did not correlate with each other. We explore the different facets of the alexithymia construct that these two measures may be distinguishing.

Alexithymia in nonviolent offenders

BACKGROUND

Alexithymia is a trait involving difficulties processing emotions. Existing data suggest it is associated with violent offending. In violent offender programmes, therefore, violent offenders are screened for alexithymia and it is attended to if necessary. No studies have, however, examined alexithymia levels in nonviolent offenders and it is, therefore, unknown whether it is also a criminogenic factor in this population.

AIMS

To investigate alexithymia levels among incarcerated nonviolent offenders and compare them with a community comparison group.

METHOD

The 20-item Toronto Alexithymia Scale was used to compare the alexithymia levels of 67 incarcerated nonviolent offenders with a group of 139 people from the general public living in the community.

RESULTS

Alexithymia levels did not differ between the groups.

CONCLUSION

It appears that alexithymia is not a criminogenic factor for nonviolent offenders and screening of such offenders appears unnecessary.

Factorial validity of the 20‐item Toronto Alexithymia Scale

The 20‐item Toronto Alexithymia Scale (TAS‐20) was developed in previous research to measure a general dimension of alexithymia with three inter correlated factors. These three factors reflect distinct facets of the alexithymia construct: (1) difficulty identifying feelings and distinguishing them from the bodily sensations of emotion, (2) difficulty describing feelings to others, and (3) an externally orientated style of thinking. This study tested the three‐factor model for the TAS‐20, using confirmatory factor analysis, in separate samples of young adults from Germany, Canada, and the United States. The previously established three‐factor model was found to be replicable in all three samples. In addition, the full TAS‐20 and its three factors demonstrated adequate internal reliability in all three samples. Although evaluation of the convergent, discriminant, and criterion validity of the TAS‐20 is required in diverse cultural groups, the present results provide evidence for the factorial validity and internal reliability of the TAS‐20.

'Too many BeEPs in our teens!' Behavioral and emotional problems in a large group of Italian adolescents

BACKGROUND

One in six adolescents suffers from mental health problems. Despite the presence of general information on Italian adolescents' mental health, researches conducted with standardized assessment tools are scarce in the literature. We evaluated the prevalence of self-reported behavioral and emotional problems in a group of Italian adolescents and examined their relation to socio-demographical variables.

METHODS

This population-based sampling survey was conducted on high school students aged 14-18 from urban areas of Rome and Latina. Participants completed Youth Self-Report (YSR) and a socio-demographic schedule to collect information on age, gender, type of school attended, socio-economic status, urbanicity.

RESULTS

Final sample consisted of 1400 adolescents (38.61% male, mean age 16 years, s.d. 1.42). Prevalence of Internalizing Problems, Externalizing Problems and Total Problems was 29.55%, 18.34% and 24.13%. In our multivariable model, Internalizing Symptoms were not explained by sociodemographic variables while Externalizing Symptoms were explained by Male Gender [OR = 1.53 (1.14-2.06)], older age [OR = 2.06 (1.52-2.79)] and attending a Technical and Professional Institute [OR = 2.15 (1.53-3.02)], with an adjusted R2 = 4.32%. Total Problems were explained by School Type [Technical and Professional Institutes and Art and Humanities v. Grammar and Science School; OR respectively 1.93 (1.40-2.67) and 1.64 (1.08-2.47)], adjusted R2 = 1.94.

CONCLUSIONS

The study provides, for the first time, evidence of a great prevalence of self-reported behavioral and emotional problems in a large sample of Italian adolescents, highlighting the role of different socio-demographic variables as risk factors for externalizing behaviors. Our results emphasize the urgent need for implementing prevention programs on mental health in adolescence.

Alexithymia as a possible specifier of adverse outcomes: Clinical correlates in euthymic unipolar individuals

BACKGROUND

Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature.

METHODS

The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants.

RESULTS

Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = <.001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005).

LIMITATIONS

The study is limited by the small sample size and its cross-sectional nature.

CONCLUSIONS

Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

The role of alexithymia in memory and executive functioning across the lifespan

Alexithymia is a personality trait characterised by difficulties identifying feelings (DIF), describing feelings (DDF), and externally oriented thinking (EOT). Alexithymia has been associated with poorer memory, at least for emotive materials, and recently, with executive and neural dysfunction. Aging is also accompanied by poorer memory and executive functioning (EF), neural dysfunction, and increasing alexithymia. Thus, the hypothesis of a general cognitive impairment in alexithymia, particularly in elders, needs investigation. Three large, independent, cross-sectional experiments (n = 296, 139 and 121, respectively) investigated memory and EF in healthy adults, ranging from young to old adulthood, with age, sex, and the three Toronto Alexithymia Scale-20 subscales (DIF, DDF, EOT) as predictors in hierarchical regressions. Across studies, alexithymia contributed to poorer memory (via EOT) and EF (via DIF), in younger and older adults. Additionally, these effects occurred in non-emotive contexts with neutral stimuli. Moreover, although memory was worse with greater age and poor EF contributed to poor memory, those who had both high EOT and poor EF had particularly poor memory. Thus, alexithymia (particularly via high DIF or high EOT) is a risk factor for age-related cognitive decline. Further research should clarify the direction and nature of these complex relationships.

Application of a worry reduction intervention in a medically unexplained symptoms-analogue student-sample

OBJECTIVE

Worry is an important perpetuating factor of Medically Unexplained Symptoms (MUS). Former research has shown that a worry postponement instruction is effective in reducing Subjective Health Complaints (SHC) in non-clinical samples. This study aimed to (1) replicate these findings in a MUS-analogue student-sample and (2) assess alexithymia as a moderator.

DESIGN

The current study had an experimental design with two waves of data collection: pre- and post-intervention.

MAIN OUTCOME MEASURES

A MUS-analogue student-sample consisting of 114 undergraduate students with high self-reported health worry and a minimum of two doctor visits in the previous year with no current diagnosis for a (chronic or acute) disease were instructed to register their worry frequency and duration eight times per day via an experience sampling-application on their smartphones. The intervention group additionally postponed their worries to a 30-minute period in the evening. SHC were assessed pre- and post-intervention.

RESULTS

The intervention did not have an effect on worry or SHC. Alexithymia did not moderate this effect (p's > .05).

CONCLUSION

Our study did not find evidence for the effectiveness of the worry reduction intervention on SHC in a MUS-analogue student-sample. This finding contributes to several previous studies that have found mixed evidence for the effectiveness of the worry reduction intervention on SHC and suggests that the worry intervention may not be effective in all cases.

The Emotion Mapping Activity: Preliminary evaluation of a mindfulness-informed exercise to improve emotion labeling in alexithymic persons

Alexithymia is a psychoemotional trait associated with many treatment-resistant psychological and social difficulties. Research suggests that these difficulties stem primarily from an inability to appropriately apply linguistic labels to emotional experiences and content. The present research introduces and preliminarily evaluates a novel mindfulness-informed exercise to improve emotion-labeling ability in alexithymic persons. Based in culturally universal patterns of somatic experience, the Emotion Mapping Activity (EMA) directs alexithymic persons to reflect on their internal, somatic experiences as a source of information for interpreting and labeling emotional experiences. In the present study, 67 alexithymic persons completed a series of emotion-labeling tasks either with or without assistance of the EMA. Results suggest that completion of the EMA may improve ability to label emotions that would be otherwise misinterpreted - without interfering with labeling that is already intact. Though further research is necessary, the present study suggests that the EMA may hold the potential to be incorporated into psychotherapy protocols as an exercise for improving emotion-labeling ability in alexithymic clients.

The Self-Access Form

Abstract. Different lines of research suggest that individuals differ in accessing self-referential information, that is, to know who they are, what they think, want, need, or feel, and that this construct is positively associated with emotion regulation, adaptive functioning, well-being, and meaning in life. We developed a brief scale of five items, the Self-Access Form (SAF) and conducted four studies to approve its validity with respect to markers of adaptive personality functioning and health. Study 1 shows a clear, unidimensional factor structure for the SAF. Self-access correlates positively with adaptive self- and emotion regulation, as well as with psychological and physical health, but does not correlate with private self-consciousness (Study 2). Additionally, self-access is positively related to self-complexity and self-integration as two markers of adaptive self-development (Study 3). It is also inversely related to self-infiltration, that is, the misconception of other individuals’ expectations as own goals (Study 4). We conclude that self-access can validly be measured by a brief scale and positively relates to adaptive functioning and health.

Alexithymia Has No Clinically Relevant Association With Outcome of Multimodal Treatment Tailored to Needs of Patients Suffering From Somatic Symptom and Related Disorders. A Clinical Prospective Study

Introduction: Alexithymia may moderate the effectiveness of treatment and may predict impaired general functioning of patients suffering from somatic symptom and related disorders (SSRD). Aim: We compared alexithymia levels in a clinical prospective study with 234 consecutive patients suffering from SSRD from the Centre of Excellence for Body, Mind, and Health, Tilburg using the Bermond-Vorst Alexithymia Questionnaire, with general population norm scores. Second, we explored treatment outcomes of a multimodal treatment tailored to patient needs by Shared Decision Making (SDM) and Patient Related Outcome Monitoring (PROM) in patients with SSRD. Third, we explored whether alexithymia is associated with treatment outcome. Fourth, we explored if the presence of a chronic medical condition (e.g., diabetes mellitus, cardiovascular diseases) affects the association of alexithymia with treatment outcomes. Results: Compared to norm scores, SSRD patients showed elevated scores on the subscales identifying, verbalizing, and fantasizing, and on the cognitive dimension. All patients benefited from treatment in terms of anxiety, depression, and physical symptoms. The association of alexithymia with treatment outcome was significant, but the effect size was negligible (range odds ratios 1.02-1.25). The association between alexithymia and treatment outcome was stronger in patients suffering from chronic medical conditions compared to patients without chronic medical conditions. However, the effect size of this association was negligible (range odds ratio 0.94-1.12). Discussion: Alexithymia scores are elevated in patients with SSRD compared to general population scores, but the level of alexithymia has no clinically relevant association with treatment outcome both in SSRD patients with and without comorbid chronic medical conditions.

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.

The interaction of emotion and pain in the insula and secondary somatosensory cortex

Pain is processed in a large neural network that partially overlaps structures involved in emotion processing. Despite the fact that pain and emotion are known to share neural regions and interact in numerous clinical conditions, relatively little is known about the interaction of pain and emotion at the neural level. This study on healthy adults aimed to investigate the interaction between negative and positive emotional stimuli and experimental pain in an essential pain processing network. Sixteen healthy young adult subjects were exposed to pictures from the International Affective Picture System (IAPS) with negative, neutral or positive valence, along with laser pain stimuli. The stimuli were pseudo-randomly arranged in three 15-min experiment series comprising 49 stimuli each (picture, laser or simultaneous picture and laser stimuli). The whole-brain blood-oxygen-level-dependent (BOLD) signal was acquired using 3T functional magnetic resonance imaging (fMRI). As expected, the pain stimulus elicited activation in the secondary somatosensory cortex (SII), insula and anterior cingulate cortex (ACC) when compared to the baseline. The interaction of negative emotion and laser stimuli related to the activation of the left SII. The interaction of positive emotion and pain stimuli led to bilateral activation of the SII and left insula. These findings reveal interaction in parts of the pain processing network during simultaneous emotion and physical pain. We demonstrated a valence-independent interaction of emotion and pain in SII.

Interoception and psychopathology: A developmental neuroscience perspective

Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one's own emotion), underscoring the link between bodily and emotional awareness. Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding. This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood. Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception. Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology. We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.

Reliability and Factorial Validity of a Farsi Version of the 20-Item Toronto Alexithymia Scale with a Sample of Iranian Students

This study investigated the psychometric properties of the Farsi version of the 20-item Toronto Alexithymia Scale for 587 undergraduate students (349 women and 238 men) at the University of Tehran. All participants were asked to complete the Farsi version of the TAS-20, the Emotional Intelligence Scale, and the Mental Health Inventory. Findings supported the internal consistency, test-retest reliability, concurrent validity, and three-factor structure of the Farsi version of the 20-item Toronto Alexithymia Scale. The factors found in the Farsi version of this scale are similar to the three factors found previously and were accordingly labeled as Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking. The results provide evidence for applicability of the TAS-20 and its cross-cultural validity.

The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory

Objective

This article adopts the perspective of psychosomatic medicine to present and test a theoretical model of the classification of clinical somatic symptoms. The theoretical model consists of four dimensions: emotional somatic symptoms, biological somatic symptoms, imaginative somatic symptoms, and cognitive somatic symptoms.

Method

A clinical somatic symptom classification scale was developed according to the theoretical model. A total of 542 participants completed the clinical somatic symptoms classification scale. The data were analyzed using exploratory and confirmatory factor analyses.

Results

The results confirmed the theoretical model. The analyses found that the proposed theoretical structure of the scale was good, as indicated by factor loadings and fit indices, and that the scale had good reliability and construct validity.

Conclusions

Based on the interpretation of the clinical symptoms of psychosomatic medicine, the treatment of chronic non-infectious diseases includes at least three dimensions: the first is the etiological treatment, the second is the pathophysiological and pathopsychological dimension, and the third is symptomatic treatment. The unified psychosomatic point of view and diverse clinical thinking modes are aimed at identifying different classes of somatic symptoms and important prerequisites for the treatment of these symptoms. We registered the study with the Chinese Clinical Trial Registry and it was approved by the West China Hospital, Sichuan University ethics committee. Trial registration: The registration number is ChiCTR-OCS-14004632 (time: 2014-05-12).

Live happily live in hiding (from our affect): Alexithymia Influences affect intensity and affect frequency ratings in men

Alexithymia has been frequently studied in the context of negative affect frequency but rarely in the context of positive affect frequency or in the context of affect intensity. However, affect intensity and frequency, even if they are independent, are generally confounded due to an overlap in items wording (tapping both dimensions). The aim of the study was to examine the incremental validity of alexithymia for predicting both affect intensity and frequency, regarding positive and negative valence. Two hundred and fifty five students fulfilled measurements for alexithymia, affect intensity and affect frequency. Results showed that the factor "Difficulty identifying feelings" is related to higher positive and negative affect intensity, as well as to negative affect frequency. Men were also more sensitive to positive affect intensity and frequency if they scored higher on alexithymia. They experienced less often positive affect, but the intensity of their affect was more intense. Conversely, alexithymia did not influence women's affect intensity or affect frequency. Thus, alexithymia factors are associated with specific patterns of affect intensity and frequency, highlighting an overall deficit in the processing of emotions with contrasting patterns regarding gender.

Associations of somatic symptom attribution in Turkish patients with major depression

BACKGROUND

There are differences across ethno-cultural groups in the degree of somatization among patients with major depressive disorder (MDD). Studies showed that the attribution style of somatic symptoms is an important predictor of health outcome in depressed patients.

AIMS

The aims of this study were to investigate associations of psychologizing, normalizing and somatizing attribution styles as measured by the Symptom Interpretation Questionnaire (SIQ) in Turkish patients with MDD.

METHODS

Ninety patients who were diagnosed with a major depressive episode using a semi-structured interview were administered the SIQ to assess attribution styles, each of which was regressed on age, gender, educational level, depressive symptom severity, tendency for somatosensory amplification, current somatic symptoms and alexithymia.

RESULTS

Scores on somatizing, psychologizing and normalizing attribution subscales of the SIQ were strongly correlated with each other. Somatosensory amplification and alexithymia were independent correlates of somatizing attributions. Higher levels of psychologizing and normalizing attributions were both related to more severe symptoms of depression and to somatosensory amplification.

CONCLUSIONS

These results suggested that patients with higher levels of depressive symptoms were more likely to engage in a greater diversity of attribution styles as measured by the SIQ in our sample. Independent correlates of somatic symptom attribution in patients with MDD were found to be different from Western countries, suggestive of disparate cultural characteristics and help-seeking pathways and behaviour in Turkey.

Disordered eating attitudes, alexithymia and suicide probability among Turkish high school girls

We aimed to examine association between disordered eating attitudes (DEAs), alexithymia and suicide probability among adolescent females and to explore potential link between alexithymia and suicide probability in subjects with DEAs. 381 female students completed Eating Attitude Test (EAT-26), Toronto Alexithymia Scale (TAS-20) and Suicide Probability Scale (SPS). It was found that 13.2% (n=52) of the subjects have DEAs. Results indicated that total TAS-20 score and scores of Difficulty in Identifying Feelings (DIF) and Difficulty in Describing Feelings (DDF) subscales were significantly higher in DEAs group than in those non DEAs group (p<0.05). Additionally, total SPS score (p<0.001), Hopelessness (p=0.001), Suicide Ideation (p<0.001) and Hostility (p=0.003) subscales scores of SPS were significantly higher in the alexithymic DEAs than the non-alexithymic DEAs group. In order to control potential effect of depression, SPS subscales were used as covariate factors in ANCOVA. Negative Self-Evaluation subscale yielded a statistically significant difference between groups, other subscales did not. Results point out these; DEAs are relatively frequent phenomenon among female students in Turkey and presence of alexithymia was associated with an increased suicide probability in adolescents with DEAs. The results should be evaluated taking into account that depressive symptomatology was not assessed using a depression scale.

Do alexithymic individuals avoid their feelings? Experiential avoidance mediates the association between alexithymia, psychosomatic, and depressive symptoms in a community and a clinical sample

OBJECTIVE

Alexithymia is defined as the trait associated with difficulty in identifying and describing feelings as well as poor fantasy and imagery. While alexithymia is related to psychopathology in general, it has been associated with increased reporting of medically unexplained symptoms and depression in particular. This study attempts to assess the extent to which alexithymia represents a learned, avoidant coping strategy against unwanted emotions. In this way the study aims to identify a potential mechanism that may elucidate the relationship between alexithymia and psychological symptoms.

METHOD

Alexithymia is examined in two different samples, students from two universities in Cyprus and intensive outpatients/residents in an American anxiety disorder treatment program. We examine whether alexithymia predicts psychosomatic and depressive symptoms respectively through the mediating role of experiential avoidance, a coping mechanism believed to be reinforced because of the immediate relief it provides.

RESULTS

Experiential avoidance was found to correlate strongly with alexithymia, especially its difficulty in identifying feelings factor, while the mediation hypothesis was supported in all models tested. Furthermore, results from the clinical sample suggest that clinical improvement in depression was associated with a decrease in alexithymia, especially difficulty in identifying feelings, mediated by decreased experiential avoidance.

CONCLUSIONS

Alexithymia, and more specifically its difficulty in identifying feelings aspect, may be a learned behavior used to avoid unwanted emotions. This avoidant behavior may form the link between alexithymia and psychopathology. Implications for alexithymia theory and treatment are discussed.

Alexithymia and Self-Esteem in Patients with Ankylosing Spondylitis

INTRODUCTION

Ankylosing spondylitis (AS), which has an unknown etiology, inflammatory disorder, characterized by inflammation of the spinal joints and adjacent structures. It has a negatif effect on all aspects of a patients's life: Physcally, psychologically and socially. The purpose of this study was to determine the effect of AS on self-esteem and alexithymia.

METHOD

In this study, 50 patients from the department of physical therapy and rehabilitation with the diaognosis of AS who were under traetment and follow-up and 50 healty volunteers who matched for age and gender were taken. Toronto Alexithymia Scale (TAS), Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), Beck Anxiety Inventory (BAI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were performed to both patients and control group.

RESULTS

Compared to the control group, the anxiety and depression scores were higher in the patient group and the alexithymic characteristics were significantly higher, self-esteem scores were significantly lower in the patient group (p<.05).

CONCLUSION

Like all the other inflammatory chronic diseases, depression and anxiety are commonly seen in AS patients. Alexithymai and self-esteem of these patients should be considered carefully. More studies are needed on this regard.

Alexithymia in patients with conversion disorder

BACKGROUND AND AIMS

In the recent years, it has been observed that alexithymia is not specified for the psychosomatic disorders. It is known that alexithymia is observed frequently in various psychiatric disorders especially in the somatoform disorders. The aim of this study is to evaluate alexithymia in the patients with the conversion disorder.

METHODS

The study was performed in the Psychiatry Outpatients Clinics of the Izmir Atatürk Training and Research Hospital and Erenköy Psychiatry Education and Research Hospital. A total of 93 cases-47 outpatients who were diagnosed with conversion disorder according to the DSM-IV criteria and 46 age, gender and educational level matched healthy controls-were included in the study. All the cases were assessed by a Structured Clinical Interview for DSM-IV and were evaluated with a questionnaire (which included demographics and clinical data), the Toronto Alexithymia Scale and the Somatosensory Amplification Scale.

RESULTS

When the two groups were compared, the Toronto Alexithymia Scale scores (except "externally oriented thinking" subscale) and the Somatosensory Amplification Scale score of the conversion disorder group were statistically significantly higher than the control group. The number of the alexithymic cases of the patient group was significantly higher than the control group's.

CONCLUSIONS

The level of alexithymia in conversion disorder patients, without any other psychiatric disorder, is higher than that of the healthy controls. During the evaluation of the psychological state of patients with conversion disorder, it could be useful to keep in mind the probability of them having alexithymia to determine the type of suitable therapy.

The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: a moderated mediation analysis

This study investigated the incidence of posttraumatic stress disorder (PTSD) and psychiatric co-morbidity following epileptic seizure, whether alexithymia mediated the relationship between self-efficacy and psychiatric outcomes, and whether the mediational effect was moderated by the severity of PTSD from other traumas. Seventy-one (M=31, F=40) people with a diagnosis of epilepsy recruited from support groups in the United Kingdom completed the Posttraumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20 and the Generalized Self-Efficacy Scale. They were compared with 71 people (M=29, F=42) without epilepsy. For people with epilepsy, 51% and 22% met the diagnostic criteria for post-epileptic seizure PTSD and for PTSD following one other traumatic life event respectively. For the control group, 24% met the diagnostic criteria for PTSD following other traumatic life events. The epilepsy group reported significantly more anxiety and depression than the control. Partial least squares (PLS) analysis showed that self-efficacy was significantly correlated with alexithymia, post-epileptic seizure PTSD and psychiatric co-morbidity. Alexithymia was also significantly correlated with post-epileptic seizure PTSD and psychiatric co-morbidity. Mediation analyses confirmed that alexithymia mediated the path between self-efficacy and post-epileptic seizure PTSD and psychiatric co-morbidity. Moderated mediation also confirmed that self-efficacy and PTSD from one other trauma moderated the effect of alexithymia on outcomes. To conclude, people can develop posttraumatic stress disorder symptoms and psychiatric co-morbidity following epileptic seizure. These psychiatric outcomes are closely linked with their belief in personal competence to deal with stressful situations and regulate their own functioning, to process rather than defend against distressing emotions, and with the degree of PTSD from other traumas.

[Development of the Japanese version of the Emotion Awareness Questionnaire for junior high school students]

This study reports about the development of the Japanese version of the Emotion Awareness Questionnaire for junior high school students. Emotion Awareness Questionnaire (EAQ; Rieffe, Oosterveld, Miers, Meerum Terwogt, & Ly, 2008) for children and adolescents aims not only to monitor and differentiate emotions but also to measure attitudes about emotions. It consists of six factors: differentiating emotions, verbal sharing of emotions, not hiding emotion, bodily awareness, attending to others' emotion, analyses of emotions. To examine the reliability and validity of the Japanese version of the EAQ, junior high school students (7th to 9th grades) were requested to complete the questionnaires (n = 535 in time 1, n = 537 in time 2, n = 330 in time 3). The results showed that the Japanese version of the EAQ had almost the same six-factor structure as the original one. It also had moderate internal consistency and test-retest reliability (three weeks). The validity of the scale was examined in relation to emotional intelligence, social anxiety, depression, psychological stress responses, evaluation of emotions, self esteem and sense of authenticity. The results confirmed that the Japanese version of the EAQ had good validity.

Alexithymia and posttraumatic stress disorder following asthma attack

This study examined the levels of posttraumatic stress disorder (PTSD) following asthma attack (post-asthma attack PTSD) and psychiatric co-morbidity among college students. It also investigated the association between these variables and alexithymia. One hundred and six college students participated in the study and completed an on-line survey comprising the Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28 and Toronto Alexithymia Scale. Ninety-one students without asthma and major illness formed the control group. 2 % met the diagnostic criteria for full-PTSD, while 42 and 56 % met the partial and no-PTSD criteria respectively. Compared with the control, the asthma group reported significantly more somatic problems, social dysfunction and depression and was five times more likely to have an elevated risk of developing a general psychiatric disorder. After adjusting age, marital status, asthma experience and symptoms, alexithymia did not predict PTSD, while difficulty identifying feelings predicted psychiatric co-morbidity. Mediational analyses showed that asthma symptoms partially mediated the link between difficulty identifying feelings and psychiatric co-morbidity. People can develop PTSD symptoms and other psychological difficulties following asthma attack. Alexithymia influenced general psychological difficulties independently of PTSD symptoms.

A Comparative Study on Alexithymia in Depressive, Somatoform, Anxiety, and Psychotic Disorders among Koreans

OBJECTIVE

Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388).

METHODS

Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68).

RESULTS

We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables.

CONCLUSION

These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.

Somatic presentations of distress in China

OBJECTIVE

Somatic presentations of distress are common cross-culturally and are thought to predominate in Asian cultures such as that of China. From an etic perspective, researchers utilizing empirically validated standardized assessment measures find that somatic symptoms are no more common in individuals of Chinese descent than they are in individuals of European descent. In contrast, patient presentations are heavily influenced by culture and are associated with patterns of illness behavior. The objective of the current review is to determine the culture-specific factors contributing to somatic presentations and descriptions of distress in China.

METHOD

The current review was based on a literature search of PubMed and PsychInfo using the terms 'China,' 'Asia,' 'somatoform,' 'somatization,' and 'psychogenic.'

RESULTS

Factors contributing to somatic presentations of distress in China include stigma and help-seeking behavior, and assessment approaches that ignore culture-specific patterns of symptom reporting, fail to incorporate somatic metaphor and Chinese conceptualizations of distress that emphasize bodily sensation, and ignore the role that culture-specific normative data and culture specific response patterns may produce on assessment results.

CONCLUSIONS

From an emic perspective, there are numerous factors contributing to the appearance of a predominantly somatic presentation of distress in China. Implications for clinical practice are discussed.

The relationship between alexithymia and psychological factors in systemic lupus erythematosus

BACKGROUND

Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients.

METHODS

Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patient's clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy.

RESULTS

An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale-Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE.

CONCLUSION

Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patient's daily routine, and how patients adapt emotionally to a chronic disease.

Potential link between body dysmorphic disorder symptoms and alexithymia in an eating-disordered treatment-seeking sample

This study aimed to explore the manifestation of body dysmorphic disorder symptoms in a sample of people with eating disorders and to investigate possible associations between body dysmorphia and alexithymia. Forty patients currently seeking treatment for an eating disorder completed a battery of six measures assessing alexithymia, mood, eating behaviours, weight-related body image, body dysmorphia and non-weight related body image. Significant moderate positive correlations (Pearson's r) between selected variables were found, suggesting that participants with high levels of dysmorphic concern (imagined ugliness) have more difficulty with the affective elements of alexithymia, that is, identifying and describing feelings. When depression, eating attitudes, and weight-related body image concerns were controlled for, significant moderate positive correlations between this alexithymia factor and dysmorphic concerns remained present. An independent-samples t-test between eating-disordered participants with and without symptoms of body dysmorphic disorder (BDD) revealed significant group differences in difficulties identifying feelings. This pattern of results was replicated when the groups were identified on the basis of dysmorphic concerns, as opposed to BDD symptoms. This study highlights the associations between alexithymia and body dysmorphia that have not previously been demonstrated.

Anger and alexithymic characteristics of the patients diagnosed with insomnia: a control group study

The research was designed with a descriptive purpose to compare the alexithymic characteristics, trait anger and anger expression styles of those who are diagnosed with insomnia with those who are not. It was conducted with 96 patients who applied to Department of Sleep Disorders and were diagnosed with insomnia and 96 volunteers were not diagnosed with any psychiatric diagnosis and had not any sleep disorders in two Medical Faculty Hospitals in west of Turkey. Three types of forms were used to collect research data. The first form is the Sociodemographic Characteristics Form, the second one is The Toronto Alexithymia Scale and the third one is the Trait Anger-Anger Expression Scale. It was determined that the patients diagnosed with insomnia had displayed much more alexithymic characteristics than control group. Insomniac patients had higher level of anger and anger expression-in than the control group was found. In accordance with the findings, it is suggested that more comprehensive data should be obtained from the patients having sleeping problems and, that the nursing interventions on the patients' recognition, expression and anger management should be reflected on the nursing holistic care.

The impact of alexithymia on somatization after traumatic brain injury

INTRODUCTION

High rates of alexithymia have been reported following traumatic brain injury (TBI). Difficulty modulating emotional states has been shown to increase the risk of affective distress and the tendency to express this distress in the form of physical symptoms. The current study therefore examined relationships between alexithymia, affective distress and somatization in a TBI sample.

METHOD

Eighty-three patients with TBI completed the Toronto Alexithymia Scale (TAS-20) and the Symptom Checklist (SCL-90-R).

RESULTS

Alexithymic individuals reported higher ratings of anxiety, low mood and somatic symptoms. Alexithymia accounted for a significant amount of variance in anxiety, depression and somatization ratings. Scores on sub-scale 1 of the TAS-20 (difficulty identifying feelings) made a significant unique contribution to explaining somatization ratings after controlling for the influence of anxiety and depression ratings.

CONCLUSION

Alexithymia after TBI increases the risk of affective disturbance and somatization. It needs to be identified at an early stage to direct rehabilitation interventions and improve prospects for psychosocial outcome.