Alexithymia in essential hypertensive and psychiatric outpatients: a comparative study

Why is it Important to Assess and Treat Alexithymia in the Cardiologic Field? An Overview of the Literature

Background

Alexithymia has been found to be associated with several somatic illnesses, such as cardiovascular, indicating that it might be a risk factor for early death in the long-term course of post-myocardial infarction. From the cardiology perspective, the aim was to collect current evidence about the relationship between alexithymia and somatic illness.

Methods

The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed. Pertinent studies published in the last 50 years written in English were included and organized by three main topics ("The relation between alexithymia and somatic illness from the cardiology perspective"; "How do assess alexithymia?"; "Treating alexithymia") to be discussed.

Results

High alexithymia is a dimensional trait that affects around 10% of the general population and up to 55% of people with essential hypertension. Also, the link between alexithymia and cardiovascular activity has been pointed out. There are several validated tools to assess alexithymia, as well as treatment options.

Conclusion

Knowledge about the main features of alexithymia, as well as its assessment and treatment, can promote a multifactorial approach to the primary, secondary, and tertiary prevention of cardiac diseases.

Alexithymia for cardiologists: a clinical approach to the patient

Alexithymia literally meaning 'no words for emotions' is a term used in mental health settings to describe people who have difficulties in identifying and verbalizing their emotional states. There is evidence in the literature that this personality trait may influence negatively the illness behavior when an acute coronary event occurs. In fact, people with high alexithymia are more likely to experience wrong appraisal and interpretation of symptoms, and because of their difficulty in describing feelings to others, they can be poor in reporting symptoms at the first consultation with a physician. This behavioral pattern (alexithymic) may put patients with acute myocardial infarction at higher risk for delayed medical care. Here, we aim to present an overview of alexithymia from the perspective of the clinical cardiologist, with a focus on the definition, clinical recognition, and potential impact on cardiovascular health.

Mental and Body Health: The Association between Psychological Factors, Overweight, and Blood Pressure in Young Adults

Comorbidity between cardiometabolic risk factors and major mental health disorders is a public health concern. The close interconnection between the mental and physical aspects of health precludes considering each condition separately. Accordingly, this study sought to explore the interrelationships between psychological factors, overweight, and blood pressure in young adults. One hundred and forty-five young adults participated in the study and were classified according to two independent characteristics: weight condition (normal weight, overweight) and blood pressure (low blood pressure, high blood pressure). Anxiety, depression, and emotional dysregulation were assessed. The results confirmed certain associations, highlighting how cardiometabolic risk factors, such as blood pressure and body mass index, were associated in different ways with mental health, although an interaction between the variables was not reported. In particular, a relationship between body mass index and depression and between anxiety and blood pressure was detected.

Alexithymia is associated with increased all-cause mortality risk in men, but not in women: A 10-year follow-up study

OBJECTIVE

Alexithymia is associated with various mental as well as physical disorders. Some evidence also suggested high alexithymia to increase mortality risk, but these results are few and based on specific sample compositions. We aimed to investigate the impact of alexithymia on mortality risk in a large population based cohort. In addition, we sought to elucidate the effects of the subfactors of alexithymia and sex differences.

METHODS

In a sample of N = 1380 individuals from the Study of Health in Pomerania (SHIP), we investigated the hazard-ratio (HR) of alexithymia as obtained by the Toronto Alexithymia Scale-20 (TAS-20) on all-cause mortality over an average observation time of 10 years. Sex-by-TAS-20-interactions as well as sex-stratified analyses were performed.

RESULTS

Alexithymia was significantly associated with enhanced mortality risk (HR = 1.033; 95%-CI = 1.008-1.058); p = 0.009). While sex-by-TAS-20 interactions remained insignificant, sex-stratified analyses showed that this effect was only significant in men (HR = 1.050; 95%-CI = 1.022-1.079; p ≤ 0.001), but not in women (HR: 1.008; 95%-CI = 0.960-1.057; p = 0.76). The effect was validated for the "difficulties identifying feelings" (DIF) and "difficulties describing feelings" (DDF) subfactors of the TAS-20.

CONCLUSION

Our study supports and extents previous findings by indicating that mortality risk enhancing effects of alexithymia are specific to male subjects and validated for the DIF and DDF facets. Socioeconomic, clinical and metabolic factors were associated with this relationship. Finding that the impact of alexithymia remains stable in the fully adjusted models suggests that yet unidentified additional factors must be considered.

Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines

Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This article aimed to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians' current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.

Decreased Immune Response in Alexithymic Women: A One-Year Longitudinal Study

Although previous cross-sectional studies suggested significantly dysregulated immune response in alexithymia, there is a lack of longitudinal studies. We sought to determine the reliability of the reported relationship between alexithymia and decreased immune response in a longitudinal study. Thirty-eight healthy women who had participated in a cross-sectional study were recontacted 1-year later. Of this sample, 26 were finally included: 13 females who had been found to be alexithymic, and 13 females who were classified as non-alexithymic under the 20-item Toronto Alexithymia Scale during the first phase of the study. A year later, they were still healthy women without any psychiatric disorders, their ages now ranging from 19 to 28 years old. Lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1β (IL-1β), IL-2, IL-4, and IL-10 by phytohemagglutinin stimulated peripheral blood lymphocytes, as well as serum cortisol levels, were compared between women with and without alexithymia. One-year later, alexithymic women still had significantly lowered in vitro production of IL-2 and IL-4, with lowered IL-2/IL-10 ratio and a reduced percentage of CD4. This is the first ever published study assessing cytokine production during a follow-up of alexithymics. Although our results should be interpreted with caution due the small sample size, they suggest a sustained reduction in both major type 1 and type 2 cytokines while the former seems to be more affected. The potential long-term health impact, if any, is still to be determined.

The Night Side of Blood Pressure: Nocturnal Blood Pressure Dipping and Emotional (dys)Regulation

Introduction: The dipping phenomenon is a physiological drop in blood pressure (around 10-20%) during sleep and represents an event related to the circadian blood pressure trend. This phenomenon, in some cases, is characterized by some alterations that can be expressed by an increase (extreme dipping), a decrease (non-dipping), or a reverse (i.e., higher blood pressure during sleep compared to awake state; reverse-dipping) physiological decline of blood pressure. Few studies focused on the association between the circadian variation of blood pressure and psychological variables, although this information could help understanding how psychological characteristics (e.g., emotional regulation or dysregulation) interact with individuals' physiological processes. Given the association between emotional dysregulation and essential hypertension, this study aimed to investigate the relationship between alexithymia and dipping status in a sample of healthy and hypertensive adults in the absence of other medical conditions. Methods: Two hundred and ten adults took part in the study and were classified, according to ambulatorial blood pressure measure (ABPM), into three groups: dippers (n = 70), non-dippers (n = 70), and extreme dippers (n = 70). The participants completed a socio-demographic and anamnestic interview and the Toronto Alexithymia Scale-20 (TAS-20). Results: The ANOVAs on the TAS-20 subscales showed that the groups differed in the difficulty identifying feelings and difficulty describing feelings. In both the subscales, dippers showed lower scores than non-dippers and extreme dippers. The ANOVA on the global score of TAS-20 confirmed that dippers were less alexithymic than both extreme dippers and non-dippers. Conclusions: This study confirms that some psychological factors, like alexithymia, could represent a characteristic of patients who fail to exhibit an adaptive dipping phenomenon. Moreover, an association between an excessive reduction of BP (extreme dipping) or a lack of the decrease of BP during sleep (non-dipping) and a worse emotional regulation, considering alexithymia construct, was highlighted for the first time, confirming the relevant role of the emotional process in the modulation of an essential psychophysiological process such as the circadian variation of BP.

Myocardial infarction-induced acute stress and post-traumatic stress symptoms: the moderating role of an alexithymia trait - difficulties identifying feelings

BACKGROUND

It has been acknowledged that medical life-threatening experiences such as an acute myocardial infarction (MI) often lead to acute stress disorder symptoms (ASS), which in turn can result in the development of post-traumatic stress symptoms (PTSS). Previous studies have suggested an association between various traumatic experiences and alexithymia. The association of alexithymia with ASS and PTSS in patients with MI is elusive.

OBJECTIVES

The aim of this study was to examine the association of alexithymia with MI-induced ASS and PTSS in patients at high risk of developing PTSD.

METHOD

Patients (N = 154) were examined twice, once within 48 hours, and then again three months after acute MI. All patients completed the self-rating Acute Stress Disorder Scale (ASDS) within 48 hours after the cardiac event. Three months after hospital discharge, all patients completed the Toronto Alexithymia Scale (TAS-20) and underwent the Clinician-Administered PTSD Scale (CAPS), a structured interview to assess the severity of PTSS. Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted.

RESULTS

The linear regression model explained 23% of the variance in MI-induced PTSS-symptoms (F(6.109) = 5.58, p < 0.001, R ² = 0.23. ASS was significantly related to PTSS severity (r (152) = p < 0.001). The scores of the TAS-20 subscale difficulties identifying feelings (DIF) were found to significantly moderate this relationship (R²  = 0.03, p = 0.04). The scores of TAS-20 subscales DDF and EOT as well as the TAS-20 total score had no influence on the relationship between ASS and PTSS (p > 0.05).

CONCLUSION

In MI patients with high levels of DIF, ASS predicted the development of PTSS. If replicated, the finding may inform emotion-oriented interventions to investigate whether increasing the capacity to identify feelings following acute MI could be beneficial in preventing the development of PTSS.

Biological correlates of the Toronto Alexithymia Scale (TAS-20) in cardiovascular disease and healthy community subjects

This research studies the relationship between Alexithymia, behavioural, biometric, biochemical and cardiovascular risk in clinical and healthy samples. There were 602 participants (mean age of 52.82 ± 10.59) divided into two groups. The first was made up of 202 patients (165 males and 37 females) who had suffered a cardiovascular disease (CVD), while the second was composed of 400 (285 males and 115 females) healthy volunteers without CVD diagnosis. A cardiovascular risk index (CRI) was developed with the high factorial loading of the following variables: systolic and diastolic blood pressure, total cholesterol/HDL, triglycerides, body mass index, glucose and alcohol and tobacco consumption. The results showed a significant correlation between Alexithymia and the CRI. After controlling for age, sex, occupation, alcohol and tobacco consumption, this correlation decreased, but remained significant for most values. Alexithymia predicted 6% of CRI in the entire sample, once age and sex effect were discounted. Alexithymic subjects with scores above a cut-off point set at higher than 60 had higher levels of glucose, systolic, diastolic, cholesterol/HDL and cardiovascular risk. We discuss that Alexithymia scores contribute to cardiovascular risk, supporting previous findings.

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State–Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon.

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.

Alexithymia: A facet of uncontrolled hypertension

INTRODUCTION

Proper control of blood pressure reduces the risk of developing cardiovascular and cerebrovascular complications in hypertensive people. However, this control remains mostly unsatisfactory. Although alexithymia has been associated with essential hypertension, no study has analysed the relationship between alexithymia and blood pressure control in drug-treated hypertension. This research aimed to analyse the presence and the characteristics of this relationship, considering both the pharmacological treatment and the achievement of adequate maintenance of blood pressure in a physiological range.

METHOD

One thousand two hundred and forty-one people participated in the study. Eight hundred and ten were hypertensive patients, and four hundred and thirty-one were normotensive people. The Toronto Alexithymia Scale-20 was used to assess alexithymia.

RESULTS

Results show that hypertensive people are more alexithymic than normotensive people. According to the presence of pharmacological treatment, treated hypertensive patients are more alexithymic than normotensive and not treated hypertensive patients. Considering the blood pressure control associated with the drug-therapy, people with uncontrolled hypertension are more alexithymic than normotensive and untreated hypertensive people.

CONCLUSIONS

These findings confirm a relationship between alexithymia and essential arterial hypertension, but they also highlight that alexithymia appears to be associated with higher severity of hypertension. Alexithymia could be a facet of uncontrolled hypertension.

Relationship between alexithymia and variability of blood pressure measured with ABPM in hypertensive patients

OBJECTIVE

Studies indicates that dysregulation of emotions plays an important role in the etiology of elevated blood pressure (BP). One of the signatures of emotional dysregulation is alexithymia defined as an impaired ability to experience and express emotions. Previous work indicated that primary hypertension (HT) is marked by higher alexithymia, but little research examined the relationship between alexithymia and variability of evaluated BP with 24 h Ambulatory Blood Pressure Monitoring (ABPM) in HT patients.

METHOD

Fifty-five participants diagnosed with hypertension and a matched group of thirty-nine healthy participants filled in The Toronto Alexithymia Scale (TAS-20), a clinical-demographic questionnaire, and were assessed with 24 h ABPM.

RESULTS

After removing those with white coat HT, as expected, hypertensive individuals had a higher total score and all three alexithymia subscales. Furthermore, alexithymia was positively correlated with average values of systolic BP.

CONCLUSION

These findings provided support for the contention that alexithymia is associated with elevated BP, the higher level of alexithymia the higher systolic BP in 24 h BP measurement. Future studies may examine the causal relationship between alexithymia and HT and evaluate the effectiveness of emotional regulation training interventions to reduce BP in people suffering from primary hypertension.

Motivated Cue Integration in Alexithymia: Improving Interoception and Emotion Information Processing by Awareness-of-Sensation Techniques

Recent findings indicate that alexithymia is the result of a multidomain, multidimensional failure of interoception. Whereas much of the literature addresses the cognitive and affective aspects of alexithymia, less is known about the association between the failure of interoception and the process of motivated cue integration. The theory of motivated cue integration integrates high-level control processes with low-level embodied and contextual cues, suggesting that selective attention to internal and contextual cues results in the creation of meaning that, in turn, influences judgment and action generation. Conceptualized as a special case of the cue integration problem, alexithymia may be associated with restricted access to emotional cues, indicating impaired connectivity between low-level embodied cues and top-down goals and values. This problem may also be viewed as a means substitution problem, indicating the individual's need for alternative multisensory information. Based on this reasoning, interventions that exploit awareness-of-sensation techniques (e.g., mindfulness, experiential approach, focusing) may help to improve the distinction between bodily sensation and interpretation and to create meaning of situational state by substitution of inaccessible affective cues with alternative cues. Accordingly, clinicians and neuropsychologists can help individuals who suffer from alexithymia by training them to use awareness-of-sensation techniques and directing their attention to alternative multisensory cues as well as alternative cognitive configurations (e.g., mental images). Integrating peripheral cues in the moment-by-moment generation of meaning and self-regulation can improve affective judgment through the exchange of inaccessible affective cues with alternative ones.

Parallel but independent reduction of emotional awareness and corpus callosum connectivity in older age

Differential functional specialization of the left and right hemispheres for linguistic and emotional functions, respectively, suggest that interhemispheric communication via the corpus callosum is critical for emotional awareness. Accordingly, it has been hypothesized that the age-related decline in callosal connectivity mediates the frequently demonstrated reduction in emotional awareness in older age. The present study tests this hypothesis in a sample of 307 healthy individuals between 20-89 years using combined structural and diffusion-tensor magnetic resonance imaging (MRI) of the corpus callosum. As assumed, inter-hemispheric connectivity (midsagittal callosal area and thickness, as well as fractional anisotropy, FA) and emotional awareness (i.e., increase in externally-oriented thinking, EOT; assessed with the Toronto Alexithymia Scale, TAS-20) were found to be reduced in older (> 60 years) compared to younger participants. Furthermore, relating callosal measures to emotional awareness, FA in the genu of the corpus callosum was found to be negatively correlated with EOT in male participants. Thus, "stronger" structural connectivity (higher FA) was related with higher emotional awareness (lower EOT). However, a formal mediation analysis did not support the notion that age-related decline in emotional awareness is mediated by the corpus callosum. Thus, the observed reduction of emotional awareness and callosal connectivity in older age likely reflects parallel but not inter-dependent processes.

Cross-cultural adaptation and validation of the Brazilian version of the Beliefs about Emotions Scale

Introduction Beliefs about the unacceptability of expression and experience of emotion are present in the general population but seem to be more prevalent in patients with a number of health conditions. Such beliefs, which may be viewed as a form of perfectionism about emotions, may have a deleterious effect on symptomatology as well as on treatment adherence and outcome. Nevertheless, few questionnaires have been developed to measure such beliefs about emotions, and no instrument has been validated in a developing country. The current study adapted and validated the Beliefs about Emotions Scale in a Brazilian sample. Methods The adaptation procedure included translation, back-translation and analysis of the content, with the final Brazilian Portuguese version of the scale being tested online in a sample of 645 participants. Internal consistency of the scale was very high and results of a principal axis factoring analysis indicated a two-factor solution. Results Respondents with high fatigue levels showed more perfectionist beliefs, and the scale correlated positively with questionnaires measuring anxiety, depression and fear of negative evaluation, confirming cross-cultural associations reported before. Finally, men, non-Caucasians and participants with lower educational achievement gave greater endorsement to such beliefs than women, Caucasian individuals and participants with higher educational level. Conclusions The study confirms previous clinical findings reported in the literature, but indicates novel associations with demographic variables. The latter may reflect cultural differences related to beliefs about emotions in Brazil.

Living alone and activation of the renin-angiotensin-aldosterone-system: Differential effects depending on alexithymic personality features

OBJECTIVE

Living alone is considered as a chronic stress factor predicting different health conditions and particularly cardiovascular disease (CVD). Alexithymia is associated with increased psychological distress, less social skills and fewer close relationships, making alexithymic subjects particularly susceptible to chronic stress imposed by "living alone". Only few studies investigated the renin-angiotensin-aldosterone-system (RAAS) activity in response to chronic stress. We aimed at evaluating the effects of "living alone" as a paradigm for chronic stress on RAAS activity and putatively differential effects depending on alexithymic personality features.

METHODS

Alexithymia and serum concentrations of renin and aldosterone were measured in 944 subjects from the population-based SHIP-1 study. Subgroups were formed using the median of the Toronto Alexithymia Scale-20 (TAS-20) and a cohabitation status of "living alone" or "living together". Analyses were adjusted for various psychosocial, behavioral and metabolic risk factors.

RESULTS

"Living alone" was associated with elevated plasma renin (p<0.01, β=0.138) but not aldosterone concentrations in the total sample. On subgroup level, we found associations of "living alone" and elevated renin concentrations only in subjects low in TAS-20 scores (p<0.01, β=0.219). Interactional effects of alexithymia×cohabitation status were found for the aldosterone-to-renin ratio (p=0.02, β=-0.234).

CONCLUSIONS

The association of chronic stress imposed by "living alone" with increased RAAS activity contributes to explain the relationship of this psychosocial stress condition and increased risk for CVD. In contrast, alexithymic subjects may be less affected by the deleterious effects of "living alone".

Alexithymia in Diabetes Mellitus

Background

Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation.

Objective

To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes.

Method

In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean±SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant.

Results

The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl, HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.

Is alexithymia associated with metabolic syndrome? A study in a healthy adult population

Metabolic syndrome (MetS) is a constellation of risk factors for, in particular, cardiovascular diseases and increased mortality, and it constitutes a major clinical challenge affecting millions of lives. Alexithymia is a condition that has been linked with several mental diseases and symptoms, as well as somatic illnesses, including essential hypertension and diabetes mellitus. However, there is limited research on the association of alexithymia and MetS. The aim of the present study was to comprehensively explore this association in a large (n=1648) non-clinical sample of adults. Logistic regression analyses were applied to the five separate MetS components as well as the MetS diagnosis, and the analyses included a number of sociodemographic variables and depressive symptoms as covariates. The results confirmed the previous finding of alexithymic features being independently and significantly associated with hypertension. As a new finding, this association appears to be related to two particular dimensions of alexithymia, namely difficulty describing feelings and externally oriented thinking. Interestingly, alexithymic features were also separately significantly associated with waist circumference and triglycerides as well as the MetS diagnosis. Depressive symptoms did not have any significant effect on the relations of alexithymia and MetS.

Parental emotional competence and parenting in low-income families with adolescents

Ample research has demonstrated that alexithymia, which is characterized by difficulty processing emotions, is associated with disruptions in parenting infants and toddlers. Individuals suffering from alexithymia have among other negative outcomes difficulty building and maintaining interpersonal relationships. Research on emotional expression and recognition has documented the importance of these competencies for the quality of the parent-child relationship and for skills critical for parents of adolescents, such as effective monitoring. However, literature linking parental alexithymia to parenting behaviors and related constructs during adolescents is lacking. The present study closes this gap by examining how mothers' (M age = 39.42 years, SD = 7.62; Range = 23-67) alexithymia affects parent-reported behaviors of solicitation and control, as well as youths' (53.6% female; M age = 12.13 years, SD = 1.62; Range = 9-16) reported disclosure and felt acceptance by their mothers among a sample of 358 primarily urban, African American families. Structural equation models (SEM) revealed that mothers' alexithymia was prospectively related to less parental solicitation 2 years later for both males and females, and to lower levels of felt acceptance for males. Multiple group analyses revealed that these models fits equally well for younger and older youth. Contrary to hypotheses, alexithymia was not related to control or to disclosure. Taken together, these findings indicate that parents' difficulty in processing emotions contributes to parenting beyond early childhood.

Symptom profiles of subsyndromal depression in disease clusters of diabetes, excess weight, and progressive cerebrovascular conditions: a promising new type of finding from a reliable innovation to estimate exhaustively specified multiple indicators-multiple causes (MIMIC) models

Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used. These population-weighted data combined a stratified, systematic, clustered random sample from independent residences and a census of senior housing. Physical conditions included progressive cerebrovascular disease (CVD; hypertension, silent CVD, stroke, and vascular cognitive impairment [VCI]) and co-occurring excess weight and/or diabetes. These conditions and interactions (clusters) simultaneously predicted 20 depression items and a latent trait of depression in participants with subsyndromal (including subthreshold) depression (11≤ Center for Epidemiologic Studies Depression Scale [CES-D] score ≤27). The option for maximum likelihood estimation with standard errors that are robust to non-normality and non-independence in complex random samples (MLR) in Mplus and an innovation created by the author were used for estimating unbiased effects from latent trait models with exhaustive specification. Symptom profiles reveal masked depression in 1) older males, related to the metabolic syndrome (hypertension-overweight-diabetes; silent CVD-overweight; and silent CVD-diabetes) and 2) older females or the full sample, related to several diabetes and/or overweight clusters that involve stroke or VCI. Several other disease clusters are equivocal regarding masked depression; a couple do emphasize dysphoric mood. Replicating findings could identify subgroups for cost-effective screening of subsyndromal depression.

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.

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.

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.

Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura

Background

Migraine is a type of primary headache widely known for its impact on quality of life of patients. Although the psychological aspects of the disease are receiving increasing attention in current research, some of them, as alexithymia, are still seldom explored. This study aimed to provide evidence on the relationships between markers of depression, anxiety, alexithymia, self-reflection, insight and quality of life in migraine.

Methods

Forty female outpatients from a Brazilian specialized headache hospital service and a paired control group were compared.

Results

The results revealed that women with migraine had higher levels of depression, anxiety and alexithymia, and lower levels of quality of life, self-reflection and insight, compared to controls. Quality of life in women with migraine was predicted by levels of depression and one alexithymia factor (ability to express emotions and fantasies). A binary regression analysis between clinical and control groups revealed the migraine group to comprise individuals with high anxiety, low quality of life in the physical domain and the presence of a concrete thinking style.

Conclusions

The results highlight the relevance of considering psychological variables in the routine healthcare practices for migraine patients in general, while keeping steady attention to individual case features.

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.

Alexithymia in Chinese chronic obstructive pulmonary disease (COPD) patients: the prevalence and related factors of alexithymia

In this study, 53 Chinese COPD moderate outpatients and 50 health controls, matched for age, family income and education level, were recruited to assess the prevalence of Alexithymia and its relationship to socio-demographic factors and pulmonary function. Alexithymia was measured with 20-item Toronto Alexithymia Scale (TAS-20). The patients' socio-demographic variables and the forced expiratory volume in one second percentage of predicted (FEV(1)% predicted) were recorded. The results indicated that alexithymia was significantly more common in the Chinese COPD patients than in controls. Male patients presented higher TAS-20 total scores and externally oriented thinking (EOT) scores than the females. Elder age and higher family income were connected with the patients' lower TAS-20 indexes (except for difficulty identify feeling [DIF]). All the TAS-20 indexes were negatively associated with FEV(1)% predicted. These findings suggested that, in the management of COPD, alexithymia feature should not be ignored and the appropriate psychotherapeutic treatment for Alexithymia should be applied.

Psychological correlates in patients with different levels of hypertension

The evidence linking essential systemic arterial hypertension (SAH) with psychological characteristics remains equivocal. The aims of this study were to assess clinical and subclinical distress, psychosocial aspects and psychological well-being in treated hypertensive patients and to evaluate the psychosocial variables associated with higher levels of blood pressure according to guidelines for hypertension management. A consecutive series of 125 hypertensive patients were evaluated using both self- and observer-rated reliable measures. Generalized anxiety disorder, minor depression, demoralization and alexithymia were the most frequent diagnoses. Cluster analysis revealed an association of three distinct symptomatological groups such as the Anxiety-Depression, the Alexithymia and the Somatization groups, with different levels of hypertension. In particular, patients with moderate to severe hypertension were more frequently in the Anxiety-Depression and the Alexithymia groups, whereas the Somatization cluster has been shown to be associated with isolated systolic hypertension. The results provide new insight into the psychosocial characteristics among patients with different levels of SAH according to recent guidelines of the management of hypertension. They also outline the need to monitor the clinical course of hypertensive patients characterized by these specific clinical and subclinical psychological conditions.

From Brain to Behavior: Hypertension's Modulation of Cognition and Affect

Accumulating evidence from animal models and human studies of essential hypertension suggest that brain regulation of the vasculature is impacted by the disease. Human neuroimaging findings suggest that the brain may be an early target of the disease. This observation reinforces earlier research suggesting that psychological factors may be one of the many contributory factors to the initiation of the disease. Alternatively or in addition, initial blood pressure increases may impact cognitive and/or affective function. Evidence for an impact of blood pressure on the perception and experience of affect is reviewed vis-a-vis brain imaging findings suggesting that such involvement in hypertensive individuals is likely.

Interpersonal problems in alexithymia: A study in three primary care groups

OBJECTIVES

The present study investigated the relation between alexithymia and interpersonal problems in a sample of primary care patients with either chronic fatigue syndrome (CFS); a chronic cardiovascular or auto-immune disease; or a minor medical condition. It was hypothesized that the relation between cold interpersonal functioning would account for the differences in alexithymia scores between the patient groups.

DESIGN AND METHODS

Participants were 155 primary care patients that were recruited through 52 general practitioners: 52 CFS patients; 52 patients with a chronic cardiovascular or auto-immune disease; 51 patients with a minor medical condition. Interpersonal problems were assessed by means of the Inventory of Interpersonal Problems and alexithymia was assessed by means of the Toronto Alexithymia Scale.

RESULTS

CFS patients and patients with a chronic cardiovascular or auto-immune disease have substantially higher alexithymia scores than patients with a minor medical condition. Alexithymia is positively related to cold and distant interpersonal functioning; negatively related to self-sacrificing and overly accommodating in relation to others; and positively related to vindictiveness and self-centredness. The relation between alexithymia and these interpersonal problems accounts for the differences in alexithymia scores between the patient groups.

CONCLUSIONS

Alexithymia and interpersonal problems should be considered together, in terms of one deficient affect regulatory system, and the relation between alexithymia and specific illness conditions is secondary to this. Clinical assessment of patients with problems in naming and discussing affective states should never be isolated from an examination of their interpersonal problems, and vice versa. Mentalization-based therapy is recommended for patients with problems in naming affective states, interpersonal problems, and concomitant CFS or other alexithymia-related diseases.

Alexithymia as a predictor of outcome of psychodynamically oriented inpatient treatment

This naturalistic study aimed to determine whether the initial degree of alexithymia can predict treatment outcome of psychodynamically oriented multimodal therapy. The Toronto Alexithymia Scale-26, the Global Severity Index (GSI), and the Depression subscale of the Symptom Checklist-90-Revised were administered at hospital admission and at discharge to 480 inpatients with various psychological disorders. GSI and depressive symptoms decreased significantly during treatment. High initial alexithymia total scores significantly predicted treatment outcome, especially in patients with somatoform disorders. Difficulties in verbalizing feelings had the strongest association with less favourable symptom improvement. Although significant, the predictive values were relatively small, and patients with alexithymia indeed benefited from therapy. Implications of these results are discussed for the specificity of disorders and therapeutic approach.

Differences in emotion processing in patients with essential and secondary hypertension

BACKGROUND

An impaired ability to experience and express emotions, known as alexithymia, has previously been associated with hypertension. Alexithymia and related emotion-processing variables, however, have never been examined as a function of the type of hypertension, essential (EH) or secondary (SH).

METHODS

Our working hypothesis was that if dysregulated emotional processes play a key neurobiological role in EH, they would be less present in hypertension due to specific medical causes or SH. A total of 98 consecutive hypertensive patients (73 EH, 25 SH) with similar blood pressure levels completed two complementary measures of emotion processing: the 20-item Toronto Alexithymia Scale (TAS-20) and the Levels of Emotional Awareness Scale (LEAS).

RESULTS

After controlling for confounding variables, LEAS score was lower in EH than SH (estimated means: 46.4 vs. 52.0; P = 0.028; effect size 0.52). TAS-20 scores did not differentiate EH from SH, but the differences were in the expected direction, with an effect size of 0.34 for TAS-20 total score. Neither psychometric measure was associated with the duration of hypertension or the presence of cardiovascular (CV) complications.

CONCLUSIONS

These results are consistent with a contribution of an emotional or psychosomatic component in EH and may have practical implications for the nonpharmacological management of hypertension. They also demonstrate the utility of complementary measures of emotion processing in medically ill patients.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Alexithymia, hypertension, and subclinical atherosclerosis in the general population

OBJECTIVES

As a personality trait, alexithymia is assumed to present a longstanding risk factor for emotional dysregulation that also affects the autonomic nervous system. Therefore, we hypothesize that alexithymia is associated with hypertension and carotid atherosclerosis in the general population.

METHODS

A total of 1168 subjects (age <65 years) from the Study of Health in Pomerania (SHIP) were eligible for complete case analyses. Alexithymia was assessed with the 20-item Toronto-Alexithymia-Scale (TAS-20). An extensive interview and physical examination were performed. Extracranial carotid arteries were examined bilaterally with B-mode ultrasonography. Regression models were adjusted for sociodemographic factors and classical risk factors for cardiovascular diseases and mental distress.

RESULTS

In the adjusted logistic regression models, alexithymia was significantly associated with hypertension (OR=1.60; 95% CI=1.14-2.25) and with atherosclerotic plaques (OR=1.70; 95% CI=1.14-2.54). Hypertension changed the effect of alexithymia on atherosclerosis only marginally (OR=1.76 to 1.70).

CONCLUSION

Alexithymia may represent a relevant and independent risk factor for hypertension and carotid atherosclerosis at the population level. None of the putative confounders mediated a relevant proportion of the risk. Prospective studies are needed to confirm this association.

Unexplained chronic fatigue and interpersonal problems: a study in a primary care population

OBJECTIVE

Unexplained fatigue syndromes are multidimensional phenomena that involve a constellation of symptoms. This article explores whether typical interpersonal problems are associated with self-reported and clinically-rated fatigue symptoms in chronically fatigued patients. We hypothesize that the severity of fatigue symptoms will be associated with a pattern of withdrawal from social interaction.

METHOD

Interpersonal problems were assessed by means of a self-report questionnaire. Chronic fatigue was assessed with a self-report questionnaire (both self-rated and clinically-rated) in a primary care Chronic Fatigue Syndrome (CFS) group (N = 52) and compared with two other clinical populations (minor medical condition: N = 51; chronic organic disease: N = 52).

RESULTS

Compared to patients with a minor medical condition, CFS patients are substantially more fatigued and more socially withdrawn. Compared to patients with a chronic organic disease, somewhat more fatigue-related disability was observed in CFS patients, but no distinct interpersonal problems came to the fore. CFS patients and physicians proved to differ in their opinion on the patient's motivation. In line with the hypothesis, self-rated and clinically-scored fatigue problems proved to be related to a pattern of withdrawal from social interaction.

CONCLUSION

Differences between physicians' and patients in how symptoms are interpreted might be related to patients feeling misunderstood and result in social withdrawal.

Association of alexithymia and depression symptom severity in adults aged 50 years and older

OBJECTIVES

Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults.

DESIGN

Cross-sectional.

PARTICIPANTS

One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment.

MEASURES

Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II).

RESULTS

Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores.

CONCLUSION

The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.

Effects of inpatient psychotherapy on the stability of alexithymia characteristics

BACKGROUND

Although alexithymia is associated with several psychiatric disorders, there has been little research into the effects of psychodynamic psychotherapies on this condition. Here, the influence of inpatient multimodal psychodynamic psychotherapy on alexithymia and symptom load was evaluated in a large sample of patients.

METHODS

Alexithymia [measured with the Toronto Alexithymia Scale (TAS)-26] and psychological stress and depression [measured with the Symptom Checklist 90 Revised (SCL-90-R)] were evaluated at admission and after inpatient multimodal psychotherapy in patients with various psychosomatic and psychiatric disorders admitted to this unit between 2002 and 2005. Patients undergoing both short-term (up to 4 weeks) and long-term treatment (8-12 weeks) were studied. Analyses of covariance were used to analyse the data on depression (SCL-90-R) and psychological stress (SCL-90-R), and correlations between admission and discharge scores for the TAS-26 were computed to evaluate mean and relative stability of alexithymia.

RESULTS

Data on 397 of the 568 patients admitted were analysed. Psychological stress and depression (SCL-90-R) decreased significantly during the study across all diagnostic groups. The TAS-26 total score also decreased significantly, showing that there was no mean stability of alexithymic characteristics. However, the significance of decrease was lost when psychological stress and depression were controlled for. Highly significant correlations between TAS-26 sores before and after treatment reflected high relative stability of alexithymia.

CONCLUSIONS

During inpatient multimodal psychodynamic treatment, the symptom load and alexithymia in our patients decreased. The high relative stability of alexithymia shown supports the view that alexithymia is a relative stable personality trait.

Does dissociation of emotional and physiological reactivity predict blood pressure change at 3- and 10-year follow-up?

One of the major theories of psychosomatic medicine is that pervasive dissociations between physiological reactivity and simultaneous emotion awareness may be an important marker for the long-term development of cardiac problems. Subjective autonomic discrepancy (SAD) scores are proposed as a method of capturing the dissociation between physiological and emotional reactivity and increasing the explanatory power of predictive models of cardiac health outcomes. It was found that SAD scores for blood pressure indices show trait-like stability over a period of 3 years. Although linear 3-year prediction of systolic blood pressure came close to traditional definitions of significance, neither a linear nor a quadratic model was found to show significant prospective validity in predicting ambulatory blood pressure change over a 10-year period. Dissociation between physiological arousal and emotional awareness does not appear to be an important variable in the identification of individuals at risk for later cardiovascular health problems.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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