Alexithymia Scores Research Articles

Predictive value of alexithymia: a prospective study in somatizing patients.

In the present study, the potential role of alexithymia in predicting the long-term treatment outcome was investigated prospectively in 30 patients with DSM-III-R somatoform disorders and anxiety disorders. Using SCID interviews, diagnoses were assessed before inpatient treatment and 2 years after discharge. Patients who met criteria for DSM-III-R undifferentiated somatoform disorder at follow-up exhibited higher pretreatment alexithymia scores (as measured by the TAS) as compared with patients who showed remission of their somatoform disorder or patients who never had met criteria for a somatoform disorder. As a result stepwise logistic regression analyses, high alexithymia scores emerged as a significant predictor of persistent somatization, independent of other measures of psychopathology, sociodemographic variables, and measures of illness severity.

Alexithymia and repression: contrasting emotion-focused coping styles.

A number of conceptually similar emotion-focused coping styles have been related to physical well-being. We assessed the relationship between two of these constructs, alexithymia and repressive coping, on the basis of both psychometric and psychophysiological comparisons. Questionnaires were used to classify 86 healthy female subjects as low anxious, high anxious, or repressors. These subjects then completed a self-report measure of alexithymia and participated in a stressful laboratory task in which they delivered a self-disclosing speech. Emotional response patterning was assessed by comparing self-reported negative affect to heart rate responses elicited during the stressful speech task. Results indicated that the alexithymia scores of high anxious subjects were significantly greater than those of repressors. Consistent with the psychometric data, high alexithymics exhibited an emotional response pattern characteristic of high anxious subjects (self-reported negative affect greater than heart rate), whereas low alexithymics exhibited a response pattern characteristic of repressors (heart rate greater than self-reported negative affect). The results suggest that alexithymia and repressive coping are quite distinct, with repression being more similar to low alexithymia than to high alexithymia.

A controlled study of alexithymia in eating disorders

The aims of the study were (1) to establish whether alexithymia is present in patients with bulimia nervosa (BN), (2) to compare bulimic patients with restricting anorexics (AN/R), bulimic anorexics (AN/R), and normal controls with regard to alexithymia, (3) to determine whether in BN patients alexithymia is a state or a trait, and (4) to see whether alexithymia predicts short-term treatment outcome in BN. Study 1 included 173 eating disorder patients (BN: n=93, AN/R: n=55, AN/R: n=25) who were compared with 95 controls on the Toronto Alexithymia Scale (TAS). Study 2 included 41 BN patients who were assessed prospectively with the TAS before and after a 10-week drug treatment. AN/R patients in study 1 had significantly higher alexithymia scores than BN patients. All three eating disorder groups had significantly higher alexithymia scores than controls. For BN patients in study 2, TAS scores before and after drug treatment were stable, despite significant symptomatic improvement. We conclude the following: (1) eating disorder patients are considerably more alexithymic than normal controls; and (2) in BN, alexithymia may be a trait, unaffected by clinical improvement unless psychological treatment, encouraging the expression of emotions is offered.

An application of item response theory to alexithymia assessment among abstinent alcoholics.

An item response theory (IRT) model identified three dimensions assessed by the Toronto Alexithymia Scale (TAS) in a sample of 130 male applicants for inpatient care at a Veterans Administration (VA) medical center alcoholism treatment program. A unidimensional solution did not capture all of alexithymia's theoretical features. Subjects with lower alexithymia scores gave positive responses to items tapping emotional awareness deficits; only those with higher alexithymia scores gave positive responses to items tapping external, operative cognitive style. Thus, a total TAS score may not represent alexithymia accurately in substance-abusing patient populations.

Alexithymia, Depression, and Suicidal Preoccupation

In a sample of 127 college students, alexithymia scores were associated with depression scores but, once depression was controlled statistically, not with suicidal preoccupation.

Alexithymia and Perceived Symptoms: Criterion Validity of the Toronto Alexithymia Scale

The associations between alexithymia and somatization, perceived symptoms and subjective health, were investigated in a population sample of 2,297 middle-aged Finnish men. A modified translated version of the Toronto Alexithymia Scale (TAS) was used to assess alexithymia. A graded and statistically significant relationship was observed between the TAS score for alexithymia and self-reported recent symptoms. The alexithymia score, adjusted for age, smoking and socioeconomic status, was also positively associated with the MMPI hypochondriasis index and inversely with perceived level of health. One of the factors of the TAS appeared to have a weak but significant correlation with a variety of diagnosed disorders that previously have been considered psychosomatic.

A Study of So-Called Hypochondriasis

Twenty-four patients with unexplained somatic complaints were subjected to a thorough somatic examination. Only when the examination proved negative was the patient entered into the study. The patients were clinically appraised according to criteria given in DSM-III. Generalized anxiety disorder (GAD) was diagnosed in 12, somatization disorder (SD) in 8, and hypochondriasis in 4 patients. Seventeen of the 24 patients agreed to participate in biochemical investigations including a TRH load, a dexamethasone test, and a determination of the monoamine metabolites 5-HIAA and HVA in cerebrospinal fluid (CSF). A normal TSH increase and a normal suppression of cortisol were registered. The HVA values correlated significantly with the 5-HIAA values as well as with the alexithymia scores. Concerning alexithymia and maturity level, no difference as to social class was found. The patients filled in a Zung depression chart. The Zung scale and the 5-HIAA values were both inconsistent with depressive illness. In so-called hypochondriasis a long-term relationship, including selected somatic and biochemical examinations and thorough information, was crucial in abating the patient's distrust and thus the need for health care.

Alexithymic characteristics in rheumatoid arthritis: a controlled study.

Forty rheumatoid arthritis (RA) patients diagnosed by rigid criteria were evaluated for alexithymic characteristics using the Beth Israel Hospital Psychosomatic Questionnaire (BIQ) and the Toronto Alexithymia Scale (TAS). 40 healthy subjects matched with RA patients on sociodemographic variables served as controls. RA patients scored significantly higher on the BIQ and TAS compared to controls. The two scales correlated in the expected direction. Using the TAS cutoff score of 74 and above, 11 RA patients (27.5%) were identified as alexithymic. RA patients with greater functional impairment showed significantly higher alexithymia scores.

Alexithymia and somatic conditions in patients with affective illnesses during lithium prophylaxis.

The personality trait of alexithymia was assessed in 95 patients (35 male, 60 female) with affective illnesses, receiving lithium prophylactically, by means of Schalling-Sifneos Personality Scale (SSPS). The mean SSPS score was similar to that of the healthy population: only 8 patients had a score below 50 points. No relationship was observed between alexithymia score and age, diagnostic category (bipolar I, bipolar II, unipolar) and the duration of lithium therapy. Lower SSPS scores (i.e. high alexithymia) were found in subgroups of male patients with essential hypertension and female patients with lithium-induced obesity. The results suggest that alexithymic traits have no relationship to the pathogenesis of affective illness but may play some role in somatic symptoms emerging in affective patients on lithium prophylaxis.

Concept of alexithymia. I. The prevalence of alexithymia in psychosomatic patients.

The prevalence of alexithymia was studied in a psychosomatic group consisting of 34 patients with duodenal ulcer, 35 patients with ulcerative colitis and 38 patients with irritable colon syndrome, and in a control group consisting of 29 patients with gallstone disease, 13 patients with inguinal hernia and 44 patients with varicose veins. The methods used were the Beth Israel Hospital Questionnaire, the Thematic Apperception Test, the Rorschach Test and the score of emotionality derived from Lazare's Test. The results showed that alexithymia can be detected in an unselected sample of psychosomatic patients. The social class was of no significance, but a high score of alexithymia was registered for the male psychosomatic patients.

Alexithymia, hemisphericity, and conjugate lateral eye movements.

The conjugate lateral eye movements (CLEMs) of 102 university students were measured in conjunction with the administration of the Schalling-Sifneos Personality Scale, a self-report measure of alexithymia. There was a significant positive correlation between CLEM scores and alexithymia scores for all subjects, suggesting the existence of a relationship between right hemisphere activation and alexithymic characteristics. These results are discussed in terms of some theoretical models of alexithymia.

Affective expression in organic and functional gastrointestinal disease.

Verbal affective expression and psychometric variables were studied in a group of 5 duodenal ulcer and 6 irritable bowel patients. The aim was to assess the relevance of the alexithymia contruct to the distinction between both groups. Irritable bowel patients exhibited higher scores on Zung's depressiveness scale. Alexithymia scores were significantly higher for duodenal ulcer patients. Regarding verbal affective expression a discrimination was possible between both groups in the scale of hostility directed inward. Ulcer patients expressed less affect. These findings suggest that a distinction is possible at the behavioral level between patients with functional vs. patients with organic gastrointestinal illness, thus rendering the concept of alexithymia relevant to this nosological categorization.

Do alexithymic traits predict illness?

The common theoretical speculation that alexithymic personality characteristics (impoverished fantasy life and difficulty expressing feelings verbally) lead to psychosomatic disease was tested in a sample of 181 men. Unlike previous investigations, this study used a measure of alexithymic characteristics taken at least 1 year before any of the men became ill. Comparisons were made of the premorbid MMPI alexithymia scale scores of groups of men who remained well for 10 years or within 10 years developed either physical illness (cancer or benign tumors), "classical" psychosomatic disease (hypertension or gastrointestinal ulcers), or psychiatric disorder (schizophrenia). Results did not support the notion that alexithymia leads to illness onset. There were no significant differences among the groups in their premorbid alexithymia scores. Furthermore, the groups did not differ in the percentage of individuals labeled alexithymic with the use of previously established cut-off points. Although the findings cast doubt on alexithymia as a cause of illness, they do not conflict with the idea that alexithymia can result from the stress of disease or that this type of personality configuration may lead to a decreased response to treatment and a prolonged course of illness.

Alexithymia in medical patients referred to a consultation/liaison service.

Seventy-three medically ill patients referred to a consultation/liaison service over a 4-month period were evaluated for alexithymia. Twenty-two (30%) of these patients had alexithymia. Age, race, and marital status were not associated with alexithymia scores. Patients in lower socioeconomic groups and men had significantly higher scores than their counterparts. The idea that alexithymia is prevalent in individuals with a diagnosis of a "psychosomatic disease" was not supported.

The development of an MMPI alexithymia scale.

A 22-item MMPI alexithymia scale was derived from the Beth Israel Psychosomatic Questionnaire (BIQ). The new MMPI scale yields an 82% hit rate when predicting to BIQ alexithymia scores and has been shown to have impressive stability over time. The new scale should provide a rapid, standardized means of assessing alexithymia in a variety of populations.

On the measurement of alexithymic behavior.

It is suggested in this paper that alexithymia may be a graded behavioral characteristic in much the same way as psychological dimensions are. Under this assumption every person would possess an alexithymic score, however low it could be, and the basis for distinguishing between diagnostic groups would thence be quantitative rather than qualitative. The measurement of alexithymia in any given individual poses two main problems: the nature of the underlying phenomenon and the instruments that should be used for its depiction. Whether alexithymia is a trait, a state, or both cannot be answered confidently at present. On the other hand, its quantitative assessment depends upon an interaction between phenomenon, observer and situation. Some data bearing on the application of the Beth Israel Alexithymic and Psychosomatic Questionnaire by informed and uninformed interviewers suggest the need for reliability studies of this instrument. Also advanced is the possibility that some aspects of the syndrome (reflected differently in the questionnaire items) might be easier to detect or more amenable to quantitative assessment, thus suggesting that some weighting of items is needed in order to obtain a total alexithymia score.

Psychomaintenance aspects of alexithymia: relationship to medical outcome variables in a chronic respiratory illness population.

MMPI alexithymia scores and MMPI panic-fear personality scores were calculated for 202 adult asthmatic patients. Both sets of scores were shown to be related to the number of days rehospitalized. In addition, patients who scored high on both the alexithymia and panic-fear personality scales were judged by their attending physicians as being more severely ill than other patients. Both of these relationships were independent of the objective severity of the patient's asthma as indexed by longitudinal pulmonary functions. The study highlights the fact that alexithymia and panic-fear are two dimensions which may contribute to medical intractability in chronic asthma.