Alexithymic Characteristics Research Articles

Serotonin receptor gene (5-HT1A) modulates alexithymic characteristics and attachment orientation.

Previous studies have indicated that alexithymia is associated with the availability of serotonin in the brain and with the insecure attachment orientation. Inspired by the finding that the receptor 5-HT1A modulates the level of serotonin in the brain, this study investigated to what extent a polymorphism (C-1019G, rs6295) of 5-HT1A gene modulates individuals' alexithymic characteristics and attachment orientation in 504 Chinese Han people. Results showed significantly higher total scores on the 20-item Toronto Alexithymia Scale (TAS-20) for individuals carrying the CG/GG genotype than for individuals carrying the CC genotype. Specifically, individuals with the CG/GG genotype reported greater difficulty in identifying own feelings than individuals with the CC genotype. Results also showed that individuals carrying the CG/GG genotype seemed to be less comfortable with having close relationships to others than individuals with the CC genotype. These findings provide the first evidence for the link between 5-HT1A and the development of alexithymic characteristics and attachment orientation.

Alexithymia and alcohol dependence: Do different subtypes manifest different emotion regulations?

Objective: Alcohol abusers are vulnerable to emotional disabilities. Studies have shown that alexithymia is significantly associated with alcohol dependence and many other phenotypic descriptors. Given the high phenotypic heterogeneity that characterizes the alcohol dependence syndrome, the study aims to assess alexithymia features according to a multivariate classification scheme of alcoholism – the Lesch Alcoholism Typology (LAT). Methods: A total of 274 alcohol dependence outpatients (DSM diagnosis) were recruited from the Alcoholism Unit of the Psychiatric Service of Santa Maria University Hospital. After a detailed clinical observation, subjects were evaluated with the alcoholism classification system (LAT) and self-rated alexithymia with the Toronto Alexithymic Scale – 20 items (TAS-20). Results: Data showed that almost half of the alcohol-dependent individuals were defined as alexithymic cases (48.5%). “Organic” alcohol-dependent patients (type IV of Lesch classification) presented higher scores in TAS-20 when compared to other subtypes, even after controlling for potential confounding factors. Furthermore, the TAS-20 scores were related to educational level and family history of alcoholism. Conclusions: Results indicate that the alexithymia construct is an important psychological dimension in the characterization of alcohol dependence, especially the alcohol-dependent phenotypes that are more likely to present co-existing organic complications.

Investigating the Efficacy of Interpersonal Psychotherapy on Alexithymia Features

Investigating the Efficacy of Interpersonal Psychotherapy on Alexithymia Features

Affectivity, alexithymia and psychopathology in a psychotic sample

Alexithymia is common in patients suffering from a variety of disorders, such as schizophrenia spectrum disorder. Affectivity has been considered as an individual’s characteristic that seems to modulate the relationship between personality traits and some psychological/medical symptoms. The aim of the present study was to investigate the relationship between negative and positive affect, alexithymic characteristics and psychopathology in a sample of psychotic patients. Thirty consecutive outpatients were assessed using the PANSS, the TAS-20, and the PANAS. Pearson correlations were applied to investigate the relationship between the study variables; the amount of variance in psychopathology predicted by alexithymia and affectivity was calculated by using the linear regression model. Significant relationships between psychopathology and positive and negative affect were found; negative symptoms were strongly associated with the individual’s difficulty on describing feelings and negative affect. Results provided a new approach to interpret affectivity and individual’s alexithymic traits as determinants of psychotic symptomatology.

Reduced Serum Adiponectin Levels in Alexithymia

Objectives: Clinical studies have demonstrated that circulating cytokine profiles may differ between alexithymic and non-alexithymic subjects. We examined whether the levels of adiponectin (μg/ml) and resistin (ng/ml) are independently related to alexithymic features in a population-based sample. Methods: In 2005, clinical data including laboratory assessments were obtained from a sub-sample (n = 308) of the Kuopio Depression Study general population study including subjects aged 25-64 years. Based on the Toronto Alexithymia Scale score in 1998, 1999, 2001 and 2005, a group of subjects with high alexithymic features (n = 85) was formed and compared with non-alexithymic controls (n = 206). Results: Serum adiponectin levels were significantly lower in subjects with alexithymic features than in non-alexithymic control subjects. No difference was found in resistin levels. Similarly, in a logistic regression model adjusted for age, gender and body mass index (BMI), lowered levels of adiponectin, but not resistin, were associated with an increased likelihood of belonging to the group with alexithymic features. Further adjustments for cardiovascular risk factors (i.e. smoking, BMI, metabolic syndrome, alcohol use, and coronary heart disease), depressive symptoms (Hamilton Depression Rating Scale with 17 items) and the use of antidepressants in addition to age and gender did not change these patterns. Conclusions: Our findings suggest that a disturbed anti-inflammatory balance may characterize alexithymia. In addition, our results widen the concept of alexithymia and highlight the role of immune system alterations and stress in alexithymic individuals.

Development of alexithymic personality features.

The purpose of this paper is to review the current literature regarding the development of alexithymic personality features. Modern brain imaging technologies provide interesting data on the associations of alexithymia with different aberrations in brain function related to emotion regulation; however, the development of these deviations is poorly understood. A notable amount of research covers the relation of alexithymia to different environmental factors. Many of these associations, for example, with low socio-economic status and general psychopathology in childhood, are well established. However, the retrospective and cross-sectional designs commonly used in these studies, as well as the use of self-report measures, hinder the ability to firmly establish causality. Certain individual developmental factors, such as lagging speech development and congenital cardiac malformations in childhood, have been associated with the development of alexithymia. Regarding the stability of alexithymia, a systematic review of the literature was conducted for this paper. In addition to being characterized as a personality feature in the general population, alexithymia also clearly has a state-like dimension that results in increases and decreases in alexithymic features in conjunction with mental disorder symptoms. An essential question is whether the alexithymic features in adulthood are, in fact, infantile features of a restricted ability to identify and describe emotions that simply persist in individuals through adolescence to adulthood. To firmly establish the roots of alexithymia development, longitudinal studies, particularly in younger populations, are needed. Furthermore, multifaceted study settings are encouraged.

EPA-0841 - Alexithymia: advances in theory and research

Alexithymia has been shown to be related to many psychiatric and somatic illnesses. Neurobiological underpinnings of alexithymia are important to be known. To review the literature about advances in theory and research of alexithymia Searches were undertaken in PubMed and other databases, from 2007 until 2012, using keywords ‘alexithymia’,’pshycopathology’ and ‘psychosomatics’. Neurobiological model has explored the relationship between alexithymia and emotional process. Research data indicates modulation of emotional responses from the superior cortical systems, involving an integrative hemispheric function, that is, the left hemispheric verbal capacity in conjunction with the hability to evaluate e regulate emotions of the right hemisphere. Some studies point to a bidirectional inter-hemispheric deficit, wich affects affective regulation and the hability to communicate emotions and to fantasie. Affective and cognitive cllinical features of alexithymia are described. Recent epidemiology enfatizes comorbid somatic pathology, as well as other psicopathology manifestations. Alexithymia is a multidimensional construt, wich undeniabale heuristic value. Therefore, more neurobiological research should be done, such as funcional imaging studies, to keep finding the biological factors of alexithymia's etiology, so that new perspectives can be approached.

Joint effect of alexithymia and mood on the categorization of nonverbal emotional vocalizations

The role of stable factors, such as alexithymia (i.e., difficulties identifying and expressing feelings, externally oriented cognitive style), or temporary factors, such as affective states (mood), on emotion perception has been widely investigated in the literature. However, little is known about the separate or joint effect of the alexithymia level and affective states (positive affectivity, negative affectivity) on the recognition of nonverbal emotional vocalizations (NEV) (e.g., laughs, cries, or sighs). In this study, participants had to categorize NEV communicating 10 emotions by selecting the correct verbal emotional label. Results show that the level of alexithymia is negatively correlated to the capacity to accurately categorize negative vocalizations, and more particularly sad NEV. On the other hand, negative affectivity appeared negatively correlated with the ability to accurately categorize NEV in general, and negative vocalizations in particular. After splitting the results by the alexithymia level (high vs. low scorers), significant associations between mood and accuracy rates were found in the group of high alexithymia scorers only. These findings support the idea that alexithymic features act across sensory modalities and suggest a mood-interference effect that would be stronger in those individuals.

Borderline personality disorders: the central role of emotional dysregulation

Emotional dysregulation is considered as a core feature of borderline personality disorders. Emotional dysregulation can express itself both as emotional instability (i.e. an inability to modulate affects than can become uncontrolled) or in terms of poor emotional awareness (i.e. emotional numbing, alexithymic features). Whereas the first dimension is closely related to symptoms, such as impulsivity, suicidal behaviours or inappropriate anger, the latter can be associated with dissociative experiences and chronic feeling of emptiness. Although both dimensions have been related to negative experiences during childhood, however, little is known about the specific developmental pathways leading to emotional instability or emotional awareness in borderline adolescents. In this presentation, we will show some data concerning the specific traumatic pathways observed in a sample of borderline adolescents issued from the European Network on borderline personality disorders.

Alexithymia and drinking in young adults: The role of alcohol-related intrusive thoughts

Alexithymia refers to difficulties identifying and describing emotions, an externalised thinking style and a lack of imagination. Alexithymia has been linked to heavier drinking in community samples and is strongly associated with alcohol use disorders. Among patients undergoing treatment for alcohol dependence, alexithymia is associated with more intrusive thoughts about drinking. The present research asked whether this may also be the case in a non-clinical sample of social drinkers and whether such intrusive thoughts mediate the relationship between alexithymia and drinking. Participants were 113 university undergraduates aged 18–30years who completed self-report indices of alexithymia (Toronto Alexithymia Scale-20, or TAS-20), drinking behavior (Alcohol Use Disorders Identification Test, or AUDIT), anxiety (Beck Anxiety Inventory, or BAI), sensitivity to punishment (SP scale of the Sensitivity to Punishment and Sensitivity to Reward scale), frontal lobe dysfunction (Frontal Systems Behavior Scale, or FrSBe), and intrusive thoughts about drinking (the Cognitive-Emotional Preoccupation with alcohol or CEP scale of the Temptation and Restraint Inventory). As predicted TAS-20 scores were significantly positively correlated with scores on AUDIT, CEP, BAI, SP, and FrSBe scales. CEP mediated the association between TAS-20 and AUDIT. Similar to those with alcohol dependence, alexithymic characteristics are related to intrusive thoughts about drinking which may significantly influence drinking behavior even in a non-clinical sample of young adults at university.

Alexithymia among elderlypatients with diabetes

Objective: To determine alexithymic characteristics and affecting factors in the elderly with diabetes mellitus.Methods: This study was planned as a cross-sectional and descriptive study and was conducted in a state Hospital with 120 elderly patients with diabetes. Data were collected using a personal information form and the Toronto Alexithymia Scale.Results: Alexithymia was found in 75.8% of the elderly with diabetes mellitus. It was determined that patients experienced higher than average difficulty in describing and identifying feelings. They also had more externally-oriented thinking styles. Patients’ income levels, family structure and illness duration affected their manifestation of alexithymic characteristics.Conclusion: Majority of elderly patients with diabetes exhibited alexithymic characteristics. However, these were not shown to be associated with sex, age, marital, educational or professional status. In addition, no connection was found between alexithymia and glycosylated hemoglobin (HbA1c), body mass index (BMI), postprandial glucose (PBG), and the treatment and complications of diabetes mellitus.doi: http://dx.doi.org/10.12669/pjms.296.2159How to cite this:Hintistan S, Cilingir D, Birinci N. Alexithymia among elderly patients with diabetes. Pak J Med Sci 2013;29(6):1344-1348. doi: http://dx.doi.org/10.12669/pjms.296.2159This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

P.1.k.003 Somatisation and alexithymia in general medical practice

More research is needed to further our understanding of posttraumatic stress disorder symptoms (PTSD) and psychiatric co-morbidity following stroke, especially the trajectories of such symptoms over time. Previous studies suggest that exposure to a traumatic experience such as stroke is not sufficient to explain the etiology of PTSD. Alexithymia may be involved, but its relationships with PTSD and psychiatric co-morbidity following stroke remains unclear. This study aims to address these knowledge gaps. While in hospital, stroke patients (n = 90) completed questionnaires assessing PTSD symptoms, psychiatric co-morbidity, alexithymia and physical disability. PTSD symptoms and psychiatric co-morbidity were re-assessed approximately 3 months post-stroke (n = 78). The severity of post-stroke PTSD did not change significantly over time, while psychiatric co-morbidity reduced significantly. Alexithymia, in particular difficulty in identifying feelings, was associated with severity of post-stroke PTSD and psychiatric co-morbidity at baseline, but after adjusting for these, there was no significance 3 months post-stroke. We suggest that patients' difficulty in identifying feelings had a role to play in influencing relatively short-term rather than long-term PTSD and co-morbid psychiatric symptoms. Alternatively, PTSD could be interpreted as driving the alexithymic characteristics.

Post-Traumatic Stress Disorder in Migraine Patients: Migraine, Trauma and Alexithymia.

In recent studies, it has been suggested that there is a relationship between migraine headaches and post-traumatic stress disorder (PTSD). The PTSD has not been diagnosed by a clinician in these studies; the evaluation has been carried out by the screening scales. Besides, it has also been asserted that there was relationship of alexithymia with migraine and other chronic painful disorders. In this study, our aim was to investigate the prevalence of clinically-diagnosed PTSD and alexithymic features among migraine patients. Sixty consecutive migraine patients sent from neurology clinic and 60 healthy controls having similar features constituted the sample of this study. SCID-I/CV PTSD module and the Clinician-Administered PTSD Scale (CAPS) was administered to the sample. The subjects also filled in the socio-demographic data form and the Toronto Alexithymia Scale (TAS). The level of pain perceived by the migraine patients was evaluated using a Visual Analog Scale (VAS). 17 subjects (28%) in the migraine group and 5 individuals (8.3%) in the control group were diagnosed with PTSD. Hence, PTSD was found to be statistically significantly higher in the migraine group. 25 persons in the migraine group (41.6%) and 12 in the control group (20%) scored above the TAS cutoff score in terms of alexithymic features. Alexithymia was found to be statistically significantly higher in the migraine group). In the migraine group, VAS scores of the ones with PTSD were statistically significantly higher compared to that in ones without PTSD. 94% of the persons diagnosed with PTSD in the migraine group reported that their migraine headaches started after a traumatic experience. In the migraine group, no statistically significant correlation was detected between CAPS and VAS scores in subjects with PTSD. In migraine patients, PTSD and alexithymic features have been found higher than in the healthy controls. Further studies are needed to search whether the practices aimed at treating the PTSD and alexithymic features can contribute to the treatment of migraine headaches or not.

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

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

The role of early emotional neglect in alexithymia.

Alexithymia is a personality trait associated with difficulties in identifying and communicating personal feelings. It is shown to be a risk factor for affective disorders. Previous studies have demonstrated the co-occurrence of alexithymia and early life stress in clinical samples; however, research in the absence of psychological and somatic disorders rarely exists. We therefore investigated alexithymia and early life stress in a high alexithymic but healthy community sample (n 46) in comparison with low alexithymic healthy subjects (n 44). Alexithymia was assessed by the Toronto Alexithymia Scale and BermondVorst Alexithymia Questionnaire. Emotional functioning was also measured using the Emotional Experience Scales. Early life stress was assessed by the Childhood Trauma Questionnaire and Early Trauma Inventory. There was a significantly positive correlation between alexithymia and early emotional neglect (EN) in the total sample (r .37; p .001), while physical or sexual traumata were not associated with high alexithymic features. EN also predicted the overall level of alexithymia. Within the high alexithymic group only, EN was related to significantly increased emotional dysfunction when controlling for alexithymia. The results show a first indication of differentiation between a “neglect” and a “nonneglect” subtype of alexithymia. We therefore conclude that EN should be taken into account in future studies on psychological functioning in alexithymia.

Emotion Regulation and Mental Representation of Attachment in Patients With Systemic Lupus Erythematosus

Mental representations of attachment and emotion regulation influence individual patterns of stress response and vulnerability to illness. The present study investigates the adult attachment states of mind of 40 women with systemic lupus erythematosus (SLE) using the Adult Attachment Interview. We also assessed alexithymia using the Toronto Alexithymia Scale and dissociation using the Dissociative Experiences Scale. The results showed a high prevalence of the unresolved state of mind (13 patients, 32.5%) and the entangled state of mind (10 patients, 25%). The alexithymia score also varied significantly as a function of the mental representation of attachment and was modulated by amnestic dissociation. These findings suggest that adult attachment in patients with SLE influences the presence of alexithymic features. Moreover, these also indicate that dissociative states mediate the perception of painful memories and feelings, thus contributing to the partial avoidance of emotions and the failure to fully experience and recognize them. The clinical implications of these findings are also discussed.

Alexithymia and Avoidance Coping Following Traumatic Brain Injury

Individuals who develop maladaptive coping styles after traumatic brain injury (TBI) usually experience difficulty expressing their emotional state, increasing the risk of psychological distress. Difficulties expressing emotion and identifying feelings are features of alexithymia, which is prevalent following TBI. To examine the relations among coping styles, alexithymia, and psychological distress following TBI. Seventy-one patients with TBI drawn from a head injury clinic population and 54 demographically matched healthy controls. Toronto Alexithymia Scale-20, Estonian COPE-D Inventory, Beck Depression Inventory-II, and Beck Anxiety Inventory. The participants with TBI exhibited significantly higher rates of alexithymia and psychological distress and lower levels of task-oriented coping than healthy controls. Levels of avoidance coping and psychological distress were significantly higher in a subgroup of TBI patients with alexithymia than in a non-alexithymic TBI subsample. There were significant relations among alexithymia, avoidance coping, and levels of psychological distress. Regression analysis revealed that difficulty identifying feelings was a significant predictor for psychological distress. Early screening for alexithymia following TBI might identify those most at risk of developing maladaptive coping mechanisms. This could assist in developing early rehabilitation interventions to reduce vulnerability to later psychological distress.

Alexithymia and Health-Related Quality of Life in Patients with Dizziness

Background: Alexithymia is a personality trait characterized by deficits in regulating, experiencing and verbalizing emotions and has been assumed to be associated with a tendency to express emotional arousal through somatization. Although such a tendency is often observed in patients with dizziness, the exact relationship of alexithymia to dizziness is not yet known. The aim of this study was to examine alexithymic characteristics in patients with dizziness and its relation to health-related quality of life (HRQoL). Sampling and Methods: We assessed 208 patients from an interdisciplinary center for vertigo and balance disorders for characteristics of alexithymia (20-item Toronto Alexithymia Scale), HRQoL (Short-Form 12 Health Survey, SF-12), dizziness (Dizziness Handicap Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were used to evaluate the relationship between alexithymia, dizziness and HRQoL. Results: We found that difficulties in identifying and describing feelings, two important factors of alexithymia, were significantly related to more severe symptoms of dizziness. More pronounced alexithymic characteristics were associated with lower HRQoL, especially in the mental dimension of the SF-12. The results remained significant after controlling for possibly confounding variables such as socioeconomic status and depression. Conclusions: These findings contribute to a better understanding of affect regulation in patients with dizziness, which is important for the development of psychotherapeutic interventions suitable for alexithymic patients with dizziness.

Multiple Sclerosis Decreases Explicit Counterfactual Processing and Risk Taking in Decision Making

IntroductionDeficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS). There are no data concerning the impact of MS on tasks evaluating DM under explicit risk, where different emotional and cognitive components can be distinguished.MethodsWe assessed 72 relapsing-remitting MS (RRMS) patients with mild to moderate disease and 38 healthy controls in two DM tasks involving risk with explicit rules: (1) The Wheel of Fortune (WOF), which probes the anticipated affects of decisions outcomes on future choices; and (2) The Cambridge Gamble Task (CGT) which measures risk taking. Participants also underwent a neuropsychological and emotional assessment, and skin conductance responses (SCRs) were recorded.ResultsIn the WOF, RRMS patients showed deficits in integrating positive counterfactual information (p<0.005) and greater risk aversion (p<0.001). They reported less negative affect than controls (disappointment: p = 0.007; regret: p = 0.01), although their implicit emotional reactions as measured by post-choice SCRs did not differ. In the CGT, RRMS patients differed from controls in quality of DM (p = 0.01) and deliberation time (p = 0.0002), the latter difference being correlated with attention scores. Such changes did not result in overall decreases in performance (total gains).ConclusionsThe quality of DM under risk was modified by MS in both tasks. The reduction in the expression of disappointment coexisted with an increased risk aversion in the WOF and alexithymia features. These concomitant emotional alterations may have implications for better understanding the components of explicit DM and for the clinical support of MS patients.

Alexithymia and emotional awareness in females with Painful Rheumatic Conditions

ObjectiveResearch about the deficit of emotional regulation in Painful Rheumatic Conditions (PRC) indicates that these patients have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS-20). However, the use of a unique measure to assess alexithymic trends has been questioned. The aim of the present study is twofold: to compare the levels of alexithymia and emotional awareness in females with and without PRC; and to test the predictive validity of alexithymia measures beyond negative emotions. MethodThirty-nine women with PRC of diverse etiology and twenty-two healthy females responded to the TAS-20, the Levels of Emotional Awareness Scale (LEAS) and questionnaires of anxiety and depression. ResultsThe total score, factor 1 (difficulty identifying feelings) and factor 2 (difficulty describing feelings) scores of TAS-20 were significantly higher among women with PRC than controls. Females with PRC had lower scores in the subscale “self” of the LEAS (capacity to describe their own emotional experience) than the control group. Only the LEAS significantly predicted the status group after adjusting for anxiety and depression. ConclusionOur results highlighted the impairment of emotion processing in patients with PRC and the importance of using a multimodal assessment of emotional regulation in future research.