Alexithymic Traits Research Articles

OBJECT RELATION QUALITY, ALEXITHYMIA, AND DEFENSE MECHANISMS OF DRUG ABUSERS WITH ANTISOCIAL PERSONALITY DISORDER

The purpose was to investigate, in a sample of drug abusers, whether subscales in the KAPP (Karolinska Psychodynamic Profile, Weinryb, 1992) interview and defense mechanisms explored by the DMTm (Defense Mechanism Technique modified) could differentiate between DSM-III-R clusters and personality disorders (PDs). Forty-seven (47) subjects out of the 84 injecting drug abusers (56%) recruited from a detoxification hospital ward in Sweden had a primary antisocial PD (ASPD) with a comorbid second DSM-III-R PD diagnosis. Pathology was significant on the KAPP subscales of“Dependency and separation,” “Alexithymic traits,” “Normopathic traits,”“Coping with aggressive affects,” and “Sexual satisfaction” in relation to cluster B (dramatic). All subscales were predominant in patients with ASPD/narcissistic PD, who showed the defense mechanism marked denial. The two latter subscales were related to patients with ASPD/borderline PD, who showed the defense of introaggression and the DMTm sign of disappearance of threat. Finally, some psychoanalytic constructs in KAPP and DMTm showed congruence.

Relationship Patterns in Alexithymia: A Study Using the Core Conflictual Relationship Theme Method

Background: Alexithymia is a disturbance in regulating affective states. Clinical observations suggest that alexithymic patients relate to others in a specific way. This paper explores whether specific relationship or transference patterns are typical of alexithymia. Sampling and Methods: Relationship patterns were assessed by means of the Core Conflictual Relationship Theme method, standard categories version. This method examines transference patterns and was applied to clinical interview data collected from a sample (n = 31) of mental health outpatients. Alexithymia was assessed by means of a score on the 20-item Toronto Alexithymia Scale corrected for the degree of depression (measured by the Beck Depression Inventory-II). Data were analysed by means of the leaps and bounds regression algorithm for selecting optimal subsets of indicators and by bootstrapping to determine 95% confidence intervals. Results: First, we observed that alexithymia can be meaningfully explained by typical wishes, typical subjective perceptions of how others respond and one’s own typical responses to others. This result indicates that the more marked a patient’s alexithymic traits are, the more probable it is that specific transference themes come to the fore. Second, a set of three core indicators of trait alexithymia was mapped: little concern about being good to others, a strong perception of others as cooperative, and weak levels of reacting to others and to conflict by means of somatic symptoms. Conclusion: Alexithymia is related to a double interpersonal indifference: not much is expected from others, nor is there a personal urge to fulfill the expectations of others. Moreover, in alexithymia somatic symptoms proved to be non-reactive to interpersonal situations. Implications for diagnosis and treatment are highlighted. Limitations of our study are that alexithymia was only assessed with a self-report measure and that conclusions are based only upon data from a heterogeneous mental health sample.

Alexithymia in Obsessive-Compulsive Disorder – Results from a Family Study

Background: Previous studies have suggested an association between alexithymia and obsessive-compulsive disorder (OCD). However, it is unclear to which extent alexithymic traits in OCD patients reflect familial deficits in cognitively processing and communicating feelings that are also present in their first-degree relatives. This study investigates the hypotheses of an elevated level of alexithymia in subjects with OCD and their first-degree relatives compared to controls and their first-degree relatives. Methods: 82 cases with OCD and 169 first-degree relatives were compared to 76 controls and 144 first-degree relatives from a German family study on OCD (GENOS). All subjects completed the 20-item Toronto Alexithymia Scale (TAS-20). Direct or family informant interviews were carried out with the German version of the Schedule for Affective Disorders and Schizophrenia – lifetime version for anxiety disorders (DSM-IV). Results: OCD was associated with significantly higher scores of alexithymia. However, first-degree relatives of OCD cases and of controls did not differ in TAS-20 scores. In linear regression analyses, the TAS-20 total score showed significant intrafamilial associations within the families of control subjects but not within families of OCD cases. Conclusion: OCD is a severe mental disorder that is associated independently from other current comorbid axis I disorders with deficits in identifying and expressing feelings. However, alexithymia does not represent a familial risk factor for OCD.

Alexithymia and body image disturbances in women with Premenstrual Dysphoric Disorder

Background. To evaluate alexithymia and body image in women with Premenstrual Dysphoric Disorder and test whether alexithymic traits influence severity of Premenstrual Dysphoric Disorder or body distress.Methods. Sixty-four consecutive women with a DSM-IV diagnosis of Premenstrual Dysphoric Disorder and age range of 18–45 were recruited. Alexithymia was measured with the Italian version 20-items Toronto Alexithymia Scale. Severity of premenstrual mood symptoms was measured through the use of Visual Analogue Scales. Body concerns were assessed with the Body Uneasiness Test, Body Shape Questionnaire and Body Attitude Test. Additional measures were Rosenberg Self-Esteem Scale and Sheehan Disability Scale.Results. Prevalence of alexithymia in our sample was 31.3% (n = 20). Alexithymics showed higher scores on all rating scales (p range 0.001–< 0.001). Difficulty in Identifying Feelings and Difficulty in Describing Feelings subscales of Toronto Alexithymia Scale were predictors of severity of Premenstrual Dysphoric Disorder in the multiple linear regression analysis. Conclusions. Alexithymia was associated with more severe Premenstrual Dysphoric Disorder. Alexithymic women with Premenstrual Dysphoric Disorder exhibited significantly poorer appearance evaluation and body satisfaction than non-alexithymic women.

The relationship between perceived parenting, adult attachment style and alexithymia in alcoholic inpatients

In this paper we examine the understudied relationship between alexithymia on the one hand, and adult attachment and perceived parenting on the other hand, in a clinical sample of alcoholic inpatients ( N = 101). We test whether differences between a high and a low scoring group on trait alexithymia can be predicted on the basis of attachment style and perceived parenting. We observed that the avoidant attachment style is a strong predictor. Subsequently we test whether three dimensions of alexithymia – affective, cognitive and social – are meaningfully linked to adult attachment and perceived parenting. We noticed that cognitive alexithymia especially was predicted by the avoidant attachment style and a lack of warmth perceived in the relationship to the father.

Migraine in the emergency department: a psychometric study of a migraine “repeaters” sample

To evaluate the influence of psychometric variables on the “repeater” phenomenon in an emergency department, 15 “repeaters” and 27 outpatient migraineurs were recruited. All patients were submitted to the Beck Depression Inventory (BDI), State and Trait Anxiety Inventory, Toronto Alexithymia Scale–20 (TAS–20), Tridimensional Personality Questionnaire and Migraine DIsability Assessment Scale (MIDAS). The “repeater” group showed higher MIDAS total scores (p=0.02) and higher scores in TAS–20 (p=0.02) than the outpatients. A higher frequency of alexithymic trait (p=0.02) and higher BDI scores (p=0.07) have also been observed in the “repeater” group than the outpatients. Alexithymia and depressive mood associated with high disability may be a specific psychosocial pattern of “repeater” migraineurs. The psychometric evaluation of this population may be important to explain the “repeaters” phenomenon.

The Relationship of Pressure-Pain Threshold with Alexithymia in Healthy Young Subjects

Objectives: Alexithymia is related to chronic pain with symptomatic patients, but the relationship between alexithymia and pain in healthy young subjects is unclear. Therefore, the aim of this study was to determine the relationship between pressure-pain threshold [PPT] and alexithymia in healthy young subjects.Methods: This study included young volunteers. Pressure-pain threshold was assessed using a pressure dolorimeter over the third fingertip, the biceps brachii muscle, and the pectoral muscle. The Toronto Alexithymia Scale [TAS-20] was used to assess alexithymic traits among the study subjects.Results: Total TAS-20 scores of 104 subjects [30 male, 74 female], aged 18–23, years was 45.3 [SD 7.9]. There was no significant correlation between mean the TAS-20 scores and PPT values. Three facets of TAS-20 [difficulty identifying feelings, difficulty communicating feelings, and externally oriented thinking] were not significantly correlated with PPT. The PPT values of subjects for the biceps brachii muscle, the third finger, and the pectoral muscle were numerically lower on the left side than on the right side, but only PPT of biceps brachii on the left side was significantly lower than the right side.Conclusion: We concluded that there was no correlation between alexithymia and PPT in young healthy subjects. There was no PPT asymmetry in the third finger or the pectoral muscle, whereas biceps brachii muscle revealed PPT asymmetry.

Psychological Evaluation of Patients with Cutaneous Lichen Planus

Background: Stress and anxiety have frequently been mentioned as possible factors related to the development of oral lichen planus (OLP). On the other hand, the psychological factors associated with cutaneous lichen planus (CLP) have only been insufficiently explored. A matched-pair, case-control study was conducted to perform a psychological evaluation of patients with a clinical and histological diagnosis of CLP with or without oral involvement. Patients and Methods: A consecutive, unselected series of 55 outpatients with CLP were examined. Stressful life events before disease onset, present or past psychiatric disorders, levels of anxiety and alexithymic traits were investigated. The impact of various life experiences was assessed by means of a self-report inventory. Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS), and anxiety by the State and Trait Anxiety Inventory (STAI)-1 and STAI-2. The results then were compared to those obtained in a control series of the same number of patients with superficial fungal infections, matched for age and sex. Statistical analysis was performed by t and χ square tests. Results: No significant difference was found between the groups in respect to psychiatric disorders. 88.7% of patients versus 38.1% of controls reported to have experienced stressful events before onset of their disease. This difference was found to be statistically significant (p < 0.0001). However, the incubation period (the time between the stressful life event and the onset of disease) did not differ between the groups. Significantly greater mean scores for STAI-1 and STAI-2 were observed among patients with CLP than in the control group (p < 0.0001 and p < 0.05 respectively). With regard to the degree of alexithymia, even though the mean total score of TAS was slightly higher in the CLP group, there was no significant difference between the groups (p > 0.05). Conclusion: Patients with CLP had more often been exposed to stressful life situations before disease onset and suffered from anxiety significantly more often than controls. We suggest that CLP patients should be treated both dermatologically and psychologically.

Neuronale Aktivitätsmuster auf affektinduktive Reize bei Alexithymie

In alexithymia a frontal dysfunction is supposed to be a neurobiological correlate. This study focuses on distorted patterns of neuronal activity evoked by emotional stimuli in alexithymics and controls. Out of hospitalised patients with psychosomatic diseases 8 patients with a high score (HA) and 8 with a low one (NA) on the TAS-20 were investigated with fMRI during emotional stimulation which included pictures evoking anxiety and disgust as well as neutral illustrations. As response to negative affect arousing visual stimulation HA in comparison to NA showed a lower activation in the right medial prefrontal cortex and in the right amygdala. The results were significant for the emotion disgust. The results support the existence of a complex central feedback circuit consisting of regions of the prefrontal cortex and limbic structures to process negative affects. Hypothetically a fundamental factor for the emergence of alexithymic traits is an inhibiting process between affect processing (e. g. medial prefrontal cortex, anterior cingulum) and affect generating structures (e. g. amygdala). Furthermore our findings confirm the hypothesis that alexithymia is a disorder of higher cerebral function.

Asperger Syndrome, Alexithymia and Perception of Sleep

Two research traditions, the one on Asperger syndrome (AS) and the other on alexithymia, have produced similar findings independently of each other indicating a possible association between these two phenomena. Both conditions are also associated with impaired initiation and continuity of sleep. Twenty AS adults were compared with 10 healthy controls using the Toronto Alexithymia Scale and the Basic Nordic Sleep Questionnaire. AS subjects were significantly more alexithymic and reported lower sleep quality as compared with controls. AS and alexithymia are associated although the mediating factors are unknown. It is possible that alexithymic traits predispose to anxiety, which in turn lowers the sleep quality in AS adults. Alternatively, low sleep quality might be due to AS itself.

Are there overlapping constructs between alexithymia and depression in hemodialysis patients

Chronic pain has high comorbidity with psychiatric disorders, therefore, better understanding of the relationship between chronic pain and mental illness is needed. This study aimed to investigate the pathway relationships among parental attachment, personality characteristics, alexithymic trait and mental health in patients with chronic widespread pain, those with chronic regional pain, and controls. Two hundred and thirty participants were recruited. The parental Bonding Inventory, Eysenck Personality Inventory (EPI), 20-item Toronto Alexithymia Scale (TAS-20), Chinese Health Questionnaire, and Short-Form 36 were filled out. The pathway relationships revealed that patients of mothers who were more protective were more neurotic, had more difficulty identifying feelings (DIF), worse mental health, and a higher association with chronic widespread pain. No differences were found between patients with chronic regional pain and the controls. The predisposing factors for chronic widespread pain, when compared with chronic regional pain, may be more closely related to psychiatric disorders. The pathways to chronic regional pain and chronic widespread pain differ, with neuroticism and the alexithymic DIF trait being the main factors defining chronic widespread pain. Therefore, besides therapies targeting pain symptoms, psychiatric consultation, medication and psychotherapy are also recommended for those with chronic widespread pain to alleviate their mental health conditions.

Alexithymia in Patients Attending a Sexual Disorders Clinic

We measured alexithymic traits with the Toronto Alexithymia Scale (TAS; Bagby, Taylor, & Parker, 1988) in 170 individuals attending a sexual disorders clinic. We diagnosed 114 of the subjects with a sexual dysfunction and 56 with paraphilic disorders. We determined that 20.2% of the dysfunctional group and 26.8% of the paraphilic were alexithymic when the TAS was measured categorically. When we considered the TAS as a dimensional variable, the subset with paraphilias had significantly higher scores on the TAS only when depressed mood, as measured by the Brief Symptom Inventory (Derogatis, 1993), was covaried. These data suggest that alexithymia in both sexually dysfunctional and paraphilic individuals is related to depressed mood, although the effect is more pronounced in paraphilics.

Group-Analytic and Psychoeducational Therapies for Binge-Eating Disorder: An Exploratory Study of Efficacy and Persistence of Effects

Research has evaluated cognitive-behavioral therapy and interpersonal psychotherapy for the treatment of binge-eating disorder (BED); other therapies, however, have received less attention. The aim of our research was to analyze the efficacy of two group therapies for BED patients: analytic psychotherapy and psychoeducation. The psychotherapeutic intervention consisted of group-analytic psychotherapy of 14 sessions over a 28-week period; the group psychoeducational intervention involved 10 sessions over a 10-week period. The Eating Disorder Inventory-2, the 16-Personality Factors questionnaire, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale-20 were used for psychometric assessment. Two follow-up assessments were performed after 6 and 12 months, respectively. At the end of treatment, most patients were without eating disorders and had a lower rate of binge episodes. The psychoeducational group patients improved markedly in alexithymic traits related to the ability to describe feelings. At follow-up, most patients were still without eating disorders and had few binge episodes. Although psychoeducational group patients confirmed the amelioration on alexithymic traits, analytic psychotherapy group patients showed a trend toward an improvement in personality traits related to the ability to be at ease when communicating with others.

Group-Analytic and Psychoeducational Therapies for Binge-Eating Disorder: An Exploratory Study of Efficacy and Persistence of Effects

Research has evaluated cognitive-behavioral therapy and interpersonal psychotherapy for the treatment of binge-eating disorder (BED); other therapies, however, have received less attention. The aim of our research was to analyze the efficacy of two group therapies for BED patients: analytic psychotherapy and psychoeducation. The psychotherapeutic intervention consisted of group-analytic psychotherapy of 14 sessions over a 28-week period; the group psychoeducational intervention involved 10 sessions over a 10-week period. The Eating Disorder Inventory-2, the 16-Personality Factors questionnaire, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale-20 were used for psychometric assessment. Two follow-up assessments were performed after 6 and 12 months, respectively. At the end of treatment, most patients were without eating disorders and had a lower rate of binge episodes. The psychoeducational group patients improved markedly in alexithymic traits related to the ability to describe feelings. At follow-up, most patients were still without eating disorders and had few binge episodes. Although psychoeducational group patients confirmed the amelioration on alexithymic traits, analytic psychotherapy group patients showed a trend toward an improvement in personality traits related to the ability to be at ease when communicating with others.

Insecure attachment and alexithymia in young men with mood symptoms.

According to attachment theorists, affect regulation and quality of attachment are closely linked. As a personality trait associated with deficits in the cognitive processing and regulation of affects, alexithymia has been hypothesized to correlate with insecure attachment. To test this hypothesis, we studied the relationships between alexithymia, adult attachment style, and retrospective memories of separation anxiety symptoms during childhood in 100 young men with clinically significant mood symptoms. The most common DSM-IV diagnosis (N = 72) was adjustment disorder with depressed mood, with anxiety, or with mixed anxiety and depressed mood. Each participant completed the Twenty-Item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI), the state form of the State-Trait Anxiety Index (STAI), the Attachment Style Questionnaire (ASQ), the Relationship Questionnaire (RQ), and the Separation Anxiety Symptom Inventory (SASI). Alexithymic traits were more pronounced in those participants who had patterns of insecure attachment and who reported more severe symptoms of separation anxiety during childhood, independently of the severity of their current anxiety and depressive symptoms. Among the subgroup of participants with insecure attachment styles, those with preoccupied or fearful patterns had a higher prevalence of alexithymia (65% and 73%, respectively) than those with a dismissing pattern (36%). These data suggest a role for early developmental factors in the etiology of alexithymia

Hopelessness, Depression and Alexithymia in Young Turkish Soldiers Suffering from Alopecia areata

Background: There are reports finding high prevalences of psychiatric disorders in patients with alopecia areata (AA), as well as reports refuting this association. The present study was designed to assess the prevalence of depression, anxiety, hopelessness, psychological distress and alexithymia in AA patients compared to a healthy control group. Method: 31 male patients who were soldiers with AA and 40 healthy soldier controls from the same milieu were assessed by the Beck Depression Inventory, the Beck Hopelessness Scale, the State-Trait Anxiety Inventory, the Toronto Alexithymia Scale and the Brief Symptom Inventory. Results: The patients with AA scored significantly higher than normal controls on all of the psychological measures. According to cut-off scores 58% of the patients were alexithymic, 55% were in the range of clinical depression, and 32% displayed hopelessness. AA patients displayed higher levels of psychopathology than normal controls. Conclusions: The alexithymia construct deserves further attention in patients with skin disorders, particularly in AA. State and trait alexithymia can result from deficits induced by severe and persistent stress and they have neurophysiologic causes. Alexithymic individuals who fail to cope with stress and also fail to communicate their feelings, might be more prone to develop AA. Depression, anxiety and hopelessness must be recognized and treated in AA patients for a better response to dermatological therapy.

Alexithymia and Body Weight in Obese Patients

The authors evaluated severely obese patients to determine whether being far different in body shape from the accepted standard may cause obese people to develop alexithymic personality traits. They evaluated the food- and weight-related attitudes in obesity surgery patients and in long-term follow-up of those who had previously had biliopancreatic diversion (BPD) for obesity. One quarter of the obese patients had alexithymic characteristics without any modification following stable weight loss, a rate of alexithymia similar to that observed in the nonclinical population. Furthermore, the frequency of alexithymia and the patients' scores on the Toronto Alexithymia Scale were similar in obese and post-BPD individuals. The authors concluded that being obese by itself does not influence the presence of alexithymic personality traits. However, they suggest that the improvement in food-related and weight-related attitudes following stable weight loss may be different in alexithymic and in nonalexithymic obese patients.

The Relationship between Dimensions of Alexithymia and Dissociation

Background: The study investigated the following hypotheses: (1) Alexithymia is significantly associated with dissociation. (2) Pathological versus nonpathological dissociation is associated with alexithymic traits. Methods: Psychiatric in- and outpatients (n = 173) and nonclinical subjects (n = 38) were investigated with the Toronto Alexithymia Scale (TAS-20), the FDS (German version of Dissociation Experience Scale) and the Symptom Check List (SCL-90-R; GSI). Correlation analyses followed by MANOVA and logistic regression were performed. Results: Significant correlations and partial correlations, controlling for GSI, were observed between dissociation and alexithymia. The MANOVA demonstrated significantly higher scores for the two TAS-20 dimensions ‘difficulty identifying feelings’ and ‘difficulty expressing feelings’ in the group with pathological dissociation. On the basis of the TAS-20 subscores, logistic regression analysis correctly classified 72.5% of the cases into the pathological and the nonpathological dissociation group. Conclusions: These results support our hypothesis that pathological traits of dissociation are highly associated with alexithymia. A model is discussed in which alexithymic characteristics may contribute to the development of pathological dissociation and stress-related disorders such as posttraumatic stress disorder.

Alexithymic Traits as Predictors of Difficulties with Adjustment in an Outpatient Cohort of Expatriates in Tokyo

The purpose of this study was to examine whether alexithymic characteristics, which are thought to be related to poor coping with stress, would be associated with variables thought to reflect adjustment to life abroad. The subjects were 56 expatriates living in Tokyo, Japan. The Expatriate Adaptation Inventory, the Toronto Alexithymia Scale, and the Social Support Questionnaire of the Stress and Coping Inventory were given to the subjects. Scores on alexithymia were significantly associated with dissatisfaction with life abroad, higher satisfaction with life in one's home country prior to departure, and higher ratings on the perception of poor social support. An alexithymia variable, difficulty identifying feelings, was a significant predictor of dissatisfaction with life abroad and satisfaction with life in the home country. The results suggest that, because alexithymia was associated with lower satisfaction with life abroad and higher satisfaction in the home country prior to departure, it may be a predictor of adjustment difficulties when individuals live abroad. Empirical confirmation is needed.

A multidisciplinary clinical study of patients suffering from illness associated with mercury release from dental restorations: psychiatric aspects.

The aim of this study was to map the psychological/psychiatric, odontological and medical aspects of patients with symptoms allegedly related to the side-effects of mercury in dental fillings. A total of 67 consecutive patients and 64 controls matched for age, sex and residential area were included in the study. The most striking result was the high prevalence of psychiatric disorders in the patients (89%) compared to the controls (6%), predominantly somatoform disorders. The personality traits differentiating the patients according to the Karolinska Scales of Personality (KSP) were somatic anxiety, muscular tension, psychasthenia and low socialization. More patients than controls showed alexithymic traits. The prevalence of diagnosed somatic diseases was higher, but not sufficiently so to explain the large difference in perceived health. The multiple symptoms and signs of distress displayed by the patients could not be explained either by the odontological data or by the medical examination. Our data indicate that the patients show sociodemographic and clinical patterns similar to those of somatizing patients. The medicalization of the suffering of these patients and the neglect of psychiatric problems prevent the use of appropriate psychotherapeutic approaches.