Concept Of Alexithymia Research Articles

The concept of alexithymia: an empirical study using psychodynamic ratings and self-reports.

In patients with ulcerative colitis, alexithymia and related traits were studied using the Karolinska Psychodynamic Profile (KAPP), a recently constructed psychodynamic assessment instrument, and other measures of alexithymia (the Schalling-Sifneos Personality Scale (SSPS) and the Beth Israel Questionnaire (BIQ)), and other personality traits using the Karolinska Scales of Personality (KSP). The results of these measures were analyzed for correlation. The prevalence of mental disorder as defined by DSM-III was not above normal, and the KSP T-scores were within normal limits. As rated with the KAPP, alexithymia was uncorrelated with age or level of education, but was inversely correlated with proximity to a major life event (abdominal surgery), suggesting that alexithymia may have a defensive function. Cluster analysis, with Regression in the service of the ego (R), Alexithymia (A) and Normopathy (N) as clustering variables, yielded 3 groups: normal, multidisturbed (problems with R, A and N) and inhibited (problems with R and N). SSPS failed to distinguish between the multidisturbed and the inhibited groups, and BIQ between any groups. In the multidisturbed group, correlations were found with detachment and with disturbances in interpersonal relations. The results suggest that disturbances in object relations are of major importance in alexithymia.

Alexithymia – State and Trait

Alexithymia is conceptualized as both affect-deficit disorder and continuous personality variable. Two-hundred-sixty-four adolescents were surveyed using (1) a core symptom questionnaire for alexithymic state; (2) the Toronto Alexithymia Scale (TAS), and (3) the Solacing Methods Questionnaire. Three percent were positive for core symptoms and used significantly fewer solacers than matched controls (p = 0.048); the affect-deficit disorder hypothesis is supported. Twenty-three percent were TAS-positive suggesting the need for a trait measure. However, only one of the 8 core symptom subjects was TAS-positive raising a question about the sensitivity of the TAS to the extreme cases on which the alexithymia concept is based. While 62.5% of the matched controls reported using memories for solace, none of the core symptom subjects did; one of the alexithymic's central problems may consist in finding psychological as opposed to action-oriented and physical comfort.

Somatothymia: Parts I and II

The development of affective language is a complex process that may be influenced by sociocultural, psychodynamic, developmental, cognitive, and behavioral factors. This article, published in two parts, discusses the multidimensional factors influencing the acquisition and expression of affective language. The terms somatothymia and somatothymic language, derived from the concept of alexithymia, are introduced to describe the phenomenon of utilizing somatic language to communicate psychological distress.

Interrater Agreement when Assessing Alexithymia Using the Drawing Completion Test (Wartegg Zeichentest)

Due to insufficient agreement regarding the definition of the concept of alexithymia, a number of theoretically different approaches have been used when assessing the phenomenon. Primarily psychiatric interviews and questionnaires have been used, but also projective tests, principally the TAT, and the Rorschach. In this study four independent assessments of alexithymia were made, using the Wartegg, for a cohort of 50 randomly selected subjects, acting upon the alexithymia description of von Rad. Intraclass correlations were on an average 0.77.

Cancer and Psychosocial Traits, Continued

To the Editor.— The worthwhile prospective study by Zonderman et al, 1 which found that self-reports of depression do not predict cancer in a 10-year follow-up, does not definitively refute my quoted statement that emotional factors can play a role in the onset and course of cancer. Two possible combinations of state/trait psychological characteristics could account for the (likely valid in terms of methodology utilized) findings. I have postulated the existence of an immunosuppression-prone personality pattern that is akin to the type C or cancer-prone pattern and to the concept of alexithymia. 2 All these constructs include difficulty being aware of and communicating one's feelings. Lack of emotional expressiveness has been linked to psychosomatic processes by a number of investigators. 3 The first explanation for lack of correlation between apparently chronic depression and cancer might be that only in immunosuppresion-prone people, those with particular personality and coping style patterns, does

Psychometrics of the Schalling-Sifneos and Toronto Alexithymia Scales.

Two measures of alexithymia, the Schalling-Sifneos (SSPS) and the Toronto Scales (TAS) were administered to 178 male and female undergraduate students. For both measures alexithymia appears to decrease with age. Five factors for the TAS were retained accounting for 35% of the variance and for the SSPS a three-factor solution was determined accounting for 53% of the variance. The robustness of the solution analyzed with the TAS reflected greater stability. The factor structure of the TAS seemed more consistent with the concept of alexithymia than that of the SSPS.

The Concept of Alexithymia in the Light of the Work of Bion

ABSTRACT. Bion's work on the genesis, agenesis and dysgenesis of thought, and its subsequent development, allows us to delineate two fundamental mechanisms which are used to avoid the painful anxieties associated with the birth of a thought. These anxieties, which are perhaps best covered by the term catastrophic anxiety, may be avoided by evacuation of the elements that thought is born from, or by the conversion of these elements into pseudo‐elements or lies. The clinical concept of alexithymia, which evolved from work with psychosomatic patients, illustrates how these mechanisms may be manifested clinically by disordered thought and psychosomatic illness.

Concept of alexithymia. II. The consistency of alexithymia.

The stability of alexithymia in acute and nonacute disease was studied in 69 patients with 'psychosomatic' digestive disease and in 47 control patients. Methods used were the Beth Israel Hospital Questionnaire, Lazare's Personality Test, and the Rorschach Test. Subjects were interviewed to assess their somatic well-being and the psychological meaning of the illness. Three different alexithymia groups were found. The first consisted of the nonalexithymic patients who scored low in both testings and who seemed to be 'average persons' in the light of personality tests. The second comprised the patients who developed alexithymia as a reaction to illness. They had good cognitive control but a tendency to hypochondriac worry. The last consisted of patients whose alexithymia decreased during an acute disease. They were egocentric and rigid personalities who enjoyed being ill because they then felt that they were loved and noticed. This division was found to be independent of the patients' medical diagnosis.

Personality, imaginative involvement, and self-reported somatic complaints: relevance to the concept of alexithymia.

Forty-five undergraduate students were investigated to determine the relationship between personality dispositions, capacity for imaginative involvement, and self-reported physical symptoms. The results showed that somatic complaints were associated with variables reflecting psychological vulnerability and dysphoric affect (e.g. anxiety and worry/depression). Imaginative involvement, and especially the Absorption Scale, correlated positively with self-reported somatic symptoms. Factor analyses revealed that Absorption Scale and the Creative Imagination Scale loaded on a general psychological distress factor. Moreover, self-reported somatic symptoms correlated negatively with 'inner directedness' and 'sociable' coping style, and positively with the coping styles 'sensitive' and 'inhibited', thus suggesting a link between emotional expressiveness and somatic complaints. The relevance of these results to the concept of alexithymia is discussed.

Empirical study of alexithymia: methodology and results.

Starting with a review of selected examples of empirical studies on the concept of alexithymia, this paper then presents a new perspective that helps to integrate these diverse results. Studies are grouped into two types: those employing instruments (questionnaires, ratings) that directly assess alexithymia, and experimental studies. Studies of the first type are found to be inconclusive in that the search for a personality trait of alexithymia in psychosomatic patients has not been very fruitful. The evidence from experimental studies, however, does allow for some interesting interpretations: The apparent diversity in results can be resolved, if certain crucial dimensions are analyzed. On the stimulus side, interpersonal relevance and the degree of subjective involvement are found to be crucial, as results pointing towards alexithymia are mainly found when both of these are high. On the measurement side, large variations in results can be explained by reference to the "depth" of measurement level. On a more superficial or cognitive level, it is possible to find indications of alexithymia, whereas on a deeper, more unconscious level, psychosomatic patients' response to experimental stimuli are similar to that of controls. The implications of this are that alexithymia, rather than being understood as a personality trait, should be seen as a label for a set of coping behaviors that occurs in specific situations only.

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.

Verbal measures of alexithymia: what do they measure.

Previous studies have shown that measurement of verbal affective expression is influenced by the method used for obtaining speech samples, thereby supporting a situation-dependent, or state concept of alexithymia. In this study monadic speech samples obtained from 20 psychoneurotic and 20 psychosomatic patients, using selected thematic apperception test (TAT) cards, were examined using different methods of content analysis. Although no differences were found with the Gottschalk-Gleser anxiety, hostility outward and hope scales, the psychosomatic patients had a more limited emotional vocabulary than the psychoneurotic patients as measured by an 'affect vocabulary score' (AVS). In contrast to the Gottschalk-Gleser scores (GGS), the AVS correlated with measures of fantasizing ability and would appear to be a more valid method of measuring alexithymia. The findings also supported a trait concept rather than a state concept of alexithymia.

Alexithymia: concept, measurement, and implications for treatment.

Alexithymia refers to a specific disturbance in psychic functioning characterized by difficulties in the capacity to verbalize affect and to elaborate fantasies. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. The author reviews the concept of alexithymia, including its historical background, clinical and demographic features, and possible etiology. He critically evaluates the different methods used to measure alexithymia and discusses the important implications it has for medical and psychiatric treatment.

Alexithymia and symptom formation.

In regard to its clinical descriptive aspects the concept of alexithymia is based on a broad consensus of the investigators. However, with respect to its etiopathogenesis (hereditary, neurophysiological, sociogenic, psychogenic) and its relevance for the formation and maintenance of psychosomatic symptoms, this concept is controversial and unclear. In this context the psychodynamic aspects which are under discussion for the development and maintenance of alexithymic behavior are reported particularly from an object relations point of view. Some resulting principles for a possible psychotherapy of these patients are finally presented.

The clinical approach to alexithymia: A review

Since development of the concept of alexithymia about a decade ago, there has been considerable discussion of the extent to which it is a medical or a social and cultural phenomenon. However, it becomes a medical problem when it interferes with treatment, especially as alexithymic patients tend to somatize in lieu of experiencing psychic conflict. This review describes the relationship of alexithymia to psychosomatic illness, socioeconomic and cultural factors, and possible anatomicophysiologic features. Alexithymia per se should be distinguished from other conditions, such as simple denial and repression, the psychic numbing that may follow catastrophe, and primary affective disorders. Previous treatment approaches are assessed, and recommended therapeutic strategy is presented.

Sleep, scratching and dreams in eczema. A new approach to alexithymia.

6 patients with itching due to skin disorder and 6 student controls were studied in the sleep laboratory. It was found that some of the patients had personality characteristics consistent with Sifneos' concept of alexithymia and that these were associated with a trend towards less REM sleep and with a significant lack of involvement in dreams collected under standardised sleep laboratory conditions. It is suggested that dreams collection in a sleep laboratory may be a valuable new method in the study of the link between emotional life and psychosomatic disorders.

Alexithymia and chronic pain: prevalence, correlates and treatment results.

The alexithymia scale of the Minnesota Multiphasic Personality Inventory was used to determine the prevalence of alexithymia in a group of 60 patients attending a chronic pain clinic. It was found that 28 patients (47%) obtained scores in the 'alexithymic' range. The alexithymic patients had a significantly longer history of pain, but were not significantly older than the nonalexithymic group. Alexithymic patients showed significantly lower neuroticism, hypochondriasis, affective disturbance, and irritability scores. In a pilot study two subgroups of 15 alexithymic and 15 non-alexithymic patients were compared following a period of treatment; in both groups equal proportions of patients showed significant pain relief. Although this study does not support the view that alexithymia is of significance in the psychomaintenance of chronic pain, it is suggested that clinicians working with chronic pain patients should be familiar with the concept of alexithymia.

Specificity revisited: personality profiles and behavioral issues.

The notion of a connection between illness and temperament goes back at least as far as Hippocrates with his typology of melancholy, sanguine, phlegmatic and choleric personality types. In the 1930s, Dunbar studied large numbers of patients with several chronic diseases from which she derived personality profiles which correlated with the illnesses. Many other studies developed similar correlations. Following the work of Alexander, this approach was deemed superficial. More recently, the description of type A behavior has consistently been shown to correlate with coronary artery disease. The concept of alexithymia is another variant of personality typology. The present status of personality and behavior patterns as markers in psychosomatic medicine are discussed as well as the possible relationship of personality profiles to genetic factors, developmental issues, psychological conflict and other approaches to psychophysiological disorders.

Expression of affect and physiological response in psychosomatic patients.

Abstract This study examined the relationship between physiological response to stressful stimulation and subjects' self-reported ratings of stress. Five groups of ten subjects each (normal controls, migraine headache patients, tension headache patients, essential hypertensives and rheumatoid arthritics) were exposed to a physical stressor (exercise) and a psychological stressor (mental arithmetic) while frontalis and forearm muscle tension, digital temperature, heart rate, electrodermal response, and systolic and diastolic blood pressure were recorded. Although all physiological levels except diastolic blood pressure showed significant increases in the level of activation during the stressor, a tendency was observed for correlations between physiological level and subjective ratings of stressfulness to be negative. This tendency was manifest equally in the five groups studied. These results are discussed in terms of Sifneos' alexithymia concept and their possible link to stress-related diseases.

Alexithymia and the psychomaintenance of bronchial asthma.

A total of 579 adult and adolescent asthmatic patients were assessed for alexithymia while inpatients. Subsequent rehospitalization data was collected 6 months after discharge. Analyses revealed that alexithymia was related both to rehospitalization (yes-no) and to the number of days rehospitalized. These findings were seen to reinforce the concept of alexithymia as a psychomaintenance variable.