Alexithymic features in migraine patients

Abstract. The aims of the present study were 1) to investigate the alexithymic features in migraine patients and, 2) if alexithymia has any relation with the results of other psychological scales that are widely used in clinical practice to describe the psychopathologies, such as depression and anxiety. Demographic and clinical data of 50 cases with migraine without aura and 50 normal volunteers were supplied. All cases completed the Beck Depression Inventory, Hamilton Depression Rating Scale, State and Trait Anxiety Inventory and Toronto Alexithymia Scale. Migraine patients were significantly more depressive, anxious and alexithymic than the control group; there was no correlation between TAS scores and demographic variables; not depression but anxiety was significantly correlated with alexithymia in the migraine group, whereas none of the scores were found to be related to alexithymia in controls. According to our results, alexithymia is a frequent finding in migraine patients and is associated with anxiety to a considerable extent but not with depression.     

Alexithymia and anxiety sensitivity in Turkish depressive,anxiety and somatoform disorder outpatients

Objective. To assess the relations between anxiety sensitivity, and dimensions of alexithymia in somatoform, anxiety and depressive disorder patients. Methods. The sample consisted of 124 patients with the diagnosis of depressive, anxiety, or somatoform spectrum disorders (DSM-IV). Toronto Alexithymia Scale (TAS-20), 16-item Anxiety Sensitivity Index (ASI), Hamilton Depression (HDRS), and Anxiety (HAS) scales were used. Results. The total sample (n=124) was divided into three diagnostic categories. There was one Depression Group (n=69). Due to small sample sizes, diagnoses in anxiety and somatoform spectrum disorders were combined in two relatively larger Anxiety (n=42) and Somatoform Groups (n=13) for statistical purposes. No statistically significant difference was found in the TAS-20 total or subscale scores between the three diagnostic groups. In all three diagnostic groups, there was a strong and significant positive correlation between ASI and TAS-20 total scores. In all three groups, there was a significant positive correlation between TAS-20 Factor 1 and ASI. In the Depression and Somatoform Groups, ASI scores were found to be significantly positively correlated with scores on TAS-20 Factor 2. Conclusion. This study reveals that alexithymia does not differentiate depressive, anxiety, or somatoform disorders, yet suggests a functional relation with anxiety sensitivity on a subscale basis.     

Relationship between alexithymia, dissociation and anxiety in psychiatric outpatients from Turkey

Several studies have examined the relationship between dissociation and alexithymia. In this study, the objective was to investigate whether there was a relationship between alexithymia, dissociation and state and trait anxiety in psychiatric outpatients. The evaluations of psychiatric outpatients (n=154) were based on the Toronto Alexithymia Scale, the Dissociative Experiences Scale and the State and Trait Anxiety Index. The data were analyzed using chi2 test and multiple covariance analyses. Subjects with alexithymia (46.8%) were significantly less educated and showed higher state and trait anxiety. The mean Toronto Alexithymia Scale total score of the female and male patients was similar. The mean Dissociative Experiences Scale score of the study group was 10.8 (sd=9.8, ranged 0 to 45). A multivariate analysis of covariance showed that state and trait anxiety was a significant covariant for the Toronto Alexithymia Scale-Difficulty Identifying Feelings subscale. Only the trait anxiety was a significant covariant for the Toronto Alexithymia Scale-Difficulty Expressing Feelings subscale. The overall main effect of dissociation was not significant on the Toronto Alexithymia Scale total and subscales. These data suggest that dissociation is fundamentally a different construct from alexithymia, while state and trait anxiety are closely related to alexithymia.     

The relationship between alexithymia and psychological factors in systemic lupus erythematosus

Background

Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients.

Methods

Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patient's clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy.

Results

An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale–Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE.

Conclusion

Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patient's daily routine, and how patients adapt emotionally to a chronic disease.     

Taking the measure of anxiety and depression. Validity of the reconstructed Hamilton scales

The ability of the Hamilton Psychiatric Rating Scale for Depression (HRSD) and the Hamilton Anxiety Rating Scale (HARS) to discriminate major depressive disorder (MDD) from generalized anxiety disorder (GAD) was studied in 120 psychiatric outpatients and cross-validated with another 71 outpatients. Factor and discriminant analyses were used to develop revised anxiety and depression scales that were less positively correlated with each other, showed greater internal consistency, and differentiated MDD and GAD better than the original scales. The recombined scales also displayed higher rates of correctly assigning the samples to these disorders than did the original scales.     

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.     

Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder

Background: The Depression and Somatic Symptoms Scale (DSSS) is a self‐administered scale developed for monitoring both depression and somatic symptoms. The aims of this study were to establish the criterion‐related validity of the DSSS by testing the correlation between the DSSS and the Short Form 36 (SF‐36) scale and to compare the ability of the DSSS and two other scales in predicting the outcome of the SF‐36. Methods: The study enrolled 135 outpatients with a major depressive episode, 95 of whom received treatment for 1 month. Four scales were administered and evaluated: the DSSS, the SF‐36, the Hospital Anxiety and Depression Scale, and the Hamilton Depression Rating Scale. Pearson correlation was used to test correlations among scales. Multiple linear regressions were used to find the scales most effective in predicting the SF‐36. Results: The three scales were significantly correlated with most of the SF‐36 subscales. The depression and somatic subscales of the DSSS significantly correlated with the mental and physical subscales of the SF‐36, respectively. The DSSS and the Hospital Anxiety and Depression Scale were better able to predict physical and mental subscales of the SF‐36, respectively. The Hamilton Depression Rating Scale had a good ability to predict functional impairment. Conclusions: Psychometric scales with appropriate somatic symptoms might be more compatible with both physical and mental dimensions of the SF‐36. DSSS proved to be a valid scale for monitoring both depression and somatic symptoms in patients with depression. Future studies should test whether the DSSS is better at predicting the treatment and prognosis of depression than conventional scales for depression. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Alexithymia in adolescents with chronic fatigue syndrome

BACKGROUND: Alexithymia is postulated as an important factor in the development of medically unexplained physical symptoms. Chronic fatigue syndrome (CFS) is presently medically unexplained. The aim of this study was to investigate whether the prevalence of alexithymia was higher in adolescents with CFS compared to healthy adolescents. Comorbidity such as anxiety and depression were analyzed as possible confounding factors. Secondly, alexithymia was investigated as a prognostic factor for the recovery of CFS. METHODS: A cross-sectional study was performed among 40 adolescent outpatients diagnosed with CFS and 36 healthy controls. The 20-item Toronto Alexithymia Scale was used to assess all participants for alexithymia. Additionally, all participants completed a number of questionnaires regarding fatigue (Checklist Individual Strength), somatic complaints (Checklist Somatization Inventory), depression (Children's Depression Inventory), and trait anxiety (Spielberger State Trait Anxiety Questionnaire). A follow-up study was performed among the CFS adolescents 1 1/2 years after the initial assessment. RESULTS: CFS adolescents scored higher only on the subscale identifying feelings of the TAS-20 [mean difference after adjustment for depression and anxiety 2.8 (95% CI: 0.6; 4.9]. Twelve CFS adolescents (30%) fulfilled criteria for alexithymia. This subgroup was characterized by higher scores for depression and anxiety and equal scores for fatigue and somatic complaints. At follow-up, no differences in recovery were established between the alexithymic and nonalexithymic CFS adolescents. CONCLUSIONS: Alexithymia neither appears to be a unique correlate of CFS nor to be a prognostic factor for recovery of the CFS illness.     

The amplification of somatic symptoms in upper respiratory tract infections

To assess the cultural differences in the role of somatosensory amplification in Japan and North America, we re-examined the role of psychological amplification of objective physical symptoms, as measured by the Somatosensory Amplification Scale (SSAS), in 82 Japanese patients with upper-respiratory tract infections. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). We determined the association among continuous variables using the Spearman correlation coefficient. Next, we used multiple regression analysis and selected all symptoms as independent variables. The SSAS was significantly associated with all somatic symptoms. It was also closely related to discomfort, but the SSAS was not significantly correlated with either anxiety or depression. All somatic symptoms were not significantly correlated with the objective physical findings. Multiple regression analyses indicated that amplification by SSAS was a statistically significant predictor of the patient's somatic symptoms and discomfort. The objective findings did not significantly predict the patient's symptoms. Our study provides some empirical evidence regarding psychological amplification of objective physical symptoms, as measured by SSAS, in Japanese patients with upper-respiratory tract infections. Our findings suggest that there is no difference in the role of amplification of bodily sensations between Japanese and North Americans.     

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     

Alexithymia,Suicide Ideation,C-Reactive Protein,and Serum Lipid Levels Among Outpatients with Generalized Anxiety Disorder

The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP), and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG), and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings, and subthreshold depressive symptoms. Study limitations and future research implications are discussed.     

酒依赖患者的情绪障碍和述情障碍

目的：探讨酒依赖患者的情绪障碍和述情障碍。方法：采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、多伦多述情障碍量表（TAS）以50例酒依赖患者和50例正常对照组进行比较研究。结果：酒依赖组与对照组在焦虑、抑郁情绪和述情障碍方面存在明显差异。结论：纠正情绪和述情障碍可能有利于戒酒成功。     

Alexithymia in patients with conversion disorder

Abstract

Background and Aims: In the recent years, it has been observed that alexithymia is not specified for the psychosomatic disorders. It is known that alexithymia is observed frequently in various psychiatric disorders especially in the somatoform disorders. The aim of this study is to evaluate alexithymia in the patients with the conversion disorder. Methods: The study was performed in the Psychiatry Outpatients Clinics of the Izmir Atatürk Training and Research Hospital and Erenköy Psychiatry Education and Research Hospital. A total of 93 cases—47 outpatients who were diagnosed with conversion disorder according to the DSM-IV criteria and 46 age, gender and educational level matched healthy controls—were included in the study. All the cases were assessed by a Structured Clinical Interview for DSM-IV and were evaluated with a questionnaire (which included demographics and clinical data), the Toronto Alexithymia Scale and the Somatosensory Amplification Scale. Results: When the two groups were compared, the Toronto Alexithymia Scale scores (except “externally oriented thinking” subscale) and the Somatosensory Amplification Scale score of the conversion disorder group were statistically significantly higher than the control group. The number of the alexithymic cases of the patient group was significantly higher than the control group's. Conclusions: The level of alexithymia in conversion disorder patients, without any other psychiatric disorder, is higher than that of the healthy controls. During the evaluation of the psychological state of patients with conversion disorder, it could be useful to keep in mind the probability of them having alexithymia to determine the type of suitable therapy.     

Alexithymia as a predictor of residual symptoms in depressed patients who respond to short-term psychotherapy

Residual symptoms are increasingly becoming recognized as an important problem in the treatment of major depression. It is unclear which individuals are more likely to suffer from residual symptoms following treatment. This study investigated the role of alexithymia in the prediction of residual symptoms following treatment with psychotherapy. The study utilized data from 33 outpatients with major depression who were positive responders to psychotherapy. Alexithymia was assessed prior to treatment using the 20-item Toronto Alexithymia Scale. Depressive and anxious symptomatology were assessed using the Beck Depression Inventory and the Spielberger State-Trait Anxiety Inventory, respectively. Alexithymia factor 1 (difficulty identifying feelings) was predictive of the severity of residual symptoms, over and above the effect of initial levels of depression and anxiety, form of psychotherapy, and use of antidepressant medication. The findings suggest that difficulty identifying feelings may constrain one's ability to effectively utilize psychotherapy, thereby contributing to the persistence of residual symptoms.     

Alexithymia in insulin-dependent diabetes mellitus is related to depression and not to somatic variables or compliance

OBJECTIVES: To assess the prevalence of alexithymia in insulin-dependent diabetic mellitus (IDDM) outpatients. To examine whether alexithymia is associated with diabetic somatic variables, depression, and compliance. METHOD: Our sample comprised 69 diabetic outpatients followed in a university hospital. We assessed the prevalence of alexithymia (26-item Toronto Alexithymia Scale, TAS-26) and the relationships among alexithymia, depression (13-item Beck Depression Inventory, BDI-13), somatic diabetic variables (glycosylated hemoglobin, number of mild or severe hypoglycemia, somatic complications), and compliance (observer-rater scale completed by diabetologist). RESULTS: The prevalence of alexithymia in IDDM patients was low (14.4%). Alexithymia and depression, as measured by TAS-26 and BDI-13 scores, respectively, correlated with each other. Alexithymia was not correlated with glycemic control, somatic complications, or compliance. CONCLUSION: In our sample, alexithymia was related to depression and not to somatic factors or compliance.     

Poststroke depression and anxiety: different assessment methods result in variations in incidence and severity estimates

Patients with right and left hemisphere stroke (RH, LH) and a control group (CG) were administered a structured clinical interview (SCID-R) and rating scales for anxiety and depression (Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, and Hamilton Depression Rating Scale). The three groups did not differ when compared for the mean level of distress on the rating scales or frequency of mood or anxiety disorder diagnosis using the SCID-R. By contrast, participants in the LH group were more likely to be classified as distressed using rating scales cutoff scores and on measures of severity when compared only to the RH group. The rating scales were sensitive to psychiatric disorders, but lacked specificity in all groups. There were significant correlations between scales suggesting the rating scales measure a common factor in the controls, while in the stroke groups associations were weaker and less likely to be significant. Together, these results suggest the need for caution in using rating scales of depression and anxiety in neurologic patients and support the notion that these scales are sensitive to distress rather than specific for identifying depressive and anxiety disorders.     

Alexithymia, Emotional Awareness and Perceived Dysfunctional Parental Behaviors in Heroin Dependents

The aim of this study was to analyse alexithymia and deficits in emotional awareness, in heroin addicts, and their relationship with perceptions of early parental interactions. The sample included 99 opiate dependent outpatients and 43 healthy controls. Assessment was performed using the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Inventory for Assessing Memories of Parental Rearing Behavior, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. Findings suggest parental representations, which were mostly characterized by emotional unavailability and a rejection interaction pattern, significantly related to alexithymia. Emotional awareness was associated with the number of years of drug use and methadone level. Negative affect was associated with alexithymia but not to emotional awareness. Regression analyses emphasized the influence of perceived dysfunctional parenting behaviors in alexithymia and difficulties in identifying feelings, particularly an interaction with paternal rejection, moderated by self-reported anxiety. These results are discussed addressing comprehensive issues of emotion regulation and treatment strategies in heroin dependence.     

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression,panic disorder,eating disorders and substance use disorders

Background

This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression.

Methods

Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D).

Results

The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels.

Conclusions

Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself.     

Alexithymia in somatoform and depressive disorders

OBJECTIVE: Alexithymia and its association with attribution styles, amplification and illness attitudes was studied among subjects with somatoform disorders, depressive disorders and normal subjects. METHODS: Two groups of 30 subjects each, bearing diagnoses of somatoform disorder and depressive disorder respectively (ICD-10 DCR), and one group of 30 normal controls were recruited. The study subjects were assessed using the Toronto Alexithymia Scale and scales for assessing attribution styles, amplification and illness attitudes. RESULTS: Mean alexithymia scores in the somatoform (60.4) and depressive disorder groups (62.5) were higher than in normal subjects (54.2). In the somatoform disorder group, total alexithymia and 'difficulty describing feelings' scores positively correlated with psychological attribution (the latter correlation was also noted in the depressive disorder group), but not with the illness attitudes, amplification, somatic attribution scores or any of the sociodemographic variables. Compared with normal subjects, those with somatoform and depressive disorder had greater difficulty in identifying bodily sensations and feelings. Subjects with depressive disorder had more difficulty in expressing feelings compared to somatoform disorder subjects. CONCLUSIONS: While total alexithymia scores do not differentiate somatoform from depressive disorders, the two diagnostic groups do differ in that depressed subjects have greater difficulty in expressing feelings. However, all three groups had mean scores within the non-alexithymic range. Alexithymia and difficulty in expressing feelings were associated with psychological attribution of innocuous bodily sensations in the somatoform disorder group suggesting that alexithymic subjects are more able to psychologize bodily symptoms than non-alexithymic subjects. Somatoform and depressive disorder subjects and normals differ from each other in certain alexithymic characteristics, which could have potential therapeutic implications.     

The relationship between alexithymia and perinatal depressive symptomatology

OBJECTIVE: The purpose of this study was to examine the relationship between alexithymia and perinatal depressive symptoms and the stability of the alexithymia construct in a sample of low-income, predominantly Latina women during pregnancy and the early postpartum period. METHODS: Seventy-seven pregnant women completed self-report questionnaires and were classified as "high risk" or "low risk" for developing a major depressive episode based on a history of depression and/or current high depressive symptom scores. Measures included the Toronto Alexithymia Scale, the Center for Epidemiological Studies Depression Scale, and the Maternal Mood Screener, and were completed during pregnancy and at postpartum month 2. RESULTS: Alexithymia was positively associated with depressive symptoms during pregnancy and early postpartum. Women at high risk for depression had significantly higher alexithymia levels than low-risk women during pregnancy but not during postpartum. Alexithymia and depressive symptoms were independently and strongly correlated across the ante- and postpartum periods. Hierarchical regression analyses indicate that alexithymia scores at postpartum were predicted by alexithymia scores during pregnancy, above and beyond the variance explained by the depressive symptom scores during pregnancy and postpartum. CONCLUSION: Alexithymia is positively correlated with depressive symptoms during the perinatal period and is a stable phenomenon.