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.     

Large bowel disorders. II. Psychopathology and alexithymia.

Psychopathology and alexithymia were investigated in a consecutive series of 60 patients suffering from large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis). Patients with irritable bowel syndrome reported the highest percentage of psychiatric illness and the lowest alexithymic score. Conversely, patients with ulcerative colitis showed very pronounced alexithymic traits with limited psychopathology. Implications for psychosomatic research and treatment are discussed.     

Emotion-processing deficit in alexithymia.

College undergraduates were identified as alexithymic or control, based on their scores on the Toronto Alexithymia Scale (TAS; Taylor, Ryan, & Bagby, 1985). All subjects were presented standardized emotion-eliciting color slides for 6 s while facial muscle, heart rate, and skin conductance activity were recorded. Stimuli were presented a second time while subjects were asked to provide emotion self-reports using a paper-and-pencil version of the Self-Assessment Manikin (SAM; Lang, 1980) and to generate a list of words describing their emotional reaction to each slide. Consistent with the definition of alexithymia as a syndrome characterized, in part, by a deficit in the identification of emotion states, high TAS subjects supplied fewer emotion-related words than did controls to describe their response to the slides. Alexithymics also indicated less variation along the arousal dimension of the SAM, produced fewer specific skin conductance responses and showed less heart rate deceleration to the slides, regardless of category. No valence-related differences between alexithymic and control subjects were noted.     

The alexithymia construct. A potential paradigm for psychosomatic medicine

During the past decade, the alexithymia construct has undergone theoretical refinement and empirical testing and has evolved into a potential new paradigm for understanding the influence of emotions and personality on physical illness and health. Like the traditional psychosomatic medicine paradigm, the alexithymia construct links susceptibility to disease with prolonged states of emotional arousal. But whereas the traditional paradigm emphasizes intrapsychic conflicts that are presumed to generate such emotional states, the alexithymia construct focuses attention on deficits in the cognitive processing of emotions, which remain undifferentiated and poorly regulated. This paper reviews the development and validation of the construct and discusses its clinical implications for psychosomatic medicine.     

The influence of defense mechanisms on secondary alexithymia in hemodialysis patients.

The influence of psychodynamic aspects such as the defense mechanisms for conflict on secondary alexithymia in hemodialysis (HD) patients was examined among 35 HD patients and their family members. Although HD patients had quite strong conflicts due to HD therapy, the manifestation of conflict and expressiveness toward the family were significantly lower in HD patients with alexithymia than in those without alexithymia. Significantly positive and negative correlations were observed between conflict and expressiveness, and between expressiveness and degree of alexithymia, respectively. These results suggest that this defense mechanism strongly suppresses the manifestation of conflict, and that secondary alexithymia in HD patients may be derived from defense mechanisms such as denial.     

The relationship between dissociative proneness and alexithymia

BACKGROUND: Dissociative reactions and alexithymia are two strategies that have been put forward as coping mechanisms to alleviate painful emotions. It is the clinical impression that dissociation is related to certain alexithymia features. In line with the coping hypothesis, it was predicted that the relationship between dissociative tendencies and alexithymia would be partly mediated by current levels of stress and/or by past traumatic experiences. Furthermore, dissociation may also be related to enhanced fantasizing, although alexithymia has traditionally been associated with an incapacity to fantasize. METHODS: Data were obtained from 833 nonclinical participants on dissociative tendencies, alexithymia, childhood abuse, current stress and socially desirable behavior. Correlation analyses followed by multiple regression were performed. RESULTS: Dissociative tendencies appeared to be especially related to one alexithymic feature: a difficulty in identifying feelings. This relationship was partially mediated by levels of current stress. A history of trauma did not predict dissociation measures. Furthermore, highly dissociative participants were more fantasy prone than low-dissociative participants. CONCLUSIONS: The results of this study support the idea that in a nonclinical group dissociation may provide a way to cope with current stressful events, and that this is associated with a difficulty in identifying feelings. It is argued that two types of dissociation may exist, one trait-like type of dissociation that is associated with fantasy proneness and other related factors, and a trauma-related type of dissociation that is more apparent within the clinical range.     

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.     

Towards a teleological model of alexithymia: alexithymia and post-traumatic stress disorder

22 combat Viet Nam veterans with post-traumatic stress disorder were investigated for alexithymia. Of those subjects examined, 41% proved to be alexithymic. Theoretical implications for this finding are discussed.     

The relationship between alexithymia and abnormal illness behavior

The relationship between abnormal illness behavior, measured by the illness Behavior Questionnaire and alexithymia, measured by the Toronto Alexithymia Scale, was studied in four cohorts of subjects. The two measures overlap in that the more alexithymic subjects endorsed more disease conviction, hypochondriacal concern, affective inhibition, affective disturbance, and irritability. Denial was not related to alexithymia, which supports the construct validity of alexithymia. Regression models developed for the four cohorts that consisted of psychiatric outpatients, psychiatric inpatients, medically ill patients and controls differed to suggest that alexithymia state phenomena interact with trait characteristics.     

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.     

The construct of alexithymia: associations with defense mechanisms

Alexithymia is a dimensional personality construct that encompasses a cluster of cognitive and affective characteristics relating to difficulty identifying and describing feelings, limited imaginal capacity, and having an externally oriented thinking style. Attempts to explain the etiology of high levels of alexithymia have resulted in disagreements regarding the relationship between alexithymia and psychological defense mechanisms. Much of the previous research suggests strong associations between alexithymia and immature or maladaptive defense styles. To examine these relationships using correlations, multiple regression and factor analytic techniques, three nonclinical populations in Australia and Canada were studied with a view to evaluating the association of defense mechanisms and response styles with alexithymia. Our results support the association of alexithymia with emotional inhibition, but extend those associations to immature defense styles and aspects of social desirability.     

Psychosomatic aspects of patients on hemodialysis. 4. The relationship between quality of life and alexithymia

The relationship between quality of life (QOL) and alexithymia was examined in dialysis patients. Hemodialysis (HD) patients with diabetic nephropathy had poor QOL in medical dimension. Although they had good QOL in psychological and social dimensions, a high prevalence of alexithymia associated with self-control ability was observed. These results suggest that their inability to care for themselves was reflected in poor medical dimension, and that good psychological and social dimensions were merely an outward appearance. Therefore, identification of alexithymia in dialysis patients is important along with a three-dimensional evaluation of QOL. Multidisciplinary comprehensive assessment of QOL including alexithymia will lead to a real improvement of dialysis patients' QOL.     

Challenges for alexithymia research: a commentary on "The construct of alexithymia: associations with defense mechanisms"

The author comments on an article by Helmes and colleagues (this issue, pp. 000-000) that studied defense mechanisms related to alexithymia. What these authors observed is theoretically meaningful, and a distinct strength of this study is that the results are replicated in three independent samples. The study is also exemplary for two typical drawbacks- only student samples and self-report measures are used. The author suggests that when studying alexithymia, researchers use samples that contain a substantial number of alexithymic subjects. Furthermore, variables such as emotional processing and regulation should not be measured with self-report questionnaires alone. Emotional processing and regulation are, in part, implicit and researchers should consider this. The author argues that the standard of alexithymia research could be raised by including interdisciplinary perspectives and experimental methods, and by embedding research more explicitly in theories.     

Shared neuroendocrine patterns of post-traumatic stress disorder and alexithymia.

High norepinephrine/cortisol ratios have been shown to be useful indicators of post-traumatic stress disorder (PTSD). Alexithymia can result from overwhelming stress; thus, we hypothesized that sympathetic-adrenal medullary/hypothalamic-pituitary adrenal ratios would be positively associated with alexithymia severity. In the present study, we correlated 3-methoxy-4-hydroxyphenylethylene glycol (MHPG)/adrenocorticotropic hormone (ACTH) and MHPG/cortisol ratios with self-report Toronto Alexithymia Scale (TAS) scores in a group (n = 17) of nondepressed, formerly alcohol-dependent men. The correlations between the respective ratios and TAS scores were 0.515 (p = 0.034) and 0.561 (p = 0.019). We suggest that increasing degrees of alexithymia are accompanied by an increasing separation of these two endocrine systems and then speculate that this dissociation has an anatomical basis in the lateralization of emotions.     

Relationship between conjugate lateral eye movements and alexithymia.

The relationship between conjugate lateral eye movements (CLEMs) and alexithymia was investigated in a group of 60 (23 male and 37 female) right-handed university students. Subjects completed the Toronto Alexithymia Scale (TAS), the Schalling-Sifneos Personality Scale, and the Basic Personality Inventory, which measures 12 basic dimensions of personality and psychopathology, CLEMs were recorded while subjects were asked 20 general knowledge questions that have no tendency to elicit eye movements predominantly in one direction. A series of gender by CLEM preference (left vs. right mover) ANOVAs were conducted with the various measures. There was a significant relationship between right CLEM preference and higher scores on the TAS, but no relationships between CLEMs and any of the other measures. These results suggest that alexithymia is associated with left cerebral lateralization, and support the hypothesis that alexithymic characteristics reflect a variation in brain organization.     

Parallel Visual Information Processing Test. An experimental assessment of alexithymia.

A novel clinical and experimental situation has been created, based on the psychopathological concepts of 'pensée opératoire' and alexithymia and the contribution of recent trends in cognitive science as to the dual skills of the brain hemispheres: the Parallel Visual Information Processing Test. This test was validated in more than 100 subjects, and revealed that holistic visual attention is reduced during logical task performance; this impairment appeared to be typical of patients with poor fantasizing ability and operative behavior. Such findings are consistent with some authors' theory according to which there is a functional commissurotomy in alexithymic and psychosomatic patients.     

A twin study of alexithymia

BACKGROUND: Factors contributing to the development of alexithymia and the nature of alexithymia's relation with trait negative and positive affectivity are unclear. In this study, a twin approach was used to examine the degree of genetic and environmental contributions to the different facets of alexithymia, and the nature of their relations to trait negative and positive affectivity. METHOD: Forty-five monozygotic and 32 same-sex dizygotic twin pairs completed the Toronto Alexithymia Scale-20, the Eysenck Personality Inventory, and a zygosity questionnaire. RESULTS: Model fitting analyses indicated that familial influences contributed significantly to all three facets of alexithymia. Parameter estimates and intraclass correlations suggested, though could not confirm, that it was shared environmental factors that contributed to difficulty identifying and communicating emotions (ID and COM), but shared genetic factors that contributed to externally oriented thinking (EOT). Between-twin cross-trait twin analyses revealed strong correlations between ID and neuroticism, and between COM and extraversion, and suggested that it is shared familial influences which account for these associations. CONCLUSIONS: The results of this study indicate that: (a) the different facets of alexithymia are influenced by familial factors; (b) the previously noted associations between ID and COM and trait affectivity are not merely methodological artifacts; and (c) the associations between ID and COM and trait affectivity are influenced by familial factors. The results also suggest that ID and COM are largely influenced by shared environmental factors, but that EOT is influenced by genetic factors.     

学习成绩与述情障碍的关系初探

目的　探讨学习成绩与述情障碍的关系。方法　以多伦多述情障碍量表 ( TAS)对60名成绩优秀的学生和 77名成绩差的学生进行测评。结果　两组学生的 TAS总分分别为66.63± 6.74和 65.74± 7.51 ,无显著性差异 ;成绩差的男生因子 显著高于成绩优秀的男生。结论　成绩差的男生述情障碍明显。