Alexithymie, dépression et incarcération prolongée

On the basis of an investigation by auto-questionnaires in a population of 230 prisoners condemned to prolonged prison sentences, the authors noted the strong prevalence of the alexithymy (42.86%), its correlation with the depression, but its absence of correlation with the duration of the sentence accomplished and of that remaining. They deduced from this that alexithymya is a stable feature of personality.     

Relations entre dimensions émotionnelles et symptômes somatiques : effets médiateurs de la dépression et de l’alexithymie

Objectives

The aim of the present study was first to complete previous research on negative affectivity, alexithymia, depression and somatic symptoms by testing a theoretical model of their relations. It was second to investigate potential mediating effect on the relations between negative emotionality (i.e. neuroticism) and somatic symptoms.

Patients and method

A sample of 309 subjects (77% F et 23% M; mean age = 20, 61 ± 1.55) completed the following questionnaires: the Positive and Negative Emotion questionnaire-31 items (EPN-31), the Toronto Alexithymia Scale 20 items (TAS-20), the Center for Epidemiological Studies Depression scale (CES-D), and the Symptom Check List Revised, 90 items (SCL-90 R). Theoretical model and mediating effects were tested using structural equation modeling, and bootstrapping method.

Results

Three measurement models were tested: First, a direct effect model did not fit the data. Second, a partially mediated model fit partially the data for some indices, but not for others, and was rejected for lack of parsimony. Finally, a full mediation model showed the best adjustment with results confirming the good fit of this structural model including (Chi² = 10.245, P = 0.069, ns; CFI = 0.989 > 0.95, RMSEA = 0.058 < 0.07 [90% IC = 0.000–0.100], SRMR = 0.026 < 0.08). So as, our results show that alexithymia and depression are full mediators of the negative affectivity–somatic symptoms relation. In other words, when depression and alexithymia are introduced in the relation between negative affectivity and somatic symptoms, the direct effect of negative affectivity becomes non-significant, and turns to an indirect effect. Moreover, depression as a stronger effect on somatic symptoms than alexithymia, which seems to confirm previous research on the distinction between both constructs. These results are compatible with that of previous works on somatic symptoms and negative affectivity, and on somatic symptoms and alexithymia.

Conclusion

The propensity to experiment negative emotional states may contribute to develop negative emotion regulation strategies such as alexithymia, which as a direct effect on somatic symptoms. But more precisely, we can hypothesize that alexithymia is not fully efficient as a defense against negative emotions, and that depression remains a strong characteristic of subjective emotional experience for some subjects, constituting a strong contributor to declarative somatic symptoms. Implications for psychotherapy are discussed, supporting the enhancement of negative emotions regulations strategies for subjects showing somatic complaints.     

Régulation des émotions, dépression et conduites à risques : l’alexithymie, un facteur modérateur

The repetitive involvement in risk-taking behaviour is a major cause of somatic damage or accidents in adolescents and young adults. Previous research points out the importance of psychological factors such as personality variables and cognitive-emotional functioning. In this field, relationships between risk-taking, anxiety and depression have been well-established. However, few studies take into account emotion-regulation processes as implicated in risk-taking. According to Bonnet et al. (2003), risk-taking behaviours are similar to those of coping strategies for subjects maintaining a homeostatic state. Another perspective considers risk-taking as a consequence of an emotional processing deficit, a trait called alexithymia. Following this hypothesis, the aim of this study was to test a) differences between risk-takers and non risk-takers in depressive disorder and alexithymic functioning, b) relations between emotional functioning, depression and risk-taking. Two groups were formed from a sample of 259 subjects, aged from 18 to 25: an RT group (Risk-Taking, N = 123), and an NRT group (Non Risk-Taking, N = 136). Participants completed a risk-taking questionnaire (elaborated by the authors especially for this study), the Toronto Alexithymia Scale (TAS-20) and the Center for Epidemiologic Studies Depression Scale (CES-D). Our results show significant differences between the two groups: risk-takers seem to present more depressive symptoms than controls (P < 0.0001), and to be more alexithymic (P < 0.0001). Strong correlations (from 0.59 to 0.44) were found between alexithymia, depression and risk-taking behaviours. Finally in a model explaining 43% of the variance of risk-taking behaviours (R² = 0.43; F(3.258) = 66.103, P < 0.0001), multiple regression shows that alexithymia and depression might be risk factors for such conducts. There may be several interpretations of our results. In the first one, alexithymia could be considered as a part of a general depressive syndrome, which may be at the origin of the problematic behaviours. In this case, risk-taking would be used in order to diminish or suppress negative emotions. But this interpretation is not satisfying, because both depression and alexithymia have similar effects on risk-taking, and because we have been able to propose a statistical model in which alexithymia is a variable that explains depressive symptoms. These remarks lead us to consider alexithymia as a moderating variable, which allows subjects to avoid negative emotions, which cannot be processed. This process maintains risk-takers in a depressive state that they try to treat using risk-taking behaviours as illusory attempts to avoid negative feelings. Finally, limits and need for further research are discussed. In conclusion, our results point out the importance of emotional variables in the study and treatment of subjects involved in risk-taking behaviour.     

Joueurs de machines à sous dans une population française : étude de la dépression, de l’alexithymie et de la recherche de sensations

There are a multitude of factors implied in the acquisition, the development and the maintenance of gambling behavior. Among them, sensation seeking occupies an important place. Zuckerman originally suggested a relationship between sensation seeking and gambling. However, studies in this area have provided heterogeneous results. To explain these discrepancies, Zuckerman emphasized the fact that the type of gambling may be a crucial factor in the relationship with sensation seeking. Nevertheless, few studies have evaluated the link between the different types of gambling and problem behaviors. Furthermore, few studies were interested specifically on slot machines. While recent research has found high-levels of alexithymia in individuals with substance use and eating disorders only two studies have investigated the relationship between alexithymia and pathological gambling. Thus, these studies were focused on students. It is therefore important to study alexithymia in adult gamblers. Empirical data has shown that alexithymia levels may be influenced by negative mood states, especially depression. Some studies have found a positive correlation between alexithymia and depression scores, particularly in people with addictive behaviours. Nevertheless, studies found heterogeneous results. The main objective of this research was to evaluate scores on sensation seeking, alexithymia and depression (and the link between those variables) in gamblers of slot machines. Thus, slot machines gamblers were selected in the casino of Enghien-les-Bains, which is Paris nearest casino. Among them one distinguishes: regular gamblers (n = 45) from which were extracted pathological gamblers (n = 27), and occasional gamblers (n = 19). The South Oaks Gambling Screen and the criteria of the DSM-IV were used to measure the intensity of gambling behavior; sensation seeking was evaluated by the Sensation Seeking Scale form V; alexithymia by the Toronto Alexithymia Scale (TAS-20) and the depression by the Beck Depression Inventory. No differences appeared significant between the three groups of gamblers for the sensation seeking scores. Pathological gamblers obtained higher alexithymia scores than occasional gamblers. Nevertheless, these findings didn’t remain stable when controlling for the effect of depression. Among pathological gamblers, the BDI score is positively correlated to the ‘difficulty identifying feelings’ factor. This result is consistent with the literature, which shows that alexithymia is closely related to depression in addictive behaviors. Indeed, the ‘difficulty identifying feelings’ factor seems to be explained by depression severity. These results suggest that the emotional component of alexithymia would be thymo-dependent, whereas the cognitive component would be independent and constitute a stable clinical feature. Pathological gamblers who play slot machine are low sensation seekers who shun the more dramatic and extraverted form of sensation seeking. They play to reduce or avoid unpleasant emotional states like depression. Pathological gambling could therefore be in part a maladaptive coping strategy to deal with affective disturbances; the game may function as a self-medication to treat emotional states, which the gambler finds no other way of treating. According to previous studies, slot machine gambling is referred to as ‘escape’ gambling, where gamblers may dissociate.     

Relation entre styles d’attachement, perception du soutien social et dépression

Objectives

Previous research has proved that some types of attachment styles as well as poor social support are critical risk factors for depression. This study aims to examine the relation between attachment style, social support and vulnerability to depression.

Materials and methods

The authors compared 80 patients suffering from mood depressive disorder, diagnosed on the basis of the DSM-IV TR criteria, to 80 normal controls. The importance of depression was evaluated in patients using the Hamilton depression scale. All the subjects completed two self-report scales: the Relationship Questionnaire designed to evaluate the attachment models in adult close relationships, and the Social Support questionnaire assessing perceived number of social supports and satisfaction with available social support.

Results

The sex ratio in our sample was 1,7 women for one man; and the mean age was 44 years in patients and 34 years in controls. A significant difference was found between the two groups concerning attachment style (p < 0,001): only 29% of depressed patients had secure attachment versus 56% in normal controls, and fearful/avoidant attachment was more frequent in patients (25%) than in controls (1%). Depressed subjects received less social support than their controls (p = 0,014), and had less satisfaction with perceived social support (p < 0,001).

Conclusions

In depressed subjects social network features were characterized by insecure attachment and poor social support.     

La douleur chronique en psychiatrie : comorbidité et hypothèses

Over previous decade, psychiatry has become peripheral to pain management and anaesthesiology has moved onto centre stage with ever more sophisticated interventions, including radiofrequency neurolysis, implanted medication pumps, and spinal cord stimulators. However, a sizeable sample of patients with chronic pain is not achieving satisfying remission. With regard to the high prevalence of psychiatric disorders among those patients, psychiatry has an important amount to offer this field, at least as much as any other single discipline. Since Freud’s psychodynamic theory of hysteria, as an explanation for chronic pain without a located physical basis, other important contributions from psychiatry have been made, including the concept of pain-prone disorder as a variant of depression and the liaison psychiatrist George Engel’s biopsychosocial medical model.Nineteen consecutive patients with chronic pain, 12 females and 7 males, were admitted to a 5- or 10-days inpatient program in a psychiatric department. None of those patients were working at the time of their admission. The main purpose of this program was to examine psychiatric comorbidity and the need for further psychiatric follow-up. This sample is described in terms of the two first axes of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) nosology. Diagnoses were retrospective for 10 patients (52.6%) and prospective for the others (47.4%). The retrospective diagnoses were those mentioned in the patient file. Results regarding personality disorders are with the exclusion criteria not applied for other personality disorders.Not surprisingly, with chronic pain disorder excepted, depressive disorders were the most frequent diagnoses on axis I (diagnosed in 52.6%). Major depressive disorder was diagnosed in 36.8% (current episode = 26.3%), while dysthymic disorder was diagnosed in 15.8%. Anxious disorders as social phobia, post-traumatic stress disorder and generalised anxiety were each respectively diagnosed in 15.8%. Substance misuse or dependence was diagnosed in 21.1%. Schizophrenia and dementia were each respectively diagnosed in 5.2%. Among somatoform disorders, chronic pain disorder was diagnosed in 78.9%. 10.5% had no diagnosis on axis I. Personality disorder was diagnosed in 73.7%. Histrionic personality disorder and avoidant personality disorder were each respectively diagnosed in 26.3%. Other diagnoses on axis II are detailed.Previous studies have shown such a positive association between pain and depression. Those results are summarised. Evidence supporting a direct link between these two variables is less robust. Although chronic pain as a variant of depression is a useful psychodynamic concept in some individual cases, it seems insufficient as a general model of chronic pain. Other hypothesis are reviewed, especially those which conceptualise both depression and chronic pain as relevant to a unique underlying process. This process may be conceptualised as a proneness to generalise negative events as acute pain or fear. Previously, Swanson advanced that chronic pain may belong to the category of emotions. According to such a model, analogies can be used to compare acute and chronic pain with fear and anxiety and also with sadness and depression. This proneness to generalise negative emotional events may be adequately described by a unique personality trait like Eysenck’s Neuroticism or Cloninger’s Harm Avoidance. Previous results supporting this hypothesis are reviewed. The last six patients were given the Temperament and Character Inventory—Revised (TCI-R). Preliminary findings are discussed. Despite several limitations, those results are consistent with our hypothesis, showing homogenous Harm Avoidance scores.     

Peine, douleur et dépression

Kierkegaard contrasts pain, which proceeds from a fate beyond individuals, with suffering which is internalized within a subjective memory. This analysis can be useful to tackle depression with the cognitive theory of representation. We outline a framework to construct a representational space as a subjective universe defined from memory. Suffering can be linked to a splitting of the representational space and retardation corresponds to a retraction of this space into what can be described as a well. Beyond an apparent accident, the depressive retraction can only be explained as a wound of a founding area of representational space, involving an original pain. Several degrees of melancholy can be defined within this conceptual framework. We underline the hazards of extracting the original pain when it unifies the whole representational space.     

Déficit émotionnel et intelligence machiavélique : étude des interrelations entre l'échelle d'alexithymie de Toronto (TAS-20) et l'inventaire mach-iv dans une population de 201 étudiants

The aim of the study was to explore the relationship between alexithymia and machiavellianism in a group of 201 university students. The subjects filled out the TAS-20 and the MACH-IV forms. The results showed firstly, a significant correlation between the two total scores (r = 0.35, P < 0.05), and secondly between the identification of feelings subscale of the TAS-20 and the opinions about human nature subscale of the Mach-IV (r = 0.44, P < 0.05). The results were discussed in light of the different factors (depression, dependency, psychoticism…) that could explain the relationship between the two concepts.     

Schémas dépressogènes et espace subjectif

The concept of schema used in cognitive psychotherapy is an heuristic tool that has more a metacognitive value than a psychological value: it doesn't involve directly the cognitive processes and the representations in memory. Therefore, the understanding of the therapeutic action is limited and insufficient for a satisfying account of the complex clinical data observed during the course of treatment of resistant depression. To overcome this problem, we propose a conceptual framework that describes a subjective universe as a representational space that is displayed from memory. From this point of view, depression is equivalent to a retraction of the subjective space. This retraction is primed by the reactivation of some past traumatic events. We show the influence of early painful situations on the Home Image, which is an essential area for the unification of the representational space. This conceptual framework allows us to define the representational structures underlying the cognitive model of learned helplesness of Abramson et al. [1]. Two levels of schemas are specified: (1) the symbolic structures that constitute the “web” of the subjective space and correspond to the schemas of the cognitive psychology; (2) the metaschemas that are the constructs of the therapist. The formation of the depressogenic schemas during the personal story is linked to the development of metaschemas of vulnerability, gratitude, and control. A therapeutic block is defined as a closing of the therapeutic space - that is, the intersubjective world constructed between the patient and the therapist. Such a block indicates the necessity of a global restructuration to release the memory from a depressogenic metaschema. In this case, the therapeutic strategy requires a technical adaptation to mobilize the mass of the subjective space. The therapeutic medium needs to resonate with the core of the depressogenic metaschema that is deeply buried in memory. The patient should also actively grasp the processes of the symbolic structuration of his/her subjective space. This conceptual framework allows us to account of the concept of insight as a spatial feeling of unification and widening that is associated to a restructuration. Thus, a cognitive therapy can be analyzed as a succession of phases that mirrors in reverse order the development of the depressogenic metaschemas. A case study confirms the relevance of this approach and we underline the crucial function of the therapist's creativity to overcome the therapeutic blocks. We insist also on the carefulness that is necessary to approach the early painful situations deeply buried in memory.     

Déni,négation et dénégation : aspects psychopathologiques et cas cliniques

The word “denial” has several meanings; in psychoanalytically inspired psychopathology, it signifies a refusal to recognize sensory evidence, and it has a defensive function. Denial makes the perception of certain realities disappear from mental and unconscious life, whereas repression, while performing a similar task, integrates the intolerable reality into the unconscious. The term “negation” points to the negating of a psychic reality; it is the refusal to recognize a thought, a desire, or a feeling that is a source of intrapsychic conflict as one's own. Psychotic denial is multifactorial; it includes the existence of psychic troubles, but also the medico-legal behaviors that result from these. Neurotic denial is partial; it plays the role of a defense mechanism in that, it rejects the reality of a perception perceived as dangerous or painful for the ego. Perverse denial is characterized by the coexistence – within the same personality – of two contradictory judgments, unrelated to external reality. In order to maintain emotional stability in the face of anxieties concerning his physical or psychological soundness, the subject resorts to banalization and minimization. These mechanisms are not limited to the unconscious. The denial of an act and/or its consequences characterizes psychopathic denial; this also includes law and authority. Anosognosia is not a defense mechanism, but rather a pathological symptom, demonstrating a neuropsychological deficit or a cerebral dysfunction. “Insight” is an Anglo-Saxon term related to denial, anosognosia, and introspection, depending on the context. Two clinical examples illustrate different types of denial in different psychiatric pathologies.     

De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.