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Hall OT, Gunawan T, Teater J, Bryan C, Gorka S, Ramchandani VA. Withdrawal interference scale: a novel measure of withdrawal-related life disruption in opioid use disorder and alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2025; 51:44-56. [PMID: 38853684 DOI: 10.1080/00952990.2024.2350057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/19/2024] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Background: Hyperkatifeia describes amplified emotional and motivational withdrawal due to addiction-related sensitization of brain-stress-systems. Hyperkatifeia has been proposed as a target for addiction treatment development. However, translation of basic research in this area will require new tools designed to measure hyperkatifeia and related phenomena outside of laboratory settings.Objectives: We define a novel concept, withdrawal interference, and introduce a new tool - the Withdrawal Interference Scale (WIS) - which measures the impact of withdrawal on daily life among individuals with OUD or AUD.Methods: Described are the combined results of three separate cross-sectional studies. The structural validity, convergent validity, construct validity, trans-diagnostic (AUD/OUD) configural, metric, and scalar invariance, internal consistency, and composite reliability of WIS was tested among three independent samples of 1) treatment-seeking adults with OUD (n = 132), 2) treatment-seeking adults with AUD (n = 123), and 3) non-treatment-seeking adults with OUD (n = 140). Males numbered 218 and females were 163.Results: WIS exhibited structural validity (1 factor), convergent validity (average variance extracted .670-.676), construct validity, trans-diagnostic configural (χ2/df = 2.10), metric (Δχ2 = 5.70, p = .681), and scalar invariance (Δχ2 = 12.34, p = .338), internal consistency (α .882-928), and composite reliability (.924-.925).Conclusion: These results suggest WIS is a valid and reliable instrument for measuring withdrawal-related life disruption in AUD and OUD. Further, given our findings of transdiagnostic measurement invariance, WIS scores of individuals with AUD and OUD can be meaningfully compared in future statistical analyses.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Tommy Gunawan
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
- Intramural Science Program, Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
| | - Vijay A Ramchandani
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
- Intramural Science Program, Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Šalčiūnaitė-Nikonovė L, Leonas L, Sapranavičiūtė-Zabazlajeva L. The Effect of Alexithymia, Attention, and Pain Characteristics on Mentalizing Abilities Among Adults With Chronic Pain. Psychol Rep 2024:332941241226895. [PMID: 38214236 DOI: 10.1177/00332941241226895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction: Impaired mentalizing abilities are found among persons with chronic pain, yet it is still unknown why. The current study focuses on mentalizing abilities and how these could be affected by different pain factors, alexithymia traits, and other aspects of psychological functioning (depression, anxiety, attention) in persons experiencing chronic pain.Methods: 71 participants (80.3% female; mean age 56.1 (SD = 13.1)) with subjectively reported chronic pain conditions participated in the study. Mentalizing abilities were assessed using an objective assessment of the Frith-Happé animations test. Alexithymia was measured using Toronto Alexithymia Scale. Subjectively reported data on various pain characteristics and other related psychological factors (depression, anxiety, attention) were collected. Bivariate linear regression analyses were used to identify variables that had statistically significant relationships with Frith-Happé test scores as dependent variables, which were then used to build multivariate models.Results: Mentalization task scores had no significant associations with alexithymia. However, in bivariate models, greater Frith-Happé animations categorisation score was associated with higher attention task scores (βs = .332, p = .005), higher education (βs = .317, p = .007), and lower level of depressiveness (βs = -.234, p = .049). Greater animations feelings scores were associated with less severe pain intensity (βs = -.322, p = .006), younger age (βs = -.399, p = .001), and better attention (βs = .383, p = .001). In multivariate analysis models predicting both animations categorisation and feelings scores, attention was found to be the only statistically significant factor (respectively, βs = .257, p = .029 and βs = .264, p = .035).Conclusions: No significant correlations were found between mentalizing abilities and alexithymic features in persons with chronic pain. Disruptions of attention was the most significant factor leading to lower mentalizing abilities in persons with chronic pain.
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Affiliation(s)
- Laura Šalčiūnaitė-Nikonovė
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Leonas
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laura Sapranavičiūtė-Zabazlajeva
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Pei JH, Wang X, Ma T, Du Y, Dou X. Alexithymia in a Chinese Patient with Chronic Pain and Associated Factors: A Cross-Sectional Study. Pain Manag Nurs 2023:S1524-9042(23)00024-3. [PMID: 36774311 DOI: 10.1016/j.pmn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Alexithymia is more prevalent among those with patients living with chronic pain. Information on the prevalence of alexithymia in Chinese patients with chronic pain and associated factors is limited. AIM The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score of 61 or greater in the 20-item Toronto Alexithymia Scale (TAS-20), in a Chinese patient with chronic pain. The secondary objective was to investigate the relationship between alexithymia and the clinical and psychological aspects of chronic pain. METHODS A cross-sectional observational study used the TAS-20 to assess alexithymia of Chinese patients with chronic pain. Sociodemographic and clinical information were obtained and participants filled in the Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and General Self-efficacy Scale. RESULTS Of the 346 patients screened, 321 patients living with chronic pain were enrolled into the study. The prevalence of alexithymia among the study population (TAS-20 score ≥61) was 19.6% (95% confidence interval [CI]: 15.3-24.0). The findings showed anxiety (odds ratio [OR] = 2.474; 95% CI, 1.241-4.935), pain catastrophizing (2.649; 1.014-6.921), and self-efficacy (0.952; 0.908-0.988) as independent predictors of alexithymia in patients living with chronic pain. CONCLUSIONS Patients with chronic pain exhibiting alexithymia were at higher risk of pain catastrophizing, anxiety, and lower self-efficacy, compared with patients without alexithymia. It is important to identify and pay a special attention in clinical practice to patients with chronic pain exhibiting alexithymia, as these individuals are unable to properly express their emotions.
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Affiliation(s)
- Ju-Hong Pei
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; The first clinical medical college, Lanzhou University, Lanzhou, Gansu, China
| | - Xinglei Wang
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tong Ma
- Spine minimally invasive orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Yehui Du
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xinman Dou
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; School of nursing, Lanzhou University, Lanzhou, Gansu, China.
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Fresán A, González-Castro TB, Pool-García S, Tovilla-Zárate CA, Castellanos-Narvaéz E, Cruz JPSDL, Juárez-Rojop IE, López-Narváez ML, Lopez AM. Evaluation of alexithymia in individuals with chronic pain in a Mexican population: Alexithymia in a Mexican population. Int J Psychiatry Med 2021; 56:177-188. [PMID: 33327844 DOI: 10.1177/0091217420982086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Alexithymia is the difficulty in identifying and describing feelings. Several studies have suggested that chronic pain can be linked to alexithymia. The aims of this study were to determine the presence of alexithymia in a sample of Mexican individuals who attended public health services, to assess if alexithymia is higher in medically ill individuals with pain than in those without pain, and to determine which alexithymia dimensions are more affected by the presence of pain. METHODS Demographic and clinical features were evaluated in 250 Mexican outpatients of the General Hospital of Comalcalco, Tabasco. Pain was evaluated using the Visual Analogue Scale for Pain Assessment (VAS-P) and alexithymia was evaluated using the Toronto Alexithymia Scale (TAS-20). RESULTS 38.8% of the sample was identified with probable/definite alexithymia and up to 61.2% of individuals were currently experiencing pain. Individuals with pain exhibited higher scores in the TAS-20 dimensions: difficulty describing feelings (p = 0.02), difficulty identifying feelings (p < 0.001) and higher total TAS-20 score (p < 0.001). Also, Probable/definite alexithymia was more frequently reported in individuals with pain (49% vs. 21.6%, p < 0.001). CONCLUSIONS Our results show that a large proportion of individuals who attend public health services in a Mexican population present pain. We also identified that pain could be associated with alexithymia, in particular with a difficulty in describing and identifying feelings. An early identification and treatment of alexithymia could help in reducing the clinical burden of chronic pain in Mexican outpatients.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México
| | - Sherezada Pool-García
- Hospital General de Comalcalco "Dr. Desiderio G Rosado Carbajal", Secretaría de Salud, Comalcalco, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Eduardo Castellanos-Narvaéz
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Juan Pablo Sánchez de la Cruz
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. José Manuel Velasco Silez", Secretaría de Salud, Yajalón, Chiapas, México
| | - Alejandro Molina Lopez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
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Isoardo G, Ciullo S, Titolo P, Fontana E, Battiston B, Stella M, Luxardo N, Laino F, Migliaretti G, Stura I, Ardito RB, Adenzato M. The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy. J Neural Transm (Vienna) 2021; 128:61-71. [PMID: 33315145 PMCID: PMC7815565 DOI: 10.1007/s00702-020-02282-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.
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Affiliation(s)
- Gianluca Isoardo
- Department of Neurosciences and Mental Health, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Stefano Ciullo
- Department of Psychology, University of Turin, Turin, Italy
| | - Paolo Titolo
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Elena Fontana
- Department of Psychology, University of Turin, Turin, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maurizio Stella
- Department of Plastic Surgery Burn Center, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Nicola Luxardo
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Federica Laino
- Department of Anesthesia, Intensive Care and Emergency, Unit of Pain Management and Palliative Care, Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Rita B Ardito
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy
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Natalucci G, Faedda N, Baglioni V, Guidetti V. The Relationship Between Parental Care and Pain in Children With Headache: A Narrative Review. Headache 2020; 60:1217-1224. [PMID: 32474926 DOI: 10.1111/head.13822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE In migraine or primary headache in children, parents play a fundamental role in pain management. For this narrative review, PubMed, Google Scholar, and Psych Info were searched using the terms "parent headache", "mother/father headache", "parental impact headache", "alexithymia parents headache", "catastrophizing parent headache", "family headache", "children parent headache", and "quality of life family headache". Articles were chosen for inclusion based on their relevance in to the topic. OVERVIEW Several parental and psychological characteristics can influence in children and adolescent headache, such as parental attitudes as oppressive or overprotective; punitive parenting styles; familial psychological symptoms, especially anxiety and depression; catastrophizing about their child's pain or excessive worry about their child's headache; inability to express emotions; and feelings that may lead to somatization problems. DISCUSSION Parents' attitudes and behaviors toward their child's headache have a strong relation with the severity of headache attacks. Mothers seem to have more influence than fathers on children's pain and emotional regulation. We suggest that the presence of caregiver-child transmission of maladaptive coping strategies, arising from difficulties expressing emotion, may lead to incorrect management of headache pain, further facilitating headache chronification.
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Affiliation(s)
- Giulia Natalucci
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Noemi Faedda
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Valentina Baglioni
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Guidetti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis. Pain 2020; 160:994-1006. [PMID: 31009416 DOI: 10.1097/j.pain.0000000000001487] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non-self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
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Bagby RM, Parker JDA, Taylor GJ. Twenty-five years with the 20-item Toronto Alexithymia Scale. J Psychosom Res 2020; 131:109940. [PMID: 32007790 DOI: 10.1016/j.jpsychores.2020.109940] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Twenty-five years ago, this journal published two articles reporting the development and initial validation of the 20-Item Toronto Alexithymia Scale (TAS-20). Since then the literature on alexithymia has burgeoned with the vast majority of this research using the TAS-20, including multiple language translations of the scale. METHOD In this article we review the psychometric literature evaluating various aspects of the reliability and validity of the TAS-20 and examine some of the controversies surrounding the scale and the construct it assesses. We reflect on the ways in which the TAS-20 has advanced the measurement of the construct and theory of alexithymia. We also discuss recent developments and some future directions for the measurement of alexithymia. RESULTS Although not without some controversy, the preponderance of the accumulated evidence over a 25-year period supports various aspects of the reliability and validity of the TAS-20, including findings from confirmatory factor analytic and convergent and discriminant validity studies which are consistent with Nemiah et al.'s (Nemiah et al., 1976 [3]) and Taylor and colleagues (Taylor et al., 1997 [9]) theoretical formulations and definition of the alexithymia construct. CONCLUSIONS Based on the accumulated empirical evidence of 25 years, we conclude that the TAS-20 is a reliable and valid instrument and accurately reflects and measures the construct as it was originally defined by Nemiah et al. Nemiah et al. (1976) [3] as composed of deficits in affect awareness and expression and pensée opératoire (operational thinking). Clinicians and researchers can use the TAS-20 to confidently measure alexithymia, the roots of which have foundations in psychosomatic medicine.
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Affiliation(s)
- R Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - James D A Parker
- Department of Psychology, Trent University, Peterborough, Ontario, Canada
| | - Graeme J Taylor
- Department of Psychiatry (Emeritus), University of Toronto, Toronto, Ontario, Canada
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Aaron RV, Blain SD, Snodgress MA, Park S. Quadratic Relationship Between Alexithymia and Interoceptive Accuracy, and Results From a Pilot Mindfulness Intervention. Front Psychiatry 2020; 11:132. [PMID: 32210852 PMCID: PMC7076086 DOI: 10.3389/fpsyt.2020.00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
Alexithymia, or a reduced ability to label and describe one's emotions, is a transdiagnostic construct associated with poor psychosocial outcomes. Currently, the mechanisms underlying affective deficits associated with alexithymia are unclear, hindering targeted treatment delivery. Recent research suggests deficient interoceptive awareness, or reduced awareness of one's internal bodily state, may be key in the etiology of alexithymia. It has long been demonstrated that mindfulness meditation can alter perceptions of one's own emotions and bodily cues. Therefore, it is possible that mindfulness meditation may reduce affective deficits associated with alexithymia by improving interoceptive awareness. In this study, we aimed to (1) elucidate the role of interoceptive accuracy and sensibility, two dimensions of interoceptive awareness, in alexithymia, and (2) test the efficacy of a brief mindfulness meditation for improving interoceptive accuracy, interoceptive sensibility, and emotional awareness. Seventy six young adults completed a baseline heartbeat detection task, to assess interoceptive accuracy and sensibility, and the Toronto Alexithymia Scale-20 item. They were randomly assigned to a brief mindfulness-based body scan meditation intervention or control condition. Afterwards, participants completed tasks assessing emotional awareness (i.e., affect labeling, emotional granularity) and follow-up heartbeat detection task. Relationships between alexithymia and interoceptive accuracy and sensibility were best described as quadratic (p = 0.002) and linear (p = 0.040), respectively. Participants in both conditions showed robust improvements in interoceptive accuracy from baseline to follow-up (p < 0.001; η p 2 = 0.15); however, there were no group (meditation or control) differences in degree of improvement. Similarly, there were no group differences in affect labeling or emotional granularity. These preliminary results suggest that heightened alexithymia may be associated with either relatively high or low interoceptive accuracy. The meditation condition did not result in improved interoceptive accuracy or sensibility above and beyond that of a control group. Improvements in interoceptive accuracy, interoceptive sensibility, and emotional awareness may require longer or more interactive intervention approaches. More research is needed to parse the potentially complex relationship between alexithymia and interoceptive awareness, and to develop targeted treatment approaches to ameliorating associated affective deficits.
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Affiliation(s)
- Rachel V Aaron
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| | - Scott D Blain
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Matthew A Snodgress
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
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Pothier DD, Shah P, Quilty L, Ozzoude M, Dillon WA, Rutka JA, Gerretsen P. Association Between Catastrophizing and Dizziness-Related Disability Assessed With the Dizziness Catastrophizing Scale. JAMA Otolaryngol Head Neck Surg 2019; 144:906-912. [PMID: 30128545 DOI: 10.1001/jamaoto.2018.1863] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Catastrophizing is a maladaptive thought process that involves irrational fear and worry about anticipated or actual symptoms. Although clinically relevant, the role of catastrophizing in patients with chronic dizziness or imbalance has not yet been explored to our knowledge. Objectives To validate a measure of dizziness catastrophizing and to assess its association with dizziness-related disability compared with other negative affect constructs (eg, anxiety and depression). Design, Setting, and Participants For this retrospective medical record review, the Dizziness Catastrophizing Scale (DCS), a dizziness-specific catastrophizing assessment tool, was adapted from the previously validated Pain Catastrophizing Scale. Psychometric evaluation of the DCS was performed. In addition, the associations of dizziness catastrophizing and positive and negative affectivity with dizziness-related disability were assessed using structural equation modeling and regression analyses. Data were collected using a retrospective medical record review from April 27, 2010, to June 25, 2014. The dates of analysis were June 3 to August 15, 2017. The setting was the Multidisciplinary Neurotology Clinic at the Toronto General Hospital (Toronto, Ontario, Canada). Participants were 457 adult outpatients with dizziness or imbalance who were referred to the clinic. Main Outcomes and Measures Psychometric properties of the DCS and its association with dizziness-related disability, as measured with the Dizziness Handicap Inventory. Results Among 457 patients (mean [SD] age, 53.4 [15.4] years; 154 [33.7%] male), the DCS demonstrated good convergent (r = 0.78, P < .001) and discriminant validity (r = -0.40, P < .001) with the negative and positive affectivity, respectively; internal consistency (α = .95); and test-retest reliability (intraclass correlation coefficient, 0.92; P < .001 at the 95% CI). An exploratory dimension reduction analysis revealed a single latent component of the DCS. The results of the structural equation modeling and regression analyses revealed that dizziness catastrophizing, although associated with negative affectivity (eg, symptoms of anxiety and depression), was independently associated with dizziness-related disability (standardized β = 0.378; P < .001). Furthermore, a strong association was found between catastrophizing and dizziness-related disability across different dizziness-related diagnoses (r ≥ 0.6; P < .001). Conclusions and Relevance In this study, the DCS was a valid and reliable measure for evaluating catastrophic thinking in patients with dizziness, which was independently associated with dizziness-related disability. Future studies should investigate the influence of alleviating symptoms of catastrophizing on functional outcomes in patients with dizziness or imbalance, the results of which will help guide novel approaches to the clinical care of patients with chronic dizziness.
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Affiliation(s)
- David D Pothier
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lena Quilty
- Multimodal Imaging Group, Research Imaging Centre, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanda A Dillon
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John A Rutka
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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11
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Aaron RV, Fisher EA, Palermo TM. Alexithymia in adolescents with and without chronic pain. Rehabil Psychol 2019; 64:469-474. [PMID: 31393153 DOI: 10.1037/rep0000287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE/OBJECTIVE Alexithymia refers to reduced emotional awareness and is associated with higher levels of burden and disability in adults with chronic pain. Limited research has examined alexithymia in adolescents with chronic pain. The current study aimed to (a) determine whether alexithymia was higher in adolescents with (vs. without) chronic pain and (b) examine the relationship between alexithymia and pain experiences in youth. Research Method/Design: We assessed alexithymia in 22 adolescents with chronic pain and in 22 adolescents without chronic pain (otherwise healthy), and its relation to pain experiences (i.e., self-reported pain intensity, pain bothersomeness, and pain interference), while controlling for the concomitant effects of psychological distress (i.e., depressive and anxiety symptoms). RESULTS After controlling for psychological distress, adolescents with versus without chronic pain had higher total alexithymia scores (p = .042; η2 = .10), and specifically, greater difficulty identifying feelings (p = .001; η2 = .23). Difficulty identifying feelings was related to worse pain interference (r = .55; p = .015) and pain bothersomeness (r = .55; p = .015). CONCLUSIONS/IMPLICATIONS These preliminary findings suggest that adolescents with chronic pain may have greater difficulty identifying their emotions, and that this might be related to increased pain interference and pain bothersomeness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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12
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Marchi L, Marzetti F, Orrù G, Lemmetti S, Miccoli M, Ciacchini R, Hitchcott PK, Bazzicchi L, Gemignani A, Conversano C. Alexithymia and Psychological Distress in Patients With Fibromyalgia and Rheumatic Disease. Front Psychol 2019; 10:1735. [PMID: 31417462 PMCID: PMC6685004 DOI: 10.3389/fpsyg.2019.01735] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a chronic rheumatologic disease characterized by widespread musculoskeletal pain and other psychopathological symptoms which have a negative impact on patients' quality of life. FMS is frequently associated with alexithymia, a multidimensional construct characterized by difficulty in identifying feelings (DIF) and verbally communicating them difficulty describing feelings (DDF) and an externally oriented cognitive thinking style (EOT). The aim of the present study was to investigate the relationship between alexithymia, anxious and depressive symptoms and pain perception, in patients with FMS and other rheumatic diseases (RD). METHODS The sample consisted of 127 participants (M = 25, F = 102; mean age: 51.97; SD: 11.14), of which 48 with FMS, 41 with RD and 38 healthy control group (HC). All groups underwent to a test battery investigating anxiety and depressive symptoms (HADS), pain (VAS; QUID-S/-A) and alexithymia (TAS-20). RESULTS A high prevalence of alexithymia (TAS ≥ 61) was found in FMS (47.9%) and RD (41.5%) patients, compared to the HC group (2.6%). FMS patients showed significant higher scores than HC on DIF, DDF, EOT, anxiety and depression. The clinical sample, FMS and RD groups combined (n = 89), alexithymic patients (AL, n = 40) exhibited higher scores in pain and psychological distress compared to non-alexithymic patients (N-AL, n = 34). Regression analysis found no relationship between alexithymia and pain in AL, meanwhile pain intensity was predicted by anxiety in N-AL. CONCLUSION While increasing clinical symptoms (pain intensity and experience, alexithymia, anxiety, and depression) in patients with fibromyalgia or rheumatic diseases, correlations were found on the one side, between alexithymia and psychological distress, on the other side, between pain experience and intensity. Meanwhile, when symptoms of psychological distress and alexithymia were subthreshold, correlations with pain experience and intensity became stronger.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Shim EJ, Park A, Park SP. The relationship between alexithymia and headache impact: the role of somatization and pain catastrophizing. Qual Life Res 2018; 27:2283-2294. [PMID: 29869297 DOI: 10.1007/s11136-018-1894-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The present study compared psychological factors (i.e., alexithymia, somatization, pain catastrophizing (PC), anxiety, and depression) and QOL for headache patients and headache-free individuals, and examined whether somatization and PC mediate the relationship between alexithymia and headache impact in headache patients. METHODS Study participants consisted of 123 headache patients from an outpatient clinic at a university hospital and 124 headache-free individuals in Daegu, Korea. The survey employed the somatization and anxiety subscales of the Symptom Checklist-90-revised, the Patient Health Questionnaire-9, Pain Catastrophizing Scale, Toronto Alexithymia Scale, Short-Form Health survey-8 (SF-8), and the Headache Impact Test-6. RESULTS Headache patients showed a higher level of all psychological factors and lower level of two summary scores (physical and mental health) as well as the seven dimensions of the SF-8 compared with headache-free individuals. Examination employing the SPSS Process macro found that the direct effect of alexithymia on headache impact was not significant after controlling for somatization and PC. The total indirect effects of alexithymia on headache impact were significant without anxiety and depression as covariates with the significant indirect effects of alexithymia on headache impact via somatization or via PC as well as via somatization and PC. However, after controlling for anxiety and depression, PC was the only significant pathway through which alexithymia was related to headache impact. CONCLUSIONS Headache patients may benefit from interventions aiming at improving psychological factors in order to improve the functioning and QOL of headache patients.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Aram Park
- Department of Psychology, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea.
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14
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Tesio V, Di Tella M, Ghiggia A, Romeo A, Colonna F, Fusaro E, Geminiani GC, Castelli L. Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia. Front Psychol 2018; 9:442. [PMID: 29670558 PMCID: PMC5893813 DOI: 10.3389/fpsyg.2018.00442] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/16/2018] [Indexed: 12/29/2022] Open
Abstract
Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients’ quality of life, especially regarding the psychosocial functioning.
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Affiliation(s)
| | | | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy
| | - Annunziata Romeo
- Department of Psychology, University of Turin, Turin, Italy.,Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio Colonna
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | | | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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15
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Di Tella M, Ghiggia A, Tesio V, Romeo A, Colonna F, Fusaro E, Torta R, Castelli L. Pain experience in Fibromyalgia Syndrome: The role of alexithymia and psychological distress. J Affect Disord 2017; 208:87-93. [PMID: 27750065 DOI: 10.1016/j.jad.2016.08.080] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/21/2016] [Accepted: 08/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome with a high prevalence of alexithymia, a personality disposition that affects emotional self-awareness. The present study aimed to investigate the relationship between alexithymia and pain, differentiating between the sensory and affective components of pain experience, in a sample of FM patients. METHODS One hundred and fifty-nine FM patients completed a battery of tests assessing pain experience, pain intensity, alexithymia and psychological distress. In order to characterize the clinical profile of alexithymic FM patients, alexithymic and non-alexithymic groups were compared on the different measures. Two regression analyses were performed on the total sample, in order to investigate the relationship between alexithymia and pain, controlling for psychological distress. RESULTS Alexithymic FM patients presented higher scores on all the clinical measures compared to non-alexithymic ones. Positive correlations were found between alexithymia and the affective, but not the sensory, dimension of pain experience variables. Regression analyses showed that alexithymia (difficulty identifying feelings factor) ceased to uniquely predict affective pain, after controlling for psychological distress, particularly anxiety. In addition, none of the alexithymia variables significantly explained pain intensity variance. Finally, a significant effect of anxiety in mediating the relationship between alexithymia and affective pain was found. LIMITATIONS No longitudinal data were included. CONCLUSIONS These findings show the presence of higher levels of pain and psychological distress in alexithymic vs. non-alexithymic FM patients, and a relevant association between alexithymia and the affective dimension of pain experience. Specifically, this relationship appears to be significantly mediated by anxiety.
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Affiliation(s)
| | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy.
| | | | | | - Fabrizio Colonna
- A.O.U. Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Enrico Fusaro
- A.O.U. Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Riccardo Torta
- Department of Neuroscience, University of Turin, Turin, Italy; A.O.U. Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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16
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Eating Disorders in Adolescents With Chronic Pain. J Pediatr Health Care 2017; 31:67-74. [PMID: 27021242 DOI: 10.1016/j.pedhc.2016.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Given that youth with chronic pain frequently experience disruptions in eating patterns that may place them at risk for disordered eating, the purpose of this study was to examine the clinical characteristics and illness course of adolescents with chronic pain and comorbid eating disorders. METHODS Using a retrospective chart review, 34 adolescents with chronic pain and concurrent eating disorders were identified. These adolescents were compared with 34 age-, gender-, and eating disorder symptom-matched adolescents who had an eating disorder without chronic pain. RESULTS The majority of adolescents with chronic pain and an eating disorder had a primary medical diagnosis of abdominal pain (n = 14), followed by autonomic dysfunction (n = 10) and headache (n = 6). Although in 41.2% of teens with chronic pain, eating disorder symptoms developed after the onset of their pain, 35.3% reported having eating disorder symptoms before they experienced chronic pain. Body mass index did not differ between the groups, but the duration of eating disorder symptoms was significantly longer for the chronic pain group (p < .001). DISCUSSION Despite comparable severity, eating disorders are undetected for longer periods in patients with chronic pain, which may contribute to a poorer prognosis. Implications for eating disorder conceptualization, detection, and treatment are discussed.
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17
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Ghorbani F, Khosravani V, Ardakani RJ, Alvani A, Akbari H. The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: Evidence from Iranian asthmatic patients. Psychiatry Res 2017; 247:144-151. [PMID: 27898375 DOI: 10.1016/j.psychres.2016.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic and episodic psychosomatic disease whose symptoms include coughing, wheezing, chest tightness, and shortness of breath. The present study aimed to investigate the effects of cognitive emotion regulation strategies (CERS) as mediators on the relationships between alexithymia subscales and physical symptoms (PS). 300 asthmatic patients (males=42.7%, females=57.3%, age range=16-65, mean age=29.40) and 100 normal controls participated in the study and completed the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), the Persian version of the Toronto Alexithymia Scale (FTAS-20), and the Powell & Enright Physical Symptoms Inventory (PSI). Asthmatic patients showed higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) as well as non-adaptive CERS than normal controls. On the other hand, normal controls earned higher means in adaptive CERS. Results revealed that each of the three alexithymia subscales had indirect effects on PS through the non-adaptive cognitive emotion regulation strategy of catastrophizing. It is concluded that alexithymia can intensify PS through catastrophizing in asthmatic patients.
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Affiliation(s)
- Fatemeh Ghorbani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Vahid Khosravani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | | | - Amin Alvani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | - Hedayat Akbari
- Allergist & Asthma Specialist at Private Allergic Office, Shiraz, Iran.
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18
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Taylor GJ, Bagby RM, Parker JD. What’s in the name ‘alexithymia’? A commentary on “Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud’s legacy.”. Neurosci Biobehav Rev 2016; 68:1006-1020. [DOI: 10.1016/j.neubiorev.2016.05.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/20/2016] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
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19
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20
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Assogna F, Cravello L, Orfei MD, Cellupica N, Caltagirone C, Spalletta G. Alexithymia in Parkinson's disease: A systematic review of the literature. Parkinsonism Relat Disord 2016; 28:1-11. [PMID: 27086264 DOI: 10.1016/j.parkreldis.2016.03.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/29/2016] [Accepted: 03/28/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION In this systematic review, we aimed to evaluate the role of alexithymia in Parkinson's disease (PD) and its relationship to neurological, neuropsychiatric, cognitive, and neuroimaging correlates. METHODS The database was selected using PubMed Services, Cochrane, PsycNET and Scopus and a number of key words. Further studies were sought by manually searching for secondary sources, including relevant journals and references in primary articles. The search was restricted to articles written in English between January 1980 and August 2015. RESULTS Ten studies reported that alexithymia prevalence was about double in PD patients compared to control subjects and that specific dimensions of alexithymia might be related to depression, anxiety, apathy and impulsivity. Some studies investigated the relationship between alexithymia and neuropsychological symptoms and found correlations with frontal and parietal lobe functions. Two studies on neurological features reported a link between alexithymia and disease stage or a specific motor subtype of PD; the remaining studies found that alexithymia was independent from neurological symptoms, dopaminergic therapy and laterality of motor symptom onset. Data on neuroimaging correlates and therapeutic intervention on alexithymia in PD patients are still lacking. CONCLUSION Although results suggest that alexithymia is a primary characteristics of PD, further studies with larger patient samples are needed to definitively clarify the impact of alexithymia on the clinical features of PD patients.
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Affiliation(s)
| | - Luca Cravello
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; ASST-Rhodense, Rho, Milan, Italy
| | | | | | - Carlo Caltagirone
- I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; Department of Medicine of Systems, University "Tor Vergata", Rome, Italy
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Baudic S, Jayr C, Albi-Feldzer A, Fermanian J, Masselin-Dubois A, Bouhassira D, Attal N. Effect of Alexithymia and Emotional Repression on Postsurgical Pain in Women With Breast Cancer: A Prospective Longitudinal 12-Month Study. THE JOURNAL OF PAIN 2015; 17:90-100. [PMID: 26476266 DOI: 10.1016/j.jpain.2015.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/03/2015] [Accepted: 10/03/2015] [Indexed: 11/12/2022]
Abstract
UNLABELLED Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism used to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs might predict pain after breast cancer surgery has not been assessed. The present study was conducted to assess the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing, and psychological adjustment were also assessed. Data were collected before surgery, and then at 2 days and 2, 3, 6, and 12 months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at 3 months, alexithymia at 3, 6, and 12 months, and body image and catastrophizing predicted acute or subacute pain at 2 months. In contrast, emotional repression was not predictive of pain. The generalized estimating equation approach was used and identified alexithymia as the only significant predictor of pain during the 12-month period after surgery. Alexithymia, but not emotional repression, predicted the development of persistent pain after breast surgery independently of anxiety and depression. Thus, alexithymia might be involved in mechanisms of pain chronicity. PERSPECTIVE This prospective study, conducted in women with breast cancer surgery, showed that alexithymia but not emotional repression predicted postsurgical pain. These results highlight the role of dysfunction in emotional processing in the development of postsurgical pain.
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Affiliation(s)
- Sophie Baudic
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France.
| | - Christian Jayr
- Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France
| | - Aline Albi-Feldzer
- Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France
| | | | | | - Didier Bouhassira
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France
| | - Nadine Attal
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France
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Karukivi M, Saarijärvi S. Development of alexithymic personality features. World J Psychiatry 2014; 4:91-102. [PMID: 25540724 PMCID: PMC4274591 DOI: 10.5498/wjp.v4.i4.91] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/06/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
The purpose of this paper is to review the current literature regarding the development of alexithymic personality features. Modern brain imaging technologies provide interesting data on the associations of alexithymia with different aberrations in brain function related to emotion regulation; however, the development of these deviations is poorly understood. A notable amount of research covers the relation of alexithymia to different environmental factors. Many of these associations, for example, with low socio-economic status and general psychopathology in childhood, are well established. However, the retrospective and cross-sectional designs commonly used in these studies, as well as the use of self-report measures, hinder the ability to firmly establish causality. Certain individual developmental factors, such as lagging speech development and congenital cardiac malformations in childhood, have been associated with the development of alexithymia. Regarding the stability of alexithymia, a systematic review of the literature was conducted for this paper. In addition to being characterized as a personality feature in the general population, alexithymia also clearly has a state-like dimension that results in increases and decreases in alexithymic features in conjunction with mental disorder symptoms. An essential question is whether the alexithymic features in adulthood are, in fact, infantile features of a restricted ability to identify and describe emotions that simply persist in individuals through adolescence to adulthood. To firmly establish the roots of alexithymia development, longitudinal studies, particularly in younger populations, are needed. Furthermore, multifaceted study settings are encouraged.
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Faramarzi M, Salmalian H. Association of psychologic and nonpsychologic factors with primary dysmenorrhea. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e16307. [PMID: 25389482 PMCID: PMC4222008 DOI: 10.5812/ircmj.16307] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/01/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
Background: Primary dysmenorrhea seems to be one the most common gynecologic condition in women of childbearing age. Objectives: The aim of this research was to evaluate psychologic and nonpsychologic risk factors of primary dysmenorrhea. Materials and Methods: A cross-sectional study was conducted on medical sciences students of Babol University of Medical Sciences. In this study, 180 females with dysmenorrhea and 180 females without dysmenorrhea were enrolled. Psychological risk factors were evaluated in four domains including affect, social support, personality, and alexithymia. Four questionnaires were used to assessed aforementioned domains, namely, Social Support Questionnaire (SSQ), depression, anxiety, stress (DAS-21), 20-item Toronto Alexithymia Scale (TAS-20), and NEO-Five Factor Inventory of Personality (NEO-FFI). In addition, nonpsychologic factors were evaluated in three domains including demographic characteristics, habits, and gynecologic factors. Data were analyzed using the χ2 test and multiple logistic regression analysis. Results: The strongest predictor of primary dysmenorrhea was low social support (OR = 4.25; 95% CI, 2.43-7.41). Risk of dysmenorrhea was approximately 3.3 times higher in women with alexithymia (OR = 3.26; 95% CI, 1.88-5.62), 3.1 times higher in women with menstrual bleeding duration ≥ 7 days (OR = 3.06; 95% CI, 1.73-5.41), 2.5 times higher in women with a neurotic character (OR = 2.53; 95% CI, 1.42-4.50), 2.4 times higher in women with a family history of dysmenorrhea (OR = 2.43; 95% CI, 1.42-4.50), and twice higher in women with high caffeine intake (OR = 1.97; 95% CI, 1.09-3.59). Conclusions: Low social support, alexithymia, neuroticism trait, long menstrual bleeding, family history of dysmenorrhea, and high-caffeine diet are important risk factors for women with primary dysmenorrhea. This study recommended considering psychologic factors as an adjuvant to medical risks in evaluation and treatment of primary dysmenorrhea.
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Affiliation(s)
- Mahbobeh Faramarzi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, IR Iran
| | - Hajar Salmalian
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, IR Iran
- Corresponding Author: Hajar Salmalian, Fatemeh Zahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, IR Iran. Tel: +98-9111122259, E-mail:
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Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S, Iwaki R, Yamashiro K, Yoshida T, Imada Y, Kubo C, Kiyohara Y, Sudo N, Hosoi M. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PLoS One 2014; 9:e90984. [PMID: 24621785 PMCID: PMC3951296 DOI: 10.1371/journal.pone.0090984] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic pain is a significant health problem worldwide, with a prevalence in the general population of approximately 40%. Alexithymia -- the personality trait of having difficulties with emotional awareness and self-regulation -- has been reported to contribute to an increased risk of several chronic diseases and health conditions, and limited research indicates a potential role for alexithymia in the development and maintenance of chronic pain. However, no study has yet examined the associations between alexithymia and chronic pain in the general population. METHODS We administered measures assessing alexithymia, pain, disability, anxiety, depression, and life satisfaction to 927 adults in Hisayama, Japan. We classified the participants into four groups (low-normal alexithymia, middle-normal alexithymia, high-normal alexithymia, and alexithymic) based on their responses to the alexithymia measure. We calculated the risk estimates for the criterion measures by a logistic regression analysis. RESULTS Controlling for demographic variables, the odds ratio (OR) for having chronic pain was significantly higher in the high-normal (OR: 1.49, 95% CI: 1.07-2.09) and alexithymic groups (OR: 2.56, 95% CI: 1.47-4.45) compared to the low-normal group. Approximately 40% of the participants belonged to these two high-risk groups. In the subanalyses of the 439 participants with chronic pain, the levels of pain intensity, disability, depression, and anxiety were significantly increased and the degree of life satisfaction was decreased with elevating alexithymia categories. CONCLUSIONS The findings demonstrate that, in the general population, higher levels of alexithymia are associated with a higher risk of having chronic pain. The early identification and treatment of alexithymia and negative affect may be beneficial in preventing chronic pain and reducing the clinical and economic burdens of chronic pain. Further research is needed to determine if this association is due to a causal effect of alexithymia on the prevalence and severity of chronic pain.
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Affiliation(s)
- Mao Shibata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kozo Anno
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yonemoto
- Biostatistics Center, Kurume University, Fukuoka, Japan
| | - Seiko Makino
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Iwaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashiro
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiyuki Yoshida
- Department of Speech and Hearing Sciences, International University of Health and Welfare, School of Health Sciences at Fukuoka, Fukuoka, Japan
| | - Yuko Imada
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chiharu Kubo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- * E-mail:
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Martínez MP, Sánchez AI, Miró E, Lami MJ, Prados G, Morales A. Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia. THE JOURNAL OF PSYCHOLOGY 2014; 149:115-40. [PMID: 25511201 DOI: 10.1080/00223980.2013.844673] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Struggling in an emotional avoidance culture: a qualitative study of stress as a predisposing factor for somatoform disorders. J Psychosom Res 2014; 76:94-8. [PMID: 24439683 DOI: 10.1016/j.jpsychores.2013.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore patterns of experienced stress and stress reactions before the onset of illness in the life history of patients with severe somatoform disorders to identify predisposing stress-mechanisms. METHODS A systematic, thematic analysis was conducted on data collected from 24 semi-structured individual life history interviews. RESULTS Generally, patients had experienced high psychosocial stress during childhood/youth. However, there was considerable variability. Characteristic of all patients were narrations of how communication with significant adults about problems, concerns, and emotions related to stress were experienced to be difficult. The patients described how this involved conflicts stemming from perceived absent, insufficient, or dismissive communication during interactions with significant adults. We conceptualized this empirically based core theme as "emotional avoidance culture." Further, three related subthemes were identified: Generally, patients 1.) experienced difficulties communicating problems, concerns, and related complex feelings in close social relations; 2.) adapted their emotional reactions and communication to an emotional avoidance culture, suppressing their needs, vulnerability and feelings of sadness and anger that were not recognized by significant adults; and 3.) disconnected their stress reaction awareness from stressful bodily sensations by using avoidant behaviors e.g. by being highly active. CONCLUSION Patients adapted to an emotional avoidance culture characterized by difficult and conflicting communication of concerns and related emotions in social interactions with significant adults. Patients experienced low ability to identify and express stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact, which made them vulnerable to stressors. Generally, patients resolved stress by avoidant behaviors, prolonging their stress experience.
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