Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology

Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Italy. Electronic address: .
General hospital psychiatry (Impact Factor: 2.61). 05/2013; 35(5). DOI: 10.1016/j.genhosppsych.2013.04.005
Source: PubMed


To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria.

Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis.

Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%).

The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.

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Available from: Piero Porcelli, Jan 09, 2014
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    • "Downloaded by [Columbia University] at 06:54 12 April 2015 processing emotional stimuli through use of worry in patients with GAD [Mennin, McLaughlin & Flanagan, 2009; Onur, Alkın, Sheridan & Wise, 2013].Therefore, a lower level of awareness of psychic anxiety in alexithymic subjects with GAD may be likely, due to the suppression of emotional processing and the poorer verbalization of emotional contents. Thus, the generalized anxiety may be mainly perceived in form of severe somatic symptoms [Porcelli et al., 2013], as found also in the present study. "
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    ABSTRACT: The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP) and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Scale of Suicide Ideation (SSI) and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG) and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings and subthreshold depressive symptoms. Study limitations and future research implications have been discussed.
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  • 22nd World Congress on Psychosomatic Medicine; 09/2013
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