Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia

Department of Psychosomatic and Psychotherapeutic Medicine, University Hospital of Freiburg, Hauptstr. 8, D-79104, Freiburg, Germany.
Journal of Psychosomatic Research (Impact Factor: 2.74). 10/2004; 57(3):239-47.
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To determine the role of undifferentiated and dysregulated affects in somatoform disorders by using a multimethod assessment approach of alexithymia.
Forty patients with ICD-10 somatoform disorders (SoD) and 20 healthy controls, matched for age, education and sex, were included in the study. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), the Affect Consciousness Interview (ACI), and the Levels of Emotional Awareness Scale (LEAS). All classifications were made blinded with regard to clinical status.
Scores of the ACI and the TAS-20 showed that alexithymia is higher in SoD than in healthy controls. No differences were found on the LEAS. In terms of the multidimensionality of the alexithymia construct, our results indicate a specific positive association between SoD and a proneness to experience undifferentiated affects. The three subfactors of the TAS-20 were differentially related to non-self-report measures of alexithymia and to negative affectivity (NA). Only the cognitive facet of the TAS-20 (externally oriented thinking [EOT]) was related to the LEAS and the ACI. In contrast, the affective facets of the TAS-20-difficulties identifying feelings (DIF) and difficulties describing feelings (DDF)-were substantially related to NA.
The findings highlight the important role of impaired affect regulation and NA in the process of somatization.

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Available from: Elisabeth Maria Waller, Mar 21, 2014
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    • "First, we relied exclusively on self-reported measures. The literature suggests that multi-method assessments (e.g., self-reporting, interviews and observation) should be used when measuring alexithymia, to minimize measurement errors (e.g., Meganck, Inslegers, Vanheule, & Desmet, 2011; Taylor & Bagby, 2004; Waller & Scheidt, 2004). Moreover, it is arguable that the way people represent and regulate emotions is, to an important extent, implicit (e.g., Westen & Blagov, 2007). "
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    ABSTRACT: Objectives We aimed to clarify the associations between negative emotionality, avoidant coping, and alexithymia. We hypothesized that negative emotionality and avoidance strategies would interact negatively in associating with alexithymia.DesignWe examined, in one study conducted in Italy and another in the US (total N = 415), the associations among avoidant coping, negative emotionality, and alexithymia, using cross-sectional designs.Method Study 1: Participants completed paper-and-pencil measures of alexithymia, avoidant coping, and negative emotionality. Study 2: Participants completed the above-mentioned measures plus a measure of experiential avoidance (EA), by means of an online questionnaire.ResultsAs expected, an antagonistic avoidant coping × negative emotionality interaction was found to relate to alexithymia in both studies. In Study 2, EA mediated the effects of such interaction on alexithymia (mediated moderation). The interaction found implied that alexithymia would be adopted as a defence against negative affect or as a consequence of avoidant strategies.Conclusions The studies suggested that two different psychological pathways to alexithymia may be at work: Preference for avoidance and negative emotionality. This result appeared theoretically relevant and may stimulate further research.Practitioner pointsAlexithymia may develop from habitual avoidance, regardless of negative emotionality.Practitioners could consider addressing negative emotional regulation or automatic and habitual avoidant responses in dealing with alexithymic patients.
    10/2015; DOI:10.1111/papt.12079
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    • "[39] is a 33-item observer-measure, administrated to participants by the individual psychotherapists. An observer measure is fundamental in order to overcome a limit of selfreport tools to evaluate alexithymia: self-reports ask to the respondents to report on a capacity that they may lack, given the low rates of self-awareness and difficulties in emotion regulation that alexithymia itself implies [40]. For this reason, alexithymia assessment is most useful when used in combination with observational methods. "
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    ABSTRACT: Abstract— Introduction: Adolescence is a vulnerable age for experimenting with drugs, unfortunately early substance abuse has severe detrimental effects on cognitive functioning. Moreover, drug addiction is also characterized by affective dysregulation, in terms of high rates of sensation-seeking and alexithymia and poor emotional intelligence. Cognitive control and emotion regulation abilities are directly associated and are largely implemented by the same frontal cortex areas, which are also the main target of drug abuse. Objective: The present research aims to study the neuropsychological performance and the emotional functioning in young drug addicts, investigating possible interrelations between these two domains. Methods: a battery of neuropsychological tests (ENB-2) and self-report tools, addressing alexithymia (TAS-20), sensation seeking (SSS-VI) and emotional intelligence (EQ-i), were administered to 19 young drug-addicts. An observer scale to evaluate alexithymia (OAS) was also used. Results: subjects showed memory and attention deficits. High rates of alexithymia emerged, but only in the observer scale; also past experience of disinhibition and inadequate emotional intelligence abilities were identified. Several significant correlations were detected between cognitive functions and affective style, especially as regards executive functions and alexithymia. Conclusions: These findings suggest that drug-dependence in young age is not only characterized by neuropsychological deficits and difficulties in emotion regulations, but these two domains are associated, delineating a severe clinical conditions that requires specific treatment.
    The 2nd international virtual Scientific Conference, Slovakia; 06/2014
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    • "With a prevalence rate of ten percent in the general population , alexithymia ( " no words for feelings " ) is a major risk factor for a range of medical and psychiatric disorders (Taylor, Bagby, & Parker, 1997), including somatoform (Waller & Scheidt, 2004) and panic disorders (Parker, Taylor, & Bagby, 1993). In general, men seem to exhibit higher levels of alexithymia than women, though gender differences are small (Levant, Hall, Williams, & Hasan, 2009). "
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    ABSTRACT: Alexithymia ("no words for feelings") is a major risk factor for psychosomatic and psychiatric conditions characterized by affect dysregulation. The alexithymia personality construct comprises an affective dimension, the level of subjective emotional experience (emotionalizing and fantasizing), and a cognitive dimension, referring to the cognitive control of emotions (identifying, analyzing, and verbalizing feelings). These two dimensions may differentially put individuals at risk for psychopathology, but their specific neural bases have rarely been investigated. Therefore, the aim of the present study was to find out whether the two alexithymia dimensions are associated with discriminable neural correlates. By means of voxel-based morphometry (VBM), differences in gray matter volumes were compared between 20 (10 male) high-scorers and 20 (9 male) low-scorers on the Toronto Alexithymia Scale (TAS-20), reflecting the cognitive alexithymia dimension. In a subset of 32 subjects, the impact of the affective alexithymia dimension was tested in addition, as assessed with the affective subscale of the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Analysis 1 (cognitive alexithymia dimension) revealed significantly larger gray matter volumes in the right posterior insula in high-scorers compared to low-scorers on the TAS-20. Analysis 2 (affective alexithymia dimension) revealed that the affective alexithymia dimension, specifically the emotionalizing factor indicative of low emotional reactivity, was associated with larger gray matter volumes of the right cingulate cortex. These results suggest that the two alexithymia dimensions are associated with distinct structural correlates.
    Neuropsychologia 01/2014; 53:284–292. DOI:10.1016/j.neuropsychologia.2013.12.006 · 3.30 Impact Factor
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