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Psychosomatics 42:235-240, June 2001
© 2001 The Academy of Psychosomatic Medicine

Alexithymia in DSM-IV Disorder

Comparative Evaluation of Somatoform Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Depression

Bettina Bankier, M.D., Martin Aigner, M.D., and Michael Bach, M.D.

Received May 4, 2000; revised November 27, 2000; accepted November 30, 2000. From the Department of Psychiatry, University of Vienna, Austria. Address reprint requests to Dr. Bankier, Department of Psychiatry, Division of Social Psychiatry and Evaluation Research, University of Vienna, Austria, A-1090 Vienna, Waehringer Guertel 18–20; E-mail: bettina.bankier{at}akh-wien.ac.at


  ABSTRACT

 
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.

Key Words: Alexithymia • Somatoform Disorder • Panic Disorder

  INTRODUCTION

 
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The term "alexithymia," which literally means "no words for mood," was introduced by Sifneos1,2 to designate a cluster of cognitive and affective characteristics that Nemiah and Sifneos3 had observed among patients with classic psychosomatic diseases. Considering alexithymia as a multidimensional construct, it is defined by the following characteristics: striking difficulties in identifying and describing feelings, difficulties in discriminating between feelings and bodily sensations of emotional arousal, markedly constricted imaginative processes (as evidenced by a paucity of fantasies), a cognitive style that is concrete and reality based (also denoted as externally oriented thinking or "pensée opératoire"), and a high degree of social conformity with little contact with their own psychic reality.4 However, an increasing body of studies indicates that alexithymia features exist not only in classic psychosomatic disorders but also in other severe and chronic somatic diseases and psychiatric disorders.5–9

Accordingly, alexithymic characteristics have been investigated in patients with different psychiatric disorders, such as substance abuse,10–14 posttraumatic stress disorder,15,16 somatoform disorder,17–23 anxiety disorders,24–26 obsessive-compulsive disorder,24 and depression.27–32 Regarding somatoform disorder, some findings support the theoretical conception and clinical impression of an association between alexithymia and complaints of somatic symptoms.17,19,21 However, Kooiman23 suggests that allexithymia appears to be a theoretically important and clinically appealing concept, but the empirical evidence that alexithymia predisposes to the development or persistence of medically unexplained physical symptoms is imperfect. Bach et al.33 demonstrated that alexithymia and somatization reflect separate constructs that may occur simultaneously. Regarding the relationship between alexithymia and panic disorder, Cox et al.26 suggest a conceptual overlap between alexithymia and psychological aspects of panic disorder. However, considering the relationship between alexithymia and depression, previous studies27–29 suggest that alexithymia is independent of depression. In other words, there does not appear to be a causal link between depression and alexithymia. To date, there are conflicting results regarding the potential influence of the level of depression on alexithymia ratings.27,32 Additionally, with regard to cognitive and social correlates, Kirmayer and Robbins34 emphasize the multidimensionality of the TAS measures. However, Kauhanen et al.35 stress that alexithymia could be viewed not only as a psychological phenomenon but also partly as a socially determined one.

Regardless, the question of the nonspecificity of the alexithymia construct still awaits further clarification. Moreover, in some of these studies, besides the TAS total score, the multidimensionality of the alexithymia construct, as suggested by recent validational studies on the TAS-20,36 is not always taken into account. Therefore, we designed the present study for the direct comparative assessment of alexithymia in several psychiatric disorders, including somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, with regard to, besides the TAS-20 total score, the cognitive and affective characteristics integrated into the alexithymia construct. Accordingly, the different aspects of alexithymia may be outlined more distinctly in various mental disorders by considering sociodemographic variables such as age, gender, and educational level. This approach appears clinically useful and theoretically meaningful for current psychosomatic research.


  METHODS

 
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
The subject sample was drawn from 297 patients consecutively admitted to the Behavior Therapy Ward at the Department of Psychiatry, University of Vienna, Austria, during a 4-year period. Subjects were selected in light of illness severity requiring psychopharmacologic and psychotherapeutic inpatient treatment. However, for statistical purposes, we included only "pure" cases in the study, that is, subjects who fulfilled more than one DSM-IV diagnosis were not included. The final subject sample consisted of 234 subjects, and subject-to-subject comparisons were performed.

Psychiatric diagnoses were determined using the Structured Clinical Interview for DSM-IV (SCID-I), German version.37 All interviews were conducted by the senior author (MB). Subjects included in the study with the diagnosis of panic disorder fulfilled the DSM-IV criteria for panic disorder with and without agoraphobia. Subjects included in the study with the diagnosis of depression fulfilled the DSM-IV criteria for a major depressive episode.

Additionally, the Twenty-Item Toronto Alexithymia Scale (TAS-20, German version)38 was administered as part of a comprehensive psychometric investigation. This recently developed 20-item self-report measure of alexithymia has been demonstrated to be a psychometrically sound measure of alexithymia.39,40 Written instructions were given asking the subjects to respond on a 5-point Likert scale the extent to which they agreed or disagreed with each statement. As recommended in previous studies,38–40 the results are expressed as TAS-20 total score and as factor scores, using the following item-factor distribution: Factor 1 (difficulty identifying feelings and distinguishing them from bodily sensations of emotion): Items 1, 3, 6, 7, 9, 13, and 14; Factor 2 (difficulty expressing feelings): Items 2, 4, 11, 12, and 17; and Factor 3 (externally oriented thinking): Items 5, 8, 10, 15, 16, 18, 19, and 20. The German version of the TAS-20 used in this study was developed by Parker and colleagues, who used a translation-backtranslation procedure to establish cross-language equivalence.38 In their study, the three-factor model of the TAS-20 was cross-validated in samples of German, American, and Canadian undergraduate students, showing similar item-factor distributions for both the English and the German version.38 A comparable item-factor distribution could also be demonstrated for a German sample of nonpatient adults as well as a clinical sample.33

Two-tailed t-tests were conducted to compare the means for each group. Stepwise multiple regression analyses were performed to examine the influence of particular DSM-IV diagnoses such as somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression on alexithymia TAS-20 total scores and subfactors. Additionally, age, gender, and the educational level were included in the stepwise multiple regression analyses. Diagnoses, age, gender, and educational level were used as independent variables. All calculations were performed by SPSS,41 and values are means±SD unless otherwise noted.


  RESULTS

 
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 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Subjects were between 18 and 71 years (mean±SD age=35.3±10.7); 59% (n=139) of the subjects were women. In our sample, 24 subjects (10%) met DSM-IV criteria for somatoform disorder (SOM), 123 (53%) for panic disorder (PD), 59 (25%) for obsessive-compulsive disorder (OCD), and 28 (12%) for depression (DEP). With regard to the educational level, 10% of the subjects (n=24) completed elementary school, 45% (n=105) junior high, 25% (n=58) high school, 14% (n=34) apprenticeship or trade school, and 6% (n=13) college. In view of the different diagnostic subgroups, sociodemographic variables are presented in Table 1.


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TABLE 1. Sociodemographic variables in view of the different diagnostic subgroups (N=234)



Subjects with PD (49±11.4) exhibited lower TAS-20 total scores compared to subjects with OCD (51.9±8.7), SOM (54.9±12.4), and DEP (56.6±13.6). Correspondingly, the multiple regression analysis led to a significant and independent relationship between the presence of PD and lower TAS-20 total scores (Table 2).


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TABLE 2. Relationships of TAS-20 total scores and subfactors with different DSM-IV diagnoses, age, gender, and educational level (stepwise multiple regression analyses, beta-values) (N=234)



Regarding TAS-20 subfactors, Factor 1 (difficulty identifying feelings and distinguishing them from bodily sensations of emotion) was significantly associated with SOM (P=0.006) and DEP (P=0.002); Factor 2 (difficulty expressing feelings) was significantly associated with DEP (P=0.025); and Factor 3 (externally oriented thinking) was significantly associated with OCD (P=0.001), whereas PD showed a significant negative correlation with Factor 3 (P=0.001).

There was no significant relationship between the age of the subjects and the TAS-20 total scores or any of the three subfactors. Female gender was significantly associated with Factor 1, whereas Factor 3 was significantly associated with male gender. A lower educational level showed a significant relationship with the TAS-20 total scores as well as with Factor 3.


  DISCUSSION

 
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Regarding somatoform disorder, Cox et al.19 investigated alexithymia in somatoform disorder patients with chronic pain. This sample consisted of 55 consecutive referrals to a pain clinic after a motor vehicle accident with pain complaints that persisted for at least 2 years after the accident and for which no organic basis had been found. According to the affective aspects of the alexithymia construct, these researchers found alexithymic patients using significantly more words to describe their pain, suggesting that these patients may have more difficulties in expressing verbally their pain experience. In contrast, in our study, besides a mean TAS total score of 54.9±12.4, Factor 1 (difficulty identifying feelings and distinguishing them from bodily sensations of emotions) was significantly associated with somatoform disorder, whereas Factor 2 (difficulty expressing feelings) showed no significant relationship. The difference of these findings may be due, on the one hand, to the different samples investigated. On the other hand, the multidimensionality of the alexithymia construct was not taken into account in the above-mentioned study.

Considering anxiety disorders, our findings are not consistent with previous findings of Zeitlin et al.,24 who found that panic disorder is more associated with alexithymia total scores than is obsessive-compulsive disorder. This sample consisted of 27 patients with panic disorder and 31 patients with obsessive-compulsive disorder who sought treatment at an anxiety disorders clinic. In contrast, in our study, subjects with panic disorder exhibited lower TAS-20 total scores (49±11.4) compared to subjects with obsessive-compulsive disorder (51.9±8.7). Furthermore, panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores and showed a significant negative correlation with Factor 3 (externally oriented thinking), while Factor 3 was significantly related to obsessive-compulsive disorder. One possible explanation could be, on the one hand, that the investigated samples of patients with panic disorder as well as obsessive-compulsive disorder were small in the above mentioned study; on the other hand, again, the multidimensionality of alexithymia was not investigated.

As demonstrated in our study, subjects with depression exhibited a mean±SD TAS total score of 56.6±13.6, and depression was significantly associated with Factor 2 (difficulty expressing feelings). In view of alexithymia and the relationship to depression, Haviland et al.30 investigated a sample of 55 newly abstinent alcoholic inpatients on the date of their application for care (Time 1) and at the end of their third week in treatment (Time 2). They used the TAS-2610 and derived the three subscale scores "difficulties in identifying and describing feelings" (Factor 1), "daydreaming and markedly constricted imaginative processes" (Factor 2), and "externally oriented thinking" (Factor 3). They found, in contrast to the measured depression, not the expected drop of the TAS total scores. Moreover, they found Factor 1 contributing the most to the TAS total scores compared to Factor 2 and Factor 3. However, a direct comparison to our results remains questionable because of a different sample investigated and the application of different subscale scores.

With regard to the relationship between the TAS-26 total score and sociodemographic variables such as age, gender, educational level, and other variables, Parker et al.42 found, in contrast to our results, no significant relationships in a study of 101 normal adults. Moreover, our findings differ partly from the findings of Pasini et al.,43 who found increased TAS-26 total scores and subfactor scores with advancing age in a sample of 417 normal subjects. On the other hand, our results are consistent with the findings of Pasini et al.43 regarding gender. In particular, they found no significant relationships between gender and TAS total scores, whereas female subjects scored higher on the factor "difficulty identifying feelings and bodily sensations." Accordingly, we found a significant relationship between female subjects and Factor 1 (difficulty identifying feelings and distinguishing them from bodily sensations of emotions). In addition, our results point out a significant relationship between male subjects and the factor "externally oriented thinking." Furthermore, our results are consistent with their findings in view of the relationship between a lower educational level and the TAS total score as well as the factor "externally oriented thinking."

Since the early descriptions of alexithymia,1–3 an ongoing debate exists concerning the diagnostic specificity of elevated alexithymia scores.44 Regarding our results, various diagnostic subgroups exhibited different TAS-20 total scores. However, again, the question remains whether these differences represent particular diagnostic characteristics. In contrast to this assumption, several authors consider alexithymia to be a multidimensional construct. Accordingly, the TAS-20 has been developed to assess different aspects of the alexithymia construct by providing three subfactors. In our study, besides minor differences regarding the TAS total scores, cognitive and affective aspects of alexithymia significantly differed between various psychiatric disorders and sociodemographic variables.

With regard to somatoform disorder and depression, our data suggest a reduced awareness of inner feelings, and, to some degree, a reduced ability to communicate feelings to others. The kind of cognitive processing seems to discriminate between subjects with panic disorder and obsessive-compulsive disorder. Accordingly, in contrast to subjects with panic disorder, subjects with obsessive-compulsive disorder tend to cope with emotional stress by the use of an operational thinking style. In addition, in view of emotionally stressing situations, our data suggest a tendency for women to experience difficulty identifying feelings and distinguishing them from bodily sensations of emotion, whereas men tend to process by using an operational thinking style. Moreover, our data point out a significant relationship between a lower educational level and an operational thinking style. Thus, our data emphasize the multidimensionality of the alexithymia construct. Our results also emphasize, in addition to the TAS-20 total score, the three subfactors providing information about whether cognitive and/or affective aspects of alexithymia are associated with different psychiatric disorders.44 However, further research is needed to reproduce these findings.

The present data should be tempered by the methodological limitations of our study. Only a limited number of cases with somatoform disorder and depression were examined. In addition, the subjects were patients consecutively admitted to a Behavioral Therapy Ward; therefore, the results cannot be generalized to other subjects or patients.


  REFERENCES

 
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Sifneos PE: Short-Term Psychotherapy and Emotional Crisis. Cambridge, MA, Harvard University Press, 1972
  2. Sifneos PE: The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom 1973; 22:255–262[Medline]
  3. Nemiah JC, Sifneos PE: Affect and fantasy in patients with psychosomatic disorders, in Modern Trends in Psychosomatic Medicine, edited by Hill OW. London, Butterworths, 1970, volume 2, pp 26–34
  4. von Rad M: Alexithymie. Empirische Untersuchungen zur Diagnostik und Therapie psychosomatisch Kranker. Monographien aus dem Gesamtgebiet der Psychiatrie (Herausgeber: Hippius H, Janzarik W, Müller C), Springer-Verlag, 1983
  5. Cremerius J: Some reflections about the conception of "psychosomatic patients" in the French School. Psychother Psychosom 1977; 28:236–242[Medline]
  6. Ahrens S, Deffner G: Empirical study of alexithymia: methodology and results. Am J Psychotherapy 1986; 40:430–447[Medline]
  7. Rubino LA, Grasso S, Sonnino A, et al: Is alexithymia a non-neurotic personality dimension? Br J Med Psychol 1991; 64:385–391
  8. Sifneos PE: Alexithymia and its relationship to hemispheric specialization, affect, and creativity. Psychiatr Clin North Am 1988; 11:287–292
  9. Nemiah JC: The psychodynamic view of anxiety, in Diagnosis and Treatment of Anxiety Disorders, edited by Pasnau RO. Washington, DC, American Psychiatric Press, 1984
  10. Haviland MG, Shaw DG, MacMurray JP, et al: Validation of the Toronto Alexithymia Scale with substance abusers. Psychother Psychosom 1988; 50:81–87[Medline]
  11. Taylor GJ, Parker JDA, Bagby RM: A preliminary investigation of alexithymia in men with psychoactive substance dependence. Am J Psychiatry 1990; 147:1228–1230
  12. Haviland MG, Hendryx MS, Cummings MA, et al: Multidimensionality and state dependency of alexithymia in recently sober alcoholics. J Nerv Ment Dis 1991; 179:284–290[Medline]
  13. Haviland MG, Hendryx MS, Shaw DG, et al: Alexithymia in women and men hospitalized for psychoactive substance dependence. Compr Psychiatry 1994; 35:124–128[CrossRef][Medline]
  14. Loas G, Fremaux D, Otmani O, et al: Is alexithymia a negative factor for maintaining abstinence? A follow up study. Compr Psychiatry 1997; 38:296–299[CrossRef][Medline]
  15. Henry JP, Haviland MG, Cummings MA, et al: Shared neuroendrocrine patterns of post-traumatic stress disorder and alexithymia. Psychosom Med 1992; 54:407–415[Abstract/Free Full Text]
  16. Zeitlin SB, McNally RJ, Cassiday KL: Alexithymia in victims of sexual assault: an effect of repeated traumatization? Am J Psychiatry 1993; 150:661–663
  17. Taylor GJ, Parker JDA, Bagby RM, et al: Alexithymia and somatic complaints in psychiatric outpatients. J Psychosom Res 1992; 36:1–8[CrossRef][Medline]
  18. Cohen K, Auld F, Brooker H: Is alexithymia related to psychosomatic disorder and somatizing? J Psychosom Res 1994; 38:119–127
  19. Cox BJ, Kuch K, Parker JDA, et al: Alexithymia in somatoform disorder patients with chronic pain. J Psychosom Res 1994; 38:523–527[CrossRef][Medline]
  20. Wise TN, Mann LS: The relationship between somatosensory amplification, alexithymia, and neuroticism. J Psychosom Res 1994; 38:515–521[CrossRef][Medline]
  21. Bach M, Bach D: Predictive value of alexithymia: a prospective study in somatizing patients. Psychother Psychosom 1995; 64:43–48[Medline]
  22. Kosturek A, Gregory RJ, Sousou AJ, et al: Alexithymia and somatic amplification in chronic pain. Psychosomatics 1998; 39:399–404[Abstract/Free Full Text]
  23. Kooiman CG: The status of alexithymia as a risk factor in medically unexplained physical symptoms. Compr Psychiatry 1998; 39:152–159[CrossRef][Medline]
  24. Zeitlin SB, McNally RJ: Alexithymia and anxiety sensitivity in panic disorder and obsessive-compulsive disorder. Am J Psychiatry 1993; 150:658–660[Abstract/Free Full Text]
  25. Parker JDA, Taylor GJ, Bagby RM, et al: Alexithymia in panic disorder and simple phobia: a comparative study. Am J Psychiatry 1993; 150:1105–1107
  26. Cox BJ, Swinson RP, Shulman ID, et al: Alexithymia in panic disorder and social phobia. Compr Psychiatry 1995; 36:195–198[CrossRef][Medline]
  27. Wise TN, Jani NN, Kass E, et al: Alexithymia: relationship to severity of medical illness and depression. Psychother Psychosom 1988; 50:68–71[CrossRef][Medline]
  28. Wise TN, Mann LS, Hill B: Alexithymia and depressed mood in the psychiatric patient. Psychother Psychosom 1990; 54:26–31[Medline]
  29. Parker JDA, Bagby RM, Taylor GJ: Alexithymia and depression: distinct or overlapping constructs? Compr Psychiatry 1991; 32:387–394
  30. Haviland MG, Shaw DG, Cummings MA, et al: Alexithymia: subscales and relationship to depression. Psychother Psychosom 1998; 50:164–170
  31. Loas G, Dhee-Perot P, Chaperot C, et al: Anhedonia, alexithymia and locus of control in unipolar major depressive disorders. Psychopathology 1998; 31:206–212[CrossRef][Medline]
  32. Sexton MC, Sunday SR, Hurt S, et al: The relationship between alexithymia, depression, and axis II psychopathology in eating disorder patients. Int J Eat Disord 1998; 23:277–286[CrossRef][Medline]
  33. Bach M, Bach D, de Zwaan M: Independency of alexithymia and somatization: a factor analytic study. Psychosomatics 1996; 37:451–458[Abstract/Free Full Text]
  34. Kirmayer LJ, Robbins JM: Cognitive and social correlates of the Toronto Alexithymia Scale. Psychosomatics 1993; 34:41–52[Abstract/Free Full Text]
  35. Kauhanen J, Kaplan GA, Julkunen J, et al: Social factors in alexithymia. Compr Psychiatry 1993; 34:330–335[CrossRef][Medline]
  36. Haviland MG, Reise SP: Structure of the Twenty-Item Toronto Alexithymia Scale. Journal of Personality Assessment 1996; 66:116–125 [CrossRef][Medline]
  37. Wittchen HU, Zaudig M, Fydrich T: SKID. Strukturiertes Klinisches Interview für DSM-IV. Göttingen, Germany, Hogrefe, Verlag für Psychologie, 1997
  38. Parker JDA, Bagby RM, Taylor GJ: Factorial validity of the Twenty-Item Toronto Alexithymia Scale. European Journal of Personality 1993; 7:221–232
  39. Bagby RM, Parker JDA, Taylor GJ: The Twenty-Item Toronto Alexithymia Scale-I: Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38:23–32[CrossRef][Medline]
  40. Bagby RM, Taylor GJ, Parker JDA: The Twenty-Item Toronto Alexithymia Scale-II: Convergent, discriminant, and concurrent validity. J Psychosom Res 1994; 38:33–40[CrossRef][Medline]
  41. SPSS Inc. Base 7.5 for Windows, Chicago, IL, User's Guide, 1997
  42. Parker JDA, Taylor GJ, Bagby RM: The alexithymia construct: relationship with sociodemographic variables and intelligence. Compr Psychiatry 1989; 30:434–441[CrossRef][Medline]
  43. Pasini A, Delle Chiaie R, Seripa S, et al: Alexithymia as related to sex, age, and educational level: results of the Toronto Alexithymia Scale in 417 normal subjects. Compr Psychiatry 1992; 33:42–46[CrossRef][Medline]
  44. Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation. Cambridge, MA, Cambridge University Press, 1997



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