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Alexithymic Characteristics in Children With Refractory Hematological Diseases

Key Words: Alexithymia • Transplantation

TO THE EDITOR: Alexithymia refers to difficulty in describing and identifying emotions. Alexithymia is divided into primary alexithymia as a personality trait and secondary alexithymia as a state reaction.^1,2 Previous studies have shown that secondary alexithymia tends to be manifested in severely stressful circumstances, such as when a patient is diagnosed with cancer or is being cared for in the intensive care unit or when a patient has undergone an organ transplant.^3,4 However, most studies of secondary alexithymia have been on adults, not on children,^2–4 because there are few psychological instruments that can accurately assess children's alexithymic tendencies. In a previous report,⁵ we described the Alexithymia Scale for Children (ASC), which we developed to examine the manifestation of alexithymia in children.

In the present study, we examined 33 pairs of children with refractory hematological diseases and their mothers. The children were 19 boys and 14 girls (mean±SD age=8.1±4.3) admitted to the Tokyo Medical College Hospital. These patients' hematological diseases included acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), and idiopathic thrombocytopenic purpura (ITP). The control group contained 102 pairs of children and their mothers. The children in the control group had no somatic diseases and were matched for age and gender with the children in the subject group (62 boys and 40 girls; mean±SD age=8.3±4.1).

After obtaining informed consent from the children's mothers, we administered the Japanese version of the ASC⁵ to both groups. The ASC consists of a 12-item behavior checklist with two factors, Difficulty Describing Feelings (Factor 1) and Difficulty Relating to Others (Factor 2). Scores are based on ratings made by the child's caregivers (e.g., parents and schoolteachers). The ASC has been shown to have high construct validity and adequate reliability.⁵ The subjects' caregivers answered the 12 questions of the ASC with respect to the child's recent behavior and then answered the same questions again with respect to their recollection of the child's behavior before suffering a hematological disease.

We used analysis of variance (ANOVA) and post hoc t-tests to compare total scores and scores on each of the two factors among three groups: the subject group at present (Subjects-Now), the subject group before suffering a hematological disease (Subjects-Before), and the control group at present (Control).

ANOVA revealed a significant difference in total scores and scores on both factors among the three groups (total scores, df=2, F=4.46, P<0.05). Post hoc t-tests showed that total scores and scores on both factors were significantly higher for the Subjects-Now group than for either the Subjects-Before group [total scores, df=1, Fisher's protected least significant difference (PLSD)=1.65, P<0.05] or the Control group (total scores, df=1, Fisher PLSD=1.27, P<0.05). However, post hoc t-tests revealed that there were no significant differences between the Subjects-Before group and the Control group in any of the scores.

These results suggest that children with refractory hematological diseases are likely to exhibit alexithymic characteristics and that secondary alexithymia related to severely stressful medical conditions is manifested in some children. In this study, however, there were several methodological limitations. First, the sample size was relatively small. Second, no longitudinal study was performed to assess the course of the observed alexithymic characteristics. Although this research is preliminary, it suggests that secondary alexithymia, a poor capacity for verbalizing emotions, can be seen in children with hematological diseases and can interfere with their quality of life.

REFERENCES

1. Freyberger H: Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother Psychosom 1977; 28:337–342[Medline]
2. Wise TN, Mann LS, Mitchell JD, et al: Secondary alexithymia: an empirical validation. Compr Psychiatry 1990; 31:284–288[CrossRef][Medline]
3. Fukunishi I, Saito S, Ozaki S: The influence of defense mechanisms on secondary alexithymia in hemodialysis patients. Psychother Psychosom 1992; 57:50–56[Medline]
4. Fukunishi I: Psychosomatic problems surrounding kidney transplantation: incidence of alexithymia and psychiatric disturbances. Psychother Psychosom 1992; 57:42–49[CrossRef][Medline]
5. Fukunishi I, Yoshida H, Wogan J: Development of the Alexithymia Scale for Children: a preliminary study. Psychol Rep 1998; 82:43–49[Medline]

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