Relationships Between Physical Symptoms,Emotional Distress,and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.     

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross‐sectional study compared self‐reported alexithymia and observer‐rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self‐reported alexithymia was measured with the Toronto Alexithymia Scale‐20 (TAS‐20) and emotional awareness with an observer‐rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self‐reported alexithymia in the TAS‐20 compared to HC, but had similar emotional awareness capacity in the observer‐rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS‐total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self‐reported alexithymia and observer‐rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.     

Depression history and coping with chronic pain: a daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.     

Alexithymia and Early Maladaptive Schemas in chronic pain patients

Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale‐20, the Finnish version of the Young Schema Questionnaire short form‐extended, the Beck Depression Inventory‐II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co‐occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients.     

The relationship between self‐harm and alexithymia

This paper presents a systematic review of the literature concerning the relationship between alexithymia and self‐harm. Fifteen studies were selected following a systematic search of relevant databases. Results indicate significantly higher levels of alexithymia in women who self‐harm compared with women who do not self‐harm. Studies of men were less conclusive and require further investigation. A subsample of the studies found that childhood abuse and bullying were more likely to be associated with self‐harm if alexithymia was present as a mediator. Other studies found that depression mediated between alexithymia and self‐harm. The results indicate that the poor emotional cognition and expression associated with alexithymia may increase vulnerability to self‐harm, particularly in women.     

BRIEF REPORT

This study examined the different facets of emotional intelligence, alexithymia, and mood awareness. Undergraduate students (N = 129) completed the Trait Meta-Mood Scale (TMMS), the Toronto Alexithymia Scale (TAS-20), and the Mood Awareness Scale (MAS). A factor analysis revealed two dimensions, attention to and clarity of emotions, that cut across all three instruments. These two dimensions were differentially associated with personality, as measured by the neuroticism, extraversion, and openness to experience portions of the NEO-FFI, and with performance on an emotional Stroop task. We discuss the implications for the conceptualisation of broad constructs such as emotional intelligence and alexithymia, as well as the potential utility of more narrowly defined individual differences.     

A multimodal investigation of emotional responding in alexithymia

The personality construct of alexithymia is thought to reflect a deficit in the cognitive processing and regulation of emotional states. To explore the relations between alexithymia and emotional responding, 50 older adults (28 men, 22 women) were studied across different contexts: (1) initial exposure to an emotion‐evoking movie; (2) second exposure to that stimulus; (3) reports of rumination and social sharing; and (4) describing their emotional response (verbal re‐evocation). Facets of the alexithymia construct were associated at the initial exposure with lower emotional responses at the cognitive‐experiential level, but with higher emotional responses at the physiological level as measured by heart rate. At the second exposure, the results were replicated for physiological responses. Certain facets of alexithymia were associated also with lower reports of rumination and social sharing involving emotional aspects, and with a lower proportion of emotional words related to the emotional stimulus during the verbal re‐evocation.     

Alexithymia, emotion, and somatic complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.     

Stability in alexithymia levels: A longitudinal analysis on various emotional answers

Alexithymia refers to a specific disturbance in emotional processing that is manifested through difficulties in identifying and verbalizing feelings, and a tendency to focus and amplify the somatic sensations accompanying emotional arousal. The main purpose of the present study was to investigate the stability levels of alexithymia related to changes in emotional distress levels caused by university exams at two different times: after and during the exams. We carried out a 17-week follow-up on 36 university students, alexithymic features and self-reported emotional distress (anxiety, depression and somatic illness) were measured. Whereas emotional distress measures changed significantly during the follow-up period, the degree of alexithymia remained unchanged. We conclude therefore that alexithymia presents a constant trait in non-clinical samples, in contrast to anxiety and depression, which are state phenomena, influenced by stress levels.     

The Interaction of Extraversion and Anxiety Sensitivity on Social Anxiety: Evidence of Specificity Relative to Depression

Neuroticism and extraversion have been linked to the etiologies and course of anxiety and mood disorders, such that neuroticism is broadly associated with numerous disorders and extraversion is most strongly associated with social anxiety and depression. While previous research has established the broad associations between temperament and emotional disorders, less is known about the specific, proximal factors that are associated with them, and very few studies have situated these risk factors into a larger etiological model that specifies how they may relate to one another. The current study examined the interaction of extraversion and anxiety sensitivity (AS) in predicting social anxiety symptoms in a large, diagnostically diverse clinical sample (N = 826). Symptoms were assessed with self-report and dimensional interview measures, and regression analyses were performed examining the main effects and interaction of extraversion and AS (examining both total and lower-order components) on social anxiety. Results showed that at higher levels of AS, the inverse relationship between extraversion and social anxiety was stronger, and the social concerns component of AS is responsible for this effect. This interaction was also observed with regard to depression symptoms, but the interaction was not present after accounting for shared variance (i.e., comorbidity) between depression and social anxiety symptoms. Clinical and theoretical implications of the results are discussed.     

Modulation of long-term memory by arousal in alexithymia: The role of interpretation

Moderate physiological or emotional arousal induced after learning modulates memory consolidation, helping to distinguish important memories from trivial ones. Yet, the contribution of subjective awareness or interpretation of arousal to this effect is uncertain. Alexithymia, which is an inability to describe or identify one’s emotional and arousal states even though physiological responses to arousal are intact, provides a tool to evaluate the role of arousal interpretation. Participants scoring high and low on alexithymia (N = 30 each) learned a list of 30 words, followed by immediate recall. Participants then saw either an arousing (oral surgery) or neutral video (tooth brushing). Memory was tested 24-h later. Physiological response to arousal was comparable between groups, but subjective response to arousal was impaired in high alexithymia. Yet, delayed word recognition was enhanced by arousal regardless of alexithymia status. Thus, subjective response to arousal, i.e., cognitive appraisal, was not necessary for memory modulation to occur.     

Predicting Cognitive and Social Consequences of Emotional Episodes: The Contribution of Emotional Intensity, the Five Factor Model, and Alexithymia

Emotional events are followed by recurrent thoughts (rumination) and talking about the event (social sharing of emotion). Factors that can account for variations in these consequences were examined (emotional intensity, the Five Factor Model, and two factors of alexithymia). In two samples, participants reported the most negative emotional event of recent months and in one sample also reported the most positive one. Results indicated that emotional intensity predicted social sharing and rumination, while neuroticism was positively related to intrusive thoughts about negative events and extraversion to rumination and social sharing about positive events. Difficulty describing feelings was negatively related to social sharing for negative events and reduced fantasy to rumination for positive events.     

The dynamics of personality states, goals, and well-being

The authors examine the within-individual dynamics of Big-5 personality states over time in people's daily lives. They focus on the magnitude of this within-individual variability, and the associations between personality states, short-term goals, and subjective well-being states. A total of 101 undergraduate students participated in a 10-day interval-contingent diary study. The authors' findings, based on multilevel procedures, establish a considerable amount of within-individual variability that is both (a) equal or larger than that observed between individuals and (b) larger or similar to other constructs assessed with a state approach (e.g., self-esteem and mood). In addition, both neuroticism and extraversion states are systematically related to the short-term pursuit of approach-avoidance goals. Finally, support was obtained for the mediating role of both neuroticism and extraversion states of the association between goals and subjective well-being. In sum, the authors' findings testify to the importance and utility of studying within-individual variability in personality states over time.     

Alexithymia in the interpersonal domain: A general deficit of empathy?

Alexithymia and empathy have been related but very little is known on shared variance between their respective affective and cognitive dimensions. We examined this question with correlations, as well as both exploratory and confirmatory analyses, and controlled for anxiety and depression. The responses of 645 young adults to self-report questionnaires of alexithymia (TAS-20), empathy (IRI), anxiety (STAI-T) and depression (BDI-13) were examined. We observed associations between the proposed cognitive components of alexithymia (externally-oriented thinking) and that of empathy (perspective taking, fantasy) as well as empathic concern, which were insensitive to anxiety or depression. In contrast, associations between the proposed affective components of alexithymia (difficulty identifying feelings, difficulty describing feelings) and empathy (personal distress) were largely due to shared covariance with anxiety. A model encompassing an affective and a cognitive (including empathic concern) latent factors emerged, even after controlling for dysphoric affects. These findings suggest specific associations between cognitive and affective components of both constructs that were dissimilarly affected by anxiety and depression. The allocation of empathic concern to the cognitive factor is also discussed.     

Spiritual Bypass: A Preliminary Investigation

The phenomenon of spiritual bypass has received limited attention in the transpersonal psychology and counseling literature and has not been subjected to empirical inquiry. This study examines the phenomenon of spiritual bypass by considering how spirituality, mindfulness, alexithymia (emotional restrictiveness), and narcissism work together to influence depression and anxiety among college students. Results suggested that mindfulness and alexithymia accounted for variance in depression beyond what is accounted for by spirituality and that all 3 factors (mindfulness, alexithymia, and narcissism) accounted for variance in anxiety beyond what is accounted for by spirituality. Implications for counselors are provided.     

Do core self‐evaluations and trait emotional intelligence predict subjective well‐being in dental students?

We examined unique associations between surface personality traits of emotional intelligence, core self‐evaluations, and subjective well‐being in dental students. A cross‐sectional study of 218 undergraduates showed that trait emotional intelligence (trait EI) and core self‐evaluations (CSE) predicted subjective well‐being controlling the Big Five personality traits. Structural equation modeling showed that trait EI and the neuroticism component of CSE better predicted affective components of subjective well‐being, and cognitive CSE traits (self‐esteem, self‐efficacy, and locus of control) better predicted life satisfaction, the cognitive component of subjective well‐being. These findings demonstrate the utility of a parallel‐process approach that specifies differential prediction of cognitive and affective subjective well‐being components.     

The five factor model of personality and alexithymia: A meta-analysis

The main objective of the study was to examine the relationship between the Five Factor Model of Personality and alexithymia. Data were collected from 25 studies, which included 30 independent samples, 1384 effect sizes, and 7440 participants. All analyses were conducted with random effects models. Greater neuroticism and lower extraversion, openness to experience, agreeableness, and conscientiousness were associated with higher cognitive alexithymia. Greater neuroticism and openness to experience were linked to lower affective alexithymia. Additionally, age moderated the relationship between the Five Factor Model of Personality and cognitive alexithymia, in that the association between neuroticism and alexithymia became stronger with age whereas the relations of extraversion, openness to experience, agreeableness, and conscientiousness with alexithymia became weaker with age.     

The Role of Relationships in Understanding the Alexithymia–Depression Link

Alexithymia is associated with increased depressive symptoms in both clinical and community samples. One way that alexithymia may lead to depression is through its impact on interpersonal relationships. Individuals with alexithymia report lower perceived social support, intimacy, and relationship satisfaction. Furthermore, poor relationship functioning is a clear risk factor for depressive symptoms. Given the established alexithymia–depression link and marital dysfunction–depression link, a logical next step is to examine whether relationship dysfunction (low social support, intimacy, negative relationship behaviours, and relationship dissatisfaction) mediates the association between alexithymia and depressive symptoms. The hypothesized mediation model was assessed in a sample of 104 community couples with two analytical approaches—first with cross‐sectional measures using path analysis and second with daily diary measures collected over a seven‐day period using a multilevel modelling approach. Poor relationship functioning mediated the association between alexithymia and depressed mood in the daily diary data and partially mediated that association with the cross‐sectional measures. These results identify alexithymia as an important variable in understanding the marital functioning–depression association, and this finding has implications for treatment. Copyright © 2012 European Association of Personality Psychology     

On the Relationship Between Interoceptive Awareness and Alexithymia: Is Interoceptive Awareness Related to Emotional Awareness?

Interoceptive awareness (IA) is associated with emotional experience, the processing of emotional stimuli, and activation of brain structures that monitor the internal visceral and emotional state of the organism. Alexithymia is characterized by difficulties in identifying and describing one's emotions and externally oriented thinking (EOT) and reflects impairments in emotional awareness and the regulation of emotions. This study examined the relationship between alexithymia and IA in a healthy population of N=155 persons. A well-validated heartbeat perception task to measure interoceptive awareness, the Toronto Alexithymia Scale (TAS-20) and a depression questionnaire (BDI-2) were administered to 88 women and 67 men. IA was inversely associated with all features of alexithymia in the whole sample. When considering sex differences, IA turned out to be a relevant negative predictor for the EOT subscale only in men. This large sample investigation in a nonclinical population indicates that IA represents a relevant negative predictor for alexithymia.