آلکسیتیمیا در اختلالات شبه جسمی و افسردگی

Objective: Alexithymia and its association with attribution styles, amplification and illness attitudes was studied among subjects with somatoform disorders, depressive disorders and normal subjects. Methods: Two groups of 30 subjects each, bearing diagnoses of somatoform disorder and depressive disorder respectively (ICD-10 DCR), and one group of 30 normal controls were recruited. The study subjects were assessed using the Toronto Alexithymia Scale and scales for assessing attribution styles, amplification and illness attitudes. Results: Mean alexithymia scores in the somatoform (60.4) and depressive disorder groups (62.5) were higher than in normal subjects (54.2). In the somatoform disorder group, total alexithymia and ‘difficulty describing feelings’ scores positively correlated with psychological attribution (the latter correlation was also noted in the depressive disorder group), but not with the illness attitudes, amplification, somatic attribution scores or any of the sociodemographic variables. Compared with normal subjects, those with somatoform and depressive disorder had greater difficulty in identifying bodily sensations and feelings. Subjects with depressive disorder had more difficulty in expressing feelings compared to somatoform disorder subjects. Conclusions: While total alexithymia scores do not differentiate somatoform from depressive disorders, the two diagnostic groups do differ in that depressed subjects have greater difficulty in expressing feelings. However, all three groups had mean scores within the non-alexithymic range. Alexithymia and difficulty in expressing feelings were associated with psychological attribution of innocuous bodily sensations in the somatoform disorder group suggesting that alexithymic subjects are more able to psychologize bodily symptoms than non-alexithymic subjects. Somatoform and depressive disorder subjects and normals differ from each other in certain alexithymic characteristics, which could have potential therapeutic implications.

Alexithymia is a multidimensional construct defined by a difficulty in identifying and describing feelings, a difficulty in distinguishing between feelings and bodily sensations, a paucity of fantasies, and an externally focused cognitive style [1]. Alexithymic characteristics have been observed among patients with somatization (medically unexplained physical symptoms) [1] and [2]. Studies have found a high prevalence of alexithymia among somatoform disorder patients [3]. Alexithymia has also been reported to be associated with depression in a number of studies [4], [5], [6] and [7]. On the other hand, somatization and depression are closely related clinical presentations, in the sense that somatizing patients are often depressed and depressed patients often present with somatization [8] and [9]. It has been reported that subjects with alexithymic characteristics are not suited for insight oriented (dynamic) or verbal therapies. They may, however, benefit from behavioral or nonverbal modalities [1]. Hence, a study of alexithymia among somatoform and depressive disorder patients may have important therapeutic implications. Further, alexithymia has been found to be associated with illness attitudes like hypochondriacal beliefs and somatic focusing with negative health implications among somatizing and psychiatric patients. [10] and [11]. Thus, symptom appraisal and consequent help seeking may be related to alexithymia. An investigation to assess alexithymia among subjects with somatoform disorders and depressive disorders in comparison to a normal control sample was conducted. The relationship between alexithymia, its dimensions and illness attitudes, somatosensory amplification and attribution styles among these subjects was also studied.