Objective
The relationship between alexithymia and psychosocial functioning has been investigated in a few studies using indirect measures of adaptation. We aimed at directly evaluating the relationship between alexithymia and global psychosocial functioning, as measured by a standardised scale.
Methods
A large, consecutive sample of dermatological inpatients (N=545) completed the 20-item Toronto Alexithymia Scale and the Skindex-29 and were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders and the Global Assessment of Functioning (GAF) scale.
Results
Multiple regression analysis was used to control for likely determinants of psychosocial functioning such as age, sex, education, burden of skin symptoms, and psychiatric morbidity. The GAF score was associated with psychiatric morbidity (β=−.63, P<.001), alexithymia (in particular, the difficulty identifying feelings subscale) (β=−.19, P<.001), and burden of skin symptoms (β=−.07, P<.05).
Conclusion
Given the well-known association between poor psychosocial functioning and several behavioural risk factors for health, our study may provide a further reason for clinicians to pay attention to alexithymic features among their patients.
Thirty years ago, the alexithymia construct was introduced as a group of cognitive and affective characteristics typical of patients with psychosomatic disorders [1]. In the last years, there has been a growing interest in the construct that is gradually being integrated in the broader field of emotion research and is currently viewed as a deficit in affect regulation [2] and [3]. A high prevalence of alexithymia has been found in patients with a variety of health problems [4], including skin diseases [5] and [6]. For some dermatological conditions, it may play a role as a risk factor, as alexithymia, insecure attachment, and poor social support were found to be associated with the onset of alopecia areata [7] and with exacerbations of vitiligo and plaque psoriasis [8] and [9]. These findings are consistent with the modern multifactorial model of illness, according to which psychosocial, biologic, and environmental factors interact reciprocally and lead to different clinical outcomes [10].
Patients with skin diseases suffer from various and multidetermined psychological problems, including reduced psychosocial functioning, impaired quality of life, and high prevalence of psychiatric disorders and other clinical conditions of psychosomatic interest such as demoralisation, irritable mood, Type A behaviour, and somatic symptoms secondary to psychiatric disorders [5] and [11]. The multifactorial model of health and illness paves the way to the possibility of exploring a variety of relationships between health-related factors, such as the association between skin symptoms, psychopathology, alexithymia, and psychosocial functioning. Although the associations between medical symptoms, psychopathology, and adaptation have been widely investigated, little attention has been paid to the relationship between alexithymia and psychosocial functioning. The Global Assessment of Functioning (GAF) scale is the fifth axis in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) system [12] and measures the burden of psychological distress and psychopathology on social, psychological, and occupational functioning. Higher impairment of psychosocial functioning assessed with the GAF scale has been found in patients with personality disorders [13], even after a long-term follow-up of 15 years [14], and in patients with severe DSM-IV Axis I and Axis II disorders [15]. However, to our knowledge, the relationship between alexithymia and psychosocial functioning has been investigated only in few studies using indirect measures of adaptation, while no study has directly assessed the relationship between alexithymia and psychosocial functioning, as measured by the GAF scale.
The purpose of this study was to test the association between alexithymia and the GAF score in a large sample of dermatological patients, controlling for other likely determinants of psychosocial functioning such as sociodemographic factors, psychopathology, and burden of skin symptoms. Given that alexithymia is known to be related to several psychological dimensions that are relevant for well-being and functioning, our main hypothesis was that alexithymia would be associated with lower psychosocial functioning.
