ارزش پیش بینی کننده آلکسی تایمیا در بیماران مبتلا به اختلالات غذا خوردن: یک مطالعه آینده نگر 3 ساله

Objective Several cross-sectional studies have reported high levels of alexithymia in populations with eating disorders. However, only few studies, fraught with multiple methodological biases, have assessed the prognostic value of alexithymic features in these disorders. The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a sample of patients with eating disorders. Methods Within the framework of a European research project on eating disorders (INSERM Network No. 494013), we conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV eating disorder patients using the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory. Results At the 3-year assessment, 74% (n=76) of the sample still presented a syndromal or subsyndromal eating disorder (unfavorable outcome: score of ≥3 on the Psychiatric Status Rating Scale for anorexia nervosa or bulimia nervosa). In logistic and hierarchical regression analyses, the Difficulty Identifying Feelings factor of the TAS-20 emerged as a significant predictor of treatment outcome, independent of depressive symptoms and eating disorder severity. Conclusions The results of this study indicate that difficulty in identifying feelings can act as a negative prognostic factor of the long-term outcome of patients with eating disorders. Professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions. Gadget timed out while loading

The identification of variables that predict treatment outcome in patients with eating disorders is critical if we are to increase the degree of sophistication with which we treat these disorders. Understanding predictors of outcome could theoretically facilitate matching treatments to individuals based on their clinical profile at presentation. Dirks et al. [1] have coined the term “psychic maintenance” to describe the chronic outcome of an illness due to psychological reasons. Among the several psychological features that have been proposed to predict treatment outcome in patients with eating disorders, alexithymia has attracted special interest. Alexithymia is a personality construct characterized by a difficulty in identifying and describing feelings, a diminution of fantasy, and a concrete and externally oriented thinking style [2]. Several arguments, namely, factor analyses and longitudinal studies, have supported the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon linked to depression or to clinical status [3] and [4]. Several studies have reported high levels of alexithymia in patients with eating disorders, especially in individuals with anorexia nervosa [5], [6], [7] and [8]. There are several reasons to believe that this construct could play a major role in the illness course of eating disorders: due to their cognitive limitations in emotion regulation, alexithymic individuals with eating disorders may resort to maladaptive self-stimulatory behaviors such as starving, bingeing, or drug misuse to self-regulate disruptive emotions [9]. The lack of insight and the externally oriented thinking style of alexithymic subjects may also interfere with their capacity to benefit from psychotherapeutic interventions. However, in spite of the clinical relevance of this issue, clear data on the prognostic value of alexithymic features in eating disorders are still lacking. Two studies conducted on individuals with bulimia have failed to demonstrate a specific impact of alexithymia on the outcome of these patients. However, these studies presented some methodological limitations: samples were relatively small; the longitudinal time period was too short (10 weeks); both studies used an earlier version of the Toronto scale to assess alexithymic features; and finally, the outcome measures did not account for the degree of clinical change between baseline and follow-up [6] and [10]. The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a large sample of patients with eating disorders, taking into account the limitations of previous studies.