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Background Patients with bipolar disorder in mania exhibit symptoms pointing towards altered self-referential processing, such as decreased self-focus, flight of ideas and high distractibility. In depression, the opposite pattern of symptoms has been connected to increased activation of medial prefrontal cortex (mPFC) during self-referential processing. In this study, we hypothesized that (1) patients with mania will exhibit decreased activation in the mPFC during self-referential processing and (2) will be more alexithymic and that levels of alexithymia will correlate negatively with mPFC activation. Methods The neural response to standardized pictures was compared in 14 patients with bipolar I disorder in mania to 14 healthy controls using blood oxygen level dependent contrast magnetic resonance imaging. Participants were asked to indicate with button press during the scanning session for each picture whether the pictures personally related to them or not. Toronto alexithymia scale (TAS) scores were recorded from all participants. Results In the group analysis, patients with mania exhibited decreased activation in a predefined region of interest in the mPFC during self-referential processing compared to healthy controls. Patients with mania showed significantly higher levels of alexithymia, attributable to difficulties in identifying and describing emotions. Activation in the mPFC correlated negatively with levels of alexithymia. Limitations Results presented here should be replicated in a larger group, potentially including unmedicated patients. Conclusions The finding of decreased mPFC activation during self-referential processing in mania may reflect decreased self-focus and high distractibility. Support for this view comes from the negative correlation between higher alexithymia scores and decreased mPFC activation. These findings represent an opposite clinical and neuroimaging pattern to findings in depression.

Background Alexithymia is a multidimensional personality construct characterized by difficulties identifying and describing one’s feelings, and externally oriented thinking. Although extensively reported in psychiatric patients, little attention has been paid regarding its occurrence and its pathophysiology in the context of multiple sclerosis (MS). Methods A research was conducted according to the PRISMA guidelines aiming to identify original research articles in English and French languages about alexithymia in MS. Computerized databases (MEDLINE, PubMed, Scopus) were consulted. The key terms used were the following: (‘multiple sclerosis’ OR ‘MS’) AND (‘alexithymia’ OR ‘alexithymic’ OR ‘emotion processing’ OR ‘emotion awareness’ OR ‘Toronto Alexithymia Scale’ OR ‘Bermond-Vorst Alexithymia Questionnaire’) AND (‘imaging’ OR ‘neuroimaging’ OR ‘magnetic resonance imaging’ or ‘MRI’). References of the retrieved papers were scanned manually aiming to get additional sources. Results 14 papers matched the above criteria. The prevalence of alexithymia in MS ranges from 10% to 53%. It seems to be associated with anxiety, depression, fatigue, and some social cognitive aspects. Its relationship with clinical and classical cognitive variables was rarely assessed. Finally, only one study has addressed its pathophysiology and has suggested an aberrant interhemispheric transfer. Conclusion Admitting the prevalence of alexithymia in MS and its potential negative impact on the quality of life and interpersonal communication, screening for it is relevant for a better management. Its relationship with clinical, emotional and cognitive confounders merits to be further evaluated. Large-scale studies, employing neuroimaging techniques, are greatly needed in order to disentangle the neural underpinnings of this trait in MS.

Background: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. Objective: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. Methods: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. Results: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. Study Limitations: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. Conclusions: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

The aims of this study were to evaluate alexithymia subscales [i.e. difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally-oriented thinking (EOT)] in patients with obsessive-compulsive disorder (OCD) and to clarify the relationships of alexithymia subscales to obsessive-compulsive (OC) symptom dimensions and other clinical variables. One hundred fifteen OCD outpatients and two control groups including 80 normal controls and 100 alcoholic patients participated in this study. The data were collected by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Farsi version of the Toronto Alexithymia Scale (FTAS-20) and the Depression Anxiety Stress Scales (DASS-21). 60.7% of OCD patients and 48% of alcoholics were classified as alexithymics. Those with OCD revealed significantly higher scores on alexithymia and its subscales than alcoholics and normal controls. OCD patients with alexithymia showed higher means in Y-BOCS and its subscales as well as the OC dimensions of mental neutralizing and obsessing than non-alexithymics. DIF and EOT were significantly correlated with obsessing and mental neutralizing respectively. DDF and EOT were related to OCD severity. It was concluded that DIF and EOT may be specific to obsessing and mental neutralizing in OCD patients.

The Toronto Alexithymia Scale (TAS-20) is a 20-item self-report scale assessing emotional and social competency impairments like difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally-oriented thinking (EOT). Despite strong validity and predictive utility in North American and European samples, its validity in Non-Western cultures is still in need of verification. An Arabic version of the TAS-20 was given to a sample ( n = 2221) of young adults from 3 Arabic-speaking countries (Algeria, Gaza and Oman), as well as English speaking young adults from Canada ( n = 2220). Confirmatory factory analysis indicated good fit of the data from both samples, suggesting that the alexithymia construct can be extended to Arabic populations. The Arabic sample scored significantly higher on the total TAS-20 as well as all subscales and in total TAS-20 scores. This trend was consistent for both men and women and suggests important cultural differences exist in the communication of emotional information.

The aim of this study was to evaluate the potential contributing factors such as alexithymia, emotion regulation and difficulties in emotion regulation, positive/negative affects and clinical factors including severity of alcohol dependence and depression connected to high suicidality in alcohol-dependent outpatients. 205 alcohol-dependent outpatients and 100 normal controls completed the demographic questionnaire, the Persian version of the Toronto Alexithymia Scale (FTAS-20), the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), the Positive/Negative Affect Scales, the Alcohol Use Disorders Identification Test (AUDIT), and the Beck Depression Inventory-II (BDI-II). The suicidal risk was assessed using the Scale for Suicide Ideation (SSI) and history taking. Alcohol-dependent outpatients showed higher means in alexithymia, difficulties in emotion regulation, suppression subscale, negative affect, and suicide ideation than normal controls. Logistic regression analysis revealed that negative affect, duration of alcohol use, externally-oriented thinking, and severity of alcohol dependence explained lifetime suicide attempts. Depression, impulsivity, severity of alcohol dependence, reappraisal (reversely), externally-oriented thinking, difficulties engaging in goal-directed behaviors, and negative affect significantly predicted the suicidal risk. The findings may constitute useful evidence of the relevancies of alexithymia, emotion regulation, emotion regulation difficulties, and affects to suicidality in alcoholic patients.

Background and objectives Alexithymia is a multidimensional personality construct including the components difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally oriented thinking (EOT). Different features of alexithymia are thought to reflect specific deficits in the cognitive processing and regulation of emotions. The aim of the present study was to examine for the first time patterns of deployment of attention as a function of alexithymia components in healthy persons by using eye-tracking technology. It was assumed that EOT is linked to avoidance of negative images. Methods 99 healthy adults viewed freely pictures consisting of anxiety-related, depression-related, positive, and neutral images while gaze behavior was registered. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale. Measures of anxiety, depression, and (visual-perceptual) intelligence were also administered. Results A main effect of emotion condition on dwell times was observed. Viewing time was lowest for neutral images, longer for depression-related and happy images, and longest for anxiety-related images. Gender and EOT had significant effects on dwell times. EOT correlated negatively with dwell time on depression-related (but not anxiety-related) images. There were no correlations of dwell times with depression, trait anxiety, intelligence, DIF, or DDF. Limitations Alexithymia was assessed exclusively by self-report. Conclusions Our results show that EOT but not DIF or DDF influences attention deployment to simultaneously presented emotional pictures. EOT may reduce attention allocation to dysphoric information. This attentional characteristic of EOT individuals might have mood protecting effects but also detrimental impacts on social relationships and coping competencies.

Background The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. Methods Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. Results Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. Conclusions Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. Key Practitioner Message Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions

SummaryBackground Single-centre studies show that alexithymia, defined as difficulty in recognizing and describing emotions, is more prevalent among psoriasis patients than in the general population. However, its prevalence and the consequences of the association between alexithymia and psoriasis are unclear. Objectives The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score ≥61 in the 20-item Toronto Alexithymia Scale (TAS-20), in a large sample of patients who had plaque psoriasis for ≤10 years and were eligible for phototherapy or systemic treatment. The secondary objectives were to investigate the relationship between alexithymia and the clinical and psychological aspects of psoriasis. Methods Data were collected in the framework of an observational, multicenter, international study, the EPidemiological Study In Patients With Recently DiagnosEd PSOriasis (EPIDEPSO), aiming at investigating the prevalence of alexithymia and other psychosocial comorbidities in psoriasis patients with ≤10 years disease duration. Results The prevalence of alexithymia within a cohort of 670 patients was 24.8% (95%CI: 21.7-28.2). Patients with alexithymia had a higher burden of psoriasis, including significant impairment of quality of life, higher levels of anxiety and depression, a higher risk of alcohol dependency and impairment of work productivity, compared to patients without alexithymia. Conclusion It is important to identify alexithymic patients with psoriasis in clinical practice as they suffer from a higher disease burden and have a lower ability to express their feelings. This article is protected by copyright. All rights reserved.

// Rui Liu 1, * , Yingying Yue 2, * , Haitang Jiang 2 , Jian Lu 1 , Aiqin Wu 3 , Deqin Geng 4 , Jun Wang 5 , Jianxin Lu 6 , Shenghua Li 7 , Hua Tang 8 , Xuesong Lu 9 , Kezhong Zhang 10 , Tian Liu 11 , Yonggui Yuan 2 and Qiao Wang 1 1 School of Information Science and Engineering, Southeast University, Nanjing, China 2 Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China 3 Department of Psychosomatics, The Affiliated First Hospital of Suzhou University, Suzhou, China 4 Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China 5 Department of Neurology, Nanjing First Hospital, Nanjing, China 6 Department of Neurology, Gaochun People’s Hospital, Nanjing, China 7 Department of Neurology, Jiangning Nanjing Hospital, Nanjing, China 8 Department of Psychiatry, Huai’an No.3 People’s Hospital, Huai’an, China 9 Department of Rehabilitation, Affiliated Zhongda Hospital of Southeast University, Nanjing, China 10 Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China 11 The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong Univerisity, Xi’an, China * These authors have contributed equally to this work Correspondence to: Yonggui Yuan, email: yygylh2000@sina.com Qiao Wang, email: qiaowang@seu.edu.cn Keywords: post-stroke depression, socio-psychological factor, risk prediction model, logistic regression, decision tree Received: November 15, 2016 Accepted: March 14, 2017 Published: April 07, 2017 ABSTRACT Background: Post-stroke depression (PSD) is a frequent complication that worsens rehabilitation outcomes and patient quality of life. This study developed a risk prediction model for PSD based on patient clinical and socio-psychology features for the early detection of high risk PSD patients. Results: Risk predictors included a history of brain cerebral infarction (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.22-6.70; P < 0.0001) and four socio-psychological factors including Eysenck Personality Questionnaire with Neuroticism/Stability (OR, 1.18; 95% CI, 1.12-1.20; P < 0.0001), life event scale (OR, 0.99; 95% CI, 0.98-0.99; P = 0.0007), 20 items Toronto Alexithymia Scale (OR, 1.06; 95% CI, 1.02-1.10; P = 0.002) and Social Support Rating Scale (OR, 0.91; 95% CI, 0.87-0.90; P < 0.001) in the logistic model. In addition, 11 rules were generated in the tree model. The areas under the curve of the ROC and the accuracy for the tree model were 0.85 and 0.86, respectively. Methods: This study recruited 562 stroke patients in China who were assessed for demographic data, medical history, vascular risk factors, functional status post-stroke, and socio-psychological factors. Multivariate backward logistic regression was used to extract risk factors for depression in 1-month after stroke. We converted the logistic model to a visible tree model using the decision tree method. Receiver operating characteristic (ROC) was used to evaluate the performance of the model. Conclusion: This study provided an effective risk model for PSD and indicated that the socio-psychological factors were important risk factors of PSD.

Alexithymia can be considered as a defense mechanism against emotions associated with traumatic experiences that are perceived as too severe and traumatic. Due to the overwhelming nature of a traumatic event, there might be a rapid regression of affect to a pre-conceptual level of organization: so, the capacity to tolerate affect and the capacity to identify and verbalize feelings decrease. The aim of this cross-sectional study is to evaluate the trend of the correlation between psychological effects of possible childhood trauma and alexithymia in a non-clinical group of 389 Sicilian students (192 males and 197 females), aged 11–16 (M = 12.87; SD = 0.80), attending middle and secondary schools. The following instruments were used: 20-Item Toronto Alexithymia Scale and Trauma Symptom Checklist for Children. Correlation analyses seem to support the hypothesis of a relation between age and the following scales: anger, overt dissociation, sexual concerns and preoccupation; and the presence of correlat...

We investigated if alexithymia, a personality construct with difficulties in emotional processing, is stable in the general population.Altogether 3083 unselected subjects aged 30 and older in Finland completed the 20-item Toronto Alexithymia Scale (TAS-20) in the longitudinal Health 2000 and Health 2011 general population surveys (BRIF8901). The stability of alexithymia at the 11-year follow-up was assessed with t-tests, correlations, and separate linear regression models with base-line and follow-up age, gender, marital status, education, and 12-month depressive and anxiety disorders as confounders.The mean score (SD) of the TAS-20 for the whole sample was 44.2 (10.4) in 2000 and 44.2 (10.9) in 2011 (p=0.731). The mean score of the TAS-20 subscale Difficulty Identifying Feelings increased by 0.3 points, Difficulty Describing Feelings decreased by 0.6 points and Externally Oriented Thinking increased by 0.3 points. The effect sizes of the changes varied from negligible to small. Age had little effect except for the group of the oldest subjects (75-97years): the TAS-20 mean (SD) score was 49.1 (10.1) in 2000 and 53.1 (10.3) in 2011 (p0.001), the effect size for the increase was medium. TAS-20 score in 2000 explained a significant proportion of variance in TAS-20 score in 2011. Controlling for all baseline confounders improved the model incrementally; the same applied to controlling for confounders at follow-up. Baseline depression or anxiety disorders were not associated with the TAS-20 scores in 2011, whereas current diagnoses were.According to our large longitudinal study both the absolute and relative stability of alexithymia assessed with the TAS-20 are high in the adult general population.

Background A much higher prevalence of alexithymia has been reported in medical students compared with the general population, and alexithymia is a risk factor that increases vulnerability to mental disorders. Our aim was to evaluate the level of alexithymia in Chinese medical students and to explore its influencing factors. Methods A cross-sectional study of 1,950 medical students at Shenyang Medical College was conducted in May 2014 to evaluate alexithymia in medical students using the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20). The reliability of the questionnaire was assessed by Cronbach’s α coefficient and mean inter-item correlations. Confirmatory factor analysis (CFA) was used to evaluate construct validity. The relationships between alexithymia and influencing factors were examined using Student’s t-test, analysis of variance, and multiple linear regression analysis. Statistical analysis was performed using SPSS 21.0. Results Of the 1,950 medical students, 1,886 (96.7%) completed questionnaires. Overall, Cronbach’s α coefficient of the TAS-20 questionnaire was 0.868. The results of CFA showed that the original three-factor structure produced an acceptable fit to the data. By univariate analysis, gender, grade (academic year of study), smoking behavior, alcohol use, physical activity, history of living with parents during childhood, and childhood trauma were influencing factors of TAS-20 scores (p

The present study explored relationships between alexithymia—a trait characterized by difficulties identifying and describing feelings and an external thinking style—and negative moods, negative mood regulation expectancies, facial recognition of emotions, emotional empathy, and alcohol consumption. The sample consisted of 102 university (primarily psychology) students (13 men, 89 women) aged 18 to 50 years (M = 22.18 years). Participants completed the Toronto Alexithymia Scale (TAS-20), Negative Mood Regulation Scale (NMRS), Depression Anxiety Stress Scales (DASS-21), Reading the Mind in the Eyes Test (RMET), Interpersonal Reactivity Index (IRI), and Alcohol Use Disorders Identification Test (AUDIT). Results were consistent with previous findings of positive relationships of TAS-20 alexithymia scores with both alcohol use (AUDIT) and negative moods (DASS-21) and a negative relationship with emotional self-regulation as indexed by NMRS. Predicted negative associations of both overall TAS-20 alexithymia scores and the externally oriented thinking (EOT) subscale of the TAS-20 with both RMET facial recognition of emotions and the empathic concern (EC) subscale of the IRI were supported. The mood self-regulation index NMRS fully mediated the relationship between alexithymia and negative moods. Hierarchical linear regressions revealed that, after other relevant variables were controlled for, the EOT subscale of the TAS-20 predicted RMET and EC. The concrete thinking or EOT facet of alexithymia thus appears to be associated with diminished facial recognition of emotions and reduced emotional empathy. The negative moods associated with alexithymia appear to be linked to subjective difficulties in self-regulation of emotions.

Obesity is a multifactorial disease characterized by genetic, social, cultural and psychological factors. Currently, bariatric surgery represents the gold-standard intervention to treat morbid obesity in order to counteract associated disabling comorbidities. Several studies showed correlation between post-surgery weight loss and psychological factors. Also, the alexithymia may have a role in affecting post-surgery outcomes in bariatric patients, even if there are no studies investigating its role at 12-month follow-up. The purpose of the present study was to investigate the association between alexithymia and the postoperative weight loss 12 months after laparoscopic sleeve gastrectomy. Seventy-five patients undergoing laparoscopic sleeve gastrectomy were enrolled. The Toronto Alexithymia Scale (TAS-20) was administered to patients. A postoperative weight loss check was performed at 3 and then 12 months after surgery. The TAS-20 total score was negatively correlated with the percent of excess weight loss (%EWL) at the 12-month follow-up (r = −0.24; p = 0.040). The analysis showed that non-alexithymic patients had a greater weight loss at 12 months after surgery compared to both probably alexithymics (71.88 ± 18.21 vs. 60.7 ± 12.5; p = 0.047) and probably alexithymic patients (71.88 ± 18.21 vs. 56 ± 22.8; p = 0.007). The preoperative BMI was a significant covariate [F(1,70) = 6.13 (p = 0.016)]. In the present study, the patients with higher preoperative BMI and identified as alexithymic showed lower %EWL at 12 months after laparoscopic sleeve gastrectomy. Findings point out the importance to take into consideration possible psychological treatments focused on improving emotional regulations of patients who are seeking bariatric surgery.

Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.

Purpose Functional well-being (i.e., individuals' functioning in daily living activities and social roles; FWB) is often an understudied aspect of quality of life among breast cancer patients (BCP). Previous research has suggested that patients’ emotional experience is associated with their FWB. However, little is known about how intrapersonal and interpersonal barriers of emotional processing and expression (i.e., social constraints, difficulties in identifying and expressing emotions) associated with FWB among Chinese BCP, plus how positive/negative affect might explain such associations. Method Chinese BCP (N = 327) in Weifang, Shandong province, China completed a cross-sectional survey. The Functional Well-Being subscale from the Chinese version of the Functional Assessment of Cancer Therapy–Breast (FACT-B), the Social Constraints Scale, the Difficulty in Identifying Feelings (DIF; 7 items) and the Difficulty in Describing Feelings (DDF; 5 items) subscales from the Toronto Alexithymia Scale and the Positive Affect and Negative Affect Schedule were used as assessment scales. Results Path analyses results supported the proposed mediation model with satisfactory fit indices (χ2(5) = 5.12, p = .40, CFI = 1.00; IFI = 1.00; RMSEA = 0.01). Specifically, difficulty in describing emotions was associated with poorer functional well-being through increased negative affect (β = −0.06, 95%CI = −0.10, −0.03); difficulty in identifying emotions was associated with poorer functional well-being through reduced positive affect (β = −0.04, 95%CI = −0.09, −0.003). Social constraints were associated with poorer functional well-being through both increased negative affect and decreased positive affect (β = −0.16, 95%CI = −0.22, −0.10). After considering the mediators, difficulties in describing emotions still contributed significantly to functional well-being (β = −0.20, 95%CI = −0.31, −0.08). Our results indicated that positive/negative affect could mediate between barriers of emotional processing/expression and FWB. Conclusions This study was unique in revealing how intrapersonal and interpersonal barriers of emotional processing and expression could be associated with Chinese BCPs’ FWB through varied mechanisms. Practitioners should consider strategies to reduce those barriers through interventions.

Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients’ ability to benefit from the adopted interventions. For this reason, in the last years new treatment approaches targeting emotion identification, expression, and regulation have been applied and tested. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted.

Objectives Alexithymia is a personality construct that could occur in up to 53 % of patients with multiple sclerosis (MS). It entails difficulties in identifying and describing one’s feelings and an externally oriented thinking. The current work aims to assess the neural underpinnings of alexithymia in this population. Methods Forty-five patients with MS filled in the Toronto Alexithymia Scale (n = 17 with high alexithymia and n = 28 with low alexithymia). Brain magnetic resonance imaging was obtained for each patient and a morphometry algorithm (MorphoBox) was applied to calculate regional brain volumes. All patients underwent a clinical and neuropsychological evaluation which included measures for anxiety, depression, fatigue, daytime sleepiness, and basic and social cognition. Results Compared to patients with low alexithymia, patients with high alexithymia had significantly higher fatigue and depression ratings, and lower empathy scores. In addition, they had lower volumes of corpus callosum, deep white matter, pallidum bilaterally, and left thalamus. In the whole cohort, alexithymia scores were inversely correlated with gray matter (thalamus and pallidum bilaterally) and white matter volumes (corpus callosum and bilateral deep white matter) after controlling for covariates (ps Conclusion This study offers insights on the neuropsychological and neural substrates of alexithymia in MS. The current findings are consistent with alexithymia reports in other clinical populations, and suggest an association between alexithymia and atrophy of thalami, pallidum, corpus callosum and deep white matter in MS. Further research is needed to enhance the understanding of alexithymia mechanisms in this clinical context.

Objectives Posttraumatic stress disorder (PTSD) symptoms following past trauma could lead to psychological distress. Little is known, however, about the roles of defense mechanisms and alexithymia may play in the process. The current study aimed to examine the potential impact of alexithymia and defense mechanisms on the relationship between past trauma and distress among Chinese university students. Method 455 university students completed a set of questionnaires: PTSD Checklists for DSM-5, Toronto Alexithymia Scale (TAS-20), Defense Style Questionnaire, and General Health Questionnaire-28. Results PTSD following past trauma was associated with increased psychological distress. Alexithymia and defenses (especially immature defense) mediated the path between PTSD and psychological co-morbidities. Conclusion Following past trauma, people developed PTSD and other psychological symptoms. The severity of these distress symptoms was influenced by the way they defended themselves psychologically, and their ability to identify, express, and process distressing emotions.

Child abuse among adolescents in China has been documented and can lead to a whole range of psychological and behavioural problems. This study examined whether male and female adolescents would differ in level of child abuse, emotional processing difficulties, alexithymia, psychological symptoms and behavioural problems, and whether the pattern of association between these variables would vary depending on gender. Eight hundred adolescents were recruited from China and completed the Childhood Trauma Questionnaire, Emotional Processing Scale, Toronto Alexithymia Scale, General Health Questionnaire, and Prediction Test of Problem Children. Male adolescents reported significantly higher levels of emotional and physical neglect, and external oriented thinking style than female adolescents. Females reported significantly more anxiety symptoms and problems with learning than males. For males, child abuse was associated with emotional processing difficulties which were associated with alexithymia. In turn, alexithymia was associated with both psychological and behavioural problems. For females, the same association was established for predicting behavioural problems but not psychological symptoms. Male and female adolescents differed in level of child abuse, alexithymia, psychological symptoms and behavioural problems. These psychological constructs were connected in a specific pattern to trigger psychological and behavioural problems for male adolescents whereas for females, different patterns were involved.

Objective The aim of the present study was to investigate (i) whether somatic complaints predict the developmental course of compassion in adulthood, and (ii) whether this association depends on alexithymic features. Methods The participants came from the population-based Young Finns study (N = 471–1037). Somatic complaints (headache, stomachache, chest pain, backache, fatigue, exhaustion, dizziness, heartburn, heartbeat, and tension) were evaluated with a self-rating questionnaire in 1986 when participants were aged between 18 and 24 years. Compassion was assessed with the Compassion Scale of the Temperament and Character Inventory (TCI) in 1997, 2001, and 2012. The data were analyzed using growth curve models. Results We obtained a significant compassion-age interaction (B = -0.137, p = .02) and a compassion-age squared interaction (B = 0.007, p = .006), when predicting the course of somatic complaints. Specifically, in participants without frequent somatic complaints, compassion steadily increased with age in adulthood. In participants with frequent somatic complaints, however, compassion remained at a lower level until the age of 40 years, then started to increase, and achieved the normal level of compassion approximately at the age of 50 years. The association between somatic complaints and compassion over age was found to be independent of alexithymic features. The analyses were adjusted for a variety of covariates (age, gender, use of health care in childhood, depression in childhood, parental socioeconomic factors, parental care-giving practices, stressful life events, parental alcohol intoxication, and participants' socioeconomic factors in adulthood). Conclusion Frequent somatic complaints may predict delayed development of compassion in adulthood. This association was found to be independent of alexithymic features.

The majority of studies have found higher levels of alexithymia and a higher use of maladaptive coping strategies in individuals with eating disorders (ED). In this study, we consider the relationships between alexithymia and coping skills in different types of ED, in order to identify the specific role of these constructs in predicting dysfunctional eating symptoms. Thirty-four patients with anorexia nervosa (AN), 30 patients with bulimia nervosa (BN), 29 with binge eating disorder (BED) and 28 healthy control (HC) took part in the study. Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90-R (SCL-90-R), Toronto Alexithymia Scale (TAS-20) and Coping Inventory for Stressful Situation (CISS) were used to assess the constructs of interest. Patients with ED showed higher levels of alexithymia in comparison with HC. Moreover, they presented a higher use of Emotion oriented coping strategy than HC. Regression analysis showed that alexithymia difficult to identify feeling predicted the eating disorder risk in patients with AN, whereas the same risk was predicted by the Emotion oriented coping strategy in BED group. For AN group, the model remain significant also when controlling for anxiety and depression. Alexithymia appears to be a predictor of eating symptoms specifically in an AN group, whereas a high use of emotion-oriented coping strategy appears to be a predictor of ED specifically in BED patients. The present findings may orient various kinds of intervention specifically targeted to different levels of emotion processing.

Introduction: Psycho-behavioral studies have shown that sympathetic skin response (SSR), which is an indicator of sympathetic function, is associated with emotional responses. It has been reported that SSR, which is claimed to be a biological indicator of empathy, has increased in Social Anxiety Disorder (SAD) patients. The aim of this study was to evaluate the relationship between SSR and alexithymia, empathy in patients with SAD. Method: SAD patients and control group were applied Liebowitz Social Anxiety Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Toronto Alexithymia Scale, Empathy Quotient, Facial Emotion Identification and Discrimination tests (FID, FDSC); during the application FID, SSR were measured. The relationship between alexithymia and empathy levels were investigated. Results: The number of SSR was higher in all visual stimuli of SAD patients (11.13±3.01) compared to the control group (7.4±3.57). More autonomous activity to negative stimuli (SAD: 10.55±2.82, control: 6.36±3.64), sensitivity to positive stimuli (SAD: 0.58±0.69, control: 1.03±0.8) was less than control group. While 41.7% of SAD patients had alexithymic features, 36.1% were diagnosed with depressive disorder. Conclusion: It was thought that depressive and alexithymic features may have contributed to increased sympathetic sensitivity to negative stimuli in SAD patients. Further studies are needed to examine the effects of this situation on the selection and creation of the treatment modalities. © 2019 by Turkish Association of Neuropsychiatry.

The present study investigated the prevalence, the potential different profiles, and the associated psychological factors of disordered gaming using data from a large-scale epidemiological study (TURBAHAR [Turkey’s Addiction and Mental Health Risk Profile Map Project]) carried out in Turkey in 2018 with 24,494 participants aged 18–81 years. Participants completed a comprehensive survey comprising a demographic questionnaire, Gaming Addiction Risk Questionnaire, Brief Symptom Inventory, Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Toronto Alexithymia Scale, and Experiences in Close Relationships-Revised Scale. Latent class analysis showed the existence of eight different game profiles, which differed in relation to the intensity and specific features of the behavior. Results showed that 1.6% of the participants were problematic gamers. Being male, being younger, lower education level, being single, using alcohol and cigarettes, psychiatric distress, positive and negative affect, and anxious adult attachment were positively associated with problematic gaming.

Background and purpose: Different factors may influence the professional quality of life of oncology professionals. Among them, personality traits, as alexithymia and empathy, are underinvestigated. Alexithymia is about deficits in emotion processing and awareness. Empathy is the ability to understand another's 'state of mind'/emotion. The PROject on BurnOut in RadiatioN Oncology (PRO BONO) assesses professional quality of life, including burnout, in the field of radiation oncology and investigates alexithymia and empathy as contributing factors.Material and methods: An online survey was conducted amongst ESTRO members. Participants completed 3 validated questionnaires for alexithymia, empathy and professional quality of life: (a) Toronto Alexithymia Scale; (b) Interpersonal Reactivity Index; (c) Professional Quality of Life Scale. The present analysis, focusing on radiation/clinical oncologists, evaluates Compassion Satisfaction (CS), Secondary Traumatic Stress (STS) and Burnout and correlates them with alexithymia and empathy (empathic concern, perspective taking and personal distress) with generalized linear modeling. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model.Results: A total of 825 radiation oncologists completed all questionnaires. A higher level of alexithymia was associated to decreased CS (beta:-0.101; SE: 0.018; p Conclusions: Alexithymic personality trait increased burnout risk, with less professional satisfaction. Empathic concern was associated to increased stress, without leading to burnout, resulting in higher professional fulfillment. These results may be used to benchmark preventing strategies, such as work-hour restrictions, peer support, debriefing sessions, and leadership initiatives for professionals at risk. (c) 2020 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 147 (2020) 162-168

Introduction: Psycho-behavioral studies have shown that sympathetic skin response (SSR), which is an indicator of sympathetic function, is associated with emotional responses. It has been reported that SSR, which is claimed to be a biological indicator of empathy, has increased in Social Anxiety Disorder (SAD) patients. The aim of this study was to evaluate the relationship between SSR and alexithymia, empathy in patients with SAD. Method: SAD patients and control group were applied Liebowitz Social Anxiety Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Toronto Alexithymia Scale, Empathy Quotient, Facial Emotion Identification and Discrimination tests (FID, FDSC); during the application FID, SSR were measured. The relationship between alexithymia and empathy levels were investigated. Results: The number of SSR was higher in all visual stimuli of SAD patients (11.13±3.01) compared to the control group (7.4±3.57). More autonomous activity to negative stimuli (SAD: 10.55±2.82, control: 6.36±3.64), sensitivity to positive stimuli (SAD: 0.58±0.69, control: 1.03±0.8) was less than control group. While 41.7% of SAD patients had alexithymic features, 36.1% were diagnosed with depressive disorder. Conclusion: It was thought that depressive and alexithymic features may have contributed to increased sympathetic sensitivity to negative stimuli in SAD patients. Further studies are needed to examine the effects of this situation on the selection and creation of the treatment modalities. © 2019 by Turkish Association of Neuropsychiatry.

Kılıç, Fatma Arzu (Balikesir Author), Objective: A relationship has been demonstrated between stress and the increase in the skin plaques in psoriasis. In addition, psoriasis is observed in cases of severe alexithymia and stress. In depression and various psychiatric disorders, there is a relationship between rumination and both the onset and persistence of the disease. The role of rumination, being a stress related factor, was investigated in this study. Method: The study included 91 patients with psoriasis and 93 healthy controls. All participants were evaluated with the Toronto Alexithymia Scale, Coping Style Scale, the Ruminative Thought Style Questionnaire and the Hospital Anxiety and Depression Scale. Any increase in the plaque formation after the duration of 1 month was recorded by the clinician. Results: In both the patient and the control groups, rumination scores were significantly correlated with the alexithymia severity scores (psoriasis group r=0.46, p

Alexithymia is a disabling condition frequently linked to major depressive disorder (MDD) and able to enhance symptoms severity and suicide risk. This study aimed to clarify whether patients with and without alexithymia may differ concerning illness presentation and clinical course, which is a major gap in the scientific literature.The present sample included 381 euthymic outpatients with MDD recruited at the Department of Neuroscience (DINOGMI), University of Genoa. The Toronto Alexithymia Scale (TAS-20) and additional rating scales (Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), Intent Score Scale (ISS) were administered to all participants.Alexithymic patients were more likely to have lower educational level (11.6 ± 3.2 vs. 12.4 ± 3.4, p ≤ .05), have used previous psychiatric drugs (85.7% vs. 72.8%, p =.001), use current antidepressants (84.7% vs. 69.4%, p = .001), and have higher cardiological comorbid disorders (10.7% vs. 5.0%, p = ≤.05). After multivariate analyses, alexithymia was associated with lower educational level (OR=0.928, p = .05), and higher current antidepressants use (OR 2.302, p = .01); difficulties in identifying feelings were associated with lower educational level (p = ≤.005), higher psychiatric comorbidity (p = ≤.001), and previous psychiatric medications (p = .01). Furthermore, having a lower educational level remained the only factor associated with both difficulties in communicating feelings (p = ≤.001) and thoughts oriented to external context (p = ≤.005).The study is limited by the small sample size and its cross-sectional nature.Alexithymia appears a useful specifier of adverse outcomes, associated with distinct socio-demographic and clinical characteristics. Its identification would allow to provide a more personalized care.

This paper presents the results of a six-month psychodrama intervention for the prison-based treatment of people with substance dependence, held in an attenuated custody institution in Northern Italy (Istituto a Custodia Attenuata per il Trattamento delle Tossicodipendenze – ICATT). Seven patients participated in the psychodrama intervention (21 weekly sessions) and were monitored through an idiographic change process using a mixed methods design. The longitudinal quantitative assessment employed the Clinical Outcomes in Routine Evaluation − Outcome Measure (CORE-OM), the Revised Spontaneity Assessment Inventory (SAI-R), the General Self-Efficacy Scale (GSE), and the Toronto Alexithymia Scale (TAS-20). The qualitative assessment was based on the Client Change Interview Schedule (CCS) and the Helpful Aspects of Therapy Form (HAT). The quantitative and qualitative results supported the effectiveness of psychodrama as a treatment method for this group of patients, showing a decrease in psychological distress; a related decrease in depressive, anxious, physical, and/or traumatic symptoms; and a relative increase in the patients’ general emotional and social functioning.

Purpose: The aim of this study is to investigate the effect of alexithymic characteristics, metacognitive problems, mental and behavioral problems on the risk of the development of bullying behaviors and to be a victim of bullying. Study design: 450 students 61%girls, n=278 aged between 14-17 recruited from one Anatolian high school and another high school were included in this study. 20-Item Toronto Alexithymia Scale, Metacognitions questionnaire for children, and Strengths and difficulties questionnaire self-report form were used as measures. Data were analyzed by independent sample t-test, Pearson product-moment correlation coefficient, and multivariate linear regression analysis. Results: The results revealed that alexithymia and behavioral problems increase the risk of being a victim; and behavioral problems, Attention deficit hyperactivity disorder/symptoms and peer problems increase the risk of bullying behaviors. Conclusion: Early identification and treatment of alexithymia and behavioral problems may prevent the development of bullying behaviors and being a victim of bullying; and also may prevent mental and behavioral problems associated with bullying in later stages of life.

Objectives: In the present study, we evaluated if the presence of sexual abuse in the clinical history of patients with psychogenic non-epileptic seizures (PNES) is associated with a different psychopathological profile. Materials and methods: In a consecutive population of 63 PNES patients, we compared two demographically and clinically matched groups of patients with (no. 15) and without (no. 48) a history of sexual abuse using a comprehensive psychopathological assessment (Beck Depression Inventory, Hamilton Anxiety Rating Scale, Dissociative Experience Scale, Somatoform Dissociation Questionnaire, and Toronto Alexithymia Scale). Results: We found that the group of patients reporting sexual abuse is characterized by higher scores on Dissociative Experience Scale (p = 0.003) and Beck Depression Inventory (p = 0.001) with respect to the other group. No significant statistical differences in Hamilton Anxiety Rating Scale (p = 0.103), Toronto Alexithymia Scale (p = 0.137), and Somatoform Dissociation Questionnaire (p = 0.486) were captured. Moreover, we found that the negative effect on dissociate symptoms was also hampered by the increasing of seizure frequency. Conclusions: This study reinforces the importance of traumatic screening in the clinical spectrum of PNES in order to implement and improve specific therapeutic strategies.

Justification of the objectives of the study: the article discusses issues related to the present, faced by students and future professionals, as well as teachers and psychologists. Subjectivity is an integrative, complex characteristic of personality. The purpose of this study: to consider the concept of “subjectivity” as a qualitative characteristic of a personality that opens up the possibility of adapting to the challenges of our time. Identify points of underdevelopment for the prospects of psychological activity in this area. Research methods: Components of subjectivity determined the choice of methods. Accordingly, to study the level of subjective control localization, we used the J. Rotter test questionnaire, the Everett L. Shostrom questionnaire to determine personal orientations, and the diagnosis of reflexivity to study the level of development of emotional intelligence. A.V Karpova and the Toronto alexithymia scale. Research results: most students tend to focus on a structure set from the outside, focused on external, often alien personality factors, which does not contribute to the development of subjectivity, does not form responsible for the learning outcome Main conclusions. At the student age, direct directed psycho-correctional work on the development of the components of subjectivity is possible and necessary. For this, it is necessary: the inclusion in the process of goal-setting and planning of various types of activities; the creation of situations of choice and self-determination, social and professional tests. Such efforts will allow the formation of a modern personality that can meet the challenges of our time.

Objectives Fibromyalgia (FM) is a chronic pain syndrome, and alexithymia, which is a condition that is characterised by deficits in emotional self-awareness, is highly prevalent among individuals with FM. Insecure attachment styles and inadequate parental care appear to play an important role in the onset and maintenance of both alexithymia and chronic pain. Therefore, the present study aimed to examine the associations between attachment styles, parental bonding, and alexithymia among patients with FM and healthy controls (HC). Methods All participants completed a battery of tests that assessed alexithymia, attachment styles, and parental bonding. Two logistic regression models were tested to examine whether these variables predict (a) group membership (i.e. patients with FM vs. HC) and (b) the likelihood of having alexithymia (i.e. among patients with FM and HC). Results Alexithymia (i.e. difficulty identifying and describing feelings subscales of the 20-item Toronto Alexithymia Scale) significantly predicted group membership (i.e. the likelihood of having FM). On the other hand, educational level and dismissive attachment (i.e. the discomfort with closeness and relationships as secondary subscales of the Attachment Style Questionnaire) were the only significant predictors of the likelihood of having alexithymia. Conclusions These findings highlight both the relevance of alexithymic traits to the definition of FM and centrality of an insecure attachment style to the manifestation of alexithymia.

Backgrounds Alexithymia, difficulties in identifying and describing one's own feelings, is related to substantial clinical practice. Inspired by the links between serotonin functions and affective disorders, this study investigated associations of the serotonin receptor 2A (5-HT2A) gene with alexithymia and mental health. Methods We differentiated subjects according to two functional polymorphisms (i.e., rs6311 and rs6313) of 5-HT2A gene and scored alexithymia and mental health of college students with the Toronto Alexithymia Scale (TAS-20) and the Symptom Check List-90 (SCL-90), respectively. Results The analyses basing on sample 1 (N = 566) and sample 2 (N = 602) indicated that the G allele of rs6311 was related to higher score on the TAS-20 as compared to the AA genotype. The analysis with 467 individuals from sample 2 indicated that the rs6311 was associated with mental health, and this association was mediated by alexithymia. Limitations The potential confounding variables such as depression and anxiety were neglected in the analyses. Conclusions These findings demonstrate the contribution of the 5-HT2A to alexithymia, and highlight the link between alexithymia and mental health at genetic level.

Background and aimsTo date, a number of studies have investigated the prevalence and correlates of addictive food consumption. However, these studies have mostly relied on models that comprised a narrow range of variables in often small and heterogenous samples. The purpose of the present study was to comprehensively examine the measurement aspects, the prevalence, and the psychological correlates of addictive eating among a largescale national sample of Turkish adults.MethodParticipants (N = 24,380, 50% men, Mage = 31.79 years, age range = 18–81 years) completed a battery of tests including the Food Addiction Risk Questionnaire (FARQ), the Brief Symptom Inventory, the Toronto Alexithymia Scale, the Positive and Negative Affect Schedule, and the Experiences in Close Relationships-Revised.ResultsAccording to analyses conducted, the FARQ had a uni-dimensional factor structure. Based on Item Response Theory (IRT) calculated cut-off scores, 2.3% of the participants were at risk of addictive eating patterns, whilst criteria varied in their discriminating ability. The correlates of addictive food consumption were being male, being younger, having lower education, presenting with higher alcohol use, psychiatric symptoms, alexithymia, positive/negative affect, and anxious attachment.ConclusionThese results suggest that a minority of Turkish community are at risk for addictive food consumption and that adverse psychological states promote this problematic behavior.

The aim of this study is to explore network structures of the Toronto Alexithymia Scale in a large sample of 1925 French-speaking Belgian university students and compare results with previous studies from different samples and tools to identify potential targets for clinical intervention. We estimated network models for the 20 items of the Toronto Alexithymia Scale and for its three domains difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. We explored item connectivity through node predictability (shared variance with other network components). We performed an exploratory graph analysis to explore the dimensionality of our data set and compare results with the original three-factor model; because a different model was proposed, we estimated an additional network structure on the new structure. Items from the Toronto Alexithymia Scale connect both within and between domains. The three-domain network identifies difficulty describing feelings as the most connected domain. The exploratory graph analysis reported that three items from externally oriented thinking form a new domain, distraction. In the new four-domain network, difficulty describing feelings remains the most interconnected domain; however, two negative connections are found. Our findings support the relative importance of identifying and describing feelings as a meaningful target for intervention., SCOPUS: ar.j, info:eu-repo/semantics/published

A body of research has investigated the relationship between alexithymia and sleep problems, as well as the relationship between schizophrenia and alexithymia. However, there have been few studies on the relationships between the three. The current study explored the relationship between schizotypal traits and sleep problems among college students, and the potential role of alexithymia as a mediator of this relationship. The participants were all first-year students at a medical university in Guangdong province, China. A total of 2,626 college students participated. They were asked to complete a questionnaire that incorporated the Schizotypal Personality Questionnaire (SPQ), the Toronto Alexithymia Scale (TAS-20), and the Insomnia Severity Index (ISI). The results revealed a relatively high percentage of students with mild insomnia (74.8%) and a smaller percentage with moderate to severe insomnia (7.9%). Correlation analysis revealed that both the TAS-20 and ISI scores had significant positive correlations with the SPQ score (p < 0.01). There was also a significant positive correlation between the TAS-20 and ISI scores (p < 0.01). The ISI score was significantly influenced by the SPQ score in a direct way, and increased considerably with increases in the TAS-20 score, indicating the importance of alexithymia as a mediator. The mediation model was tested via regression analysis and the bias-corrected bootstrap method, and these results further confirmed the role of alexithymia as a mediator.

This cohort study was aimed to verify whether subjects at their first acute coronary syndrome (ACS) were more alexithymic than healthy controls (HC) and whether alexithymia can predispose patients with coronary artery disease to new major adverse cardiac events (MACE) during a 24-month follow-up period. The sample included 100 HC with no history of depression or ACS and 304 never depressed patients with a first-ever ACS. A total of 266 patients completed the 2-year follow-up. Patients and HC reported similar Toronto Alexithymia Scale (TAS-20) scores. During the follow-up, 69 (22.69%) patients developed incident depression and 57 (18.75%) developed a new MACE. In a proportional hazard model, developing a first-ever depressive episode, but not alexithymia (hazard ratio = 1.008, 95% confidence interval = 0.984–1.033; p = 0.500), was associated with almost 3 times the risk of a recurrent cardiac event. Incident depression, but not TAS-20 scores, represented risk factor for MACE.

Up to 20% of total knee arthroplasty (TKA) patients remain dissatisfied, with chronic pain as the most frequently named cause. A pilot study was conducted to assess the progression of peri-operative pain intensity and the parallel development of different psychological factors and coping strategies, as well as correlations indicating potential inter-relationships. Pain, psychological impairment [FESV BE], and coping strategies [FESV BW] were assessed before and after TKA [days − 5 to 31]. Patients were stratified according to the presence or absence of peri-operative pain improvement [decreasing pain: Group 1 [69%; n = 36]; persisting pain: group 2 [31%; n = 16]]. Group 2 was additionally tested with the Toronto Alexithymia Scale [TAS] and Screening for Somatoform Disorders [SOMS]. Pain intensity in group 1 decreased from significantly higher pre-operative levels to significantly lower values at 31 days post-operatively, whereas group 2 did not show significant changes. Concurrently, the psychological impairment parameter anxiety (AN) significantly decreased and the pain coping parameter relaxation significantly increased in group 1, but not in group 2. Whereas pre-operative pain was positively and significantly correlated with AN throughout time in group 2, it was negatively correlated with relaxation at day 29 in group 1. Concerning TAS and SOMS, considerable percentages of the participants in group 2 (37.5% and 68.75%, respectively) showed values > 50% of those in normal controls. Parallel (or anti-parallel) and partially correlated developments of pain improvement and parameters of psychological impairment or coping strategies after TKA suggest a pre-operative screening with tools like the FESV BE and BW or TAS and SOMS questionnaires in order to classify individuals for peri-operative mental training.

Background The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient’s perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. Methods One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. Results Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p p p Conclusions Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

OBJECTIVE Few studies have investigated associations between alexithymia and physiological mechanisms in psychosomatic diseases. We examined associations between alexithymia and 1) perception and brain processing of visceral stimulation and 2) the endocrine responses to corticotrophin-releasing hormone (CRH) in healthy individuals and patients with irritable bowel syndrome (IBS). METHODS The study included 29 patients with IBS and 35 age- and sex-matched healthy controls (HCs). Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Brain responses to rectal distention and its anticipation were measured by functional magnetic resonance imaging and analyzed at a voxel-level threshold of puncorrected < .001 combined with a cluster-level threshold of pFWE-corrected < .05. On a different day, plasma adrenocorticotropic hormone and cortisol responses after intravenous CRH administration were measured. RESULTS TAS-20 scores did not differ significantly between patients with IBS and HCs (p = .18). TAS-20 scores correlated positively with the individual rectal discomfort thresholds (βrobust = 0.49, p = .03) and negatively with the rating of fear before rectal distention (βrobust = -1.63, p = .04) in patients with IBS but not in HCs. Brain responses to rectal distention in the right insula and other brain regions were positively associated with TAS-20 scores to a greater extent in patients with IBS than in HCs. Individuals with higher TAS-20 scores (both patients with IBS and HCs) demonstrated stronger adrenocorticotropic hormone responses to CRH administration (F(4,224) = 3.54, p = .008). CONCLUSION Higher alexithymia scores are associated with stronger physiological responses, but lower anticipatory fear ratings and higher discomfort thresholds, particularly in patients with IBS.