Alexithymia : background and consequences

Aims of the study: The aim of this thesis was to acquire a deeper understanding of alexithymia and its correlates by establishing its nature of state or trait (stability over time), its prevalence among primary care patients and its prevalence in a working female population. We also aimed at identifying some of the psychological factors that are predictive of alexithymia as well as some of its consequences.

Material and methods: In paper 1, 450 patients in primary care filled in a questionnaire consisting of basic sociodemographic data, the Schalling Sifneos Personality Scale, a Symptom List and a Patient Pain Drawing Test as well as the Karolinska Scale of Personality. In paper 1170 patients with a high score for somatization on the original questionnaire were invited to a follow-up. A structured interview (Patient Evaluation Grid) was conducted as well as a psychiatric diagnostic interview concerning the presence of symptoms of depressed mood according to DSM III-R. Papers III-V are based on data from an occupational health study. All employees in the child care programme provided by Huddinge Community were given a self-report questionnaire on two occasions with 12 months in between. This consisted of basic sociodemographic data and questions assessing feelings of well-being, somatic anxiety, psychic anxiety, depressive symptoms, gastrointestinal symptoms and social dysfunction. Alexithymia was assessed by the Toronto Alexithymia Scale with 20 items.

Results: The prevalence of alexithymia was 20.0% in the primary care population. Alexithymia was significantly associated with advanced age, a low educational level, male gender and persons living alone but having more children. The results supported a relation between alexithymia and the personality traits suspicion and detachment. High scores for alexithymia were associated with higher scores on somatic anxiety, psychasthenia and irritability, as well as low scores on ability to socialise. The prevalence of depressive disorder was increased from 1.8% to 11.7% after the investigation in paper 11. Patients with undetected depression scored higher on alexithymia and psychastenia. In the study in occupational health the prevalence of alexithymia was 7.9% in the all-female population. We found TAS-20 alexithymia to be associated with symptoms of depression and somatic anxiety, a lower educational level, social disability and less well-being. The common denominator for TAS-20 global and the subfactors was low level of social support - 3.5 times more common - and having no one to turn to - 2.6 times more common. The Occurrence of life events was associated with TAS-20 global and subfactor 1. Alexithymia showed a high degree of relative stability over the 12-month period. Changes in TAS-20 scores were found to be independent of severity of psychosocial symptoms and demographic characteristics. When support was present in the alexithymic population, it had a salutary effect on social disability.

Discussion: The results are compared with those of other prevalence studies and discussed in relation to existing psychoanalytical, developmental and neuropsychological theories. The findings in this thesis underline the importance of an active collaboration between mental health professionals and primary care providers, both in training and incorporating psychiatric skills into primary care practice.

List of scientific papers

I. Posse M, Hallstrom T (1999). The prevalence of alexithymia in primary care patients. European Journal of Psychiatry. 13(1): 5-11.

II. Posse M, Hallstrom T (1998). Depressive disorders among somatizing patients in primary health care. Acta Psychiatr Scand. 98(3): 187-92.
https://pubmed.ncbi.nlm.nih.gov/9761404

III. Posse M, Backenroth-Ohsako G, Hakanson CE, Hallstrom T (2001). Alexithymia and psychiatric symptoms in a population of nursery workers. A study using the 20-item Toronto Alexithymia Scale. Social Behaviour and Personality. 29(5): 491-502.

IV. Posse M, Hallstrom T, Backenroth-Ohsako G (2001). Psychosocial predictors of alexithymia examined over a 12-month period in a non-patient female population. [Submitted]

V. Posse M, Hallstrom T, Backenroth-Ohsako G (2001). Alexithymia, social support, psych-social stress and mental health in a female population. [Submitted]