The Concept of Alexithymia

Abstract

The concept of alexithymia, which means "no words for emotions", emerged in order to explain the symptoms of psychosomatic patients and gained a quick recognition among psychiatrists. However, current studies indicate that alexithymia may be a personality trait seen both in different pathological groups and even in healthy population. At this point, many researches have been made in order to distinguish alexithymia from existing constructs and diagnosis, and to remove the questions on reliability and validity of the con-cept and its measurement. Ongoing discussions on alexithymia will be re-viewed in this study. The controversial concept of alexithymia will be exam-ined in terms of characteristics, theoretical background, relationship with the other disorders, measurement and the critique of the measurement and the concept.

Keywords

• Alexithymia, pathology, neurophysiology, psychoanalysis

Aleksitimi Kavramı

Öz

"Duygular için söz yokluğu" anlamına gelen ve psikiyatri çevrelerince hızla kabul görmüş bir kavram olan aleksitimi, başlangıçta psikosomatik hastalardaki belirtileri açıklamak için ortaya atılmıştır. Ancak güncel çalışmalar aleksitiminin birçok farklı patolojik grupta ve hatta sağlıklı popülasyonda da karşımı-za çıkan bir kişilik özelliği olabileceğini ortaya koymuştur. Bu noktada aleksi-timi kavramının var olan yapı ve tanılardan ayrılması ve gerek kuramsal gerekse ölçümsel anlamda güvenirlik ve geçerliğine yönelik soru işaretlerinin ortadan kalkması için birçok araştırma yapılmıştır. Bu kuramsal derleme çalışmasında da, kavram üzerinde süre giden tartışmaların günümüzde ne noktada olduğu sorusuna yanıt aranmaktadır. Bu bağlamda, aleksitimi kavramı; özellikleri, kuramsal temelleri, diğer bozukluklarla ilişkisi ve ölçümü boyutlarında incelenmekte; hem ölçüme hem de kavrama yönelik eleştiriler ele alınmıştır

Anahtar Kelimeler

• Aleksitimi, patoloji, nörofizyoloji, psikanaliz

Kaynakça

1. Lesser EM. A review of the alexithymia concept. Psychosom Med 1981; 43:531-543. Sifneos PE. Alexithymia: past and present. Am J Psychiatry 1996; 153:137-142.
2. Bankier B, Aigner M, Bach M. Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder and depression. Psychosomatics 2001; 42:235-240.
3. Zackheim L. Alexithymia: the expanding realm of research. J Psychosom Res 2007; 63:345-347.
4. Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res 2011; 190:43-48. Tolmunen T, Heliste M, Lehto SM, Hintikka J, Honkalampi K, Kauhanen J. Stability of alexithymia in the general population: an 11-year follow-up. Compr Psychiatry 2011; 52:536-541.
5. Batıgün AD, Büyükşahin A. Aleksitimi: psikolojik belirtiler ve bağlanma stilleri. Klinik Psikiyatri Dergisi 2008; 105-114.
6. Taylor GJ, Bagby RM, Parker JD. The alexithymia construct. a potential paradigm for psychosomatic medicine. Psychosomatics 1991; 32:153–164.
7. Leising D, Grande T, Faber R. The Toronto Alexithymia Scale (TAS-20): a measure of general psychological distress. J Res Pers 2009; 43:707-710.
8. Grabe HJ, Frommer J, Ankerhold A, Ulrich C, Groger R, Franke GH et al. Alexithymia and outcome in psychotherapy. Psychother Psychosom 2008; 77:1891

9. Ahrens S, Deffner G. Empirical study of alexithymia: methodology and results. Am J Psychother 1986; 40:430-447.
10. Ogrodniczuk JS, Piper WE, Joyce AS, Abbass AA. Alexithymia and treatment preferences among psychiatric outpatients. Psychother Psychosom 2009; 78:383-384. Taylor GJ. Recent developments in alexithymia theory and research. Can J Psychiatry 2000; 45:134-142.
11. Taylor GJ, Bagby RM, Parker JD. Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
12. Dimaggio G, Semerari A, Carcione, A, Nicolo G, Procacci M. Psychotherapy of Personality Disorders: Metacognition, States of Minds and Interpersonal Cycles. London, Routledge, 2007.
13. Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: Implications for understanding and treating health problems. J Pers Assess 2007; 89:230–246.
14. Lesser IM. Current concepts in psychiatry. Alexithymia. N Engl J Med 1985; 312:690-692.
15. Taylor GJ, Bagby RM. Measurement of alexithymia: recommendations for clinical practice and future research. Psychiatr Clin North Am 1988; 11:351–366.
16. Vanheule S, Verhaeghe P, Desmet M. In search of a framework for the treatment of alexithymia. Psychol Psychother 2011; 84:84-97.
17. Dereboy İF. Aleksitimi özbildirim ölçeklerinin psikometrik özellikleri üzerine bir çalışma (Uzmanlık tezi). Ankara, Hacettepe Üniversitesi 1990.
18. Grynberg D, Luminet O, Corneille O, Grezes J, Berthoz S. Alexithymia in the interpersonal domain: a general deficit of empathy? Pers Individ Diff 2010; 49:8458
19. Dogramji K. Emotional aspects of sleep disorders: the case of obstructive sleep apnea syndrome. New Dir Ment Health Serv 1993; 57:39–50.
20. Fitzgerald M, Bellgrove MA. The overlap between alexithymia and Asperger's syndrome. J Autism Dev Disord 2006; 36:573–576.
21. Krystal H, Giller EL, Cicchetti DV. Assessment of alexithymia in post-traumatic stress disorder and somatic illness: introduction to a reliable measure. Psychosom Med 1986; 48:84-94.
22. Freyberger H. Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother Psychosom 1977; 28:337-342.
23. Larsen JK, Brand N, Bermond B, Hijman R. Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies. J Psychosom Res 2003; 54:5335
24. Hoppe KD, Bogen JE. Alexithymia in twelve commissurotomized patients. Psychother Psychosom 1977; 28:148-155.
25. Lane RD, Ahern GL, Schwartz GE, Kaszniak AW. Is alexithymia the emotional equivalent of blindsight? Biol Psychiatry 1997; 42:834–844.
26. Taylor GJ. Alexithymia concept, measurement and implications for treatment. Am J Psychiatry 1984; 141:725-732.
27. Burgess C, Simpson GB. Cerebral hemispheric mechanisms in the retrieval of ambiguous word meanings. Brain Lang 1988; 33:86-103.
28. Damasio AR. Aphasia. N Engl J Med 1992; 326:531–539.
29. Moriguchi Y, Ohnishi T, Lane RD, Maeda M, Mori T, Nemoto K et al. Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia. NeuroImage 2006; 32:1472–1482.
30. Tychey C, Garnier S, Lighezzollo-Alnot J, Claudon P, Rebourg-Roesler C. An accumulation of negative life events and the construction of alexithymia: a longitudinal and clinical approach. J Pers Assess 2010; 92:189-206.
31. Helmes E, McNeill PD, Holden RR, Jackson C. The construct of alexithymia: associations with defense mechanisms. J Clin Psychol 2008: 64:318-331.
32. McDougall J. Alexithymia: a psychoanalytic viewpoint, Psychother Psychosom 1982; 38:81-90.
33. Von Rad M. Alexithymia and symptom formation. Psychother Psychosom 1984; 42:80-89.
34. Krystal H. Alexithymia and psychotherapy. Am J Psychother 1979; 33:17-31.
35. Koçak R. Aleksitimi: kuramsal çerçeve, tedavi yaklaşımları ve ilgili araştırmalar. Ankara Üniversitesi Eğitim Bilimleri Fakültesi Dergisi 2002; 35(1-2):185-212.
36. Pennebaker JW. Confession ınhibition and disease. Adv Exp Soc Psychol 1989; 22:211-244.
37. Lazarus RS. Thoughts on the relation between emotion and cognition. Am Psychol 1982; 37:1019-1024.
38. Martin BJ, Pihl OR. Influence of alexithymia characteristics on psychological and subjective stress responses ın normal ındividuals. Psychother Psychosom 1986; 45:66
39. Thorberg FA, Young R, Sullivan KA, Lyvers M. Alexithymia and alcohol use disorders: a critical review. Addict Behav 2009; 34:237-245.
40. Kauhanen J, Kaplan GA, Julkunen J, Wilson TW, Salonen JT. Social factors in alexithymia. Compr Psychiatry 1993; 34:1-5.
41. Taylor GJ, Bagby RM. New trends in alexithymia research. Psychother Psychosomatics 2004; 73:68-77.
42. Dimaggio G, Nicolò G, Brüne M, Lysaker PH. Mental state understanding in adult psychiatric disorders: impact on symptoms, social functioning and treatment. Psychiatry Res 2011; 190:1–2.
43. Grabe HJ, Rainermann S, Spitzer C, Gänsicke M, Freyberger HJ. The relationship between dimensions of alexithymia and dissociation. Psychother Psychosom 2000; 69:128–131.
44. Yıldırım NK, Özkan M, Özkan S, Oflaz SB, Gelincik A, Büyüköztürk S. Kronik idiyopatik ürtikerli hastalarda aleksitimi, anksiyete, depresyon ilişkisi. Nobel Medicus 2012; 8:46-51.
45. Evren C, Sar V, Evren B, Semiz U, Dalbudak E, Cakmak D. Dissociation and alexithymia among men with alcoholism. Psychiatry Clin Neurosci 2008; 62:40-47. Bruce G, Curren C, Williams L. Alexithymia and alcohol consumption: the mediating effects of drinking motives. Addict Behav 2012; 37:350-352.
46. Toneatto T, Lecce J, Bagby M. Alexithymia and pathological gambling. J Addict Dis 2009; 28:193-198.
47. Rasheed AH. Alexithymia in Egyptian substance abusers. Subs Abuse 2001; 22:11
48. Haviland MG, Hendryx MS, Cummings MA, Shaw DG, MacMurrey JP. Multidimensionality and state dependency of alexithymia in recently sober alcoholics. J Nerv Ment Dis 1991; 179:284-290.
49. Honkalampi K, Hintikka J, Laukkanen E, Lehtonen J, Viinamaki H. Alexithymia and depression: a prospective study of patients with major depressive disorder. Psychosomatics 2001; 42:229–234.
50. Honkalampi K, Hintikka J, Saarinen P, Lehtonen J, Viinamaki H. Is alexithymia a permenant feature in depressed patients? results from a 6-month follow-up study. Psychother Psychosom 2000; 69:303-308.
51. Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease: the painprone disorder. J Nerv Ment Dis 1982; 170:381-406.
52. Grabe HJ, Ruhrmann S, Ettelt S, Müller A, Buthz F, Hochrein A et al. Alexithymia in obsessive compulsive disorder – results from a family study. Psychother Psychosom 2006; 75:312–318.
53. Marchesi C, Fonto S, Balista C, Cimmino C, Maggini C. Relationship between alexithymia and panic disorder: a longitudinal study to answer an open question. Psychother Psychosom 2005; 74:56–60.
54. Zeitlin SB, McNally RJ. Alexithymia and anxiety sensitivity in panic disorder and obsessive compulsive disorder. Am J Psychiatry 1993; 150:658-660.
55. Declerqc F, Vanheule S, Deheegher J. Alexithymia and posttraumatic stress: subscales and symptom clusters. J Clin Psychol 2010; 66:1076-1089.
56. Frewen PA, Pain C, Dozois DJA, Lanius RA. Alexithymia in PTSD: psychometric and FMRI studies. Ann N Y Acad Sci 2006; 1071:397-400.
57. Cochrane CE, Brewerton TD, Wilson DB, Hodges EL. Alexithymia in the eating disorders. Int J Eat Disord 1993; 14:219-222.
58. Elfhag K, Lundh LG. TAS-20 alexithymia in obesity, and its links to personality. Scand J Psychol 2007; 48:391-398.
59. Speranza M, Corcos M, Loas G, Stéphan P, Guilbaud O, Perez-Diaz F. Depressive personality dimensions and alexithymia in eating disorders. Psychiatry Res 2005; 135:153-163.
60. Strien T, Ouwens MA. Effects of distress, alexithymia and impulsivity on eating. Eat Behav 2007; 8:251-257.
61. Rufer M, Hand I, Braatz A, Alsleben H, Fricke S, Peter H. A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive behavior therapy. Psychother Psychosom 2004; 73:101-106.
62. Rufer M, Ziegler A, Alsleben H, Fricke S, Ortmann J, Brückner E et al. A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder. Compr Psychiatry 2006; 47:394-398.
63. Shipko S. Alexithymia and somatization. Psychother Psychosom 1982; 37:193-201. Bach M, de Zwaan M, Ackard D, Nutzinger DD, Mitchell JE. Alexithymia: Relationship to personality disorders. Compr Psychiatry 1994; 35:239-243.
64. Blanchard EB, Arena JG, Pallmeyer TP. Psychosomatic properties of a scale to measure alexithymia. Psychother Psychosom 1981; 35:64-71.
65. Henry JD, Phillips LH, Maylor EA, Hosie J, Milne AB, Meyer C. A new conceptualization of alexithymia in the general adult population: Implications for research involving older adults. J Psychosom Res 2006; 60:535-543.
66. Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res 2006; 61:629-635.
67. Salminen JK, Saarijarvi S, Aarela E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res 1999; 46:75–82.
68. Shipko S, Alvarez WA, Noviello N. Towards a teleogical model of alexithymia: alexithymia and post-traumatic stress disorder. Psychother Psychosom 1983; 39:1221
69. Zeitlin SB, McNally RJ, Cassiday KL. Alexithymia in victims of sexual assault: an effect of repeated traumatization. Am J Psychiatry 1993; 150:661-663.
70. Zlotnick C, Zakriski AL, Shea MT, Costello E, Begin A, Pearlstein T et al. The longterm sequelae of sexual abuse: support for a complex post-traumatic stress disorder. J Trauma Stress 1996; 9:195-205.
71. Berthoz S, Consoli S, Diaz FP, Jouvent R. Alexithymia and anxiety: compounded relationships? a psychometric study. Eur Psychiatry 1999; 14:372-378.
72. Martínez-Sánchez F, Ato-García M, Córcoles Adam E, Huedo Medina TB, Selva España JJ. Stability in alexithymia levels: a longitudinal analysis on various emotional answers. Pers Individ Diff 1998; 24:767-772.
73. Kauhanen J, Julkunen J, Salonen JT. Validity and reliability of the Toronto Alexithymia Scale (TAS) in a population study. J Psychosom Res 1992; 36:687-694. Picardi A, Toni A, Caroppo E. Stability of alexithymia and its relationships with the “big five” factors, temperament, character, and attachment style. Psychother Psychosom 2005; 74:371-378.
74. Tolmunen T, Hintikka J, Ruusunen A, Voutilainen S, Tanskanen A, Valkonen VP et al. Dietary folate and the risk of depression in Finnish middle-aged men: a prospective follow-up study. Psychother Psychosom 2004; 73:334-339.
75. Saarijarvi S, Salminen JK, Toikka T. Alexithymia and depression: a 1-year follow-up study in outpatients with major depression. J Psychosom Res 2001; 51:729-733.
76. Schmidt U, Jiwany A, Treasure J. A controlled study of alexithymia in eating disorders. Compr Psychiatry 1993; 34:54-58.
77. Salminen JK, Saarijarvi S, Aairela E, Tamminen T. Alexithymia— state or trait? oneyear follow-up study of general hospital psychiatric consultation out-patients. J Psychosom Res 1994; 38:681-685.
78. Porcelli P, Leoci C, Guerra V, Taylor GJ, Bagby RM. A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. J Psychosom Res 1996; 41:569-573.
79. Luminet O, Rokbani L, Ogez D, Jadoulle V. An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. J Psychosom Res 2007; 62:641-648.
80. Pinard L, Negrete JC, Annable L, Audet N. Alexithymia in substance abusers: persistence and correlates of variance. Am J Addict 1996; 5:32-39.
81. Fukunishi I, Kikuchi M, Takubo M. Changes in scores on alexithymia over a period of psychiatric treatment. Psychol Rep 1997; 80:483-489.
82. Luminet O, Bagby RM, Taylor GJ. An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom 2001; 70:254-260.
83. Taylor GJ, Ryan D, Bagby RM. Toward the development of a new self-report alexithymia scale. Psychother Psychosom 1985; 44:191-199.
84. Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia Scale–I: item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38:23–32.
85. Meganck R, Vanheule S, Desmet M, Inslegers R. The Observer Alexithymia Scale: a reliable and valid alternative for alexithymia measurement? J Pers Assess 2010; 92:175-185.
86. Bagby RM, Taylor GJ, Parker JDA, Dickens SE. The development of the Toronto Structured Interview for Alexithymia: ıtem selection, factor structure, reliability and concurrent validity. Psychother Psychosom 2006; 75:25-39.
87. Zimmermann G, Rossier J, Meyer de Stadelhefen F, Gaillard F. Alexithymia assessment and relations with dimensions of personality. Eur J Psychol Assess 2005; 21:23-33.
88. Motan İ, Gençöz T. Aleksitimi boyutlarının depresyon ve anksiyete belirtileri ile ilişkileri. Turk Psikiyatri Derg 2007; 18:333-343.
89. Kirmayer LJ, Robbins JM. Cognitive and social correlates of the Toronto Alexithymia Scale. Psychosomatics 1993; 34:330-335.
90. Porcelli P, Mihura JL. Assessment of alexithymia with the Rorschach Comprehensive System: the Rorschach Alexithymia Scale (RAS). J Pers Assess 2010; 92:128-136.
91. Haviland MG, Warren WL, Riggs ML. An observer scale to measure alexithymia. Psychosomatics 2000; 41:385–392.
92. Haviland MG, Warren WL, Riggs ML, Gallagher M. Psychometric properties of the Observer Alexithymia Scale in a clinical sample. J Pers Assess 2001; 77:176–186.
93. Kooiman CG, Spinhoven P, Trijsburg RW. The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto Alexithymia Scale J Psychosom Res 2002; 53:1083-1090.
94. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a study comparing the TAS–20 with non-self-report measures of alexithymia. J Psychosom Res 2004; 57:239–247.
95. Lumley MA. Alexithymia and negative emotional conditions. J Psychosom Res 2000; 49:51–54.
96. Wagner H, Lee V. Alexithymia and individual differences in emotional expression. J Res Pers 2008; 42:83–95.
97. Swiller HI. Alexithymia: treatment utilizing combined individual and group psychotherapy. Int J Psychother 1988; 38:47–61.
98. Bach M, Bach D, de Zwaan M. Independency of alexithymia and somatization: a factor analytic study. Psychosomatics 1996; 37:451-458.
99. Cox BJ, Swinson RP, Shulman ID, Bourdeau D. Alexithymia in panic disorder and social phobia. Compr Psychiatry 1995; 36:195-198. Miray Şaşıoğlu, Uzm. Psikolog., Psikonet Psikoterapi ve Eğitim Merkezi, İstanbul; Çağla Gülol, Dr. Psikolog, Elan Vital Danışmanlık, İstanbul; Ahmet Tosun, Yrd. Doç. Dr., Okan Üniv. Psikoloji Bölümü, İstanbul. Yazışma Adresi/Correspondence: Miray Şaşıoğlu, Psikonet Psikoterapi ve Eğitim Merkezi, İstanbul, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no4/ Çevrimiçi yayım / Published online 30 Aralık/December 30, 2013; doi:10.5455/cap.20130531