The cognitive and affective alexithymia dimensions in the regulation of sympathetic responses.

OBJECTIVE: The literature regarding research into alexithymia and sympathetic responses is far from consistent. An explanation might be on the way subjects are classified. Generally, subjects are diagnosed as either alexithymic or non-alexithymic on the basis of questionnaires focusing on the cognitive aspects of alexithymia. However, alexithymia, as originally defined, concerns both emotion-affective and emotion-cognitive deficits. The aim of the present paper is to study the importance of the affective and cognitive alexithymia components in the regulation of sympathetic responses. METHODS: Subjects, who scored extremely (either high or low) on both the cognitive and the affective components of alexithymia, were shown neutral and emotional pictures, while their GSR was measured. RESULTS: The affective alexithymia component, not the cognitive component, turned out to be an important factor in the regulation of GSR peak amplitude. The results further indicate a significant interaction of type of emotional deficit (cognitive by affective) on GSR latency times. Finally, suggestive evidence indicated that baselines values, defined by the levels during the second preceding the stimulus, are related to the cognitive component of alexithymia, in the sense that higher emotion-cognitive capacities result in higher baseline values. CONCLUSIONS: We cautiously conclude that the classification of alexithymics on the basis of both the affective and cognitive components, rather than on the basis of the cognitive component only, might provide more consistent research results, and thus lead to a better understanding of emotional physiological responses in alexithymic subjects.

[Cross-cultural psychometric assessment of the Bermond-Vorst alexithymia questionnaire]. / Avaliação psicométrica transcultural do questionário da alexitimia de Bermond-Vorst.

The alexithymia construct was introduced by Nemiah and Sifneos in the early 70s. It is a multifaceted personality construct that has been recognized associated with various conditions of health disorders. Nonetheless, despite the abundant literature, due to methodological weaknesses, a great share of the studies has been proved of questionable validity and reliability. In recent years a new self-report instrument has been developed, the Bermond-Vorst Alexithymia Questionnaire (BVAQ), meant to assess the alexithymia construct in a more comprehensive way than the more commonly used 20-item Toronto Alexithymia Scale (TAS-20). The aim was to investigate the cross-cultural psychometric properties of the Portuguese version of the BVAQ. In this study, carried out in a sample of university students (n = 369), we began testing the originally proposed 5-factor structure, by means of a factor analysis; just to proceed thereafter with the internal consistencies determination. Furthermore we investigated the stability, as well as its convergent validity with the Toronto Alexithymia Scale--20 items (TAS-20). Principal Components Analysis showed that internal structure of the 40 items acceptably fitted into the 5-factor solution. The mean total score differs about 0.6 SD from the original Dutch sample. Internal consistencies are also acceptably about the ones in the original sample: Cronbach's alpha = 0.82 for the global scale and a mean 0.77 for the subscales. Moreover the instrument is reliably stable; and the expected correlations between BVAQ and TAS-20 subscales support evidence of BVAQ's validity. The Portuguese version of the BVAQ is a highly promising new instrument to comprehensively assess alexithymia, and its use can therefore be recommended.

No words for feelings: alexithymia in schizophrenia patients and first-degree relatives.

OBJECTIVE: Alexithymia refers to difficulties in emotionalizing, fantasizing, verbalizing, identifying, and analyzing emotions. The goal of this study was to investigate features of alexithymia in patients with schizophrenia. In addition, we investigated if alexithymia would be associated with vulnerability to schizophrenia, by studying unaffected first-degree relatives of schizophrenia patients. Furthermore, sex differences were taken into account. METHOD: Forty-three patients with schizophrenia, 32 unaffected siblings, and 44 healthy control subjects were compared on the Bermond-Vorst Alexithymia Questionnaire. RESULTS: Results showed that male patients with schizophrenia, in particular, demonstrated a specific pattern of alexithymia, that is, difficulty identifying and verbalizing emotions, in the face of a higher subjective emotional arousal. Moreover, male siblings showed comparable problems in verbalizing their emotions as male patients. CONCLUSIONS: We suggest that these difficulties in aspects underlying affect regulation could account for the deficits in social functioning observed in schizophrenia and could contribute to a greater vulnerability for schizophrenia, in particular, for males.

Cognitive neuropsychology of alexithymia: implications for personality typology.

INTRODUCTION: We examine the cognitive neuroscience of the five components of the alexithymia syndrome, and propose a classification of alexithymia types based on psychobiological traits. METHOD: Literature review. RESULTS: The following neural structures have been shown to be prominent in emotional function: right and left hemisphere, corpus callosum, anterior commissure, anterior cingulate, prefrontal cortex, amygdala, and insular cortex. The specific relevance of these structures to alexithymia is discussed. CONCLUSIONS: The following conclusions and/or propositions are presented: The right hemisphere produces a global, nonverbal overview of emotional information; the left hemisphere seems dedicated to analysing emotions and higher explicit emotional cognitions. Both orbitoprefrontal cortices are important in affective aspects of alexithymia, while right temporal cortex is involved in cognitive aspects. Two subparts of anterior cingulate fulfil functions in the affective and cognitive dimensions of alexithymia. The amygdalae are involved in both cognitive and affective aspects. All structures mentioned can modulate one another. The role of interhemispheric information transfer via the corpus callosum and the anterior commissure is also discussed. The evidence that that cognitive processing of emotional information inhibits affective processing of such information is discussed in terms of its implications for a theory of alexithymia subtypes.

Memory functions in prednisone-treated kidney transplant patients.

The literature indicates that high daily doses of gluco-corticosteroids have a degenerating effect upon the hippocampus and thus result in reduced declarative memory capacities. In order to prevent rejection, renal transplant recipients are treated with moderate daily doses of gluco-corticosteroids and, if necessary, with high pulse-doses during a few days. The question, therefore, arises as to whether or not such standard treatments result in memory impairments. For this reason, declarative memory capacities were measured, by means of a Dutch version of Rey's 15 Words Test, in a group of 52 renal transplant recipients. Results clearly indicated severe reductions in declarative memory capacities in these patients.

Cognitive and emotional characteristics of alexithymia: a review of neurobiological studies.

OBJECTIVE: To review neurobiological studies of alexithymia in order to achieve a better understanding of the relationship between alexithymia and psychosomatic diseases and psychiatric illnesses. METHODS: Neurobiological studies of alexithymia were reviewed with a special focus on how emotional and cognitive elements of alexithymia are reflected in earlier research. RESULTS: Studies that have correlated alexithymia to corpus callosum dysfunctioning have mainly found impairments in cognitive characteristics of alexithymia, whereas from studies of right hemisphere and frontal lobe deficits, it may be concluded that both cognitive and emotional characteristics of alexithymia are impaired. CONCLUSION: The fact that there is no general agreement on how to define alexithymia seems to have hampered theoretical and empirical progress on the neurobiology of alexithymia and related psychosomatic diseases and psychiatric illnesses. Alexithymia should no longer be approached as one distinct categorical phenomenon and follow-up studies should monitor subjects according to both the cognitive and emotional characteristics of alexithymia.

The relationship between dissociative proneness and alexithymia.

BACKGROUND: Dissociative reactions and alexithymia are two strategies that have been put forward as coping mechanisms to alleviate painful emotions. It is the clinical impression that dissociation is related to certain alexithymia features. In line with the coping hypothesis, it was predicted that the relationship between dissociative tendencies and alexithymia would be partly mediated by current levels of stress and/or by past traumatic experiences. Furthermore, dissociation may also be related to enhanced fantasizing, although alexithymia has traditionally been associated with an incapacity to fantasize. METHODS: Data were obtained from 833 nonclinical participants on dissociative tendencies, alexithymia, childhood abuse, current stress and socially desirable behavior. Correlation analyses followed by multiple regression were performed. RESULTS: Dissociative tendencies appeared to be especially related to one alexithymic feature: a difficulty in identifying feelings. This relationship was partially mediated by levels of current stress. A history of trauma did not predict dissociation measures. Furthermore, highly dissociative participants were more fantasy prone than low-dissociative participants. CONCLUSIONS: The results of this study support the idea that in a nonclinical group dissociation may provide a way to cope with current stressful events, and that this is associated with a difficulty in identifying feelings. It is argued that two types of dissociation may exist, one trait-like type of dissociation that is associated with fantasy proneness and other related factors, and a trauma-related type of dissociation that is more apparent within the clinical range.

Alexithymia in long-term survivors of childhood cancer.

OBJECTIVE: To investigate the incidence of alexithymia (difficulties in describing or recognizing one's own emotions, a limited fantasy life, and general constriction in the affective life) in a group of childhood cancer survivors and to explore medical determinants which predict alexithymia. METHODS: Five years after completing therapy, 72 participants were asked to complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ). RESULTS: Male cancer survivors scored significantly lower on overall alexithymia compared to healthy males. They also showed higher ability to fantasize, a higher emotional arousal, and were better able to verbalize their emotional reactions. The female survivors did not show differences compared to the normal female population. No medical determinant was associated with alexithymia. CONCLUSIONS: Stress due to childhood cancer does not affect the alexithymia scores of females. However, male cancer survivors score less alexithymic than age matched controls.