Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain

Abstract

The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% female, M age = 50 years) with chest pain seeking cardiac evaluation who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the Moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18 month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.

Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology

“…Alexithymic individuals may experience more severe somatic symptoms as a consequence of sustained arousal of the physiological component of emotion response systems. Alexithymia was significantly associated with hypersensitivity to visceral stimuli, blood levels of adrenaline and activity of the insula and the anterior cingulate cortex [39], with anxiety sensitivity and increased chest pain severity [40], pain perception in women with fibromyalgia [41] and pain severity in cancer patients [42]. In acute asthmatic patients, alexithymia significantly predicted higher symptom amplification, misinterpretation of emotions as asthma exacerbations, and more frequent visits to emergency rooms after the index visit [43].…”

Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China

“…[1,4] It may also be true in Chinese populations. In this study, particularly, role of psychological distress in impaired health-related QoL of NCCP patients in Central China were assessed.…”

“…[4] It leads to impaired quality of life (QoL) with daily disability and emotional distress, and increased health care costs due to repeat hospitalizations, emergency department visits and cardiac examinations. [1,3,4,6] Although gastroesophageal reflux disease (GERD), esophageal dysmotilities such as achalasia, diffuse esophageal spasm and nutcracker esophagus, and musculoskeletal disorders explain most cases of this disorder, [1,3] it is still inadequate to be responsible for the exaggerated symptoms of pain and obviously decreased health-related QoL. Recently, increased psychological morbidity, such as panic disorders, unique perceptual, and coping style, have been reported in patients with NCCP.…”

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain, anxiety and interoceptive fear

“…Theories of NCCP point to a central role of affective factors, particularly anxiety, in this syndrome (Eifert, Zvolensky, & Lejuez, 2000; Mayou, 1998; White & Raffa, 2004; White & Rosenbaum, 2011). Psychological factors are central to health care seeking generally (Taylor, 2011), and anxiety may particularly contribute to health care utilization among patients with NCCP.…”