Alexithymia and Its Relationship to Dissociation in Patients With Panic Disorder

Abstract

Conditions that impede the regulation of emotional arousal, such as alexithymia and dissociation, may underlie panic attacks. This study aimed to evaluate the relationship between alexithymia and dissociation in patients with panic disorder (PD). We assessed 95 PD outpatients with regard to alexithymia (20-item Toronto Alexithymia Scale), dissociation (Dissociation Experience Scale), and overall psychological distress (Symptom Checklist 90-Revised, Global Severity Index). Regression analyses revealed a positive correlation between alexithymia and dissociation, even when the Global Severity Index was controlled for. A specific link was observed between "difficulty in identifying feelings" and "depersonalization/derealization." Patients who showed the pathological form of dissociation had higher levels of alexithymia, with particular regard to "difficulty in identifying feelings" and, to a smaller extent, "difficulty in describing feelings." These results support a strong relationship between alexithymia and dissociation in patients with PD. Assessing alexithymia and dissociation at the outset of therapy may be helpful for individualized therapy planning.

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

“…Previous investigations have found a significant association of alexithymia with anxiety symptoms both in general [64] and in clinical [65] populations, particularly obsessive-compulsive disorder [66][67][68] and panic disorder [69,70]. It has been suggested that dissociation may be one of the leading mechanisms linking alexithymia to the experience of anxiety, reflecting the disintegration between emotion schemas and consciousness and, in particular, the transformation of stress-induced arousal into a generalized autonomic discharge [3,71] and affect dysregulation [72].…”

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders

“…Taken together, these findings support the hypothesis of a specific relationship between some anxiety and depressive symptoms and definite alexithymic dimensions. Indeed, previous studies [23,35,36] reported an association between psychic anxiety and DIF dimension. Further, DDF elevation has been associated with suicide ideation in depressed patients [37] as well as with depersonalization/derealization in PD patients [30] whereas the EOT dimension has been positively related to psychomotor retardation in major depressed patients [38].…”

Alexithymia and Health-Related Quality of Life in Patients with Dizziness

“…However, in patients with high levels of alexithymia, the aims of psychotherapy should also include improvements in the awareness of feelings, thoughts and fantasies to facilitate the regulation of emotional arousal. Furthermore, an improved ability to regulate their emotions may help patients with dizziness to cope effectively with stressful events in their daily life [56]. Thus, it may be possible for alexithymic patients with dizziness to reduce their dizziness symptoms and to improve their HRQoL.…”