Alexithymia and Plaque Psoriasis: Preliminary Investigation in a Clinical Sample of 250 Patients

Abstract

Background/Aims: Psoriasis as a dermatological disorder has complex effects on mental health and the psychological status of the patient. Many authors proposed that assessing how psoriasis affects a patient's life is better than a body surface area measurement for delineating psoriasis severity. Alexithymia is a personality dimension characterized by difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking observed in many clinical conditions, especially in psychosomatic disorders. This study aimed to determine the prevalence of alexithymia in patients with plaque psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. Methods: We enrolled 250 patients with chronic plaque psoriasis, naïve to any systemic treatment, and 215 healthy individuals. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Data analysis was done. Results: The mean TAS score was 53.5 (±15.3) for the patient group and 45.1 (±10.8) for controls (p < 0.0001). Compared to controls, the psoriasis group showed significant alexithymic features (32.4 vs. 9.3%), and no significant differences of alexithymia between patients with severe and mild psoriasis were observed. A significant relationship was determined between alexithymia and female gender and sensitive area involvement, such as the face, hands, and genital area. Conclusion: This study suggests that the assessment of alexithymia should be a part of the comprehensive care of patients with moderate to severe psoriasis. For this purpose, the TAS-20 is a useful and simple tool to be used in daily clinical practice.

Disease Severity Is Associated with Alexithymia in Patients with Atopic Dermatitis

“…Alexithymia represents a personality trait characterized by the lack of understanding, processing, and describing emotions, reflecting the tendency to have reduced symbolic thinking, limited fantasy life, externally oriented cognitive thinking, difficulty in distinguishing feelings from bodily sensations, and inadequacy in empathy and intuition [12]. This personality trait has been observed in some chronic inflammatory skin disorders, including psoriasis and hidradenitis suppurativa (HS) [13][14][15], but no association has been found with other skin diseases, such as acne and seborrheic dermatitis [16,17]. Because alexithymia has been poorly investigated in AD, this multicentric study aimed to investigate its prevalence in AD patients, and its correlation with demographic and clinical variables.…”

Reversibility of alexithymia with effective treatment of moderate‐to‐severe psoriasis: longitudinal data from EPIDEPSO

“…We and others have investigated the prevalence of alexithymia in adult patients with psoriasis. The observed prevalence of alexithymia in patients with psoriasis ranges between 15·6% and around 33% . Our study showed that patients with psoriasis with difficulty in identifying and expressing emotions were characterized by high psoriasis burden, including markedly reduced quality of life, high prevalence of anxiety and depression, and high risk of alcohol dependency.…”

“…To our knowledge, this is the first longitudinal study evaluating the change in the ability of patients with psoriasis to identify and describe emotions during treatment. In fact, the existing studies were cross‐sectional . Only a longitudinal design may allow evaluation of changes over time and evaluation of the complex association between alexithymia, disease severity and disease burden.…”

The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review

“…Alexithymia is also defined as a personality trait which manifests itself in comorbidity with different physical and psychopathological disorders (Lumley et al, 2005 , 2007 ; Mattila et al, 2009 ; Honkalampi et al, 2010 ; Tolmunen et al, 2011 ; Marchetti et al, 2019 ) and retained as a transient variable state related to both psychopathological conditions and stress levels (Pollatos et al, 2011 ). Also, alexithymia seems to be involved in the pathogenetic mechanism of several somatic illness (Porcelli et al, 1996 ; Willemsen et al, 2008 ; Mazaheri et al, 2012 ; Talamonti et al, 2016 ; Marchi et al, 2019 ; Martino et al, 2020c ) and it appears to be associated with depression and anxiety in patients with type 2 diabetes (T2DM) (Friedman et al, 2003 ; Luminet et al, 2006 ; Pouwer et al, 2010 ; Sapozhnikova et al, 2012 ; Shinkov et al, 2018 ). Alexithymia and psychological distress, as anxiety and depression, may impair patient's compliance and adherence, concurring in a worst clinical presentation and course of a chronic disease (Sapozhnikova et al, 2012 ; Hintistan et al, 2013 ; Mnif et al, 2014 ; Stanton and Hoyt, 2017 ; Marchini et al, 2018 ; Settineri et al, 2019 ; Vicario and Martino, 2020 ; Vicario et al, 2020 ; Vita et al, 2020 ).…”