Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature

Abstract

Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients' ability to benefit from the adopted interventions. For this reason, in the last years new treatment approaches targeting emotion identification, expression, and regulation have been applied and tested. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted.

Exploring changes in alexithymia throughout intensive dialectical behavior therapy for eating disorders

“…Notably, reliable change analyses indicated that only 25% of the sample reported reliable decreases in symptoms from intake to discharge. Altogether, these results are generally consistent with the conclusions from a recent review on alexithymia within treatment for anorexia nervosa (Gramaglia et al., 2020) and other forms of psychopathology (Cameron et al., 2014), which suggest small changes in alexithymia over the course of treatment. Our findings represent the first investigation of changes in alexithymia in a DBT‐informed EDs programme, although it is important to note that we cannot attribute changes in alexithymia to DBT, given that this was a naturalistic study without a control group and our findings may be accounted for by regression to the mean.…”

“…Within EDs, research on alexithymia within the context of treatment is limited (Gramaglia et al., 2020). A recent review of a small body of existing work (i.e., n = 11 studies) suggests that alexithymia may relate to worse outcomes at discharge (Vrieze, 2018) and follow‐up (Speranza et al., 2007), but is somewhat amenable to intervention (Becker‐Stoll & Gerlinghoff, 2004; Gramaglia et al., 2020; Tchanturia et al., 2015). A recent paper from our group suggested that alexithymia had a unique impact on emotion dysregulation over time in individuals with anorexia nervosa (Brown, Avery, et al, 2018).…”

“…Of note, work on alexithymia across clinical samples suggests that while alexithymia may remain relatively stable over time (Tolmunen et al., 2011), it is ‘partially modifiable’ when targeted using psychological intervention (Cameron et al., 2014). Within EDs, research on alexithymia within the context of treatment is limited (Gramaglia et al., 2020). A recent review of a small body of existing work (i.e., n = 11 studies) suggests that alexithymia may relate to worse outcomes at discharge (Vrieze, 2018) and follow‐up (Speranza et al., 2007), but is somewhat amenable to intervention (Becker‐Stoll & Gerlinghoff, 2004; Gramaglia et al., 2020; Tchanturia et al., 2015).…”

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

“…Moreover, alexithymic characteristics were found in various clinical conditions characterized by a disordered affect regulation ( 5 ), such as depression ( 16 ), self-harm and suicidality ( 17 – 19 ), schizophrenia ( 20 ), eating disorders ( 21 , 22 ), substance use disorder ( 23 ) and autism spectrum disorder ( 24 , 25 ). Hence, alexithymia started to be considered a non-specific vulnerability factor involved in the development of physical and mental disorders as well as a specifier associated with adverse outcomes when treating such conditions [see e.g., ( 26 , 27 )]. Concurrently, alexithymia was associated with several medical conditions such as diabetes, cancer or chronic illnesses ( 28 – 30 ).…”

Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment

“…Thus, this study aims to evaluate whether general and specific psychopathology is worsened by the presence of alexithymia, as the current literature suggests (Gramaglia et al, 2020), and to determine if a multidisciplinary inpatient treatment for EDs can reduce alexithymia and dissociation. Finally, we aim to point out possible relationships among specific and general psychopathological target variables.…”