Assessing Alexithymia and Type A Behavior in Coronary Heart Disease Patients: A Multimethod Approach

Abstract

Background: Despite increasing emphasis on using multiple methods to assess personality constructs in psychosomatic research, previous investigations of relations between alexithymia and type A behavior (TAB) have been limited by the use of single methods of measurement and almost no attempt to assess subcomponents of TAB. The aims of this study were to (1) evaluate levels of agreement between structured interview assessments of alexithymia, TAB, hostility, and time urgency and well-established self-report measures of these constructs, and (2) explore relations between alexithymia and TAB and its subcomponents in patients with coronary heart disease (CHD). Methods: 62 CHD patients were investigated 6 weeks after coronary angioplasty. Alexithymia was assessed with the Diagnostic Criteria for Psychosomatic Research (DCPR) and the 20-item Toronto Alexithymia Scale (TAS-20). TAB was assessed with the DCPR and the Short Form of the Jenkins Activity Survey Type A scale (JAS-SF). Time urgency was assessed with the DCPR and the Speed/Impatience scale of the Jenkins Activity Survey (JAS-S), and hostility was assessed with the DCPR and the Hostility subscale of the Revised Symptom Checklist-90 (SCL-HOS). Results: The DCPR classifications showed reasonably high levels of agreement with the TAS-20 and JAS-SF classifications of alexithymia and TAB, but lower levels of agreement in identifying patients with high hostility on the SCL-HOS and high time urgency on the JAS-S. Alexithymia measured by both the DCPR and the TAS-20 was unrelated to both self-report and structured interview measures of TAB, hostility, and time urgency. Conclusions: The DCPR is a suitable screening instrument for assessing alexithymia and TAB, although the two constructs are unrelated.

Quality of Life in Coronary Heart Disease Patients: The Role of Defense Mechanisms and Alexithymia with Mediation of Psychological Distress

“…In addition, the results showed that alexithymia is indirectly involved in predicting QOL in patients with CHD with the mediating role of psychological distress. These findings are consistent with previous studies (7,15,20,41). To explain these findings, it has been argued that alexithymia increases misconceptions of the patients about their disease and results in deteriorated of QOL (41).…”

“…Alexithymia refers to disability in identifying, processing, or describing feelings, and difficulty in differentiating feelings with physical and emotional arousal (15). Alexithymia is generally associated with health problems such as heart diseases (20,21). Moreover, alexithymia can disrupt QOL in patients with physical diseases (22).…”

The Illness Attitude Scales

“…By contrast, conscientiousness was related to the adoption of healthy attitudes measured by the health habits scale [53]. Alexithymia, the inability to use appropriate words to describe emotions with a resulting utilitarian way of thinking [82,83,84,85,86,87], also showed a positive relationship with the IAS scores [46, 88]. These results were found both in normal subjects and in clinical samples recruited in medical or psychiatric settings.…”

Psychosomatic Assessment

“…Not surprisingly, psychological assessment with DCPR was found to be more suitable than DSM-IV criteria in identifying somatization in patients with functional gastrointestinal disturbances or cardiac disease [76]. Further, the use of DCPR has disclosed that not all coronary artery disease patients display type A behavior, and, vice versa, that type A behavior is present in other settings including dermatology, gastroenterology, cancer patients and frequent attenders of primary care [48, 77, 78]. …”