Depression, Alexithymia, and Pain Prone Disorder: A Rorschach Study

Abstract

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.

Ego Defensive Styles and Alexithymia: A Discriminant Validation Study

“…Aklin [23] and Bernat have recently reported data utilizing a cogni tive behavioral framework to support this observation. They suggest that the alexi thymie individual is handicapped in coping with an affective response and thus tends to somatize when faced with a dilemma that would foster dysphoria such as lower back pain.…”

The Assessment of Alexithymia in Medical Settings: Implications for Understanding and Treating Health Problems

“…Several indexes from the Exner system (2003) have been proposed, such as low response productivity and low human movement suggesting poor fantasy ability, low numbers of blends suggesting concrete thought, and limited use of color indicating reduced affectivity. A few studies have found that these indexes are related to illness (Acklin & Alexander, 1988;Acklin & Bernat, 1987) and obesity (Clerici, Albonetti, Papa, Penati, & Invernizzi, 1992). More recently, Porcelli and Meyer (2002) furthered this line of Rorschach research and demonstrated that alexithymic participants (as identified by self-report) were more likely to show an impoverished fantasy life, poorly adapted emotional expression, poor coping resources, concrete and stereotypical thinking, and social conformity with compromised relationships.…”

Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators

“…In summary, three descriptive or cross-sectional studies using instruments of limited psychometric quality showed a positive association between alexithymia and LBP, and one clinical trial showed delayed recovery from chronic LBP in alexithymic patients [31][32][33][34][35] . More recent studies found a cross-sectional association of the difficulty identifying feelings with fibromyalgia 36 , an association between alexithymia and acute experimental pain tolerance in healthy students 29 , and a cross-sectional association of alexithymia with chronic pain in locations other than the low back but not in patients with chronic LBP 37 .…”