Alexithymia and somatization in depressed patients: The role of the type of somatic symptom attribution.
Introduction: This study aimed to establish the association between alexithymia and various factors, mainly somatization, and to determine the predictors of alexithymia in depressed patients.
Methods: A total of 90 patients with major depressive disorder who met The Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (DSM-IV) diagnostic criteria were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory, Symptom Checklist-90 (SCL-90), Somatosensory Amplification Scale, and Symptom Interpretation Questionnaire. The patients were classified into two groups as alexithymic and non-alexithymic with respect to the TAS cut-off points ([greater than or equal to]59=alexithymic). Predictors of alexithymia were tested by multiple linear regression analysis.
Results: Of all patients, 36 (40%) were in the alexithymic group. The percentage of women, depression severity, level of general psychopathology and distress, and somatic symptom reporting (SCL-90), as well as the tendency to somatosensory amplification and three forms of somatic symptom attributions, were significantly higher in alexithymic patients than in non-alexithymic patients. Furthermore, age, depression severity, somatic symptom reporting, and the tendency to attribute physical symptoms to somatic causes were predictors of alexithymia.
Conclusion: The results indicated an intimate association between alexithymia and somatization in depressed patients. Therefore, when evaluating depressed patients with alexithymia, their tendency for somatization should be considered, and alexithymic individuals should be assessed with particular attention, considering that somatization can mask the underlying depressive condition.
Keywords: Depression, alexithymia, somatization, somatic symptom attribution
Alexithymia was first defined by Sifneos in 1973 based on observations of patients undergoing dynamic psychotherapy Sifneos pointed out that some patients, particularly those suffering from psychosomatic diseases, showed marked difficulty during therapy in describing and differentiating their feelings; these patients were unable to find appropriate words to express their feelings during therapy These patients had poverty of fantasy life and were focused on the realities of the world around them rather than on their emotions. Sifneos defined this as a personality trait and coined the word "alexithymia" (from Greek a([alpha]-)=lack; lexis([lambda][epsilon][xi][iota][zeta])=word; thymos([theta][upsilon][micro][omicron][xi])=a mood or emotion) (1). Thisdefinition does not denote that alexithymic individuals have no emotions; it means that they have difficulty symbolizing and distinguishing between feelings (2).
Although many studies have indicatedan association between alexithymia and depression, it is still debated whether these two concepts are independent and distinct or whether they overlap (3,4). While some studies support the opinion that alexithymia and depression are separate concepts, others stress that they overlap or that they co-exist (5,6,7,8,9). This controversy is significant, as it is critical in establishing whether alexithymia is a personality trait; in other words, if it is a permanent phenomenon (unlike and separate from depression) or a secondary condition developed in response to various psychological stresses (overlapping with depression), as initiallyproposed by Freyberger (10).
To date, several studies have investigated the factors associated with alexithymia. These factors include sociodemographic characteristics (age, gender marital status, and education level), depression severity general psychopathology and distress level, somatic symptom reporting, somatosensory amplification, and attribution styles of physical symptoms (3,4,11,12,13,14,15,16,17,18,19,20).
Somatosensory amplification refers to the tendency to experience normal somatic sensations as intense, noxious, and disturbing; it is proposed to be associated with various somatization presentations, particularly hypochondriasis (13,19). The attribution styles of somatic symptoms refer to the individual's interpretation of a given somatic sensation. Thus, individuals either attribute a physical sensation to causative factors, such as lack of sleep, weather conditions, or tiredness, to perceive it as normal, or they regard the sensation as a pathological condition by relating it to psychological or physical abnormalities (21). The studies conducted to date have indicated multiple associations of alexithymia and depression; this complicates diagnosis, as it affects the clinical presentation (20). The difficulties of evaluating these patients and misdiagnosis inevitably lead to the administration of inappropriate and inefficient therapies. Furthermore, costly and superfluous examinations conducted for diagnostic purposes not only result in overuse of healthcare resources but also create a considerable burden on healthcare expenditure. The present study aimed to determine the predictors of alexithymia and investigate the relationships between alexithymia in depressed patients and various sociodemographic characteristics, somatic symptom reporting, somatosensory amplification tendency general level of symptoms, interpretation of somatic symptoms, and depression severity.
Patients presenting at istanbul University Cerrahpasa School of Medicine Hospital, General Psychiatry Outpatient Unit, diagnosed with a major depressive disorder according tothe Major Depressive Episode sectionof the StructuredClinicallnterviewfor DSM-IV Axis I Disorders, ClinicalVersion (SCID-I) were included in the study Of the 95 eligible patients, five declined the invitation to participate. Allpatientsprovidedwritteninformed-consent, and the study was approved by the Ethics Committee of istanbul University Cerrahpasa School of Medicine.
1) Sociodemographic data form: This form was designed by the investigators to record the basic social and demographic characteristics of the participants.
2) SCID-I, Major Depressive Episode section: The SCID-l was developed by First et al. (22); the Major Depressive Episode section was used in our study. The interview was adapted for the Turkish population by Corapgoglu et al. (23).
3) Toronto Alexithymia Scale (TAS-20): This 20-item self-report instrument uses a five-point Likert scale to investigate alexithymia severity The validity and reliability of the Turkish version of the scale, which was invented by Bagby et al. (24), was determined by Gulec et al. (25). The scale, in addition to the general alexithymia score, consists of three subscales reflecting the three main aspects of alexithymia: difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. However, only the general alexithymia score was calculated in this study because the validity and reliability assessment as well as our design did not support the three-subtype structure (the data regarding factor analysis are not given). In the study conducted by Gulec and Yenel (26), the cutoff point was established to be 59 for the Turkish version of the scale;patients with scores of 59 and above were regarded to be alexithymic.
4) Symptom Checklist-90 (SCL-90): This self-rating psychiatric inventory was developed by Derogatis et al. (27) In addition to the "global severity index," which helps to establish the general stress level of an individual, there are nine subscales: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The reliability and validity of the Turkish version of the scale were established by Dag et al. (28)
5) Beck Depression Inventory (BDI): This 21-question self-report inventory measures the physical, emotional, and motivational symptoms of depression with a rating system of 0 to 3 for each item. The validity and reliability of the Turkish version of the BDI, which was originally developed by Becket al. (29), were determined by Hisli (30).
6) Somatosensory Amplification Scale (SSAS): This five-point-Likert scale of 10 items was developed by Barsky et al. (31) to investigate an individual's tendency to amplify common somatic sensations. Its validity and reliability in Turkish have been established (32).
7) Symptom Interpretation Questionnaire (SIQ): This self-report scale evaluates the interpretation of common physical symptoms in terms of somatization, psychologization, and normalization. The scale evaluates the approach used to interpret physical symptoms and their frequency by assigning points to each answer. The scale was developed by Robbins and Kirmayer (33); two major changes were made when it was translated into Turkish (34). Firstly, instead of a four-point Likert scale, a five-point Likertscale was used, as five points are more commonly used in Turkish scales. Secondly while the original scale contained 13 common somatic symptoms, a 14th item was added to the Turkish version: "tightness in the chest," a common idiom of distress in Turkish immigrants as reported in a study conducted by Mirdal (35). The Turkish version of the scale in its adapted format was established to have Cronbach's alpha values of 0.87, 0.87, and 0.86 for somatization, psychologization, and normalization, respectively. The values for the present study were 0.79, 0.86, and 0.80, respectively.
All variables were found to be reasonably normal based on the Kolmogorov-Smirnov test. The Pearson correlation test was used to evaluate continuous variables. The participants were categorized into two groups with respect to their TAS scores (TAS score of [greater than or equal to]59: alexithymic, TAS score of <59: non-alexithymic). The Chi-square test was used for ratios, and Student's t test was used for numerical values and clinical characteristics. Multiple regression analysis was used to determine independent associations of alexithymia. A regression model was developed by including sociodemographic variables, such as age and education level, as well as all three attribution styles (somatization, psychologization, and normalization) and the most commonly investigated clinical parameters, such as level of depression, physical symptom level, and tendency of somatosensory amplification. Variance inflation factors were calculated to check for multicollinearity among the determinants in the regression analyses. All analyses were conducted with Statistical Package for the Social Sciences for Windows, version 16.0 (SPSS Inc.; Chicago, IL, USA) and all statistical tests were evaluated with a significance level of p<0.05.
Of the 90 patients in the study 55 (61.1%) were female. The mean age was 35.0[+ or -]11.43 years, and the mean education level was 9.81[+ or -]3.60school years. Fifty-four (60.0%) participants were married. The mean score on the TAS-20 in the group was 56.07[+ or -]9.59. The alexithymicgroup consisted of 36 (40%) patients who had TAS-20 scores of 59 and above. There were no statistically significant differences between the groups in terms of sociodemographic variables (age, education level, marital status), except for a higher number of femalesin the alexithymic group (Table 1).
Comparison of the groups in terms of clinical characteristics revealed that all data, except for those from the SCL-90 phobic anxiety subscale, were significantly higher in the alexithymic group (Table 2). Thus, the depression severity, level of general psychopathology and distress, tendency to somatosensory amplification, and tendency to interpret somatic sensations by somatic, psychological, or normal causes were significantly higher in alexithymic patients than in non-alexithymic patients.
The bivariate correlation analysis between alexithymia scores and age and education level showed no significant correlation. However there were significant correlations between alexithymia score and depression severity somatization level, somatosensory amplification, somatic symptom reporting, somatization, psychologization, and normalization subscale scores for all the patients (Table 3). When multiple logistic regression analyses, consisting of sociodemographic and clinic variables from the bivariate analysis, were conducted, the age, depression severity, somatization level, and SIQ somatization subscale scores were independently correlated with alexithymia (Table 3).
The number of patients in the alexithymic group was 36 (40%) in the present study. Studies conducted in various clinical settings have reported ratios varying between 21% and 42.2% (3,13,18). A study on 169 patients with depression reporteda ratio of 39% (7). Therefore, the ratio established in the present study was observed to be consistent with the literature. In contrast, studies conducted on non-clinical samples have reported lower ratios, as expected (between 8.1% and 10.3%) (4).
The mean values for all the clinical evaluation parameters used in this present study were observed to be higher in the alexithymic group; the only exception was the scores from the phobic anxiety subscale of the SCL-90, where a statistical significance level was not reached. Several investigators have examined the associations between alexithymia and the psychopathologies evaluated in the subscales of the SCL-90 as well as distress level; significant differences were observed in alexithymic patients compared with non-alexithymic patients (13).
Alexithymic patients reportedly have difficulty identifying underlying psychological stress and their emotions; therefore, these patients concentrate on physical sensations rather than the affective components of their emotions. Consequently, it is claimed that these patients express psychological stress alternatively through somatization (2). In fact, many epidemiological and clinical studies have demonstrated a significant association between alexithymia and somatic symptom reporting, and it was suggested that alexithymia was a potential factor inthe somatization (15,36,37). A study conducted in our country reported that childhood trauma rates were higher in patients with depression accompanied with alexithymia and that alexithymia contributed to the emergence of somatic symptoms in depression (16). In contrast, "tendency to somatosensory amplification" which is one of the concepts suggested to explain somatization, is defined as the tendency to experience normal somatic and visceral sensations as intense, noxious, and disturbing; it was linked to alexithymia in studies including patients with chronic pain, functional dyspepsia, and depression, as well as in samples with various psychiatric disorders (13,17,18,19,31,38). In the present study both the tendency to somatosensory amplification and somatic symptom reporting were significantly higher in alexithymic patients with depression than in non-alexithymic patients. As these results indicate a close association between alexithymia and somatization, when evaluating depressed patients with alexithymia, their tendency toward somatization should be taken into consideration.
Another factor believed to play a role in somatization is the interpretation of physical symptoms. During the somatization process, it is critically important how an individual interprets somatic sensations and to what they are attributed. Robbins and Kirmayer (33) maintained that individuals interpret a given somatic sensation in three ways: somatization, psychologization, and normalization. In our study, all three ways of interpreting sensations were significantly more common in the alexithymic depression group than in the non-alexithymicgroup. We can conclude from this result that alexithymic depressed patients attempt to normalize psychic stress and also perceive it as a pathology by attributing it to psychological and somatic causes. In a study conducted by Wise and Mann (18) on 100 patients presenting at a psychiatry outpatient clinic, alexithymic patients were observed to be more inclined to attribute somatic sensations to psychological causes compared with non-alexithymic patients; it was also noted that there were no statistically significant differences between the groups in terms of attribution to somatic and normal causes. The result observed in this present study may be due to the fact that, in contrast to Western countries, patients in Turkey can directly present themselvesto psychiatric clinics without referral by primary care physicians. Patients in Turkey can personally decide whether their somatic sensations are associated with psychological or physical causes and, accordingly, can consult a psychiatrist or another specialist. It appears that the patients in this present study sought help in different ways for their somatic sensations, attributing them to more than one factor (normalization, somatization, and psychologization); alexithymia, by definition, may have reinforced this condition. A study conducted in our country reported that patients seeking extramedical help hadgreater difficulty in describing theirfeelings and a greatertendency to consult other medical doctors; alexithymia was found to contribute to their help-seeking behaviors (39).
In our study no significant differences were observed between the patients in the alexithymic group and those in the non-alexithymic group in terms of age, marital status, or education level; however there were more female patients in the alexithymic group. In the literature, some studies are consistent with our results, while other studies report significant correlations with alexithymia and male sex, older age, low level of education, and lower socioeconomic level (11,12,40,41).The correlation between alexithymia and sociodemographic variables remains a controversial issue and, due to conflicting results, it has not been possible to draw a firm conclusion. However the higher number of female patients in the alexithymic group in our study is in contrast with studies where more alexithymic patients are male; our study is noteworthy in this regard. A higher level of somatic symptom reporting in women has been demonstrated in several studies (42). Considering the finding supporting the close relationship between alexithymia level and somatization in our study higher levels of alexithymia in women may be associated with a tendency toward somatization. However cross-sectional studies are not sufficient to demonstrate this causal relationship; longitudinal studies are required.
The regression analysis established the predictors of alexithymia in depressed patients as age, level of depression, physical symptom reporting, and attribution of somatic sensations to physical causes. In the literature, most studies report a linear correlation between age and alexithymia and an increase in the level of alexithymia with age. However, in this study, alexithymia score and age and education level were not significantly correlated in the bivariate correlation analysis; younger age wasfound to be an independent predictor of alexithymia level in the regression model. This result is noteworthy because it indicates that the relationship between age and alexithymiais affected by many factors. Honkalampiet al. (4) reported in their wide-scale study conducted on 2018 patients with depression that depression severity was a predictor of alexithymia. In other studies, the level of depression was reported to be higher in alexithymic patients (43,44). In our study, depression severity was a predictor of alexithymia. Accordingly, our result reinforces the idea that alexithymia may be a temporary condition secondary to depression rather than a personality trait (45,46). However, the cross-sectional nature of the study does not allow definitive conclusionson this issue, and the results should be considered to be case-specific and supportive.
As described above, it is hypothesized that alexithymic individuals have difficulty verbalizing their emotions, leading to somatization. Therefore, it may be claimed that these individuals attribute vague somatic sensations to physical causes. In fact, this study established physical symptom reporting and attribution of somatic sensations to physical causes as the other two predictors of alexithymia. Kirmayer and Robbins (36) reported in their study conducted on 244 patients who presented to primary care physiciansthat the tendency to attribute somatic sensations to psychological causes was a predictor of alexithymia, while the level of physical symptoms was not. However, our results are consistent with the hypothetical relationship between alexithymia and somatization. In contrast, it is notable that relationships between alexithymia and the other two methods of interpretation (psychologization and normalization) were not observable in the regression model. Therefore, we maintain that as all three methods of interpretation were more pronounced in the alexithymic group, there is a risk of initially reaching a wrong conclusion. Consequently, it is essential to conduct further statistical analyses.
This study had several limitations. First, the study group consisted of patients presenting at a university hospital providing tertiary care. As mentioned above, it is possible for patients in Turkey to directly resort to psychiatric outpatient clinics, including those at university hospitals, without referral from a primary care physician. Therefore, our study group can be regarded as a mixed group of patients presenting at primary and tertiary care clinics. This fact prevents us from reaching generalized conclusions and does not allow us to make definitive deductions. Secondly, because this study was cross-sectional, causality could not be clearly established. Another limitation of our study is the small sample size. Longitudinal studies with larger sample sizes are needed to clarify the contribution of alexithymia to depression and somatization.
The results of this study revealed a strong correlation between alexithymia and somatization in depressed patients. Therefore, when evaluating depressed patients with alexithymia, their tendency toward somatization should be taken into consideration, and alexithymic individuals should be assessed with particular attention during diagnosis and therapy because somatization can camouflage an underlying depressive condition.
Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committee of istanbul University Cerrahpasa School of Medicine.
Informed Consent: Written informed consent was obtained from patients who participated in this study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept - O.T; Design - O.T; Supervision - O.T, A.O.; Resources - O.T, A.O., S.E.T; Materials - O.T, A.O.; Data Collection and/or Processing - O.T, A.O.; Analysis and/or Interpretation - O.T, A.O., S.E.T; Literature Search - O.T, A.O., S.E.T; Writing Manuscript - O.T, A.O., S.E.T; Critical Review - O.T, A.O., S.E.T.; Other - O.T., A.O., S.E.T.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: This study was supported by a research grant by TUBI-TAK to the first author (O.T).
(1.) Sifneos PE. The prevalence of "alexithymic" characteristics in psychosomatic patients. Psychother Psychosom 1973; 22:255-262. [CrossRef]
(2.) Kirmayer LJ. Languages of suffering healing: alexithymia as a social and cultural process. Transcult Psychiatry 1987; 24:119-136. [CrossRef]
(3.) Saarijarvi S, Salminen JK, Tamminen T Aarela E. Alexithymia in psychiatric consultation-liason patients. Gen Hosp Psychiatry 1993; 15:330-333. [CrossRef]
(4.) Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamaki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res 2000; 48:99-104. [CrossRef]
(5.) Lipsanen T, Saarijarvi S, Lauerma H. Exploring the relations between depression, somatization, dissociation and alexithymia-overlapping or independent constructs? Psychopathology 2004; 37:200-206. [CrossRef]
(6.) Salminen JK, Saarijarvi S, Toikka TKauhanen J, Aarela E. Alexithymia behaves as a personality trait over a 5-year period in Finnish general population. J Psychosom Res 2006; 61:275-278. [CrossRef]
(7.) Honkalampi K, Hintikka J, Saarinen P Lehtonen J, Viinamaki H. Is alexithymia a permanent feature in depressed patients? Psychother Psychosom 2000; 69:303-308. [CrossRef]
(8.) Saarijarvi S, Salminen JK, Toikka T. Temporal stability of alexithymia over a five year period in outpatients with major depression. Psychother Psychosom 2006; 75:107-112. [CrossRef]
(9.) Honkalampi K, Koivumaa-Honkanena H, Lehto SM, Hintikka J, Haatainen K, Rissanen T Viinamaki H. Is alexithymia a risk factor for major depression, personality disorder or alcohol use disorders? A prospective population-based study. J Psychosom Res 2010; 68:269-273. [CrossRef]
(10.) Freyberger H. Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother Psychosom 1977; 28:337-342. [CrossRef]
(11.) Lane RD, Sechrest L, Riedel R. Sociodemographic correlates of alexithymia. Compr Psychiatry 1998; 39:377-385. [CrossRef]
(12.) Salminen JK, Saarijarvi S, Aarela E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res 1999; 46:75-82. [CrossRef]
(13.) Jones MP, Schettler A, Olden K, Crowell MD. Alexithymia and somatosensory amplification in functional dyspepsia. Psychosomatics 2004; 45:508-516. [CrossRef]
(14.) Leweke F, Leichsenring F, Kruse J, Hermes S. Is Alexithymia Associated with Specific Mental Disorders. Psychopathology 2012; 45:22-28. [CrossRef]
(15.) De Gucht V Heiser W. Alexithymia and somatisation: a quantitative review of the literature. J Psychosom Res 2003; 54:425-434. [CrossRef]
(16.) Gulec MY, Altintas. M, inanc L, Bezgin CH, Koca EK, Gulec H. Effects of childhood trauma on somatization in major depressive disorder: The role of alexithymia. J Affective Disord 2013; 146:137-141. [CrossRef]
(17.) Kosturek A, Gregory RJ, Sousou AJ, Trief P Alexithymia and somatic amplification in chronic pain. Psychosomatics 1998; 39:399-404. [CrossRef]
(18.) Wise TN, Mann LS. The attribution of somaticsymptoms in psychiatric outpatients. Compr Psychiatry 1995; 36:407-410. [CrossRef]
(19.) Nakao M, Barsky AJ, Kumano H, Kuboki T Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic. Psychosomatics 2002; 43:55-60. [CrossRef]
(20.) Duddu V Chaturverdi SK, Isaac MK. Amplification and attribution styles in somatoform and depressive disorders - a study from Banglore, India. Psychopathology 2003; 36:98-103. [CrossRef]
(21.) Gulec H, Sayar K, Ozkorumak E. Depresyonda bedensel belirtiler. Turk Psikiyatri Derg 2005; 16:90-96.
(22.) First MB, Spitzer RL Gibbon M, Williams JBW Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington DC. American Psychiatric Press;1997.
(23.) Corapcioglu A, Aydemir A, Yildiz M, Esen A, Koroglu E. DSM-IV Eksen I Bozukluklari (SCID-I) icin Yapilandirilmis Klinik Gorusme Turkce Versiyonu. Ankara. Hekimler Yayin Birligi; 1999.
(24.) Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia-I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38:23-32. [CrossRef]
(25.) Gulec H, Kose S, Gulec MY Qtak S, Evren C, Borckardt J, Sayar K. Yirmi soruluk Toronto aleksimi olceginin Turkce uyarlamasinin gecerlik ve guvenirliginin incelenmesi. Klin Psikofarmakol Bul 2009; 19:214-220.
(26.) Gulec H, Yenel A. 20 Maddelik Toronto Aleksitimi Olcegi Turkce Uyarlamasinin Kesme Noktalarina Gore Psikometrik Ozellikleri. Klin Psikiyatr Derg 2010; 13:108-112.
(27.) Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report inventory. Behav Sci 1974; 19:1-15. [CrossRef]
(28.) Dag I. Belirti tarama listesi (SCL-90-R)1nin universite ogrencileri icin guvenirligi ve gecerligi. Turk Psikiyatri Derg 1991; 2:5-12.
(29.) Beck AT Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571. [CrossRef]
(30.) Hisli N. Beck Depresyon Envanterinin universite ogrencileri icin gecerligi, guvenirligi. Turk J Psychol 1989; 7:3-13.
(31.) Barsky AJ, Goodson JD, Lane RS, Cleary PD. The amplification of somatic symptoms. Psychosom Med 1988; 50:510-519. [CrossRef]
(32.) Gulec H, Sayar K, Yazici Gulec M. Bedensel Duyumlari Abartma Olcegi Turkce Formunun Gecerlik ve Guvenirligi. Dusunen Adam 2007; 20:16-24.
(33.) Robbins JM, Kirmayer LJ. Attributions of common somatic symptoms. Psychol Med 1991; 21:1029-1045. [CrossRef]
(34.) Duman OY, Usubutun S, Goka E. Validity and reliability of theTurkish form of symptom interpretation questionnaire. Turk Psikiyatri Derg 2004; 15:26-40.
(35.) Mirdal GM. The condition of "tightness": the somatic complaints of Turkish migrant women. Acta Psychiatr Scand 1985; 71:287-296. [CrossRef]
(36.) Kirmayer LJ, Robbins JM. Cognitive and social correlates of the Toronto Alexithymia Scale. Psychosomatics 1993; 34:41-52. [CrossRef]
(37.) Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, Joukamaa M. Alexithymia and somatization in general population. Psychosom Med 2008; 70:716-722. [CrossRef]
(38.) Sayar K, Kirmayer LJ, Taillefer SS. Predictors of somatic symptoms in depressive disorder Gen Hosp Psychiatry 2003; 25:108-M4. [CrossRef]
(39.) Ozkorumak E, Gulec H, Kose S, Borckardt J, Sayar K.Depresyon Hastalarinda Tip Disi Yardim Arama Davranisi: Aleksitimi Bir Etken Olabilir mi? Klin Psikiyatr Derg 2006; 9:161-169.
(40.) Mason O, Tyson M, Jones C, Potts S. Alexithymia: its prevalence and correlates in a British undergraduate sample. Psychol Psychother 2005; 78:113-125. [CrossRef]
(41.) Moriguchi Y, Maeda M, Igarashi T, Ishikawa T, Shoji M, Kubo C, Komaki G. Age and gender effect on alexithymia in large, Japanese community and clinical samples: a cross-validation study of the Toronto Alexithymia Scale (TAS-20). Biopsychosoc Med 2007; 6:1-7. [CrossRef]
(42.) Wool CA, Barsky AJ. Do women somatize more than men? Gender differences in somatization. Psychosomatics 1994; 35:445-452. [CrossRef]
(43.) Conrad R, Wegener I, Imbierowicz K, Liedtke R, Geiser F. Alexithymia, temperament and character as predictors of psychopathology in patients with major depression. Psychiatry Res 2009; 165:137-144. [CrossRef]
(44.) Celikel FC, Kose S, Erkorkmaz U, Sayar K, Cumurcu BE, Cloninger CR. Alexithymia and temperament and character model of personality in patients with major depressive disorder. Compr Psychiatry 2010; 51:64-70. [CrossRef]
(45.) Saarijarvi S, Salminen JK, Toikka TB. Alexithymia and depression: a 1-year follow-up study in outpatients with major depression. J Psychosom Res 2001; 51:729-733. [CrossRef]
(46.) Marchesi C, Bertoni S, Cantoni A, Maggini C. Is alexithymia a personality trait increasing the risk of depression? A prospective study evaluating alexithymia before, during and after a depressive episode. Psychol Med 2008; 38:1717-1722. [CrossRef]
Okan TAYCAN (1), Armagan OZDEMIR (2), Serap ERDOGAN TAYCAN (1)
(1) Clinic of Psychiatry, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
(2) Clinic of Psychiatry, Bakirkoy Prof. Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
Correspondence Address: Armagan Ozdemir Bakirkoy Ruh ve Sinir Hastaliklari Egitim ve Arastirma Hastanesi, Psikiyatri Klinigi, istanbul, Turkiye E-posta: firstname.lastname@example.org
Table 1. Comparison of the groups in terms of sociodemographic characteristics (n=90) Alexithymic Non-alexithymic group group (TAS[greater than or equal to]59) (TAS<59) (n=36) (n=54) Mean[+ or -]standard Mean[+ or -]standard deviation deviation Age 32.41[+ or -]10.02 36.74[+ or -]12.06 Education level 9.52[+ or -]4.05 10.00[+ or -]3.29 (school years) N (%) N (%) Gender Female 27 (75%) 28 (51.9%) Male 9 (25%) 26 (48.1%) Marital status Married 20 (55.6%) 34 (63.0%) Evli degil 16 (44.4%) 20 (37.0%) t (d.f.) p Age 1.77 (88) 0.079 Education level 0.60 (88) 0.545 (school years) [chi square] (d.f.) Gender Female 4.87 (1) 0.030 Male Marital status Married 0.49 (1) 0.516 Evli degil TAS: Toronto Alexithymia Scale; t: Students t test; [chi square]: Chi square test Table 2. Comparison of the clinical characteristics of the groups (n=90) Alexithymic group (TAS[greater than or equal to]59) (s=36) Mean[+ or -]standard deviation Beck Depression Inventory 27.91[+ or -]8.59 Symptom Checklist-90 Global Severity Index 1.95[+ or -]0.51 Positive Symptom Total 69.02[+ or -]12.68 Positive symptom Distress Index 2.54[+ or -]0.48 Subscales: somatization 1.97[+ or -]0.80 Obsessive-compulsive 2.13[+ or -]0.55 Interpersonal sensitivity 2.26[+ or -]0.76 Depression 2.44[+ or -]0.68 Anxiety 1.84[+ or -]0.75 Hostility 2.41[+ or -]0.99 Phobic anxiety 1.02[+ or -]0.69 Paranoid ideation 1.99[+ or -]0.80 Psychoticism 1.41[+ or -]0.59 Symptom Interpretation Questionnaire Somatization 36.44[+ or -]8.98 Psychologization 45.77[+ or -]10.78 Normalization 38.11[+ or -]9.99 Somatosensory Amplification Scale 30.61[+ or -]5.28 Non-alexithymic group (TAS<59) (s=54) Mean[+ or -]standard deviation Beck Depression Inventory 21.09[+ or -]8.47 Symptom Checklist-90 Global Severity Index 1.41[+ or -]0.62 Positive Symptom Total 59.40[+ or -]16.18 Positive symptom Distress Index 2.08[+ or -]0.51 Subscales: somatization 1.44[+ or -]0.79 Obsessive-compulsive 1.64[+ or -]0.70 Interpersonal sensitivity 1.51[+ or -]0.73 Depression 1.86[+ or -]0.81 Anxiety 1.32[+ or -]0.74 Hostility 1.52[+ or -]0.93 Phobic anxiety 0.77[+ or -]0.72 Paranoid ideation 1.38[+ or -]0.70 Psychoticism 0.92[+ or -]0.63 Symptom Interpretation Questionnaire Somatization 30.05[+ or -]8.85 Psychologization 37.55[+ or -]10.53 Normalization 33.66[+ or -]8.82 Somatosensory Amplification Scale 27.51[+ or -]7.33 t (d.f.) p Beck Depression Inventory 3.72 (88) 0.000 Symptom Checklist-90 Global Severity Index 4.31 (88) 0.000 Positive Symptom Total 3.00 (88) 0.003 Positive symptom Distress Index 4.27 (88) 0.000 Subscales: somatization 3.04 (88) 0.003 Obsessive-compulsive 3.53 (88) 0.001 Interpersonal sensitivity 4.69 (88) 0.000 Depression 3.52 (88) 0.001 Anxiety 3.1 (88) 0.002 Hostility 4.30 (88) 0.000 Phobic anxiety 1.60 (88) 0.113 Paranoid ideation 3.75 (88) 0.000 Psychoticism 3.64 (88) 0.000 Symptom Interpretation Questionnaire Somatization 3.33 (88) 0.001 Psychologization 3.59 (88) 0.001 Normalization 2.22 (88) 0.029 Somatosensory Amplification Scale 2.17 (88) 0.032 TAS: Toronto Alexithymia Scale; t: Student's t test Table 3. Correlation and multiple regression analysis of Toronto Alexithymia Scale scores Bivariate correlation analysis Toronto Alexithymia Scale r p Age -0.19 0.064 Education (School years) -0.11 0.267 Beck depression inventory 0.41 0.000 Somatosensory amplification Scale 0.25 0.014 Symptom Checklist-90 0.37 0.000 Somatization Subscale Symptom Interpretation Scale 0.31 0.003 Somatization Subscale Symptom Interpretation Scale 0.35 0.001 Psychologization Subscale Symptom Interpretation Scale 0.23 0.026 Normalization Subscale Multiple regression analysis Toronto Alexithymia Scale B S.E. p %95 CI Age -0.19 0.08 0.021 -0.36 - 0.03 Education (School years) -0.21 0.25 0.411 -0.72 - 0.30 Beck depression inventory 0.30 0.11 0.010 0.07 - 0.52 Somatosensory amplification Scale 0.00 0.17 0.999 -0.34 - 0.34 Symptom Checklist-90 0.22 0.10 0.037 0.01 - 0.42 Somatization Subscale Symptom Interpretation Scale 0.28 0.14 0.048 0.00 - 0.56 Somatization Subscale Symptom Interpretation Scale 0.03 0.11 0.778 -0.19 - 0.25 Psychologization Subscale Symptom Interpretation Scale -0.15 0.13 0.257 -0.41 - 0.11 Normalization Subscale r: pearson correlation coefficient; [BETA]: non-standardized regression coefficient; S.E.: standard error; [beta]: standardized regression coefficient; CI: confidence interval
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|Title Annotation:||Research Article|
|Author:||Taycan, Okan; Ozdemir, Armagan; Taycan, Serap Erdogan|
|Publication:||Archives of Neuropsychiatry|
|Date:||Jun 1, 2017|
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