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From the Departments of Psychiatry (C.G.K., H.G.M.R.), General Internal Medicine (J.H.B.), and Medical Statistics (R.B.), Leiden University Medical Center, Leiden; and Department of Medical Psychology and Psychotherapy (R.W.T.), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Address reprint requests to: Cornelis G. Kooiman, Department of Psychiatry B1P, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. Email: cgkooiman{at}lumc.nl
OBJECTIVE: Alexithymia is presumed to play an important predisposing role in the pathogenesis of medically unexplained physical symptoms. However, no research on alexithymia has been done among general medical outpatients who present with medically unexplained physical symptoms as their main problem and in which anxiety and depression have been considered as possible confounding factors. This study investigated whether patients with medically unexplained physical symptoms are more alexithymic than those with explained symptoms and whether, in patients with unexplained symptoms, alexithymia is associated with subjective health experience and use of medical services.
METHODS: We conducted a cross-sectional study among patients attending an internal medicine outpatient clinic. All patients were given a standardized interview and completed a number of questionnaires.
RESULTS: After complete physical examinations, 169 of 321 patients had unexplained physical symptoms according to two independent raters. Patients with medically unexplained symptoms more often had a mental disorder, but overall they were not more alexithymic. In patients with unexplained physical symptoms, alexithymia was not associated with subjective health experience or use of medical services. However, patients with both unexplained symptoms and a mental disorder who also denied any possible connection between emotional problems and their physical symptoms did have more alexithymic traits.
CONCLUSIONS: In the majority of patients with medically unexplained physical symptoms, alexithymia does not play a role of clinical significance. Patients with unexplained physical symptoms are heterogeneous with respect to psychiatric syndrome pathology and probably also with respect to personality pathology.
Key Words: alexithymia, • somatization • anxiety, • depression • dissociation.
Abbreviations: ANOVA = analysis of variance; CI = confidence interval; DDF = difficulties in describing feelings; DES = Dissociative Experience Scale; DIF = difficulties in identifying feelings; EOT = externally oriented thinking; EPS = explained physical symptoms; HADS = Hospital Anxiety and Depression Scale; HADSa = HADS Anxiety scale; HADSd = HADS Depression scale; MOS-36 = 36-item Medical Outcomes Study short form; OR = odds ratio; PSQ = Physical Symptoms Questionnaire; SCL-90-R = revised 90-item Symptom Check List; TAS = Toronto Alexithymia Scale; UPS = unexplained physical symptoms; WI = Whitely Index.
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