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From the Psychosomatic Unit (P.P.) and Department of Gastroenterology, IRCCS De Bellis Hospital (M.D.C., G.L.), Castellana Grotte, Italy; Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health-Clarke Site (R.M.B.), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto and Mount Sinai Hospital (G.J.T.), Toronto, Ontario, Canada; and Department of Psychiatry, University of Bari (O.T.), Italy
Address reprint requests to: Dr. Piero Porcelli, Unità di Psicosomatica, IRCCS Ospedale "De Bellis", Via Valente, 4, I-70013, Castellana Grotte (Bari), Italy. E-mail: porcellip{at}mail.media.it
OBJECTIVE: A previous study found a strong association between alexithymia and functional gastrointestinal disorders (FGID). The objective of this study was to investigate whether alexithymia might be a predictor of treatment outcome in patients with FGID.
METHODS: A group of FGID outpatients classified by the ‘Rome I’ criteria was divided into improved (N= 68) and unimproved (N= 44) groups on the basis of pre-established criteria after 6 months of treatment. Patients were administered the 20-item Toronto Alexithymia Scale, the Hospital Anxiety and Depression Scale, and the Gastrointestinal Symptom Rating Scale both before and after 6 months of treatment.
RESULTS: At the base-line assessment, compared with the improved patients, the unimproved patients had significantly higher levels of anxiety, depression, alexithymia, and gastrointestinal symptoms. Stability of alexithymia was demonstrated by significant correlations between base-line and follow-up TAS-20 scores in the entire sample. Moreover, hierarchical regression analyses showed that the stability of TAS-20 scores over the 6-month treatment period could not be accounted for by their associations with anxiety and depression scores. In logistic regression analyses, base-line alexithymia and depression emerged as significant predictors of treatment outcome. Relative to depression, however, alexithymia was the stronger predictor.
CONCLUSIONS: Alexithymia is a reliable and stable predictor of treatment outcome in FGID patients. Although further studies are needed, clinicians might improve treatment outcome by identifying patients with high alexithymia, and attempting to improve these patients’ skills for coping with emotionally stressful situations.
Key Words: alexithymia, • functional gastrointestinal disorders, • anxiety, • depression, • prediction, • treatment outcome,
Abbreviations: FGID = functional gastrointestinal disorders;; GSRS = Gastrointestinal Symptom Rating Scale;; HADS = Hospital Anxiety and Depression Scale;; HADS-A = Hospital Anxiety and Depression Scale, Anxiety subscale;; HADS-D = Hospital Anxiety and Depression Scale, Depression subscale;; TAS-20 = Twenty-item Toronto Alexithymia Scale.
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