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Alexithymia in Chronic Fatigue Syndrome: Associations With Momentary, Recall, and Retrospective Measures of Somatic Complaints and Emotions

From Stony Brook University, Stony Brook, New York.

Address correspondence and reprint requests to Fred Friedberg, PhD, Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790. E-mail: fred.friedberg{at}stonybrook.edu

Objective: The relationship between alexithymia and real-time momentary symptom assessments has not been reported. This cross-sectional study hypothesized that alexithymia would be a predictor of somatic symptoms using three different types of symptom measurement (momentary, recall, and retrospective) in the medically unexplained illness of chronic fatigue syndrome (CFS). In addition, it was hypothesized that negative affect would be a significant mediator of the relationship between alexithymia and somatic symptoms. Finally, the relation of alexithymia to physical illness attribution (a CFS illness predictor) was explored.

Methods: Participants were 111 adults with CFS. Alexithymia was assessed with the Toronto Alexithymia Scale. Momentary ratings of current symptoms and affect were recorded in electronic diaries carried for 3 weeks. Weekly recall of these momentary reports was also recorded. Retrospective measures included 6-month ratings of fatigue and pain, the Fatigue Severity Scale, the Brief Pain Inventory–Short Form, a CFS symptom measure, the Beck Depression Inventory–II, the Beck Anxiety Inventory, and an illness attribution rating.

Results: Partial correlations, controlling for age and sex, yielded no significant associations between general or specific forms of alexithymia and momentary ratings of fatigue or pain. On the other hand, a significant association, partially mediated by anxiety scores, was found between a specific form of alexithymia and a retrospective pain measure. Finally, physical illness attribution was not significantly associated with alexithymia.

Conclusion: Based on assessments of real-time and retrospectively measured symptoms, these data provided only modest support for the alexithymia construct as a predictor of somatic symptoms in people with CFS.

Key Words: alexithymia • chronic fatigue syndrome • ecological momentary assessment

Abbreviations: CFS = chronic fatigue syndrome; TAS-20 = Toronto Alexithymia Scale–20-item form; DIF = Difficulty Identifying Feelings; DDF = Difficulty Describing Feelings; EOT = Externally Oriented Thinking; FSS = Fatigue Severity Scale; BPI = Brief Pain Inventory; BDI-II = Beck Depression Inventory–Second edition; BDI corr = BDI corrected for somatic symptoms; BAI = Beck Anxiety Inventory; NA = negative affect.