Alexithymia and the capacity to evaluate states of affect and pain

Alexithymia is conceptualized as a personality variable involving profound affective deficits. Individuals with high levels of alexithymia are characterized by difficulty in describing emotions, a preoccupation with somatic symptoms, and an insensitive interpersonal style. Alexithymia is commonly found among chronic pain patients. Despite a burgeoning literature, researchers have not identified either the precise characteristics and source of the poor interpersonal performance associated with alexithymia, or how the presence of alexithymia relates to the phenomenology and conceptualization of pain. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia in a sample of 145 female university students who had reported experiencing significant pain during the past year. An exploratory factor analysis was conducted to check the factor structure of the TAS-20 with this sample. A series of three studies was designed to explore the relationship with alexithymia and: 1) reactions to facial expressions of emotion, 2) reactions to others' pain, and 3) conceptualization of own pain. The cleanest factor solution was yielded by a Maximum Likelihood Analysis with oblique rotation. In this sample, the TAS-20 is adequately represented as 4 factors: 1) Difficulty Identifying Bodily Sensations (Body); 2) Confusion about Emotions (Emotions); 3) External Cognitive Style (External), and 4) Interpersonal Awkwardness (Awkward). Study 1 investigated the ability to judge and respond to facial expressions of emotion, as a potential source of interpersonal difficulties. Participants examined slides of adults modeling specific emotions, and attempted to identify the modeled affective states. Alexithymia was expected to be related to difficulty in assessing facial expressions of emotion. As predicted, the ability to identify and appropriately respond to modeled emotional expressions was significantly lower in high-alexithymia participants. Alexithymia scores were related to a tendency to rate various modeled emotions as "pain," providing support for the association with a somatic preoccupation. Study 2 entailed evaluation of interpersonal perception in the context of pain by investigating the relationship between alexithymia and judgement of pain in infants. Participants evaluated two dimensions of pain (sensory discomfort and emotional distress) while watching videotapes of neonates undergoing invasive but routine medical procedures. It was hypothesized that the somatic preoccupation and emotional insensitivity associated with alexithymia would lead high-alexithymia individuals to exaggerate the sensory component of pain in infants and underestimate the affective domain. Predictions were only partially supported. When depressed mood and extent of current pain were controlled, the hypothesized relationship emerged between the TAS-20 External factor and lower ratings of perceived emotional distress, and between the Body factor and higher ratings of perceived sensory discomfort. Contrary to expectations, Body factor scores were related to higher emotional distress ratings. In Study 3, participants assessed retroactively the sensory and affective components of their own painful experiences. There is an increasing trend for multidisciplinary pain clinics to include psychological interventions, treatments whose success is largely dependent upon patients distinguishing the sensory and affective components of pain. It was predicted that high-alexithymia participants would emphasize the sensory rather than the affective dimension, a judgement pattern which could explain the link found between high levels of alexithymia and poorer recovery from chronic pain conditions. Contrary to expectations, it was found that alexithymia scores were unrelated to ratings of sensory intensity. After controlling for depressed mood and extent of current pain, the only significant result to emerge was between the TAS-20 Awkward factor and higher (not lower) ratings of the affective component of participants' own painful experiences. Results suggest that a source of the social awkwardness associated with alexithymia may arise from an insensitivity to facially expressed mood states. There is some evidence that individuals with an external cognitive style pay less attention to the affective distress entailed in infants' pain experiences. The overall pattern of results suggests that alexithymia, as measured by the TAS-20, is best viewed as factorially complex. While the factors display some interdependence, there is greater utility in computing and examining all factor scores rather than describing individuals by a global TAS-20 total score.

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