Study explores link between alexithymia and auto-immune disease

This paper, which explores the link between the inability to express emotions (alexithymia) and an auto-immune disease (systemic lupus erythematosus, SLE), failed to find any statistical significant associations. One possible explanation to this finding relies on the fact that alexithymia could prompt physical or somatic symptoms, but not in a direct causal relation. SLE patients present high psychological distress and need for a stable doctor-patient relationship, as well as psychological intervention/psychotherapy, in addition to medical and psychopharmacological interventions.

A report by a group of  Portuguese investigators headed by Antonio Barbosa in the current issue of Psychotherapy and Psychosomatics is exploring a potential link between the inability to express emotions (alexithymia) and an auto-immune disease (systemic lupus erythematosus, SLE). SLE is a complex and severe rheumatic disease with exceedingly diverse clinical manifestations. Its clinical course is unpredictable and is characterized by exacerbations and periods of remission.

Patients' physical and psychological functioning is compromised by disease unpredictability and manifestation variability. Some studies have considered some psychological variables in SLE patients such as personality dimensions, life events, lower self-esteem, and social support. These patients seem to have also difficulties in  identifying, processing, managing and expressing emotions, which may reflect the presence of alexithymia. The aim of the present study was to reveal the relationship between clinical variables and alexithymia, searching for the impact of psychological variables in SLE patients.

The study subjects were patients with SLE (n = 53) who attended an outpatient autoimmune disease consultation in a university hospital. A healthy volunteer control group (n = 31) was collected in the Portuguese population. The investigators also included a clinical control group of patients with chronic urticaria (CU), a disabling chronic disease, even though there was no homogeneity of sample between the CU and SLE groups in three sociodemographic variables (age, residence and education). Participants completed a sociodemographic questionnaire and a short clinical interview was performed to assess clinical information concerning present and past psychiatric and medical conditions.

Afterwards subjects filled out four standardized self reported questionnaires that assessed alexithymia (TAS-20), personality dimensions (NEO-FFI), psychopathological symptoms (BSI) and quality of life variables (SF-36). At the same time, patients were evaluated clinically by an internal medicine doctor, who diagnosed them using criteria adopted internationally.

Investigators did not find statistically significant differences between SLE and CU patients in TAS-20 total score (t = 0.470, p = 0.639). However, they found that the SLE group scored significantly higher on TAS total score, compared with the healthy control group (t = 6.360, p< 0.000). No significant correlations were found between clinical variables and alexithymia. However, significant statistical correlations were found between alexithymia and psychopathological symptoms, such as depression (p< 0.000), anxiety (p <0.021) and psychoticism (p< 0.009), as well as neuroticism (p< 0.001), and with quality of life dimensions, namely pain ( p< 0.05), vitality (p< 0.001) and general health perception (p< 0.05). As concerns the TAS-20, for the SLE group 'openness' was the independent variable more strongly associated with TAS total score, followed by depression. In the CU group, investigators found two predictors, namely neuroticism and openness.

This analyses failed to find any associations between clinical variables and alexithymia. One possible explanation to this finding relies on the fact that alexithymia could prompt physical or somatic symptoms, but not in a direct causal relation. SLE patients present high psychological distress, covering several areas such as management of emotions, or the relationships they establish with others. Thus, there is a great need for a stable doctor-patient relationship, as well as psychological intervention/psychotherapy, in addition to medical and psychopharmacological interventions.