The impact of clinical and psychological characteristics on alexithymia in type 1 diabetes

Basilio Pintaudi, Giacoma Di Vieste, Antonio Nicolucci, Antonio Bruno, Giovanni Genovese, Maria Rosaria Anna Muscatello, Clemente Cedro, Rocco Antonio Zoccali, Antonino Di Benedetto

Abstract


Background: Alexithymia is a psychological construct characterized by inability to express emotions, poor imagination and operational thinking. It is well known its association with several chronic disease such as Diabetes type 2, little is known about diabetes type 1. We examined the association of alexithymia with clinical and psychological outcomes in subjects with type 1 diabetes.


Methods: The study was conducted in a single diabetes center. The patients fully completed a protocol composed of the following instruments: the Toronto Alexithymia Scale-20 (TAS-20), the State-Trait Anger Expression Inventory-2 (STAXI-2), the State-Trait Anxiety Inventory form Y (STAI-Y), and the Hamilton Rating Scale for Depression (HAMD). TAS-20 scores were subdivided into tertiles, Correlations and two linear regression analyses, adjusted for only clinical and clinical plus psychological characteristics, were performed. Overall, 75 patients were enrolled (mean age 41.0±11.4 years, diabetes duration 19.9±11.9 years, 49.3% males, 30.7% treated with CSII).


Results: People with diabetes of the upper TAS-20 tertile had the greatest rate of depression (with the highest degree of severity) and the higher levels of anger and anxiety. There was a significant correlation between TAS-20 scores with BMI (r=0.26; p=0.03), HAMD (r=0.38; p=0.001), STAXI-2 (r=0.34; p=0.003) and STAI-Y (r=0.48; p<0.0001).  Further regression analysis showed TAS-20 scores were associated with BMI (beta=0.29; p=0.02). The association with BMI was confirmed (beta=0.28; p=0.007) when psychological variables are considered; furthermore, a strong association with STAI-2 (beta=0.48; p<0.0001) was detected, while the analysis did reveal any significant correlation between alexithymia and HbA1c levels.


Conclusions: Alexithymia is strongly associated both with clinical and psychological characteristics, notably with BMI and anxiety traits. People with diabetes type 1 should be assessed for alexithymia. Future studies on the current topic are therefore required in order to elucidate the role of alexithymia in diabetes type 1. We believe that patients with diabetes and alexithymia could take advantage of psychological counseling.

Keywords


Alexithymia; Type 1 diabetes; Psychological outcomes; BMI; Anxiety.

Full Text:

PDF

References


Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes care, 24(6), 1069-1078.

https://doi.org/10.2337/diacare.24.6.1069

Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. Journal of psychosomatic research, 38(1), 23–32.

https://doi.org/10.1016/0022-3999(94)90005-1

Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994). The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity. Journal of psychosomatic research, 38(1), 33–40.

https://doi.org/10.1016/0022-3999(94)90006-x

Baiardini, I., Abbà, S., Ballauri, M., Vuillermoz, G., & Braido, F. (2011). Alexithymia and chronic diseases: the state of the art. G Ital Med Lav Ergon, 33(1 Suppl A), A47-52.

Barnard, K. D., Peyrot, M., & Holt, R. I. G. (2012). Psychosocial support for people with diabetes: past, present and future. Diabetic medicine, 29(11), 1358-1360. https://doi.org/10.1111/j.1464-5491.2012.03727.x

Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients with chronic illness. Jama, 288(14), 1775-1779. https://doi.org/10.1001/jama.288.15.1909

Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, I., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of psychosomatic research, 41(6), 551–559. https://doi.org/10.1016/s0022-3999(96)00228-0

Caretti, V., Porcelli, P., Solano, L., Schimmenti, A., Bagby, R. M., & Taylor, G. J. (2011). Reliability and validity of the Toronto Structured Interview for Alexithymia in a mixed clinical and nonclinical sample from Italy. Psychiatry research, 187(3), 432–436. https://doi.org/10.1016/j.psychres.2011.02.015

Chatzi, L., Bitsios, P., Solidaki, E., Christou, I., Kyrlaki, E., Sfakianaki, M., Kogevinas, M., Kefalogiannis, N., & Pappas, A. (2009). Type 1 diabetes is associated with alexithymia in nondepressed, non-mentally ill diabetic patients: a case-control study. Journal of psychosomatic research, 67(4), 307–313.

https://doi.org/10.1016/j.jpsychores.2009.04.011

Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009). Evidence on the chronic care model in the new millennium. Health affairs, 28(1), 75-85. https://doi.org/10.1377/hlthaff.28.1.75

Craparo, G., Faraci, P., & Gori, A. (2015). Psychometric Properties of the 20-Item Toronto Alexithymia Scale in a Group of Italian Younger Adolescents. Psychiatry investigation, 12(4), 500–507.

https://doi.org/10.4306/pi.2015.12.4.500

de Wit, L., Luppino, F., van Straten, A., Penninx, B., Zitman, F., & Cuijpers, P. (2010). Depression and obesity: a meta-analysis of community-based studies. Psychiatry research, 178(2), 230–235.

https://doi.org/10.1016/j.psychres.2009.04.015

Hamilton M. (1960). A rating scale for depression. Journal of neurology, neurosurgery, and psychiatry, 23(1), 56–62.

https://doi.org/10.1136/jnnp.23.1.56

Hemming, L., Haddock, G., Shaw, J., & Pratt, D. (2019). Alexithymia and Its Associations With Depression, Suicidality, and Aggression: An Overview of the Literature. Frontiers in psychiatry, 10, 203.

https://doi.org/10.3389/fpsyt.2019.00203

Hiirola, A., Pirkola, S., Karukivi, M., Markkula, N., Bagby, R. M., Joukamaa, M., Jula, A., Kronholm, E., Saarijärvi, S., Salminen, J. K., Suvisaari, J., Taylor, G., & Mattila, A. K. (2017). An evaluation of the absolute and relative stability of alexithymia over 11years in a Finnish general population. Journal of psychosomatic research, 95, 81–87. https://doi.org/10.1016/j.jpsychores.2017.02.007

Ilardi, C. R., Gamboz, N., Iavarone, A., Chieffi, S., & Brandimonte, M. A. (2021). Psychometric properties of the STAI-Y scales and normative data in an Italian elderly population. Aging clinical and experimental research, 1–8. Advance online publication. https://doi.org/10.1007/s40520-021-01815-0

Kiken, L. G., Shook, N. J., Robins, J. L., & Clore, J. N. (2018). Association between mindfulness and interoceptive accuracy in patients with diabetes: Preliminary evidence from blood glucose estimates. Complementary therapies in medicine, 36, 90–92. https://doi.org/10.1016/j.ctim.2017.12.003

Leweke, F., Leichsenring, F., Kruse, J., & Hermes, S. (2012). Is alexithymia associated with specific mental disorders?. Psychopathology, 45(1), 22–28. https://doi.org/10.1159/000325170

Li, S., Zhang, B., Guo, Y., & Zhang, J. (2015). The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: A meta-analysis. Psychiatry research, 227(1), 1–9.

https://doi.org/10.1016/j.psychres.2015.02.006

López-Muñoz, F., & Pérez-Fernández, F. (2020). A history of the alexithymia concept and its explanatory models: An epistemological perspective. Frontiers in psychiatry, 10, 1026. 10.3389/fpsyt.2019.01026

López-Pina, J. A., Sánhez-Meca, J., & Rosa-Alcázar, A. I. (2009). The Hamilton Rating Scale for Depression: a meta-analytic reliability generalization study. International Journal of Clinical and Health Psychology, 9(9), 143–159.

Luminet, O., de Timary, P., Buysschaert, M., & Luts, A. (2006). The role of alexithymia factors in glucose control of persons with type 1 diabetes: a pilot study. Diabetes & metabolism, 32(5 Pt 1), 417–424.

https://doi.org/10.1016/s1262-3636(07)70299-9

Lumley, M. A., Neely, L. C., & Burger, A. J. (2007). The assessment of alexithymia in medical settings: implications for understanding and treating health problems. Journal of personality assessment, 89(3), 230–246.

https://doi.org/10.1080/00223890701629698

Majidi, S., Driscoll, K. A., & Raymond, J. K. (2015). Anxiety in children and adolescents with type 1 diabetes. Current diabetes reports, 15(8), 47. https://doi.org/10.1007/s11892-015-0619-0

Martínez-Sánchez, F., Ato-García, M., & Ortiz-Soria, B. (2003). Alexithymia--state or trait?. The Spanish journal of psychology, 6(1), 51–59. https://doi.org/10.1017/s1138741600005205

Martino, G., Caputo, A., Schwarz, P., Bellone, F., Fries, W., Quattropani, M. C., & Vicario, C. M. (2020). Alexithymia and inflammatory bowel disease: a systematic review. Frontiers in Psychology, 11, 1763.

https://doi.org/10.3389/fpsyg.2020.01763

Merlo, E. M., Sicari, F., Frisone, F., Costa, G., Alibrandi, A., Avena, G., & Settineri, S. (2021). Uncertainty, alexithymia, suppression and vulnerability during the COVID-19 pandemic in Italy. Health Psychology Report, 9(2), 169–179. https://doi.org/10.5114/hpr.2021.104078

Mnif, L., Damak, R., Mnif, F., Ouanes, S., Abid, M., Jaoua, A., & Masmoudi, J. (2014). Alexithymia impact on type 1 and type 2 diabetes: a case-control study. Annales d'endocrinologie, 75(4), 213–219.

https://doi.org/10.1016/j.ando.2014.06.001

Nicolucci, A., Kovacs Burns, K., Holt, R. I., Lucisano, G., Skovlund, S. E., Kokoszka, A., Massi Benedetti, M., & Peyrot, M. (2016). Correlates of psychological outcomes in people with diabetes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2(™)) study. Diabetic medicine: a journal of the British Diabetic Association, 33(9), 1194–1203. https://doi.org/10.1111/dme.13178

Norman, H., Oskis, A., Marzano, L., & Coulson, M. (2020). The relationship between self-harm and alexithymia: A systematic review and meta-analysis. Scandinavian journal of psychology, 61(6), 855–876.

https://doi.org/10.1111/sjop.12668

Ospina, L. H., Shanahan, M., Perez-Rodriguez, M. M., Chan, C. C., Clari, R., & Burdick, K. E. (2019). Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry research, 273, 218-226. https://doi.org/10.1016/j.psychres.2019.01.033

Palser, E. R., Palmer, C. E., Galvez-Pol, A., Hannah, R., Fotopoulou, A., & Kilner, J. M. (2018). Alexithymia mediates the relationship between interoceptive sensibility and anxiety. PloS one, 13(9), e0203212.

https://doi.org/10.1371/journal.pone.0203212

Pink, A. E., Lee, M., Price, M., & Williams, C. (2019). A serial mediation model of the relationship between alexithymia and BMI: The role of negative affect, negative urgency and emotional eating. Appetite, 133, 270–278. https://doi.org/10.1016/j.appet.2018.11.014

Shank, L. M., Tanofsky-Kraff, M., Kelly, N. R., Jaramillo, M., Rubin, S. G., Altman, D. R., Byrne, M. E., LeMay-Russell, S., Schvey, N. A., Broadney, M. M., Brady, S. M., Yang, S. B., Courville, A. B., Ramirez, S., Crist, A. C., Yanovski, S. Z., & Yanovski, J. A. (2019). The association between alexithymia and eating behavior in children and adolescents. Appetite, 142, 104381. https://doi.org/10.1016/j.appet.2019.104381

Spielberger CD. (1983a). Manual for the State-Trait Anxiety Inventory (Form Y) (“Self-evaluation questionnaire”). Palo Alto, CA, Consulting Psychologists Press.

Spielberger CD. (1983b). State-Trait Anxiety Inventory: a comprehensive bibliography. Palo-Alto, CA, Consulting Psychologists Press.

Spielberger, C. D. (1988). State-Trait-Anger-Expression-Inventory. Palo Alto, CA: Consulting Psychologist Press.

Spielberger, C. D. (1999). Manual for the State-Trait Anger Expression Inventory-2. Odessa, FL: Psychological Assessment Resources.

Spitzer, C., Siebel-Jürges, U., Barnow, S., Grabe, H. J., & Freyberger, H. J. (2005). Alexithymia and interpersonal problems. Psychotherapy and psychosomatics, 74(4), 240-246. https://doi.org/10.1159/000085148

Taylor, G. J., & Bagby, R. M. (2000). An overview of the alexithymia construct. In R. Bar-On & J. D. A. Parker (Eds.), The handbook of emotional intelligence: Theory, development, assessment, and application at home, school, and in the workplace (pp. 40–67). Jossey-Bass.

Terock, J., Frenzel, S., Wittfeld, K., Klinger-König, J., Janowitz, D., Bülow, R., ... & Grabe, H. J. (2020). Alexithymia is associated with altered cortical thickness networks in the general population. Neuropsychobiology, 79(3), 233-244. https://doi.org/10.1159/000504983

Topsever, P., Filiz, T. M., Salman, S., Sengul, A., Sarac, E., Topalli, R., ... & Yilmaz, T. (2006). Alexithymia in diabetes mellitus. Scottish medical journal, 51(3), 15-20. https://doi.org/10.1258/RSMSMJ.51.3.15

Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of psychosomatic research, 99, 66-81. https://doi.org/10.1016/j.jpsychores.2017.06.007

Willemsen, R., Roseeuw, D., & Vanderlinden, J. (2008). Alexithymia and dermatology: the state of the art. International journal of dermatology, 47(9), 903-910. https://doi.org/10.1111/j.1365-4632.2008.03726.x




DOI: https://doi.org/10.13129/2282-1619/mjcp-2584

Refbacks

  • There are currently no refbacks.