Alexithymia and risk of death in middle-aged men

doi:10.1016/S0022-3999(96)00226-7

Journal of Psychosomatic Research

Volume 41, Issue 6, December 1996, Pages 541-549

https://doi.org/10.1016/S0022-3999(96)00226-7 Get rights and content

Abstract

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p<0.001) and a threefold greater risk of death from accidents, injury, or violence (p<0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity), physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.

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Cited by (136)

Exploring alexithymia profiles and their associations with childhood adversity and COVID-19 burnout among Chinese college students: A person-centered approach
2023, Journal of Applied Developmental Psychology
Alexithymia is associated with adverse developmental outcomes. However, this concept has been criticized for being heavily influenced by Western norms of emotional expression and for potentially pathologizing people from different cultural backgrounds. Furthermore, the widely employed variable-centered study approaches hinder research understanding of real-world alexithymia profiles. Using a person-centered approach, the current study investigated the alexithymia profiles among Chinese college students and tested the profiles' relations with childhood adversity and COVID-19 burnout. Four latent alexithymia profiles were identified. The High I profile (particular difficulty identifying feelings) emerged as a risk profile for childhood adversity and COVID-19 burnout. Our findings illustrate the heterogeneity of the alexithymia construct and represent a significant step toward expanding cross-cultural understanding of alexithymia profiles and their associations with related psychological constructs. When dealing with childhood adversity and COVID-19 burnout, health care programs should consider a specific alexithymia profile defined by difficulty identifying feelings.
Seeing things differently: Gaze shapes neural signal during mentalizing according to emotional awareness
2021, NeuroImage
Citation Excerpt :
Considering alexithymia as a categorical concept, its prevalence has been reported as approximately 10% in the general population, but may increase up to 60% in clinical samples (Honkalampi et al., 2000; Leweke et al., 2012). High alexithymia often co-occurs with psychiatric, psychosomatic and certain somatic diseases (e.g., Karukivi et al., 2016; Ricciardi et al., 2015; Schauer et al., 2019) and has been related to increased mortality risk (Kauhanen et al., 1996; Tolmunen et al., 2010) and negative treatment outcome (Lumley et al., 2007). Given that accurate judgments about emotions are crucial for successful social interaction (Jack and Schyns, 2015), it is not surprising that people with high alexithymia seem to struggle with understanding their counterpart.
Studies on social cognition often use complex visual stimuli to asses neural processes attributed to abilities like “mentalizing” or “Theory of Mind” (ToM). During the processing of these stimuli, eye gaze, however, shapes neural signal patterns. Individual differences in neural operations on social cognition may therefore be obscured if individuals’ gaze behavior differs systematically. These obstacles can be overcome by the combined analysis of neural signal and natural viewing behavior. Here, we combined functional magnetic resonance imaging (fMRI) with eye-tracking to examine effects of unconstrained gaze on neural ToM processes in healthy individuals with differing levels of emotional awareness, i.e. alexithymia. First, as previously described for emotional tasks, people with higher alexithymia levels look less at eyes in both ToM and task-free viewing contexts. Further, we find that neural ToM processes are not affected by individual differences in alexithymia per se. Instead, depending on alexithymia levels, gaze on critical stimulus aspects reversely shapes the signal in medial prefrontal cortex (MPFC) and anterior temporoparietal junction (TPJ) as distinct nodes of the ToM system. These results emphasize that natural selective attention affects fMRI patterns well beyond the visual system. Our study implies that, whenever using a task with multiple degrees of freedom in scan paths, ignoring the latter might obscure important conclusions.
Alexithymia is associated with increased all-cause mortality risk in men, but not in women: A 10-year follow-up study
2021, Journal of Psychosomatic Research
Alexithymia is associated with various mental as well as physical disorders. Some evidence also suggested high alexithymia to increase mortality risk, but these results are few and based on specific sample compositions. We aimed to investigate the impact of alexithymia on mortality risk in a large population based cohort. In addition, we sought to elucidate the effects of the subfactors of alexithymia and sex differences.
In a sample of N = 1380 individuals from the Study of Health in Pomerania (SHIP), we investigated the hazard-ratio (HR) of alexithymia as obtained by the Toronto Alexithymia Scale-20 (TAS-20) on all-cause mortality over an average observation time of 10 years. Sex-by-TAS-20-interactions as well as sex-stratified analyses were performed.
Alexithymia was significantly associated with enhanced mortality risk (HR = 1.033; 95%-CI = 1.008–1.058); p = 0.009). While sex-by-TAS-20 interactions remained insignificant, sex-stratified analyses showed that this effect was only significant in men (HR = 1.050; 95%-CI = 1.022–1.079; p ≤ 0.001), but not in women (HR: 1.008; 95%-CI = 0.960–1.057; p = 0.76). The effect was validated for the “difficulties identifying feelings” (DIF) and “difficulties describing feelings” (DDF) subfactors of the TAS-20.
Our study supports and extents previous findings by indicating that mortality risk enhancing effects of alexithymia are specific to male subjects and validated for the DIF and DDF facets. Socioeconomic, clinical and metabolic factors were associated with this relationship. Finding that the impact of alexithymia remains stable in the fully adjusted models suggests that yet unidentified additional factors must be considered.
Personality and performance: moving beyond the Big 5
2017, Current Opinion in Psychology
In this review, we examine the literature in relation to personality and performance. Much of the extant work in this area has focused on the role of the Big 5 traits (i.e., extraversion, conscientiousness, openness to experience, agreeableness, and neuroticism), at the expense of other personality variables that have a strong performance-focused rationale. Further, a focus on main effects has dominated the literature, without recourse to consider person × environment interactions. In this review we go beyond the Big 5 and consider the role of two personality traits, narcissism and alexithymia, in relation to performance. We demonstrate that both traits have considerable potential to explain differences in performance and that the personality–performance relationship is best viewed from an interactionist perspective. We close with a call for researchers to give more attention to personality in relation to performance.
Living alone and activation of the renin-angiotensin-aldosterone-system: Differential effects depending on alexithymic personality features
2017, Journal of Psychosomatic Research
Living alone is considered as a chronic stress factor predicting different health conditions and particularly cardiovascular disease (CVD). Alexithymia is associated with increased psychological distress, less social skills and fewer close relationships, making alexithymic subjects particularly susceptible to chronic stress imposed by “living alone”. Only few studies investigated the renin-angiotensin-aldosterone-system (RAAS) activity in response to chronic stress. We aimed at evaluating the effects of “living alone” as a paradigm for chronic stress on RAAS activity and putatively differential effects depending on alexithymic personality features.
Alexithymia and serum concentrations of renin and aldosterone were measured in 944 subjects from the population-based SHIP-1 study. Subgroups were formed using the median of the Toronto Alexithymia Scale-20 (TAS-20) and a cohabitation status of “living alone” or “living together”. Analyses were adjusted for various psychosocial, behavioral and metabolic risk factors.
“Living alone” was associated with elevated plasma renin (p < 0.01, β = 0.138) but not aldosterone concentrations in the total sample. On subgroup level, we found associations of “living alone” and elevated renin concentrations only in subjects low in TAS-20 scores (p < 0.01, β = 0.219). Interactional effects of alexithymia × cohabitation status were found for the aldosterone-to-renin ratio (p = 0.02, β = − 0.234).
The association of chronic stress imposed by “living alone” with increased RAAS activity contributes to explain the relationship of this psychosocial stress condition and increased risk for CVD. In contrast, alexithymic subjects may be less affected by the deleterious effects of “living alone”.
Negative effects during multicomponent group-based treatment: A multisite study
2023, Psychotherapy Research

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Original articleAlexithymia and risk of death in middle-aged men

Abstract

Psychosomatics

Compreh Psychiatry

J Psychosom Res

J Psychosom Res

J Psychosom Res

Lancet

Lancet

The prevalence of ‘alexithymic’ characteristics in psychosomatic patients

Psychother Psychosom

The effect of alexithymia on morbidity in hypertensives

Psychother Psychosom

Alexithymic characteristics in rheumatoid arthritis: a controlled study

Psychother Psychosom

Alexithymic characteristics and metabolic control in diabetic and healthy adults

J Nerv Ment Dis

Alexithymia and pain in an outpatient behavioral medicine clinic

Int J Psychiatry Med

Controlled study of alexithymic characteristics in patients with psychogenic pain disorder

Psychother Psychosom

Alexithymia and symbolic function in the obese

Psychother Psychosom

Large bowel disorders. II. Psychopathology and alexithymia

Psychother Psychosom

Alexithymic characteristics in patients with inflammatory bowel disease

Can J Psychiatry

Alexithymia and breast cancer: a survey of 200 women undergoing mammography

Psychother Psychosom

Alexithymia, immunity and cervical intraepithelial neoplasia: a pilot study

Psychother Psychosom

Alexithymia in women with anorexia nervosa

A preliminary investigation

Br J Psychiatry

Alexithymia ratings in bulimia nervosa: clinical correlates

Psychosom Med

Alexithymia in males at high genetic risk for alcoholism

Psychother Psychosom

Validation of the Toronto Alexithymia Scale with substance abusers

Psychother Psychosom

Original article
Alexithymia and risk of death in middle-aged men