© Borgis - New Medicine 3/2009, s. 51-52
*Ewa Ogłodek1, Danuta Mo?2, Aleksander Araszkiewicz1, Waldemar Placek3
Sense of alexithymia in a patient with vitiligo and paranoid schizophrenia
1Chair and Clinic of Psychiatry of the Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
2Individual medical practice
3Chair and Clinic of Dermatology, Sexually Transmitted Diseases and Immunodermatology of the Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland
Summary
Aim.The behaviour contemporarily known as alexithymia was first described in detail by psychiatrists Peter E. Sifneos and John C. Nemiah. Over the past few decades the concept of alexithymia has been refined theoretically, and it is presently defined by the following features: (1) difficulty in identifying feelings and distinguishing between feelings and bodily sensations of emotional arousal; (2) difficulty in describing feelings to other people; (3) constricted imaginal processes, as evidenced by a paucity of fantasies; and (4) a stimulus-bound, externally oriented cognitive style.
The aim of the research was to evaluate the sense of alexithymia in a female patient with vitiligo and paranoid schizophrenia.
Material and Method. DSM-IV classification was used in the psychiatric examination of the patient in question and paranoid schizophrenia was diagnosed. This was followed by examining the patient by means of the shortened version of the Toronto Alexithymia Scale (TAS-20). The scale is characterized by high discrimination power, internal coherence and reliability.
Results. An analysis of the TAS-20 scale results revealed the highest value of the "difficulties identifying feelings” factor.
Conclusions. Sense of alexithymia may be a result of long-term stress which, in turn, leads to the development of vitiligo and paranoid schizophrenia.
Introduction
Sense of alexithymia is a term which was first proposed by Sifenos to describe disorders related to a patient´s expression and perception of his/her own feelings. Alexithymia is a concept that has been receiving increasing attention in psychosomatic research. The alexithymia construct involves „difficulty in identifying and describing feelings and difficulty in distinguishing between feelings and the bodily sensations of emotional arousal”. Limited abilities of a patient with vitiligo and sense of alexithymia to experience emotions cognitively lead to the patient´s concentration on somatic sensations. This is accompanied by emotional excitement and by poorly controlled compulsive reactions to negative stimulation. Sense of alexithymia in patients with paranoid schizophrenia and vitiligo is treated as a personality trait which, in combination with other features, predisposes a patient to emotional disturbances.
Vitiligo is a disease characterized clinically by the sudden appearance of sharply demarcated patches of milk white skin. This is a chronic, progressive disease in which depigmentation results in extreme alterations in appearance and intense psychological distress for the patient [1].
Aim
The aim of the research was to evaluate the sense of alexithymia in a female patient with vitiligo and paranoid schizophrenia.
MATERIAL AND Method
12 patients with schizophrenia and vitiligo were included in the study (average age 34.20 ± 5.3 years). The patients were under the care of the Chair and Clinic of Dermatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz. A control group consisted of 12 mentally healthy persons (average age 34.20 ± 5.3 years). Both the study group and the control group included 6 men and 6 women.
Patients with paranoid schizophrenia and vitiligo were tested for sense of alexithymia by the shortened version of the Toronto Alexithymia Scale (TAS-20). Patients in the control group were tested in the same way.
The Toronto Alexithymia Scale is a 20-item Likert scale to measure alexithymia. Items are rated using a 5-point Likert scale whereby 1 = strongly disagree and 5 = strongly agree. The TAS-20 uses cut-off scoring: equal to or less than 51 = non-alexithymia, equal to or greater than 61 = alexithymia. Scores of 52 to 60 = possible alexithymia.
The scale is characterized by high discrimination power, internal coherence and reliability.
Results
In the research a DSM-IV classification was used in the psychiatric examination of the patients with paranoid schizophrenia. The patients had remission of the disease for at least 2 years. In the study and control group the TAS-20 scale was used to measure the following 3 factors of alexithymia: F-1: difficulties in identifying feelings, F-2: difficulties in describing feelings, and F-3: externally oriented thinking. The measurements conducted in the study group were compared to the control group. The total score of TAS-20 in patients with paranoid schizophrenia and vitiligo was 70. The analysis of the TAS-20 scale results in this group revealed the highest value of the "difficulties in identifying feelings” factor. The control group did not show features of alexithymia; the total score was 25. Fig. 1 presents the percentage distribution of particular alexithymia factors in patients with paranoid schizophrenia and vitiligo.
Fig. 1. TAS-20 scale in patients with paranoid schizophrenia and vitiligo.
Discussion
In our investigation patients with paranoid schizophrenia and vitiligo met the criteria of alexithymia. The patient´s score was 70 points on the Toronto Alexithymia Scale (TAS-20). The analysis of the TAS-20 scale results in this group revealed the highest value of the "difficulties identifying feelings” factor.
This may suggest specific difficulties in identifying feelings in patients suffering from schizophrenia.
According to Cedro A et al. [1] and Picardi A et al. [4] in alexithymia and schizophrenia, there is a risk that physical and emotional feelings will become signs of psychological distress.
Ongenae K et al. [3] showed that the relationship between vitiligo and alexithymia is increasingly studied in epidemiological surveys that use different instruments to measure alexithymia. Moreover, the risk of further psychosomatic diseases increases in the presence of alexithymia.
According to Maggini C et al. and Koshevenko I [5, 6] alexithymia was first introduced in the field of psychosomatic medicine and has recently been referred to as a personality trait characterized by a deficiency in the cognitive processing of emotions, namely, difficulties in identifying and communicating emotions, and externally-oriented thinking. These characteristics reflect a disruption in the conscious experience of emotions.
Sampogna F et al. [7] stated that voluntary control, as an important aspect of consciousness and the source of attention, is critical for regulating mental computations including emotional processes. However, this supervisory system is possibly severely impaired in individuals with high alexithymia.
Spitzer C et al. and Todarello O et al. [8, 9] also observed that alexithymia has a specific structure in schizophrenia. Alexithymia components may be interpreted as signs of intra- and inter-subjective disturbances of both state and trait quality.
In addition to difficulties in recognizing and expressing emotions in schizophrenia and vitiligo, patients often manifest flattened emotions at default, yet accompanied by random and abrupt emotional outbursts which they cannot interpret; they also have low control of their internal needs, an exaggerated defensive system, and dysregulated autonomic responses such as increased heart rate to emotion-evoking stimuli, although fewer emotional experiences are always reported. All these manifestations indicate a disconnection between the physiological responses and the voluntary control of emotions in alexithymia [10].
Conclusions
1. Sense of alexithymia may be a result of long-term stress which, in turn, leads to the development of vitiligo and paranoid schizophrenia.
2. Alexithymia is an important factor affecting the patient´s interpersonal relationships.
Piśmiennictwo
1. Cedro A et al.: Alexithymia in schizophrenia: an exploratory study. Psychol Rep. 2001; 89(1): 95-8. 2. Bagby RM et al.: The twenty-item Toronto Alexithymia Scale. I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994; 38(1): 23–32. 3. Ongenae K et al.: Effect of vitiligo on self-reported health-related quality of life. Br J Dermatol. 2005; 152(6): 1165-72. 4. Picardi A et al.: Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study. Psychother Psychosom. 2003; 72(3): 150-8. 5. Koshevenko I: The psychological characteristics of patients with vitiligo. Vestn Dermatol Venerol. 1989; (5): 4-6. 6. Maggini C et al.: Alexithymia and schizophrenic psychopathology. Acta Biomed. 2004; 75(1): 40-9. 7. Sampogna F et al.: Identification of categories at risk for high quality of life impairment in patients with vitiligo. Br J Dermatol. 2008; 159(2): 351-9. 8. Spitzer C et al.: Alexithymia and interpersonal problems. Psychother Psychosom. 2005; 74(4): 240-6. 9. Todarello O et al.: Is Alexithymia related to negative symptoms of schizophrenia? Psychopathology. 2005; 38(6): 310-4. 10. Willemsen R et al.: Alexithymia and dermatology: the state of the art. Int J Dermatol. 2008; 47(9): 903-10.
