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Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

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Abstract

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.

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References

  • Acklin, M. W., & Alexander, G. (1988). Alexithymia and somatization. A Rorschach study of four psychosomatic groups. Journal of Nervous and Mental Disease, 176, 343–350.

    Article  PubMed  CAS  Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Aslan, S. H., Alpaslan, Z. N., Gürkan, S. B., Aslan, R. O., & Cenkseven, F. (1997). The levels of social anxiety, alexithymia and coping styles among the university students. Archives of Neuropsychiatry, 34, 127–134.

    Google Scholar 

  • Bach, M., & Bach, D. (1995). Predictive value of alexithymia: A prospective study in somatizing patients. Psychotherapy and Psychosomatics, 64, 43–48.

    PubMed  CAS  Google Scholar 

  • Bagby, R. M., Parker, J. D. A., & 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, 23–32.

    Article  PubMed  CAS  Google Scholar 

  • 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, 33–40.

    Article  PubMed  CAS  Google Scholar 

  • Bankier, B., Aigner, M., & Bach, M. (2001). Alexithymia in DSM-IV disorder: Comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression. Psychosomatics, 42, 235–240.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Steer, R. D., & Brown, C. K. (1996). Manual for Beck Depression Inventory-II (BDI-II). San Antonio, Texas: Psychological Corporation.

    Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    PubMed  CAS  Google Scholar 

  • Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162, 1179–1187.

    Article  PubMed  Google Scholar 

  • Calikusu, C., Yucel, B., Polat, A., & Baykal, C. (2002). Expression of anger and alexithymia in patients with psychogenic excoriation: A preliminary report. International Journal of Psychiatry in Medicine, 32, 345–352.

    PubMed  Google Scholar 

  • Cordan Yazici, A., Basterzi, A., Ustunsoy, D., Ikizoglu, G., Demirseren, D., & Kanık, A. (2006). Alopecia areata and alexithymia. Turkish Journal of Psychiatry, 17, 101–106.

    PubMed  Google Scholar 

  • Cox, B. J., Swinson, R. P., Shulman, I. D., & Bourdeau, D. (1995). Alexithymia in panic disorder and social phobia. Comprehensive Psychiatry, 36, 195–198.

    Article  PubMed  CAS  Google Scholar 

  • Dag, I. (1991). Reability and validity of Symptom Check List-90-Revised among university students. Turkish Journal of Psychiatry, 2, 5–12.

    Google Scholar 

  • Derogatis, L. R. (1983). SCL-90: Administration, scoring and procedure manual-II for the revised version. Towson, MD: Clinical Psychometric Research.

    Google Scholar 

  • Fortune, D. G., Richards, H. L., Griffiths, C. E., & Main, C. J. (2002). Psychological stress, distress and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. The British Journal of Clinical Psychology, 41(Pt 2), 157–174.

    Article  PubMed  Google Scholar 

  • Fukunishi, I., Kikuchi, M., Wogan, J., & Takubo, M. (1997). Secondary alexithymia as a state reaction in panic disorder and social phobia. Comprehensive Psychiatry, 38, 166–170.

    Article  PubMed  CAS  Google Scholar 

  • Gaikwad, R., Deshpande, S., Raje, S., Dhamdhere, D. V., & Ghate, M. R. (2006). Evaluation of functional impairment in psoriasis. Indian Journal of Dermatology, Venereology and Leprology, 72, 37–40.

    PubMed  Google Scholar 

  • Gupta, M. A., Gupta, A. K., Ellis, C. N., & Koblenzer, C. S. (2005). Psychiatric evaluation of the dermatology patient. Dermatologic Clinics, 23, 591–599.

    Article  PubMed  CAS  Google Scholar 

  • Heinrichs, N., Rapee, R. M., Alden, L. A., Bogels, S., Hofmann, S. G., Oh, K. J., et al. (2006) Cultural differences in perceived social norms and social anxiety. Behaviour Research and Therapy, 44, 1187–1197.

    Article  PubMed  Google Scholar 

  • Hisli, N. (1989). Reability and validity of Beck Depression Inventory among university students. Journal of Turkish Psychology, 7, 3–13.

    Google Scholar 

  • Honkalampi, K., Hintikka, J., Laukkanen, E., Lehtonen, J., & Viinamaki, H. (2001). Alexithymia and depression: A prospective study of patients with major depressive disorder. Psychosomatics, 42, 229–234.

    Article  PubMed  CAS  Google Scholar 

  • Honkalampi, K., Hintikka, J., Saarinen, P., Lehtonen, J., & Viinamaki, H. (2000). Is alexithymia a permanent feature in depressed patients? Results from a 6-month follow-up study. Psychotherapy and Psychosomatics, 69, 303–308.

    Article  PubMed  CAS  Google Scholar 

  • Jacoby, A. (1994). Felt versus enacted stigma: A concept revisited. Evidence from a study of people with epilepsy in remission. Social Science & Medicine, 38, 269–274.

    Article  CAS  Google Scholar 

  • Kent, G., & al-Abadie, M. (1996). Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers. Clinical and Experimental Dermatology, 21, 330–333.

    Article  PubMed  CAS  Google Scholar 

  • Kent, G., & Keohane, S. (2001). Social anxiety and disfigurement: The moderating effects of fear of negative evaluation and past experience. The British Journal of Clinical Psychology, 40(Pt 1), 23–34.

    Article  PubMed  CAS  Google Scholar 

  • Kose, S., Sayar, K., Gulec, H., Evren, C., & Borckardt, J. (2005). The Turkish version of the 20-Item Toronto Alexithymia Scale (TAS-20): Reliability, validity, and factorial structure. Society of Biological Psychiatry Symposium, May 19–22, Atlanta, GA.

  • Leary, M. R., Rapp, S. R., Herbst, K. C., Exum, M. L., & Feldman, S. R. (1998). Interpersonal concerns and psychological difficulties of psoriasis patients: Effects of disease severity and fear of negative evaluation. Health Psychology, 17, 530–536.

    Article  PubMed  CAS  Google Scholar 

  • Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173.

    PubMed  CAS  Google Scholar 

  • Lowe, J. G. (1993). The stigma of acne. British Journal of Hospital Medicine, 49, 809–812.

    PubMed  CAS  Google Scholar 

  • Luminet, O., Bagby, R. M., & Taylor, G. J. (2001). An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychotherapy and Psychosomatics, 70, 254–260.

    Article  PubMed  CAS  Google Scholar 

  • Mercan, S., & Kivanc Altunay, I. (2006). Psychodermatology: A collaboration between psychiatry and dermatology. Turkish Journal of Psychiatry, 17, 305–313.

    PubMed  Google Scholar 

  • Panconesi, E. (2005). Psychosomatic factors in dermatology: Special perspectives for application in clinical practice. Dermatologic Clinics, 23, 629–633.

    Article  PubMed  CAS  Google Scholar 

  • Picardi, A., Pasquini, P., Cattaruzza, M. S., Gaetano, P., Baliva, G., Melchi, C. F., et al. (2003a). Psychosomatic factors in first-onset alopecia areata. Psychosomatics, 44, 374–381.

    Article  PubMed  CAS  Google Scholar 

  • Picardi, A., Pasquini, P., Cattaruzza, M. S., Gaetano, P., Melchi, C. F., Baliva, G., et al. (2003b). Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study. Psychotherapy and Psychosomatics, 72, 150–158.

    Article  PubMed  CAS  Google Scholar 

  • Picardi, A., Pasquini, P., Cattaruzza, M. S., Gaetano, P., Melchi, C. F., Baliva, G., et al. (2005). Stress, social support, emotional regulation, and exacerbation of diffuse plaque psoriasis. Psychosomatics, 46, 556–564.

    Article  PubMed  CAS  Google Scholar 

  • Picardi, A., Porcelli, P., Mazzotti, E., Fassone, G., Lega, I., Ramieri, L., et al. (2007). Alexithymia and global psychosocial functioning: A study on patients with skin disease. Journal of Psychosomatic Research, 62, 223–229.

    Article  PubMed  Google Scholar 

  • Picardi, A., Porcelli, P., Pasquini, P., Fassone, G., Mazzotti, E., Lega, I., et al. (2006). Integration of multiple criteria for psychosomatic assessment of dermatological patients. Psychosomatics, 47, 122–128.

    Article  PubMed  Google Scholar 

  • Poot, F., Sampogna, F., & Onnis, L. (2007). Basic knowledge in psychodermatology. Journal of the European Academy of Dermatology and Venereology, 21, 227–234.

    Article  PubMed  CAS  Google Scholar 

  • Richards, H. L., Fortune, D. G., Griffiths, C. E., & Main, C. J. (2005). Alexithymia in patients with psoriasis: Clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 58, 89–96.

    Article  PubMed  Google Scholar 

  • Root, S., Kent, G., & al-Abadie, M. S. (1994). The relationship between disease severity, disability and psychological distress in patients undergoing PUVA treatment for psoriasis. Dermatology, 189, 234–237.

    Article  PubMed  CAS  Google Scholar 

  • Salminen, J. K., Saarijarvi, S., Aairela, E., & Tamminen, T. (1994). Alexithymia—state or trait? One-year follow-up study of general hospital psychiatric consultation out-patients. Journal of Psychosomatic Research, 38, 681–685.

    Article  PubMed  CAS  Google Scholar 

  • Sayar, K., Acar, B., & Ak, I. (2003). Alexithymia and suicidal behavior. The Israel Journal of Psychiatry and Related Sciences, 40, 165–173.

    PubMed  Google Scholar 

  • Schneider, G., Driesch, G., Heuft, G., Evers, S., Luger, T. A., & Stander, S. (2006). Psychosomatic cofactors and psychiatric comorbidity in patients with chronic itch. Clinical and Experimental Dermatology, 31, 762–767.

    Article  PubMed  CAS  Google Scholar 

  • Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.

    Article  PubMed  CAS  Google Scholar 

  • Solmaz, M., Sayar, K., Ozer, O.A., Ozturk, M., & Acar, B. (2000). Alexithymia, hopelessness and depression in social phobic patients: A study with a control group. Turkish Journal of Clinical Psychiatry, 3, 235–241.

    Google Scholar 

  • Soykan, C., Ozguven, H. D., & Gencoz, T. (2003). Liebowitz Social Anxiety Scale: The Turkish version. Psychological Reports, 93, 1059–1069.

    PubMed  Google Scholar 

  • Spielberger, C., Gorsuch, R., & Lushene, R. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press.

    Google Scholar 

  • Taylor, G. J., & Bagby, R. M. (1997). Affect dysregulation and alexithymia. In G. J. Taylor, R. M. Bagby, & J. D. A. Parker (Eds.), Disorders of affect regulation (pp. 26). Cambridge, MA: Cambridge University Press.

    Google Scholar 

  • Taylor, G. J., & Bagby, R. M. (2000). An overview of the alexithymia construct. In R. Baron, & J. D. A. Parker (Eds.), Handbook of emotional intelligence (pp. 40–46). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Wittkowski, A., Richards, H .L., Griffiths, C. E., & Main, C. J. (2004). The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. Journal of Psychosomatic Research, 57, 195–200.

    Article  PubMed  Google Scholar 

  • Zachariae, R., Zachariae, C., Ibsen, H. H., Mortensen, J. T., & Wulf, H. C. (2004). Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients. Acta Dermato-Venereologica, 84, 205–212.

    Article  PubMed  Google Scholar 

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Acknowledgement

The authors would like to thank Dr. Melda Koyuncu (MK), from the Outpatient Dermatology Department at Baltalimani State Hospital for Muskuloskeletal Disorders, not only for her helpful support during the present study but also for the concern she shows for her patients in general.

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Correspondence to Cuneyt Evren.

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Evren, B., Evren, C. Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation. J Clin Psychol Med Settings 14, 258–265 (2007). https://doi.org/10.1007/s10880-007-9072-9

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