Marialaura Di Tella

Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function

Background Fibromyalgia (FM) is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. In the aetiology of this syndrome a crucial role is played by complex interactions among biological, genetic, psychological, and socio-cultural factors. Recently, researchers have started to explore emotional functioning in FM, with their attention focused on alexithymia, a personality construct that affects the regulation of a person’s own emotions. On the other hand, the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people’s mental states (i.e. Theory of Mind, ToM) in these patients. Here we present the first study investigating a large set of social-cognitive abilities, and the possible relationships between these abilities and the performance on executive-function tasks, in a homogenous sample of patients with FM. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study. Social cognition was assessed with a set of validated experimental tasks. Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM. Relationships between social-cognitive abilities and demographic, clinical and psychological variables were also investigated. Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other’s emotions, as well as in representing other people’s mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed. Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice.

Alexithymia and fibromyalgia: clinical evidence.

This review proposes a critical discussion of the latest studies investigating the presence of alexithymia in patients with fibromyalgia (FM) and its relation to other psychological disorders. The focus is on the most relevant literature exploring the relationship between FM, a chronic pain syndrome, and alexithymia, an affective dysregulation, largely observed in psychosomatic diseases. The articles were selected from the Medline/Pubmed database using the search terms “Fibromyalgia,” “Alexithymia,” and “Psychological Distress.” Of the seven studies fulfilling these criteria, one found no differences between FM patients and the control group, four found significant differences, with higher levels of alexithymia in the FM sample, while two showed unclear results. Overall, the majority of findings highlighted the high prevalence of alexithymia in FM patients. Future studies should clarify the role of alexithymia in FM, paying attention to two principal aspects: the use, as a control group, of patients with chronic pain conditions but a low psychosomatic component, and the use of other measures, in addition to the Toronto Alexithymia Scale (TAS-20), to assess alexithymia.

Pain experience in Fibromyalgia Syndrome: The role of alexithymia and psychological distress

BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome with a high prevalence of alexithymia, a personality disposition that affects emotional self-awareness. The present study aimed to investigate the relationship between alexithymia and pain, differentiating between the sensory and affective components of pain experience, in a sample of FM patients. METHODS One hundred and fifty-nine FM patients completed a battery of tests assessing pain experience, pain intensity, alexithymia and psychological distress. In order to characterize the clinical profile of alexithymic FM patients, alexithymic and non-alexithymic groups were compared on the different measures. Two regression analyses were performed on the total sample, in order to investigate the relationship between alexithymia and pain, controlling for psychological distress. RESULTS Alexithymic FM patients presented higher scores on all the clinical measures compared to non-alexithymic ones. Positive correlations were found between alexithymia and the affective, but not the sensory, dimension of pain experience variables. Regression analyses showed that alexithymia (difficulty identifying feelings factor) ceased to uniquely predict affective pain, after controlling for psychological distress, particularly anxiety. In addition, none of the alexithymia variables significantly explained pain intensity variance. Finally, a significant effect of anxiety in mediating the relationship between alexithymia and affective pain was found. LIMITATIONS No longitudinal data were included. CONCLUSIONS These findings show the presence of higher levels of pain and psychological distress in alexithymic vs. non-alexithymic FM patients, and a relevant association between alexithymia and the affective dimension of pain experience. Specifically, this relationship appears to be significantly mediated by anxiety.

Alexithymia in Chronic Pain Disorders

This review proposes a critical discussion of the recent studies investigating the presence of alexithymia in patients suffering from different chronic pain (CP) conditions. The term CP refers to pain that persists or progresses over time, while alexithymia is an affective dysregulation, largely observed in psychosomatic diseases. Overall, the examined studies showed a high prevalence of alexithymia, especially difficulties in identifying feelings, in all the different CP conditions considered. However, the association between alexithymia and pain intensity was not always clear and in some studies this relationship appeared to be mediated by negative effect, especially depression. The role of alexithymia in CP should be clarified by future studies, paying particular attention to two aspects: the use of additional measures, in addition to the Toronto Alexithymia Scale, to assess alexithymia, and the analysis of the potential differences in the evolution of different CP conditions with reference to the presence or absence of alexithymia.

Alexithymia and depression in patients with fibromyalgia: When the whole is greater than the sum of its parts

This study investigated the link between alexithymia and depressive symptoms in Fibromyalgia (FM). 181 FM women and 181 healthy controls (HC) were compared using the Hospital Anxiety and Depression Scale and the Toronto Alexithymia Scale. A moderation analysis was performed to examine the moderation effect of the group (FM vs. HC) on the relationship between alexithymia and depression. Group was a significant moderator, highlighting a stronger relationship between alexithymia and depressive symptoms in the FM compared to HC. The study highlighted that the association between alexithymia and depression is different when we consider FM patients rather than the healthy population.

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self-awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem-focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally-oriented thinking factor of alexithymia significantly explained both problem- and emotion-focused coping, while the difficulty-describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.

Post-traumatic growth, distress and attachment style among women with breast cancer

ABSTRACT Identifying factors fostering post-traumatic growth (PTG) is very important to promote PTG itself through specific psychological interventions. To this end, we investigated PTG and its relationship with clinical and psychological variables in a sample of 108 female breast cancer survivors. Results showed that women with higher depressive symptoms presented lower levels of PTG than women without. Moreover, women who had undergone combined treatment presented higher levels of PTG than women who had not. The results highlighted the resulting importance of psychological intervention focusing on depressive symptoms, which negatively interfere with the patients’ psychological growth.

Alexithymia, not fibromyalgia, predicts the attribution of pain to anger-related facial expressions

BACKGROUND Fibromyalgia (FM) is a syndrome characterized by chronic, widespread musculoskeletal pain, occurring predominantly in women. Previous studies have shown that patients with FM display a pattern of selective processing or cognitive bias which fosters the encoding of pain-related information. The present study tested the hypothesis of an increased attribution of pain to facial expressions of emotions (FEE), in patients with FM. As previous studies have shown that alexithymia influences the processing of facial expressions, independent of specific clinical conditions, we also investigated whether alexithymia, rather than FM per se, influenced attribution of pain to FEE. METHODS One hundred and twenty-three women (41 with FM, 82 healthy controls, HC) were enrolled in this cross-sectional case-control study. We adopted two pain-attribution tasks, the Emotional Pain Estimation and the Emotional Pain Ascription, both using a modified version of the Ekman 60 Faces Test. Psychological distress was assessed using the Hospital Anxiety and Depression Scale, and alexithymia was assessed using the Toronto Alexithymia Scale. RESULTS Patients with FM did not report increased attribution of pain to FEE. Alexithymic individuals demonstrated no specific problem in the recognition of basic emotions, but attributed significantly more pain to angry facial expression. LIMITATIONS Our study involved a relatively small sample size. The use of self-reported instruments might have led to underestimation of the presence of frank alexithymia in individuals having borderline cut-off scores. CONCLUSIONS Alexithymia, rather than FM per se, plays a key role in explaining the observed differences in pain attribution to anger-related facial expressions.

Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia

Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients’ quality of life, especially regarding the psychosocial functioning.