Alexithymia and Functioning in Psychosis Disorders


(The following work has recently been published, and may be found here.)

Alexithymia, or the inability to identify and describe one's emotions, is significantly higher in bipolar disorder and schizophrenia, compared to healthy controls. Clinically, individuals with high levels of alexithymia avoid speaking about their feelings; instead they describe the logic of their cognitive and behavioral actions. Their speech is monotonous, stilted, and lacks richness. While they may not admit to feeling clinical symptoms such as depression or anxiety, they may complain about physical symptoms. They are also characterized by impaired emotional functioning, an impoverished fantasy life, and present with difficulty in interpersonal relationships

Alexithymia has also been observed to predict psychosocial functioning, particularly in schizophrenia. We investigated whether alexithymia predicted social and everyday functioning in bipolar disorder, as well as transdiagnostically in healthy controls, bipolar disorder, and schizophrenia patients. Given commonalities (i.e. genetic, clinical, and neurobiological) between schizophrenia and bipolar disorder, we hypothesized that alexithymia would predict social and everyday functioning in our bipolar sample. Additionally we explored whether and to what degree facets of alexithymia would predict functioning in all three diagnostic groups simultaneously.

56 bipolar disorder, 45 schizophrenia, and 50 healthy control participants were administered and compared on tests measuring neurocognition, social cognition, functioning and alexithymia. We conducted linear regressions assessing whether alexithymia predicted functional outcomes in our bipolar disorder group. Next, we conducted hierarchical stepwise linear regressions investigating the predictive ability of neurocognition, social cognition and alexithymia on everyday and social functioning in our overall sample. Bipolar disorder and schizophrenia patients were comparable on most demographics and demonstrated higher alexithymia compared to healthy controls. In bipolar disorder, alexithymia predicted social functioning only. In the overall sample (i.e., three diagnostic groups simultaneously), difficulty identifying and describing feelings predicted everyday functioning; also, difficulty describing feelings predicted social functioning.

Results suggest that aspects of alexithymia significantly predict functioning among these psychiatric groups and healthy controls, above and beyond the contributions of previously identified factors such as neurocognition and social cognition. Results may aid in developing proper interventions aimed at improving patients’ ability to articulate their feelings, which would subsequently improve their functioning and overall quality of life.