Alexithymia, literally meaning “without words for emotions,” refers to difficulties in both identifying and expressing emotions (Sifneos, 1972
). A strong body of evidence exists documenting the relationship between difficulties with emotion identification and expression and physical health problems (e.g., Lumley, Beyer, & Radcliffe, 2008
), including adult patients with inflammatory bowel disease (n = 108) (Iglesias et al., 2010
), rheumatoid arthritis (n = 40) (Fernandez, Sriram, Rajkumar, & Chandrasekar, 1989
), and fibromyalgia (n = 70) and chronic low back pain (n = 56) (Tuzer et al., 2010
). In adolescents, somatoform pain disorder (n = 120) (Burba et al., 2006
) and tension headaches (n = 32) (Gratta et al., 2010
) have been associated with higher levels of alexithymia as compared to healthy controls. Alexithymia has also been linked to somatization (e.g., De Gucht & Heiser, 2003
), which is the attribution of the physiological sensations of emotions to physical illness rather than recognizing them as a component of one’s emotions and dysfunctional cognitive processes (Kooiman, Spinhoven, & Trijsburg, 2002
). Yet, while the links among alexithymia, physical illness and somatization have been clearly established, little has been done to better understand the nature of these relationships, particularly from a developmental perspective, and what other factors may contribute to the connection between alexithymia and somatization (De Gucht & Heiser, 2003
Although the exact mechanisms underlying these associations are not clear, some have hypothesized that shared neurobiological pathways for emotions and physical health may result in problems for both (Lumley, Stettner, & Wehmer, 1996
). Another intriguing possibility is that alexithymic individuals fail to respond adaptively to emotional situations, thereby leading to chronic levels of negative emotions. Without emotion identification and subsequent appropriate action, individuals become mired in a pattern of negative emotions and maladaptive responses to both external and internal stimuli (e.g., pain) that have potential long-term consequences on physical and mental health (Rieffe et al., 2007
). In this model, emotional distress and negative emotions may help explain some of the relationship between alexithymia and somatization.
Past research has demonstrated a strong link between alexithymia, somatization, and psychological constructs such as anxiety and depression (De Gucht & Heiser, 2003
; Mattila et al., 2008
). Somatization has also been shown to be associated with both alexithymia and with depressive disorders (Bailey & Henry, 2007
; Garyfallos et al., 1999
; Simon & VonKorff, 1991
). The relationships between the constructs of alexithymia, somatization and psychopathology are complex, with some arguing that alexithymia predisposes a person to experience chronic negative mood states (Lumley, 2000
), which could potentially lead to somatization. It remains to be determined whether the alexithymia-somatization connection can be fully explained by psychopathology, and at least some evidence suggests that anxiety and depression cannot fully account for this relationship (Mattila et al., 2008
). However, in previous studies, only diagnoses of anxiety and depression (i.e., presence v. absence) were considered, and exploring the role of anxious and depressive symptoms might provide a clearer understanding of how psychopathology is related to alexithymia and somatization.
Lumley, Smith and Longo (2002)
proposed that, with depression’s link to alexithymia and somatization, depression could be a mediator of the relationship between alexithymia and somatization in chronic pain patients. These authors included both depression and alexithymia as predictors of the affective (i.e., “unpleasantness”) component of pain in a hierarchical regression, and results indicated that only depressive symptoms significantly contributed to the variance in pain unpleasantness – evidence consistent with the idea of depression as a mediator of an alexithymia-pain association, although a mediational relationship was not directly tested. A direct test of depression as this proposed mediator between alexithymia and somatization is lacking, whether in clinical or healthy samples.
A major limitation of the majority of the studies described earlier is that study populations have consisted primarily of adult samples. The complex nature of the association between alexithymia, somatization, and depression may be different as individuals get older, and there is a need for further examination of these relationships in younger populations. Biological (e.g., hormonal), social, and psychological factors may be different in children and adolescents, and developmental differences between children and adults may result in different relationships or pathways between these constructs. For example, Rieffe et al. (2010)
explored the relationship between alexithymia, moods (i.e., happiness, anger, sadness, and fear), and internalizing symptoms (i.e., somatic symptoms and worry/rumination) in a sample of Iranian children ages 10–15. The authors found that mood states mediated the relationship between alexithymia and internalizing symptoms, but alexithymia also contributed to internalizing symptoms above the effects of mood, suggesting that an independent relationship with alexithymia and somatization also exists. Yet, in another recent study, Jellesma, Rieffe, Terwogt & Westenberg (2009)
found that the children reporting many somatic symptoms did not have an impaired ability to identify emotions, as compared to children reporting few somatic symptoms. However, those reporting many somatic symptoms did have difficulty identifying and communicating negative internal states (i.e., moods) but were better able to identify multiple emotions as compared to children reporting few somatic complaints. Given these findings, it appears as if the exact nature of the relationship between alexithymia, emotions, and somatization is quite complex in children and warrants further investigation.
The purpose of the current study was to investigate the association between alexithymia, depression, and somatization in a sample of healthy children. Exploring these relationships in children allows us to consider the developmental aspects of how alexithymia and somatization may be related, and whether this is different in younger populations as compared to adults. We hypothesized that measures of alexithymia, depression, and somatization would all be significantly correlated, as evidenced by past research demonstrating strong relationships between these constructs (e.g., De Gucht & Heiser, 2003
; Lumley, 2000
; Mattila et al., 2008
). Consistent with prior research in adult populations suggesting the possible mediation of alexithymia and somatization (Lumley et al., 2002
), the hypothesized model (see ) posited that difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) would independently predict depression (Path a) and somatization (Path c), and depression would also predict somatization (Path b). Moreover, within the hypothesized model, depression was expected to mediate the association between DIF/DDF and somatization (Path c’).
Figure 1 Mediation models of difficulty identifying feelings (DIF), difficulty describing feelings (DDF), depression, and somatization, controlling for child age. B = unstandardized regression coefficient; β = standardized regression coefficient. **p < (more ...)