Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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The Therapeutic Implications of Alexithymia in Patients with Eating Disorders

식이장애 환자에서 나타나는 감정표현불능증의 치료적 함의

  • Kim, Seung-Jun (Department of Psychiatry, Konyang University College of Medicine, Konyang University Hospital)
  • 김승준 (건양대학교 의과대학 정신과학교실)
  • Received : 2016.05.11
  • Accepted : 2016.06.18
  • Published : 2016.06.30
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Abstract

Alexithymia is characterized by difficulties identifying and describing feelings, impoverished fantasy life, and concrete and poorly introspective thinking. Alexithymic patients have been reported to show a stable deficit with regard to processing and regulating emotions. Eating disorders are characterized by a persistent disturbance of eating or eating-related behavior that significantly impairs physical health or psychosocial functioning. Like alexithymic patients, patients with eating disorders show the impaired capacity to process and regulate emotions. There is a robust body of literature showing patients with eating disorders are more alexithymic than healthy controls. Specifically, patients with eating disorders experience difficulties identifying and describing emotions. Childhood maltreatment can increase the risk for depression and alexithymia, which can in turn lead to disordered eating symptoms. Also, higher levels of alexithymia are correlated with a less favorable clinical outcome in patients with eating disorder. Therefore, treatments to help processing and regulating emotions of eating disorder patients with pronounced alexithymic traits may seem to lead to a higher possibility of recovery.

감정표현불능증(alexithymia)은 자신의 감정을 판별하거나 감정과 신체 감각을 구별하지 못하고 감정을 교류하지 못하며 공상이 부족하고 외부적 환경에만 인지적으로 집중하는 특성으로 정의되며, 그 기저에는 감정 처리 과정 상의 지속적인 결함이 존재하는 것으로 알려져 있다. 한편, 식이장애는 비적응적인 식이 관련 행동들로 인하여 신체적, 심리사회적 기능이 저하되는 질환으로서 이러한 비적응적 식이 관련 행동은 감정을 처리하고 조절하는 능력의 저하와 관련이 있다는 보고들이 있다. 식이장애 환자들에게 나타나는 감정표현불능증을 연구한 기존 연구들을 살펴 보면 식이장애 환자들은 정상인들에 비해 높은 수준의 감정표현불능증을 보이며, 감정표현불능증 요소 중 감정을 판별하기 어려움 요소와 감정을 묘사하기 어려움 요소가 정상인들에 비해 높은 수준으로 나타난다. 높은 수준의 감정표현불능증은 유년기 학대 및 우울증과 상호 작용하면서 식이장애 행동의 발생 위험성을 증대시키며 식이장애의 치료 효과 또한 반감시키는 것으로 보인다. 이상의 논의를 종합해 볼 때 감정표현불능증을 포함한 정서 처리 및 조절 능력의 결함에 도움을 줄 수 있는 치료가 식이장애의 치료에도 도움이 될 가능성이 있으므로 이에 대한 추가적인 연구가 필요할 것이다.

Keywords

References

  1. Sifneos PE. The prevalence of 'alexithymic' characteristics in psychosomatic patients. Psychother Psychosom 1973;22:255-262. https://doi.org/10.1159/000286529
  2. Spitzer C, Siebel-Jurges U, Barnow S, Grabe HJ, Freyberger HJ. Alexithymia and interpersonal problems. Psychother Psychosom 2005;74:240-246. https://doi.org/10.1159/000085148
  3. Marchesi C, Fonto S, Balista C, Cimmino C, Maggini C. Relationship between alexithymia and panic disorder: a longitudinal study to answer an open question. Psychother Psychosom 2005;74:56-60. https://doi.org/10.1159/000082028
  4. Luminet O, Bagby RM, Taylor GJ. An evaluation of the absolute and relative stability of alexithymia in patients with major depression. Psychother Psychosom 2001;70:254-260. https://doi.org/10.1159/000056263
  5. de Timary P, Luts A, Hers D, Luminet O. Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: relationship to depression and anxiety. Psychiatry Res 2008;157:105-113. https://doi.org/10.1016/j.psychres.2006.12.008
  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5 ed. Arlington, VA: American Psychiatric Publishing;2013.
  7. Goodsitt A. Self-regulatory disturbances in eating disorders. International Journal of Eating Disorders 1983;2:51-60. https://doi.org/10.1002/1098-108X(198321)2:3<51::AID-EAT2260020305>3.0.CO;2-N
  8. Grotstein JS. The psychology of powerlessness: Disorders of self-regulation and interactional regulation as a newer paradigm for psychopathology. Psychoanalytic Inquiry 1986;6:93-118. https://doi.org/10.1080/07351698609533619
  9. Cooper MJ. Cognitive theory in anorexia nervosa and bulimia nervosa: progress, development and future directions. Clin Psychol Rev 2005;25:511-531. https://doi.org/10.1016/j.cpr.2005.01.003
  10. Waller G, Corstorphine E, Mountford V. The role of emotional abuse in the eating disorders: implications for treatment. Eat Disord 2007;15:317-331. https://doi.org/10.1080/10640260701454337
  11. Bagby RM, Taylor GJ, Parker JD. Construct validity of the Toronto Alexithymia Scale. Psychother Psychosom 1988;50:29-34. https://doi.org/10.1159/000288097
  12. Taylor GJ, Bagby RM, Parker JD. The Revised Toronto Alexithymia Scale: some reliability, validity, and normative data. Psychother Psychosom 1992;57:34-41. https://doi.org/10.1159/000288571
  13. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23-32. https://doi.org/10.1016/0022-3999(94)90005-1
  14. Meganck R, Vanheule S, Desmet M. Factorial validity and measurement invariance of the 20-item Toronto Alexithymia Scale in clinical and nonclinical samples. Assessment 2008;15: 36-47. https://doi.org/10.1177/1073191107306140
  15. Haviland MG, Warren WL, Riggs ML. An observer scale to measure alexithymia. Psychosomatics 2000;41:385-392. https://doi.org/10.1176/appi.psy.41.5.385
  16. Cochrane CE, Brewerton TD, Wilson DB, Hodges EL. Alexithymia in the eating disorders. Int J Eat Disord 1993;14:219-222. https://doi.org/10.1002/1098-108X(199309)14:2<219::AID-EAT2260140212>3.0.CO;2-G
  17. Rastam M, Gillberg C, Gillberg IC, Johansson M. Alexithymia in anorexia nervosa: a controlled study using the 20-item Toronto Alexithymia Scale. Acta Psychiatr Scand 1997;95:385-388. https://doi.org/10.1111/j.1600-0447.1997.tb09650.x
  18. Jimerson DC, Wolfe BE, Franko DL, Covino NA, Sifneos PE. Alexithymia ratings in bulimia nervosa: clinical correlates. Psychosom Med 1994;56:90-93. https://doi.org/10.1097/00006842-199403000-00002
  19. Beales DL, Dolton R. Eating disordered patients: personality, alexithymia, and implications for primary care. Br J Gen Pract 2000;50:21-26.
  20. De Panfilis C, Rabbaglio P, Rossi C, Zita G, Maggini C. Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology 2003;36:239- 246. https://doi.org/10.1159/000073449
  21. Schmidt U, Jiwany A, Treasure J. A controlled study of alexithymia in eating disorders. Compr Psychiatry 1993;34:54-58. https://doi.org/10.1016/0010-440X(93)90036-4
  22. Parling T, Mortazavi M, Ghaderi A. Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept? Eat Behav 2010;11:205-210. https://doi.org/10.1016/j.eatbeh.2010.04.001
  23. Troop NA, Schmidt UH, Treasure JL. Feelings and fantasy in eating disorders: a factor analysis of the Toronto Alexithymia Scale. Int J Eat Disord 1995;18:151-157. https://doi.org/10.1002/1098-108X(199509)18:2<151::AID-EAT2260180207>3.0.CO;2-E
  24. Bydlowski S, Corcos M, Jeammet P, Paterniti S, Berthoz S, Laurier C, Chambry J, Consoli SM. Emotion-processing deficits in eating disorders. Int J Eat Disord 2005;37:321-329. https://doi.org/10.1002/eat.20132
  25. Montebarocci O, Codispoti M, Surcinelli P, Franzoni E, Baldaro B, Rossi N. Alexithymia in female patients with eating disorders. Eat Weight Disord 2006;11:14-21. https://doi.org/10.1007/BF03327739
  26. Gilboa-Schechtman E, Avnon L, Zubery E, Jeczmien P. Emotional processing in eating disorders: specific impairment or general distress related deficiency? Depress Anxiety 2006; 23:331-339. https://doi.org/10.1002/da.20163
  27. de Groot JM, Rodin G, Olmsted MP. Alexithymia, depression, and treatment outcome in bulimia nervosa. Compr Psychiatry 1995;36:53-60. https://doi.org/10.1016/0010-440X(95)90099-H
  28. Sexton MC, Sunday SR, Hurt S, Halmi KA. The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients. Int J Eat Disord 1998;23:277-286. https://doi.org/10.1002/(SICI)1098-108X(199804)23:3<277::AID-EAT5>3.0.CO;2-G
  29. Rozenstein MH, Latzer Y, Stein D, Eviatar Z. Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls. J Affect Disord 2011;134:386-395. https://doi.org/10.1016/j.jad.2011.06.009
  30. Hund AR, Espelage DL. Childhood emotional abuse and disordered eating among undergraduate females: mediating influence of alexithymia and distress. Child Abuse Negl 2006;30: 393-407. https://doi.org/10.1016/j.chiabu.2005.11.003
  31. Mitchell KS, Mazzeo SE. Mediators of the association between abuse and disordered eating in undergraduate men. Eat Behav 2005;6:318-327. https://doi.org/10.1016/j.eatbeh.2005.03.004
  32. Mazzeo SE, Mitchell KS, Williams LJ. Anxiety, alexithymia, and depression as mediators of the association between childhood abuse and eating disordered behavior in African American and European American women. Psychol Women Quart 2008;32:267-280. https://doi.org/10.1111/j.1471-6402.2008.00435.x
  33. Speranza M, Loas G, Wallier J, Corcos M. Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study. J Psychosom Res 2007;63:365-371. https://doi.org/10.1016/j.jpsychores.2007.03.008
  34. Leweke F, Bausch S, Leichsenring F, Walter B, Stingl M. Alexithymia as a predictor of outcome of psychodynamically oriented inpatient treatment. Psychother Res 2009;19:323-331. https://doi.org/10.1080/10503300902870554
  35. Tchanturia K, Davies H, Harrison A, Fox JR, Treasure J, Schmidt U. Altered social hedonic processing in eating disorders. Int J Eat Disord 2012;45:962-969. https://doi.org/10.1002/eat.22032
  36. Shiina A, Nakazato M, Mitsumori M, Koizumi H, Shimizu E, Fujisaki M, Iyo M. An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement. Psychiatry Clin Neurosci 2005;59:690-696. https://doi.org/10.1111/j.1440-1819.2005.01438.x
  37. Balestrieri M, Isola M, Baiano M, Ciano R. Psychoeducation in Binge Eating Disorder and EDNOS: a pilot study on the efficacy of a 10-week and a 1-year continuation treatment. Eat Weight Disord 2013;18:45-51. https://doi.org/10.1007/s40519-013-0014-2
  38. Clyne C, Latner JD, Gleaves DH, Blampied NM. Treatment of emotional dysregulation in full syndrome and subthreshold binge eating disorder. Eat Disord 2010;18:408-424. https://doi.org/10.1080/10640266.2010.511930
  39. Becker-Stoll F, Gerlinghoff M. The impact of a four-month day treatment programme on alexithymia in eating disorders. Eur Eating Disord Rev 2004;12:159-163. https://doi.org/10.1002/erv.566
  40. Iancu I, Cohen E, Yehuda YB, Kotler M. Treatment of eating disorders improves eating symptoms but not alexithymia and dissociation proneness. Compr Psychiatry 2006;47:189-193. https://doi.org/10.1016/j.comppsych.2006.01.001
  41. Storch M, Keller F, Weber J, Spindler A, Milos G. Psychoeducation in affect regulation for patients with eating disorders: a randomized controlled feasibility study. Am J Psychother 2011;65:81-93. https://doi.org/10.1176/appi.psychotherapy.2011.65.1.81
  42. Lafrance Robinson A, Dolhanty J, Stillar A, Henderson K, Mayman S. Emotion-Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2-Day Transdiagnostic Intervention for Parents. Clin Psychol Psychother 2016;23:14-23. https://doi.org/10.1002/cpp.1933
  43. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press;1993.
  44. Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol 2001;69:1061-1065. https://doi.org/10.1037/0022-006X.69.6.1061
  45. Safer DL, Robinson AH, Jo B. Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behav Ther 2010;41:106-120. https://doi.org/10.1016/j.beth.2009.01.006