Background Systemic Sclerosis (SSc) is an autoimmune connective tissue disease characterized by abnormal fibrotic processes that can affect multiple organ systems. Indeed the disease is associated with chronically painful symptoms related to ulcerations, joint contractures, arthritis, gastroesophageal reflux or Raynaud phenomenon. Patients with SSc may be at particular risk for depression due to the high levels of chronic pain, fatigue, dissatisfaction with their appearance, and overall disability: all these features may influence the emotional suffering. The psychological construct of alexithymia, literally meaning “no words for mood”, was firstly coined in 1972 to describe people who lack the ability to communicate their feelings and who seem unable to fantasize, often presenting with multiple somatic symptoms (1). In turn alexithymia makes rather difficult to recognize any possible underlying psychiatric disorders.
Objectives To evaluate the presence of alexithymia in ScS patients, comparing its prevalence with that of a group of healthy subjects.
Methods We used the Italian validated translation of Toronto Alexithymia Scale (TAS-20) (2) to assess the alexithymic tract. It was administered to 50 ScS patients (F/M = 48/2; mean age = 59 years; diffuse form/limited form = 24/26) and to 37 healthy subjects (F/M = 35/2; mean age = 56 years). We also measured depressive symptoms by administering the Italian validated version of Beck Depression Inventory (BDI) to both groups.
Results In the SSc patient group a TAS-20 score indicating alexithymia (≥ 61) was present in 15 subjects (30%). The prevalence of alexithymia was significantly higher than in the healthy subject group, where it was found in 4 cases (11%)(P=0,038). The proportion of subjects with moderate to severe depression (BDI≥23) was greater in the SSc patient group (24%) than in healthy subjects (3%) (P= 0,01). Finally the SSc group with alexithymia had a strong association with moderate to severe depression (P= 0,0002). There was no statistically significant difference between the diffuse and the limited forms.
Conclusions We found that SSc patients are more likely than healthy subjects to have difficulty in identifying and describing feelings, as well as higher alexithymia scores. Besides a moderate to severe depression is more prevalent in the patient group. These results underline the importance of considering emotions in the SSc patients, without underestimating their psychological aspects.
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Caretti V, Taylor GJ: Reliability and validity of the Toronto Structured Interview for Alexithymia in a mixed clinical and nonclinical sample from Italy. Psychiatry Res. 2011; 187:432-6.
Disclosure of Interest None Declared