Alexithymia in children with medically unexplained symptoms: a systematic review

Abstract

Objective: Adult research investigating the link between alexithymia and medically unexplained symptoms (MUS) has found a significant relationship between increased alexithymia and MUS. This difficulty in expressing emotions is likely to begin in childhood so the objective of this paper is to present a quantitative review of studies focussing on the association between MUS and alexithymia in children. Methods: Databases were searched with predefined terms relating to alexithymia and MUS in children (0-17 years). Two reviewers independently assessed abstracts, extracted data and undertook quality analyses. Systematic review methods were used in accordance with Cochrane guidelines. Results: Ten studies met the criteria for inclusion in the review. Seven of the eight studies which focused on a comparison between children with MUS and healthy controls, found higher levels of self-reported alexithymia in the children with MUS. However, in the two studies where children were asked to complete tasks that objectively measure alexithymia, significant differences were not found. Results of studies comparing alexithymia in children with MUS and children with medical/psychiatric controls were inconsistent; there was some evidence of increased anxiety and depression in young people with alexithymia and MUS but inconsistency of measures across studies makes drawing conclusions difficult. Conclusion: There is preliminary evidence that children with MUS have significantly higher levels of alexithymia than controls based on self-report measures; however, this finding was not replicated in objective tasks of alexithymia. Future studies should include validated tasks that objectively measure emotion recognition abilities and focus on possible mediating factors such as neurodevelopmental and mental health difficulties.

RETRACTED ARTICLE: Improving the measurement of alexithymia in autistic adults: a psychometric investigation and refinement of the twenty-item Toronto Alexithymia Scale

“…Removal of the EOT and reverse-coded items from the model greatly improved overall fit, but three additional items needed to be removed in order to meet our a priori standards of adequate IRT model fit and negligible I-DIF by diagnostic group. The final TAS-8 short form consisted of five DIF items [1,6,9,13,14] and three DDF items [2,11,12] that ostensibly form the core of the "general alexithymia" construct measured by the TAS-20 total score. Using item response theory, we generated norm-referenced TAS-8 scores that are immediately interpretable on the scale of a Z-score (i.e., M = 0, SD = 1) and can similarly be scaled to the familiar T-score metric (M = 50, SD = 10).…”

“…These individuals also tend to exhibit a reduction in imaginal processes and a stimulus-bound, externally oriented style of thinking (i.e., "concrete thinking"). Alexithymia is not itself considered a psychiatric diagnosis; rather, the condition can better be described as a dimensional personality trait that is expressed to varying degrees in the general population and associated with a host of medical, psychiatric, and psychosomatic conditions [2][3][4][5][6][7][8][9][10][11][12][13][14]. Although there is taxometric evidence to suggest that alexithymia is a dimensional rather than categorical construct [15][16][17], researchers frequently categorize a portion of individuals as having "high alexithymia" based on questionnaire scores above a certain threshold, with upwards of 10% of the general population exceeding these thresholds [18][19][20].…”

Prevalence of Alexithymia in Patients with Medically Unexplained Physical Symptoms: A Cross-sectional Study in Egypt

“…Given that patients with alexithymia are not expected to fully understand that physical symptoms can be somatic representations of emotions, they are considered to be more likely to falsely attribute physical signs to physical illness and to request medical attention for symptoms with no underlying medical cause. Therefore, alexithymia is known to be a predisposing and persistent factor in the occurrence of MUPS, contributing to one of the somatoform disorders [ 10 , 11 ]. Various studies, usually non-clinical trials, have reported a correlation between alexithymia and multiple somatization interventions.…”

Socio-demographic characteristics and psychopathological assessment in a sample of 13 paediatric patients with functional neurological disorders: A preliminary report

“…First, in the adult population, alexithymia is significantly associated with FND (Demartini et al, 2014); in particular, our group previously hypothesized that functional symptoms might arise when adult individuals with alexithymic and obsessive-compulsive personality traits might fail to interpret correctly as anxiety or panic the autonomic arousal occurring during a physical precipitating event and might interpret these sensations as symptoms of physical illness. A recent systematic review about alexithymic traits in children with Medically Unexplained Symptoms (MUS, including pain, tension-type headache, functional abdominal pain, headache and Chronic Fatigue Syndrome) showed that alexithymia appears significantly higher in children with MUS, with respect to healthy controls, only when assessed through self-report questionnaires and not when investigated with objective tasks of identification of one’s own emotions (Hadji-Michael et al, 2019). In this study, alexithymia was only investigated with the self-report questionnaire TAS-20, where only two subjects scored above the cut off.…”