Interoceptive Abilities in Inflammatory Bowel Diseases and Irritable Bowel Syndrome

Abstract

Alexithymia is usually described by three main dimensions difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). The most commonly used questionnaire investigating alexithymia, the Toronto Alexithymia Scale (TAS-20), supports this three-factor structure. One important assumption is that alexithymia severity is associated to vulnerability to somatic diseases, among them gastrointestinal disorders. However, the association between alexithymia and gastrointestinal disorders is not systematic, thus questioning the role of alexithymia as a vulnerability factor for those illnesses. A recent factor analysis suggested another fourfactor structure for the TAS-20: difficulties in awareness of feelings (DAF), difficulties in interoceptive abilities (DIA), externally oriented thinking (EOT), and poor affective sharing (PAS). We assume that DIA and DAF might be more relevant to investigate the association between alexithymia and gastrointestinal disorders. The rationale is that DIA and DAF reflect impairments in emotion regulation that could contribute to an inappropriate autonomic and HPA axis homeostasis in irritable bowel syndrome (IBS), ulcerative colitis (UC), or Crohn's disease (CD). The aim of this study was to investigate whether DIA and DAF are associated with the presence of IBS, UC or CD, while checking for anxiety, depression, parasympathetic (vagus nerve) activity and cortisol levels. We recruited control participants (n=26), and patients in remission who were diagnosed with IBS (n=24), UC (n=18), or CD (n=21). Participants completed questionnaires to assess anxiety, depression, and alexithymia. A blood sample and an electrocardiogram were used to measure the level of cortisol and parasympathetic activity, respectively. Logistic regressions with the four-factor structure of the TAS-20 revealed that DIA was a significant predictor of IBS (W(1)=6.27, p=.01). Conversely, DIA and DAF were not significant predictors in CD and UC patients. However, low cortisol level was a Frontiers in Psychiatry | www.frontiersin.org

Alexithymia and Inflammatory Bowel Disease: A Systematic Review

“…This seems consistent with previous systematic reviews reporting issues of body image dissatisfaction, poor quality of life (Beese et al, 2019), and greater prevalence of anxiety and depression in IBD populations (Hyphantis et al, 2010;Neuendorf et al, 2016;Choi et al, 2019). This difference seems particularly relevant in patients with CD (Fournier et al, 2020), especially regarding difficulties identifying and describing feelings, thus supporting the previously discussed comparison between IBD subpopulations.…”

“…Compared with healthy samples, the present review highlights that patients with IBD have overall higher alexithymic levels, despite to a different extent in terms of effect size (Huang et al, 2016;Yanartaş et al, 2019;Fournier et al, 2020). This seems consistent with previous systematic reviews reporting issues of body image dissatisfaction, poor quality of life (Beese et al, 2019), and greater prevalence of anxiety and depression in IBD populations (Hyphantis et al, 2010;Neuendorf et al, 2016;Choi et al, 2019).…”

“…This difference is confirmed by the study by Yanartaş et al (2019), despite with a smaller effect size, d = 0.48, 95% CI [0.12, 0.84]. Based on the findings by Fournier et al (2020), it seems to be higher in patients with CD, d = 1.05, 95% CI [0.44, 1.67], than in patients with UC, d = Barbera et al (2017) concluded that differences between the TAS-20 total score for patients and control participants were quite small and insignificant.…”

“…Despite being preliminary, these findings seem to indicate some differences between IBD subpopulations. As suggested by Fournier et al (2020), this could depend on the diverse psychophysiological functioning of UC and CD, as the digestive expression of the disease is less restricted and affects the entire gastrointestinal tract in CD. As a result, some patients whose CD is present closer to the stomach, may be more likely to experience disturbing symptoms, such as nausea and vomiting.…”

“…All the studies provided descriptive statistics about the Toronto Alexithymia Scale (TAS-20) total score in patients with IBD. Overall, the mean value of alexithymia ranged from 39 (Fournier et al, 2020) to 53.2 (La Barbera et al, 2017), thus mostly falling in the normal range, indicating no alexithymia, which scores ≤51 points. In this regard, it should be acknowledged that the highest alexithymia prevalence reported by La Barbera et al (2017) was found in clusters of patients characterized by high neuroticism, impulsivity, and severe physical conditions.…”