Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness

Abstract

ObjectiveEvidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self‐report and real‐time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED).Method145 participants (90 ED, 55 healthy controls (HC)) underwent a real‐time evoked examination of pain and completed self‐report questionnaires for pain (Pain Detect Questionnaire (PD‐Q), PD‐Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI‐II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS‐20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS‐20 as mediators, were tested.ResultsParticipants with ED and HC exhibited similar pain type and intensity (self‐report and real‐time). Eating disorders diagnosis was associated with lower self‐report pain intensity and non‐neuropathic like pain experience (model 1–2). Depressive symptoms partially (model 1–2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology.DiscussionED diagnosis is associated with non‐neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

Is Interoception Deficit Linking Alexithymia and Eating Spectrum Symptoms? Study on a Non-Clinical Sample of Young Adults

“…Moreover, we found that females showed more relevant alexithymic traits than males (as detected by the TAS-20), especially in the domain of an inadequate identification of feelings. This finding is partially in line with the literature and could be explained with the more frequent occurrence of eating spectrum traits in females than in males: the 'psychopathological core' of alexithymia is characterized by a marked difficulty in emotions' identification and elaboration and by a significant interference with self-regulation processes predisposing to dysfunctional eating behaviors, such as binge-eating [38][39][40] or emotional eating [41]. However, several studies pointed out that alexithymic traits might be more frequent among males than females as a consequence of the so-called 'normative male alexithymia' [42], characterized by a deficit in processing emotions.…”

Interoceptive awareness in a clinical setting: the need to bring interoceptive perspectives into clinical evaluation

“…A novel study by Fazia et al (2024) investigated how depression, IA, and alexithymia mediate the relationship between ED and pain perception. The study found that individuals with EDs exhibited reduced pain sensitivity compared to healthy controls.…”

“…The study found that individuals with EDs exhibited reduced pain sensitivity compared to healthy controls. Notably, it highlighted the role of depressive symptoms, either independently associated with alexithymia (i.e., depression is associated with an increased likelihood of perceiving greater pain) or a marked reduction in IA among those with EDs, indicating that depression may compromise IA ( Fazia et al, 2024 ).…”

Using exploratory graph analysis (EGA) in validating the structure of the Perth alexithymia questionnaire in Iranians with chronic pain

“…Patients grappling with CP encounter heightened difficulties in regulating emotion., These are often accompanied by associated physical ailments ( La Touche et al, 2021 ). Research indicates that elevated levels of alexithymia are linked to various adverse outcomes in individuals with CP, including somatization ( Lanzara et al, 2020 ), diminished quality of life ( Tesio et al, 2018 ), psychological distress ( Ghiggia et al, 2022 ), sexual dysfunction ( Aboussouan et al, 2021 ), eating disorders ( Fazia et al, 2024 ), increased pain intensity ( Aaron et al, 2019b ), pain catastrophizing ( Shim et al, 2018 ), anger ( Di Tella et al, 2018 ), and post-traumatic stress disorder ( Fang and Chung, 2023 ).…”