Psychophysical Distress and Alexithymic Traits in Chronic Fatigue Syndrome with and without Comorbid Depression

Abstract

Patients with Chronic Fatigue Syndrome (CFS) often report a comorbid depressive disorder. Comorbid depression may negatively influence the long-term outcome of CFS therefore it must be correctly diagnosed and treated. The aim of the present study is to provide a clinical and psychometric assessment of CFS patients with and without depressive features. A comparative analysis between 57 CFS subjects (CDC, 1994), 17 of whom with a comorbid depression, and 55 matched healthy volunteers was assessed to evaluate the presence of any psychophysical distress and alexithymic traits, by means of Symptom Checklist-90-R (SCL-90R) and Toronto Alexithymia Scale (TAS-20). The severity of fatigue was also assessed in all CFS patients using the Fatigue Impact Scale (FIS). With regard to psychiatric comorbidity, the SCL-90R scores showed higher levels of somatic complaints in CFS patients than in healthy subjects, whereas augmented depressive and obsessive-compulsive symptoms were observed only in the depressed CFS subgroup. When comparing the TAS-20 scores, we observed a selective impairment in the capacity to identify feelings and emotions, as measured by the Difficulty in Identifying Feelings subscale (DIF), non-depressed CFS patients showing an intermediate score between depressed CFS and healthy controls. Finally, in terms of FIS scores, a statistical trend versus a higher fatigue severity in depressed CFS patients, with respect to non-depressed ones, was observed. In conclusion, comorbid depression in CFS significantly increased the level of psychophysical distress and the severity of alexithymic traits. These findings suggest an urgent need to address and treat depressive disorders in the clinical care of CFS cases, to improve social functioning and quality of life in such patients.Chronic Fatigue Syndrome (CFS) is still an unclear clinical entity, characterized by an unexplained disabling fatigue, immunological alterations and aspecific accompanying symptoms : sleep disorders, neurocognitive dysfunctions and multiple somatic complains, such as muscle pain , multi-joint pain and unusual headache (1-2). The Centers for Disease Control (CDC) criteria (3) exclude CFS when subjects are affected by bipolar disorders and major depressive disorders with psychotic or melancholic features. Major depressive disorders without psychotic or melanchonic features ,

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

“…Using a conservative p ‐value, no difference was found between CFS and ES in TAS‐20 measures, the only exception being the scale difficulty describing feelings (DDF) where CFS patients reported less difficulty compared to ES patients. Previous studies indicate that patients with CFS report more difficulties in identifying feelings than HCs (Sepede et al ., ; van de Putte et al ., ), and even after adjusting for multiple comparisons, this study confirmed previous results. Moreover, the results of this study indicate that emotional awareness capacity might be hampered in CFS when a performance‐based measure such as the LEAS is used (Oldershaw et al ., ).…”

“…However, only difficulties of identifying feelings remained significant after controlling for age, gender, anxiety and depression. In a similar vein, depressed and non‐depressed adult CFS patients were found to report more impairment in identifying feelings compared to healthy controls (Sepede, Racciatti, Gorgoretti et al ., ). Other studies indicate that CFS patients report more difficulties identifying feelings compared to “minor health conditions” (e.g., the common cold) (Vanheule, Vandenbergen, Verhaeghe & Desmet, ), but, in contrast, less difficulties compared to patients with rheumatoid arthritis (Wood & Wessely, ).…”

Alexithymia and metabolic syndrome: the mediating role of binge eating

“…In a model proposed by Goldbacher et al [54], psychological factors may contribute to the pathogenesis of MetS via physiological as well as behavioral mediating pathways. Several studies confirm that alexithymia is related to physical [55] and psychological distress [56], and directly associated with hyperarousal, sympathetic over-activity [57], and altered immune responses [58]. It may represent a personality marker of stress sensitivity or a vulnerability marker of stress, facilitating both unhealthy behaviors and inflammatory processes [57].…”

The longitudinal effects of seated isometric yoga on blood biomarkers, autonomic functions, and psychological parameters of patients with chronic fatigue syndrome: a pilot study

“…In this study, we assessed the effects of regular practice of isometric yoga on HADS-D (depressive symptoms), HADS-A (anxiety), and TAS-20 (alexithymia) and found that isometric yoga exclusively improved HADS-D scores, suggesting an improvement in depressive symptoms by regular practice of yoga. As comorbid depression has been demonstrated to increase the level of psychophysical distress in patients with CFS [73], the seated isometric yoga-induced reduction in depressive symptoms must be beneficial for them.…”