Psychosomatic Illness: A Problem in Communication

Abstract

The transcripts of recorded clinical psychiatric interviews with 20 patients (8 women and 12 men) suffering from psychosomatic illness were studied to ascertain the nature of their mental content and their capacity to experience affect. In 16 of the 20 patients there was evidence of a form of mentation that appears to have escaped the explicit attention of all but a few investigators: 1) These patients manifested either a total unawareness of feelings or an almost complete incapacity to put into words what they were experiencing. 2) The associations of the majority of the patients were characterized by a) a nearly total absence of fantasy or other material related to their inner, private mental life of thoughts, attitudes and feelings, and b) a recounting, often in almost infinite detail, of circumstances and events in their environment, including their own actions. Their thoughts, that is, were stimulus-bound rather than drive-directed.

The Dutch Language Version of the Toronto Structured Interview for Alexithymia: Reliability, Factor Structure and Concurrent Validity

“…As stated in the studies by Bagby and colleagues (2006) and Grabe and colleagues (2009), this hierarchical four-factor model also proved to be most consistent with Nemiah and Sifneos's (1970;see also Nemiah et al, 1976) formulation that the alexithymia construct is comprised of deficits in affect awareness (difficulties in identifying and describing subjective emotional feelings) and an operative thinking style (a preoccupation with the details of external events and a paucity of fantasies). The theoretical view that alexithymia is a coherent, but multifaceted construct (Taylor et al, 1997) is also supported by good levels of internal consistency of the Affect Awareness and Operatory Thinking domain scales, a significant correlation between these two domain scales, and significant correlations with the facet scales and the total TSIA as observed in our study and in previous research (Bagby et al, 2006;Caretti et al, 2011;Grabe et al, 2009).…”

“…The alexithymia construct was formulated by Nemiah and Sifneos (1970; see also Nemiah, Freyberger, & Sifneos, 1976) on the basis of clinical observations on patients with classic psychosomatic diseases. Many of these patients manifested "a striking incapacity for the verbal description and expression of feelings", and their associations and thoughts referred "to external events and actions rather than to internal fantasies" (Nemiah & Sifneos, 1970, p. 159).…”

Interpersonal Problems and Cognitive Characteristics of Interpersonal Representations in Alexithymia

“…Next to these early clinical observations, several authors have noted other characteristics of alexithymic patients' mental life, including detached and withdrawn interpersonal functioning. Alexithymic patients have been described as dull, cold, lifeless, and colorless and the therapeutic relation has been described as sterile and non-productive (Apfel and Sifneos, 1979;Nemiah and Sifneos, 1970). Marty and colleagues (1963) used the term 'blank relationship' to characterize the lack of psychical investment in the therapeutic relationship as well as in their interpersonal life in general.…”

The Convergence of Alexithymia Measures

“…The concept of alexithymia was proposed in the seventies by Sifneos (1973) based on clinical observations of the psychic functioning in psychosomatic patients (Nemiah & Sifneos, 1970). It consists of four defining dimensions: (1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal, (2) difficulty describing feelings to other people, (3) constricted imaginal processes, and (4) a stimulus-bound, externally orientated cognitive style.…”