The role of alexithymia in the development of functional motor symptoms (conversion disorder)

Abstract

BackgroundThe mechanisms leading to the development of functional motor symptoms (FMS) are of pathophysiological and clinical relevance, yet are poorly understood.AimThe aim of the present study was to evaluate whether impaired emotional processing at the cognitive level (alexithymia) is present in patients affected by FMS. We conducted a cross-sectional study in a population of patients with FMS and in two control groups (patients with organic movement disorders (OMD) and healthy volunteers).Methods55 patients with FMS, 33 patients affected by OMD and 34 healthy volunteers were recruited. The assessment included the 20-item Toronto Alexithymia Scale (TAS-20), the Montgomery-Asberg Depression Rating Scale, the Reading the Mind in the Eyes’ Test and the Structured Clinical Interview for Personality Disorders.ResultsAlexithymia was present in 34.5% of patients with FMS, 9.1% with OMD and 5.9% of the healthy volunteers, which was significantly higher in the FMS group (χ2 (2)=14.129, p<0.001), even after controlling for the severity of symptoms of depression. Group differences in mean scores were observed on both the difficulty identifying feelings and difficulty describing feelings dimensions of the TAS-20, whereas the externally orientated thinking subscale score was similar across the three groups. Regarding personality disorder, χ2 analysis showed a significantly higher prominence of obsessive-compulsive personality disorder (OCPD) in the FMS group (χ2 (2)=16.217, p<0.001) and 71.4% of those with OCPD also reached threshold criteria for alexithymia.ConclusionsBecause alexithymia is a mental state denoting the inability to identify emotions at a cognitive level, one hypothesis is that some patients misattribute autonomic symptoms of anxiety, for example, tremor, paraesthesiae, paralysis, to that of a physical illness. Further work is required to understand the contribution of OCPD to the development of FMS.

Sense of body ownership in patients affected by functional motor symptoms (conversion disorder)

“…This dissociation is in line with the recent finding that patients with FMS are more alexithymic than patients with organic movement disorders and healthy controls (REF). FMS patients were significantly more alexithymic on factor I (difficulty identifying feelings) and II (difficulty describing feelings), whereas we did not find a significant difference on factor III (externally orientated thinking) (Demartini et al, 2014). We have interpreted this finding, suggesting that a difficulty in identifying and explaining emotions in FMS patients relates only to the self, and not generally to the understanding of the emotional states of others.…”

“…We have previously demonstrated (Ricciardi et al, in press) that patients with FMS have poorer interoceptive awareness (sensitivity to internal bodily signals) than healthy subjects and they commonly have alexithymia (failure to identify and describe emotions in oneself and a difficulty in distinguishing and appreciating the emotions of others) when compared to patients with organic movement disorders and healthy controls (Demartini et al, 2014). Moreover we showed that in FMS patients lower interoceptive awareness was a significant predictor of self-objectification.…”

Insights into Chronic Functional Movement Disorders: The Value of Qualitative Psychiatric Interviews

“…Others have speculated that these factors are often contributory for individuals with FMD and PNES. 9,11,12 Psychological explanations may also include the construct of alexithymia which has been found to be elevated among some patients with FMD 13 and PNES. 4 Thus, some patients with impairment of cognitive processing of emotions may manifest movements rather than recognize and report psychological symptoms such as anxiety.…”

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

“…The Dissociative Experience Scale [42], a 28-item scale ranging from 0 (never) to 100 (always) investigating the presence of psychological manifestations of dissociation (the higher the score, the more severe the dissociation), was conducted to screen for possible additional psychological dissociation like dissociative amnesia, fugue or dissociative identity disorder (DSM-IV-TR). The Toronto Alexithymia Scale, French version [43], was also administered, as alexithymia, a mental state denoting an inability to identify emotions, has been shown to be frequent among patients suffering from conversion symptoms [44]. It is a self-report scale of 20 items, with scores of 1 to 5 (some scored in reverse) and with a total maximum score of 100, investigating the presence, absence and severity of alexithymia.…”