Alexithymia in anorexia and bulimia: Ubiquitous and primary trait?

Abstract

Background: Alexithymia is associated to Eating Disorders (ED) and relevant for their prognosis but it is uncertain if it is ubiquitous, primary, and necessary for ED outburst. Methods: 124 ED outpatients and 80 healthy controls were compared with the Toronto Alexithymia Scale, personality, and psychopathology measures. Alexithymia and the other features are compared between anorexia nervosa (AN), bulimia nervosa (BN) and control groups. Alexithymia-based clusters were explored and compared with controls. Alexithymia traits are correlated with the other features. Results: Difficulty in identifying feelings was ubiquitous in ED subjects. A Non-Alexithymic Cluster (NAC) and an Alexithymic Cluster (ALC) were found with no difference in AN/BN distribution. ALC displays disordered personality and high psychopathology. Self-directiveness and interoceptive awareness were independently related to alexithymia and to depressive feelings. These two features along with depressive features completely accounted for alexithymia variance. Conclusion: Even though the difficulty in identifying feelings is ubiquitous in ED subjects, Alexithymia may not represent a primary trait but a complex dysfunction consequent to co-occurring character immaturity, altered interoceptive awareness, and depressive traits.

Keywords

• alexithymia
• anorexia nervosa
• bulimia nervosa
• cluster analysis
• eating psychopathology
• personality traits