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The role of difficulties in expressing emotions in psychiatric patients
09 May 2012
Journal of Psychotherapy and Psychosomatics
This study is the first to identify an association between type D personality and alexithymia. The affect regulation tendencies of type D personality appear to correspond to features of alexithymia. Future research should consider evaluating the effectiveness of interventions aimed at improving emotion expression deficits, which may improve the health status of type D patients.
The relationship between inability to express emotions (alexithymia) and a particular type of personality in psychiatric patients was explored in a study published in the current issue of Psychotherapy and Psychosomatics. Individuals with ‘distressed’ (type D) personality tend to harbor negative emotions and engage in pervasive withdrawal or avoidance of social contact or communication. One mechanism that might explain the link between type D personality and poor health outcomes is maladaptive affect regulation. The developers of the type D construct argue that ‘it is not the experience of negative emotions per se, but rather the chronic psychological distress that results from holding back negative emotions, that is likely to affect … health’. A great deal of evidence supports the connection between difficulties with affect regulation and poor physical and mental health. One construct that has received attention within this literature is alexithymia, generally understood as a trait deficit in the cognitive processing of emotional experience, such that individuals have limited capacity to symbolize emotions and elaborate upon emotional experience. Individuals with alexithymia have difficulties identifying and expressing feelings, distinguishing emotions from bodily sensations, and have an externally orientated style of thinking. Authors have speculated that the characteristics of alexithymic individuals reflect the type D personality profile.
The present study examined the association between type D personality and alexithymia among a psychiatric outpatient sample, a population expected to report high levels of both personality characteristics. Participants (n = 68) were consecutively admitted patients to the Core Program of the Richmond Mental Health Outpatient Services, a psychotherapy service that receives referrals from family physicians and community mental health agencies. Diagnoses provided by the referring sources indicated that 70% of subjects presented with a depressive disorder and 20% presented with an anxiety
disorder. Participants’ average age was 42.5 years (SD = 10.5, range =19–61). Seventy-three percent were women. Participants were assessed through the type D personality scale (DS14), the Toronto Alexithymia Scale and the Beck Depression Inventory (BDI-II). Among the 68 participants, 56 (82.4%) were classified as having type D personality by using the recommended cutoff point of ≥10 on both negative affectivity (NA) (mean =20.82; SD = 4.69) and social inhibition (SI) (mean = 19.41;SD = 4.76) subscales. Patients with type D personality presented with higher overall alexithymia, greater difficulties describing feelings, and more externally oriented thinking. NA was significantly associated with difficulty identifying feelings and SI was significantly associated with difficulty describing feelings and externally oriented thinking. Type D patients were more alexithymic than non-type D patients. They had greater difficulties communicating their feelings and a stronger propensity to engage in externally oriented thinking. Given the high prevalence of both alexithymia and type D characteristics in this psychiatric outpatient sample, and the strong association between the two constructs, it is tempting to speculate on the role that they might play in affecting the adaptive functioning of such patients. However, the correlational nature of this study precludes conclusions about causality. Finding of an association between negative affect and difficulty identifying feelings suggests that while type D persons may be aware of their negative emotions, their awareness may be more a vague perception of distress rather than a clear appreciation of the precise nature of the distressing emotions. Furthermore, finding that SI was associated with difficulty describing feelings suggests that the socially avoidant behavior of type D persons may be related to a difficulty with articulating their emotional experiences to others. Finally, the association between SI and externally oriented thinking may suggest that the anxious defensiveness of type D manifests as a tendency to focus on external events rather than internal thoughts and feelings. This study is the first to identify an association between type D personality and alexithymia. The affect regulation tendencies of type D personality appear to correspond to features of alexithymia. Future research should consider evaluating the effectiveness of interventions aimed at improving emotion expression deficits, which may improve the health status of type D patients.