Since high score on measures·ofhealth indicate peor health, the observed pattern ofcorrelation suggests that alexithymia is associated with pom health.
The relationship of emotional and cognitive components of alexithymia with stress and health Indiar. Journal of Social Science Researches, Vol No, V(2) Page: 16-24, October, 2008
----------------------------------~~.~---------------------------------
THE RELATIONSHIP OF EMOTIONAL AND COGNITIVE
COMPONENTS OF ALEXITHYMIA WITH STRESS AND HEALTH
Rakesh Pandey* and Anil Kumar Chaubey** Abstract Alexithymia refers to multidimensional construct consisting of three interrelated dimensions- difficulty in identifying feelings, describing feelings and externally oriented thinking. Researchers have dichotomized these three components into emotional (the first two dimensions) and cognitive components (the third dimension). The present study reports the relationship ofthe cognitive and emotional component ofalexithymia with perceived stress and health. A heterogeneous sample of209 adults belonging to dijferent occupational groups in the age range of 21 to 50 years was assessed on the self report measures of ,'dexithymia, ps~vchosocial stress, andphysical and mental health. The relationship of vW';ous components ofalexithymia 'r1Jith measures ofstress and health was ascertained by computing bivariate correlation coefficients. The analysis revealed thaI only one affective component of alexith.vmia ld
Ifflcu lty m iden tifymg feelings) was ·fbund aSSOClB ted
Vi
Ith eleva ted
level 0 f psych oso cia lstr'ess particu larly W Ith stress ansmg from d ifficu It:{ m m
nalrelatJonsh1p, imancia lproblem s,health related problem s
m 8ClSUIBS of health correlatEd s19niticantly w itt bom
e
C:~, C-':::';,7,c"
com ponentsofalexlthym ia, that is, difficulty in identifying feelings and difficulty m describing feelings. The cognitive com ponentofalexithym ia lexternallyoriented thmking) fulled to correlatew ith m easures0 fstr'ess and hea 1m, 0 vera
find 1'1gs 0 f the presen t study suggest a d if:feren tial
role o£cognltive and em otlOnalcorn ponentsofalexithym ia 1'1 predicting stress and hea 1m , The 0 b ta ined tind ings have been discussed in the ligh t
'" ReaderDepal1ment ofPsychologyBanaras Hindu UniversityVaranasi VAranasi. * '" Research ScholarDepartment of PsychologyM.G. Kashi Vidyapith, Varanasi.
16
ofthe earlier empirical evidences which suggest that poor verbalizotion and inhibition ofemotional expression impairs the physical and menIal health ofan individual. Alexithymia was fItst introduced by Sifneos in 1972 which literally means lack of words for emotions (a = lack, lexis = word, and thymos = emotion). Alexithymia refers to a relative narrowing in emotiomJ fimctioning and includes such traits as difficulty in recognizing and verbalizing feelings, focusing more on description ofphysical symptoms instead ofemotions. concrete speech and thought closely tied to external events, and paucity offantasy life. As formulated by Nemiah and associates (1970, 1976) alexithymia is a multi-dimensionaL hypothetical construct which encompasses; (a) a difficulty in identifYing and communicating feelings, (b) a difficulty in distinguishing between feelings and bodily sensations, (c) impaired symbolization, as reflected by the paucity offantasy and other imaginative activity, and (d) a preference for focusing on external events rather than inner experiences (see Taylor, 1984). The subsequent psychometric studies refIned the construct of alexithymia and with the development ofthe TAS-20, alexithymia was conceptualized as a construct consisting three interrelated dimensions- difficulty in identifying feelings, describing feelings and externally oriented thinking (Bagby, Parker & Taylor, 1994). Tne former two dimensions are considered as emotional component and the last one as the cognitive compcnent ofalexithymia (e.g .. Dabkowska, 2007) Although initially described in the context ofpsychosomatic illness, alexith}mia rna:. be observed in patients with a wide range of medical and psychiatric disorders such as. somatization disorder, anorexia nervosa, substance abuse. A number of researchers have also reported the relationship ofalexithymia with measures of symptomatic complaints, depression and anxiety (see Taylor, 1984, 1994 for a review). Several researchers have obtained a positive correlation between the measures ofsomatic complaints and alexithymia (Parker, Bagby, & Taylor, 1989; Rodrigo, Lusiardo, & Normey, 1987; Taylor, Parker, Bagb~t;, &Acklin, 1992; Vassend, 1987). Alexithymia has been linked with hypertension (Todarello, Taylor, Parker & Fanalli, 1995), inflammatory bowel disease (porcelli, ~ Leoci, Centonze. Taylor & Parker, 1995), somatoform disorders (Cox, Kuch, Parker, Shulman & Evans, 1994), panic disorder (Zeitlin & McNally, 1993) and eating disorders (De Groot, Rodin & Olmstead, 1995). The mechanism that links alexithymia with somatic illness is not very much clear and researchers have proposed several pathways to explain this relationship. For example, in a review Lumley and associates (Lumley, Stettner, & Wehmer, 1996) proposed that the relationship between somatic illness and alexithymiacan be explained on the basis ofthe mediating role ofphysiological, behavioural, and socio-cultural mechanisms. Accordingly, some researchers hypothesized that alexithymia may lead to stress vulnerability which in tum may result in tonic somatic arousal that in long term may lead to somatic illness. USSR/Vol No. V, Oct. 2008 / i7
ast few decades attempts have be~n made to examine the relationship between : .. ~~s and alex.ithymia. Fukunishi and Rahe (1995) observed that alexithymia was associated with lower social support and poorer responses to stress. In another study, Friedlander, Lumley. Farchione and Doyal (1997) examined the physiological and sUbjective responses lo an autogenic relaxation exercise and three different laboratory stn.ssors. They observed that alexithYTnic su'bjects had tonically greater electrodermal activity and reported more arousal and displeasure in general than non-alexithymic subjects. Further, they noted that alexithymic subjects reported less enjoyment, less involvement and poorer imagery during relaxation. Similarly, Posse, Hallstrom and Backenroth-Ohsako (2002) studied the vulnerability for psycho-social stress among alexithymics and reported a lack ofsocial support and pronene~s to high levels ofnegative emotion and to social distress among alexithymic individuals. Several uther researchefs have also noted elevated level ofalexithymic traits among high stressed individuals (e.g., De Vente, Kamphuis, & Emmelkamp, 2006). However, these researches do not explicitly focus on the relative significance ofthe cognitive and affective component of alexithymia in predicting stress. Recently, studies done on post traumatic stress disorder (PTSD) patients reveal that only difficuhy in communicating emotions and feelings predicted the occurrence ofPTSD symptoms (e.g., Dabkowska, 2007). From the foregoing review, it is evident that alexithymia is associated with proneness ,I) somatic and psychiatric illness as well as to experience high level of stress. However, it is not clear from the available literature that how and to what extent the various components (affective and cognitive) ofale xi thymi a correlate with various measures ofhealth. Thus, it would be interesting to explore whether it is the emotional or the cognitive component of ale'\ithymia that correlates with health. Similarly, the psychosocial stress is also a multidimensiO:lal construct and therefore there is a need to explore that how and to what extent the various components ofalexithymia are associated with stress expel ienced in various domains of psycho-social life. In view ofthese observations the present research makes an attempt to explore the relationship ofthe emotional and cognitive component ofalexithymia \\ith various measures ofhealth and psychosocial stress. I) t 11"
.~. 1he
J
i\lcthod Sample: The present study was conducted on a relatively heterogeneous sample of 209 adults belonging to different occupational groups including self-employed, housewives, students and employed participants. The age ofparticipants ranged from 21 to 50 years and all ofthem belonged to ,;middle class socio-economic status. Tools The following selfrep0l1 measures were used in the pres':nt research to assess ulexithylnia, psychosocial stress and various dimensions ofhealth.
i8
1 The Hindi version oftwenty-item Toronto Alexithymia Scale (TAS-20-H: Pandey, 1993; Pandey, MandaI, Taylor, & Parker, 1996) was used to a'isess alexithymic characteristic among the participants. The TAS-20H has been found to be highly comparable with the original TAS-20, and has demonstrated satisfactory internal consistency, good test-retest reliability and validity (Pandey, 1993, 1995; Pandey & MandaI, 1993). It consists of20 items which are rated on a 5-point scale ranging from strongly disagree (1) to strongly agree (5). The possible score on this scale ranges from 20 to 100; the higher score on this scale indicates higher level ofalexithymia. 2 ICMR Stress Questionnaire (Srivastava, 1996) was used to quantity the perceived psycho-social stress. There are several subscales in this questionnaire but in the present study we used the Perceived Psychosocial Stress and Life Event Stress subscales. The fonner subscale consists of40 items rated on 4-point scale of frequency whereas the later lists 10 Stressful Life events. On the life event scale subjects were asked to check the occurrence of these events during the last year and estimate the intensity ofthe stress experienced due to those events. The former sub scale measures psychosocial stress related to interpersonal relationship, responsibilities and expectations ofothers, [mancial problems, marriage related problems, health related problems, adverse or unfavorable situations, social position and prestige. The Pennebaker Inventory ofLimbic Languidness (the PILL, Pennebaker, 1982) 3 was used to assess physical health ofparticipants. This is a 54-item scale, which taps the frequency of occurrence ofa group of common physical symptoms and sensations. The inventory has been found to be highly reliable and valid (Pennebaker, 1982). 4 General Health Questionnaire (GHQ, Goldberg, 1978). The 28-item version ofGHQ was used to assess four dimensions ofmental health, viz. anxiety, somatic complaints, social dysfimction and depression. Each item in this questionnaire is followed by four response alternatives with score credit ranging from 0 to 3. The response alternatives have been arranged in such a way that higher scores indicate greater health problems. Procedure: The aforesaid tests/scales were administered to participants either individually or in small groups, consisting of3 to 4 persons. In some cases where the respondents insisted that they will return the complete booklet after a couple ofdays, the booklet was left to them and collected back in due time. However, In any case, instructions related to each scale were clearly explained to each participant and their queries (ifany) were attended appropriately. In addition to it each participant was requested to ensure that they have responded to each and every item ofthe test booklet. When any unattempted item was detected the participants were requested to complete them again. The scoring was done as per the standard scoring procedure ofrespecti ve scale/inventories.
IJSSR 1Vol No. V, Oct. 2008/19
Results and Discussion To ascertain relationship between various components ofalexithymia and domains of psychosocial stress bivariate correlation c()efficients were computed. The obtained results have been presented in Table-I. It is evident from the Table that only one component of alexith)'lnia., namely, difficulty in identifYing feelings correlated significantly and positively with yarious domains ofpsychosocial stressors. The other two dimensions ofalexithymia., viz., difficulty describing feelings and externally-oriented thillking failed to correlate significantly with any dimension ofpsychos0cial stress. Even the total alexithymia score did not correlate significantly with any ofthe dimensions ofpsychosocial stress except stress due to health related problems.
Table 1: Correlation between components of alexithymia and stress Alexithymia Difficulty total score identifying feelings Cotal stress
,104
.174*
.040
.003
Stress d uc to interpersonal relationship
.101
.188**
.052
-.040
Stress due to responsibilities and liabilities of others
.033
.098
.032
-.068
Stress due to financial problems
•J 12
.152*
.049
,043
Stress due to marriage related problems
.035
.101
-.009
-.036
Stress due to health related problems
.191 **
.223**
.091
.106
.098
.146*
.011
.046
Stress related to social status
.009
.075
.045
-.110
Life event stress
-.008
.026
-.0.;8
.021
Stress due to !
Difficulty Externallydescribing oriented feelings thinking
adver~e
or unfavorable situations
-
** Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).
This pattern ofobtained correlation between the components ofstress and alexithymia suggests that difficulty in identifYing feelings is the only component ofalexithymia which is associated with elevated level ofpsychosocial stress particularly with stress arising from difficulty in interpersonal relationship, financial problems, health related problems, and adverse and unfavorable situations oflife. 'The present fmding, thus, implies that alexithymia in general is not associated with elevated levels ofperceived stress rather a specific emotional component ofalexithymia (the difficulty in identifYing emotions and feelings) is linked with the experience of high stress. The cognitive component ofalexithymia (i.e., externally oriented thinking) is not associated with elevated level ofstress.
20
This finding i'5 in congruence with the earlier observations that only emotional component cC :1lexith,miapredict'i the occurrenceefPTSD symptoms (e.g., Dabkowsk~ 2007). -n1e present finding that only the emotional component ofalexlthymia is linked with elevated level ofstress also supplements the earlier observations which reported a relationsrup ofalexithymia with elevated level of stress or social distress (De Vente, Kamphuis, & Emmelkamp. 2006: Friedlander, Lumley, Farchione & Doyal, 1997; Posse, Hallstrom & Backenroth-Ohsako, 2002) and poor response to stress (Fukunishi & Rahe, 1995). Another objective ofthe present research was to examine the relationship nf various components ofalexithym;,a with different measures ofphysical cmd mental heClJth. The obt?i ned correlations between measures ofhealth and alexithymia have been presented in Tabe-2. Table- 2: Correlation between components ofemotion related traits and health
I
Alexithymia Difficulty total score identifying feelings
, I
Difficulty Externall;- describing oriented feelings thinking
GHQ total score
.356**
.254**
.086
.329**
Somatic complaint scote
.295*'"
.199**
.062
161 **
Anxiety and insomnia score
.407**
.259**
.019
.345 H
Social dysftll1ction score
.098
.102
.076
.129
Depression s':ore
.276**
.205**
j
.087
.269**
.218*'"
214**
I
.019
.201**
L
Total score on PILL ** Correlatio!1 is significant at the 0.01 level (2-tailed). Corr~lation is: significaN at the 0.05 level (2-tailed).
-
1
J
It is evident from Tabl e-2 that al exi thymia (total score) is correlated sign itlcantl y an d positively with all the measures ofhealth except social dysfl.ll1.ction. Exactly simaar patterl1 of con-elation was observed between various measures ofh~alth on the one hand and the t\\ 0 dimensions ofalcxithymia (difficulty in identifying feelings and difficulty in describing feelings) on the other. The third component ofalexithymia, namely, extenmlly oriented thinking failed to correlate -with any measure ofhea!th. Since high score on measures·ofhealth indicate peor health, the observed pattern ofcorrelation suggests that alexithymia is associated with pom health. This finding of the present study corroborate the findings ofearlier studies which linked alexithymia with somatic health problems (e.g., Parker, Bagby, & Taylor, 1989; Rodrigo, Lusiardo, & Normey, 1987; Taylor, Parker, Bagby, & Acklia, 1992; Vassend, 1987) and s)mptoms ofpsychopathology (e.g., Devine~ Stewart & 'Watt, ] 999; Ho:1kalampi, HintiJ.
