Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients?
OBJECTIVE
Alexithymia is presumed to play an important predisposing role in the pathogenesis of medically unexplained physical symptoms. However, no research on alexithymia has been done among general medical outpatients who present with medically unexplained physical symptoms as their main problem and in which anxiety and depression have been considered as possible confounding factors. This study investigated whether patients with medically unexplained physical symptoms are more alexithymic than those with explained symptoms and whether, in patients with unexplained symptoms, alexithymia is associated with subjective health experience and use of medical services.


METHODS
We conducted a cross-sectional study among patients attending an internal medicine outpatient clinic. All patients were given a standardized interview and completed a number of questionnaires.


RESULTS
After complete physical examinations, 169 of 321 patients had unexplained physical symptoms according to two independent raters. Patients with medically unexplained symptoms more often had a mental disorder, but overall they were not more alexithymic. In patients with unexplained physical symptoms, alexithymia was not associated with subjective health experience or use of medical services. However, patients with both unexplained symptoms and a mental disorder who also denied any possible connection between emotional problems and their physical symptoms did have more alexithymic traits.


CONCLUSIONS
In the majority of patients with medically unexplained physical symptoms, alexithymia does not play a role of clinical significance. Patients with unexplained physical symptoms are heterogeneous with respect to psychiatric syndrome pathology and probably also with respect to personality pathology.
Kooiman
C G
CG
Department of Psychiatry, Leiden University Medical Center, The Netherlands. cgkooiman@lumc.nl
Bolk
J H
JH
Brand
R
R
Trijsburg
R W
RW
Rooijmans
H G
HG
D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D000553:Ambulatory Care; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D004213:Dissociative Disorders / Q000523:psychology; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012307:Risk Factors; D012803:Sick Role; D013001:Somatoform Disorders / Q000523:psychology*