title: The relationship between alexithymia and salivary cortisol levels in somatoform disorders.
abstract: The purpose of this study was to investigate cortisol levels as a function of the hypothalamic-pituitary-adrenal axis (HPA) in relation to alexithymia in patients with somatoform disorders (SFD). Diurnal salivary cortisol was sampled in 32 patients with SFD who also underwent a psychiatric examination and filled in questionnaires (Toronto Alexithymia Scale, TAS scale; Screening for Somatoform Symptoms, SOMS scale; Hamilton Depression Scale, HAMD). The mean TAS total score in the sample was 55.6+/-9.6, 32% of patients being classified as alexithymic on the basis of their TAS scores. Depression scores were moderate (HAMD=13.2, Beck Depression Inventory, BDI=16.5). The patients' alexithymia scores (TAS scale "Difficulty identifying feelings") correlated significantly positively with their somatization scale scores (Symptom Checklist-90 Revised, SCL-90-R); r=0.3438 (P<0.05) and their scores on the Global Severity Index (GSI) on the SCL-90-R; r=0.781 (P<0.01). Regression analysis was performed with cortisol variables as the dependent variables. Cortisol levels [measured by the area under the curve-ground (AUC-G), area under the curve-increase (AUC-I) and morning cortisol (MCS)] were best predicted in a multiple linear regression model by lower depressive scores (HAMD) and more psychopathological symptoms (SCL-90-R). No significant correlations were found between the patients' alexithymia scores (TAS) and cortisol levels. The healthy control group (n=25) demonstrated significantly higher cortisol levels than did the patients with SFD; in both tests P<0.001 for AUC-G and AUC-I. However, the two groups did not differ in terms of their mean morning cortisol levels (P>0.05). The results suggest that pre-existing hypocortisolism might possibly be associated with SFD.
authors.affiliation: Psychosomatic Out-Patient-Clinic, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, Germany. Francisco.Pedrosa.Gil@med.uni-muenchen.de
authors.forename: Francisco
authors.initials: F
authors.lastname: Pedrosa Gil
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Nathan
authors.initials: N
authors.lastname: Ridout
authors.forename: Carl Eduard
authors.initials: CE
authors.lastname: Scheidt
authors.forename: Samantha
authors.initials: S
authors.lastname: Caton
authors.forename: Claudia
authors.initials: C
authors.lastname: Schoechlin
authors.forename: Marius
authors.initials: M
authors.lastname: Nickel