title: Fibromyalgia: unspeakable suffering, a prevalence study of alexithymia.
abstract: BACKGROUND
  Fibromyalgia patients often present with multiple somatic concerns in a pattern suggestive of underlying depression. The psychological construct of alexithymia complicates the recognition of psychiatric disorders.
  
  
  OBJECTIVE
  To measure the prevalence of alexithymia among fibromyalgia patients and compare this with the prevalence among general medicine and rheumatoid arthritis patients.
  
  
  METHODS
  The Toronto alexithymia scale (TAS-20) and the Beck depression inventory (BDI) were administered to 50 patients in each of three experimental groups: fibromyalgia, general medicine and rheumatoid arthritis. Logistic regression was used to test for differences in the prevalence of alexithymia among experimental groups, first unadjusted and then adjusted for baseline and demographic variables. In addition, ANOVA was used to analyze the numeric scores of the TAS-20, the BDI and the three alexithymia components measured by the TAS-20.
  
  
  RESULTS
  The prevalence of alexithymia in fibromyalgia patients (44%) was significantly higher than in either the general medicine group (8%; P=0.001) or the rheumatoid arthritis group (21%; P=0.023). Alexithymia was strongly associated with moderate to severe depression χ2=49.3, P<0.001), and when the mood disturbance was controlled for, no group differences were detected.
  
  
  CONCLUSIONS
  Fibromyalgia patients are more likely than general medicine patients or patients with rheumatoid arthritis to have difficulty identifying and describing feelings, and to have higher alexithymia scores. Moderate to severe depression is also more prevalent in fibromyalgia patients, and, when controlled for, the difference in alexithymia scores becomes insignificant.
authors.affiliation: General Medicine Division, Carilion Clinic, Roanoke, VA 24018, USA. dlsteinweg@carilionclinic.org
authors.forename: Donald L
authors.initials: DL
authors.lastname: Steinweg
authors.forename: Apostolos P
authors.initials: AP
authors.lastname: Dallas
authors.forename: William S
authors.initials: WS
authors.lastname: Rea
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology / Q000209:etiology*; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D012959:Socioeconomic Factors