title: The role of alexithymia in the development of functional motor symptoms (conversion disorder).
abstract: BACKGROUND
  The mechanisms leading to the development of functional motor symptoms (FMS) are of pathophysiological and clinical relevance, yet are poorly understood.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate whether impaired emotional processing at the cognitive level (alexithymia) is present in patients affected by FMS. We conducted a cross-sectional study in a population of patients with FMS and in two control groups (patients with organic movement disorders (OMD) and healthy volunteers).
  
  
  METHODS
  55 patients with FMS, 33 patients affected by OMD and 34 healthy volunteers were recruited. The assessment included the 20-item Toronto Alexithymia Scale (TAS-20), the Montgomery-Asberg Depression Rating Scale, the Reading the Mind in the Eyes' Test and the Structured Clinical Interview for Personality Disorders.
  
  
  RESULTS
  Alexithymia was present in 34.5% of patients with FMS, 9.1% with OMD and 5.9% of the healthy volunteers, which was significantly higher in the FMS group (χ(2) (2)=14.129, p<0.001), even after controlling for the severity of symptoms of depression. Group differences in mean scores were observed on both the difficulty identifying feelings and difficulty describing feelings dimensions of the TAS-20, whereas the externally orientated thinking subscale score was similar across the three groups. Regarding personality disorder, χ(2) analysis showed a significantly higher prominence of obsessive-compulsive personality disorder (OCPD) in the FMS group (χ(2) (2)=16.217, p<0.001) and 71.4% of those with OCPD also reached threshold criteria for alexithymia.
  
  
  CONCLUSIONS
  Because alexithymia is a mental state denoting the inability to identify emotions at a cognitive level, one hypothesis is that some patients misattribute autonomic symptoms of anxiety, for example, tremor, paraesthesiae, paralysis, to that of a physical illness. Further work is required to understand the contribution of OCPD to the development of FMS.
authors.affiliation: The Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Psychiatry, San Paolo Hospital and University of Milan, Milan, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Demartini
authors.affiliation: Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: Panayiota
authors.initials: P
authors.lastname: Petrochilos
authors.affiliation: The Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ricciardi
authors.affiliation: Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Price
authors.affiliation: The Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: The Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Joyce
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000150:complications / Q000523:psychology*; D016022:Case-Control Studies; D003193:Compulsive Personality Disorder / Q000150:complications / Q000523:psychology*; D003291:Conversion Disorder / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000523:psychology*; D011569:Psychiatric Status Rating Scales
keywords: NEUROPSYCHIATRY