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Procedia Social and Behavioral Sciences 5 (2010) 1084–1089

WCPCG-2010

Comparative study of alexithymia in patients with schizophrenia

spectrum disorders, non-psychotic disorders and normal people
Rasoul Heshmatia * , Esa Jafarib, Jafar Hoseinifarc, Mohsen Ahmadid
F F

a
Faculty of Psychology and Education, Tehran University,Tehran,5667184449,Iran
b
Payame Noor University,Astara,Iran
C
Faculty of Psychology and Education, Allame tabatabaei University,Tehran ,Iran
d
Islamic Azad University,Hamedan, Iran

Received January 17, 2010; revised February 6, 2010; accepted March 9, 2010

Abstract

In the present study attempt has been made to investigate the extent of alexithymia in patients with schizophrenia spectrum
disorders, non-psychotic disorders and normal people. The research sample consisted of 60 patients with schizophrenia spectrum
disorders and 60 non-psychotic disorders from inpatients and outpatients of Mostafa Khomeini and Hazrat Rasoul hospitals, and
140 students from Tehran university (results of Leven test indicated the homogeneity of variance among three groups). Using
Torento Alexithymia Scale (TAS-20) they were compared.
Results showed that alexithymia had significant difference in patients with schizophrenia spectrum disorders and normal people;
and non-psychotic disorders and normal people, but differences weren`t significant between patients with schizophrenia spectrum
disorders and non-psychotic disorders. The difficulty in describing feelings, difficulty in identifying feelings and externally-
oriented thinking were higher in patients with schizophrenia spectrum disorders than other groups. In all groups, males had more
problems in describing feelings and externally-oriented thinking. These results suggest that high level of alexithymia could
contribute to a greater vulnerability for schizophrenia spectrum disorders and it could set males at high risk for these disorders.
thus, it is essential to contrive a special treatment to decrease alexithymia in these patients.
© 2010 Elsevier Ltd. All rights reserved.

Keywords: Alexithymia; regulation of emotion; schizophrenia spectrum disorders; non-psychotic disorders.

1. Introduction

The term alexithymia was coined by Sifneos (Sifneos, 1973) to characterize a difficulty in identifying and
verbalizing emotions (a, absence; lexi, words; thymia, emotions, affects). This construct defines a deficit in
processing and regulating emotions. People with alexithymia are characterized by an inability to identify and
express emotions, difficulty in differentiating between feelings and bodily sensations that accompany emotional
arousal, and a paucity of imaginary life with externally oriented rather than psychologically minded thought.
Alexithymia was initially identified in individuals with so-called ‘‘psychosomatic diseases’’ (Nemiah, and Sifneos,

* Rasoul Heshmati. Tel: +98-0935-862-8166; fax: +98-021-3388-2314.

E-mail address: n_heshmati@yahoo.com.

1877-0428 © 2010 Published by Elsevier Ltd.

doi:10.1016/j.sbspro.2010.07.240
 Rasoul Heshmati et al. / Procedia Social and Behavioral Sciences 5 (2010) 1084–1089 1085

1970; Todarello et al., 1995; Dirks, Robinson, and Dirks, 1981; Numata, et al. 1998; Kauhanen, et al. 1994). It has
been regarded as a potential risk factor that seems to increase unhealthy behaviours (Lumley, Stettner, and Wehmer,
1996).
Dating back to Bleuler (1911/1950), psychopathologists have posited that psychoses symptoms are related to
disturbed emotional processes. That emotional processes may play an important role in the development of
cognitive–perceptual disturbances is consistent with the evidence that emotions play a significant role in influencing
judgments, decision making, and behaviours (e.g., Clore et al., 2001; Lowenstein et al., 2001). A great deal of
theorizing and research has linked elevated levels of unpleasant emotions with cognitive– perceptual disturbances,
ranging from odd perceptions and beliefs to delusions and hallucinations (e.g., Bentall et al., 2001; Freeman et al.,
2001) and growing body of evidence demonstrates emotion disturbances in schizophrenia spectrum disorders as
schizophrenia, schizoaffective and schizotypal disorders including deficits in emotional expression, perception, and
recognition (Aleman, and Kahn, 2005). Schizophrenia is typically regarded as a neurocognitive disorder with a
genetic component, which suggests that emotional disturbances reflect abnormalities in brain areas important for
emotion processing (Phillips, et al., 2003). Indeed, emotion abnormalities observed in schizophrenia even extend to
persons at risk for schizophrenia, including relatives of patients with schizophrenia (van Rijn, et al., 2005) and other
psychotic disorders. Interestingly, there appears to be some specificity in these emotion deficits. For instance, the
recognition of negative emotions might be in particular deficient, and male patients seem especially worse in
emotion recognition (Scholten, et al., 2005). And although the expression of emotions is impaired in schizophrenia
spectrum, evidence is accumulating that the subjective emotional experience may not be reduced and that even more
intense negative emotions are experienced (Myin-Germeys, Delespaul, DeVries, 2000; Aghevli, Blanchard, and
Horan, 2003; Kring, et al., 1993) . Moreover, levels of emotional arousal, that is, anxiety, seem to precede
symptoms as hallucinations (Delespaul, DeVries, van Os, 2002)
With regard to behavioural measures of emotional processing in schizophrenia spectrum, deficits in emotion
recognition have been found (Edwards et al., 2002). In addition, schizophrenic spectrum patients appear to
inadequately process facial affect (Addington and Addington, 1998; Streit et al., 2001) and demonstrate a reduced
left-perceptual bias in the processing of emotional chimeric faces (Gooding et al., 2001). There might also be a bias
towards material with a negative emotional valence, as observed in a study in which hallucinating patients were
more sensitive to negative words compared to controls (Johns et al., 2002). Moreover, another study (e.g.Hoschel
and Irle, 2001) reported that negative emotional expressions yield stronger priming effects in schizophrenia
spectrum patients compared to control subjects (hyperpriming).
Surprisingly, no past research has examined in a psychiatric sample whether levels of cognitive–perceptual
symptoms are associated with levels of alexithymia. Based on the results of past research with schizophrenia
spectrum samples, we hypothesized that greater alexithymia would be associated with higher levels of psychoses
symptoms. We tested these hypotheses in acute psychiatric inpatient and outpatient samples.

2. Method

2.1. Sample

In This causal-comparative (retrospective) study, Between all outpatient and hospitalized patients with
schizophrenia spectrum and non-psychotic disorders (males and females) referred to psychiatric sections of Tehran
city Hazrat Rasoul and Mostafa Khomeini hospitals, 60 patients with schizophrenia spectrum and 60 patients with
non-psychotic were selected as research sample, also normal group consisted of 140 Tehran University different
students.

2.2. Procedure

Investigators went to these hospitals, and studied cases of patients with schizophrenia spectrum disorders and
other psychiatric patients. Patients who had acute and severe disease status were excluded from subject lists and the
other patients were used as only those who volunteered and were willing to answer questions. questionnaire
instruction were instructed to subjects and were asked to carefully read the questions and answers them according to
their characteristics. Multivariate Analysis of variance (MANOVA) Post Hoc Tukey (HSD) and Levene tests were
used for analyzing of data.
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2.3. Data collection instrument

Toronto Alexithymia Scale-20 (TAS-20). This is a widely used, 20-item scale that yields a global alexithymia
score, as well as scores on 3 facets: Difficulty Identifying Feelings(Factor 1), Difficulty Describing Feelings (Factor
2),and Externally Oriented Thinking (Factor 3) , Each item is rated on a scale of 1 ("strongly disagree") to 5
("strongly agree"). Higher total and facet scores indicate greater alexithymic characteristics. psychometric properties
of Toronto Alexithymia Scale-20 (TAS-20) have been approved in past researches (eg., Pandley, Mandal, Taylor,
Parker, 1996; Taylor, & Bagby, 2000).Ghorbani and et al. (2002) have studied psychometric properties of this scale
in Iranian and American samples and have reported high reliability and validity for it.

3. Findings

The age mean (and standard deviation) were 37/01 (and 13/31) for schizophrenia spectrum patients, 28/23 (and
7/98) for non-psychotic patients, 25/48 (and 2/18) for normal group and 28/82 (and 892) for total groups
respectively. Leven test results showed that three groups had equal variances.
Table 1.MANOVA test results for comparing of three groups in alexithymia
U

schizophrenia Non- Normal(3)

spectrum (1) psychoses(2)

variable M SD M SD M SD F Sig. Group MD Sig.

comparison

alexithymia 60/46 10/94 56/34 9/05 46/76 10/64 40/28 0/001 1>2 4/10 0/07

1>3 13/70 0/001

2>3 9/60 0/0001

Table 1 shows that three groups of schizophrenia spectrum, non-psychotic disorders and normal persons have
significant difference in alexithymia variable (F=0/28, P<0/001). more Studies and Post Hoc Tukey test showed that
the patients with schizophrenia spectrum disorders and normal persons (P<0/001) and patients with non-psychotic
disorders and normal persons (P<0/001) had significant differences in alexithymia, but differences between
schizophrenia spectrum and non-psychotic patients were not significant. Among these three groups, patients with
schizophrenia spectrum disorders had highest level of alexithymia mean and patient with non-psychotic disorder had
higher level of it than normal subjects.

Table 2.MANOVA test results for comparing of three groups in alexithymia subscales
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schizophrenia Non-
Normal(3)
spectrum(1) psychoses(2)

Group
variable M SD M SD M SD F Sig. MD Sig.
comparison

difficulty 21/30 5/85 19/61 5/51 15/51 5/19 26/17 0/001 1>3 5/78 0/001
in
1>2 1/68 0/20
identifying
feelings 2>3 4/10 0/001

difficulty 15/45 4/37 14/20 3/65 12/22 3/67 15/03 0/001 1>3 3/22 0/001
in
1>2 2/15 0/16
describing
feelings 2>3 1/97 0/002

23/83 5/10 22/55 4/55 18/97 4/64 24/28 0/001 1>3 4/86 0/001
externally-
oriented 1>2 1/28 0/29
thinking
2>3 3/57 0/001

Table 2 shows that three groups have significant difference in the difficulty in describing feelings
(F=15/03,P<0/001), difficulty in identifying feelings (F=26/17, P<0/001) and externally-oriented thinking
(F=24/28,P<0/001). These alexithymia subscales were higher in patients with schizophrenia spectrum disorders than
other groups.
In all groups, Males and females had significant difference in the difficulty in describing feelings (F=13/27,
P<0/001) and externally-oriented thinking (F=9/67, P= 0/002), but difference is not significant in difficulty in
identifying feelings. In all groups, male had more problem in describing feelings and externally-oriented thinking.
Interaction effects of three groups of schizophrenia spectrum, non-psychotic, normal subjects and two female
and male sexes (2 × 3) is significant only in the difficulty describing feelings subscale (F=4/56,P<0/01).This Means
that when sex factor is placed alongside group factor, people have more problem in describing feelings and do not
have problem in other subscales.

4. Discussion and Conclusion

Results showed that alexithymia level in patients with schizophrenia spectrum disorders is further than patients
with non-psychotic disorders and normal group. Also, The difficulty in describing feelings, difficulty in identifying
feelings and externally-oriented thinking levels are different among these three groups. Means that patients with
schizophrenia spectrum disorders have higher levels of these three subscales of alexithymia.These findings are
concordant with other findings obtained in this field (Cedro, Kokoszka, Popiel & Narkiewicz-Jodko, 2001;
Edwards, Jackson & Pattison, 2002; Wout, & et al., 2007; Serper, & Berenbaum, 2008). Common etiology between
alexithymia and schizophrenia spectrum disorders can explain these results. means that the same neurobiological
factors affect both schizophrenia spectrum disorders and high level of alexithymia in people. Limbic system,
forebrain cortex and dopamine neurotransmitter is considered in etiology of schizophrenia spectrum disorders, the
same brain areas that also play a vital role in alexithymia.
Also this study showed that males and females have significant difference in alexithymia. In all groups of
patients with schizophrenia spectrum, non-psychotic and normal, males had high level of alexithymia than females.
This finding are concordant with other findings obtained in this field ( Salminen, Saarijarvi, Aarela, Toikka,
Kauhanen, 1999; Lane, Sechrest, Riedel, 1998; Vorst, Bermond, 2001).
Because men verbally are weaker than women, so they naturally have more difficulties in describing feelings, on
the other hand, women being more emotional than men, therefore they easily can experience and recognize their
emotions and transfer them others. In according to this logic, the findings of previous researches and present
research are understandable. Also another achievement of this study in regard to being significant of interactive
effects of gender × group in the difficulty in describing feeling component be explained based on this logic. this
means that when gender factor stand beside group factor three groups of patients with schizophrenia spectrum
disorders, non-psychotic disorders and normal subjects suffer from describing feeling problems.
1088 Rasoul Heshmati et al. / Procedia Social and Behavioral Sciences 5 (2010) 1084–1089

These results suggest that high level of alexithymia could contribute to a greater vulnerability for schizophrenia
spectrum disorders and it could set males at high risk for this disorders. thus, it is essential to contrive a special
treatment to decrease alexithymia in these patients.
although we hypothesize that alexithymia can contribute to the development of schizophrenia spectrum disorders
(especially the latter), we must acknowledge that this is speculation on our part given that our research is causal-
comparative in nature. It is also quite plausible that the formation of schizophrenia spectrum disorders contribute to
changes in alexithymia. It will be important for future research to test these alternative possibilities by examining
alexithymia and schizophrenia spectrum disorders longitudinally. In terms of clinical implications, the present
results clearly suggest that examination of alexithymia variables have important implications for the etiology and
treatment of schizophrenia spectrum disorders.

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