Alexithymia and Somatization in Chronic Pain Patients: A Sequential Mediation Model

• Published in: Frontiers in psychology 2020-10, Vol.11, p.545881
• Main Authors: Lanzara, Roberta, Conti, Chiara, Camelio, Martina, Cannizzaro, Paolo, Lalli, Vittorio, Bellomo, Rosa Grazia, Saggini, Raoul, Porcelli, Piero
• Format: Article
• Language: English
• Subjects: alexithymia; chronic pain; distress; Psychology; quality of life; somatization
• ISSN: 1664-1078; 1664-1078
• DOI: 10.3389/fpsyg.2020.545881

To investigate whether chronic pain (CP) patients with somatization reported higher alexithymic traits than those without somatization and to study the different relationships between psychological characteristics, pain, health-related quality of life (HRQL), and somatization. A consecutive sample of 134 CP treatment-seeking outpatients were evaluated for alexithymia (TAS-20), somatization (PHQ-15), distress (HADS), HRQL (SF-12), and pain (BPI). Patients with somatization (37.04%) reported significantly higher TAS-20 total scores ( < 0.001) and difficulty in identifying feelings (DIF) ( < 0.001) than those without somatization. The somatizer group had also a significantly higher disease duration, severity and interference of pain, distress, and lower HRQL than the non-somatizer group. Hierarchical regression analysis showed that although distress, pain interference and the mental HRQL component are closely related to somatization ( = 0.55), DIF was the strongest predictor of severity of somatization (β = 0.31). A sequential indirect effect from DIF to somatization via distress symptoms and pain interference turned out to be significant [95% CI (0.01, 0.09)]. Support was also found for sequential mediation paths from DIF to somatization via distress and mental HRQL [95% CI (0.01, 0.11)]. Our results pointed-out that alexithymia, particularly DIF, may be major factor for somatization risk in CP patients. Longitudinal observations are needed for evaluating the role of alexithymia in clinical outcomes.