Alexithymia and psychiatric symptoms in a population of nursery workers: A study using the 20-item Toronto alexithymia scale

Social Behavior and Personality, 2001 by Posse, M, Backenroth-Ohsako, G, Hakanson, C-E, Hallstrom, T

This study investigated alexithymia in a sample of professional nursery workers in Huddinge community, Sweden. In a previous study in general practice it was found that alexithymia, in a mixed population seeking medical advice, was associated with higher age, male gender, low

Keywords: Alexithymia, Depressive symptoms, Gastro-intestinal symptoms, Somatic anxiety, Wellbeing, Social dysfunction, Women, Occupational Health. education and the personality traits suspicion and distance as well as undetected depression. The choice of a professional female population allowed alexithymia to be studied in a refined way without the impact of some of the confounding elements of previous studies. The six variables investigated apart from alexithymia were feelings of well-being, symptoms of somatic and psychic anxiety, depressive symptoms, gastro-intestinal symptoms, and level of social dysfunction. The prevalence of alexithymia was 7.9%. Fifty percent of the items assessing somatic anxiety and 28.5% of those assessing depressive symptoms were related to high TAS20 scores in this healthy all-female population. The feeling factors of TAS-20, difficulty in identifying and expressing feelings, accounted in this study for the majority of relations to the other variables whilst the third factor, externally oriented thinking, remained independent and mainly nonrelated to the other measured variables. It had been hypothesised that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal. Confirmation of these theories was found in this study where subjects expressing high levels of vegetative and visceral symptoms of anxiety also scored high for alexithymia and depressive symptoms.

Women's role in society has changed considerably during the last decades. We have also started to understand that methods implied to assess men's role in society and their health do not necessarily have the same implications for women in psycho-social work-environment research (Johnson & Hall, 1996).

Mental health problems in the form of depression, anxiety and eating disorders are known to be more prevalent in women than in men (Robins & Regier, 1991), and an increased risk of committing suicide has also been detected in the female population with professional roles as carers, nurses and medical staff in the Health service in Sweden (Jarvholm, 1996).

Alexithymia, defined as a difficulty in identifying feelings, a difficulty in describing feelings and a preoccupation with externally orientated thinking, has long been reported to be a common finding in psychosomatic disorders and eating disorders with significantly higher alexithymia scores found (Schmidt, Jiwany & Treasure, 1993; de Zwaan, et al., 1995; Nemiah & Sifneos, 1970; Sifneos, 1973). In a previous study performed in primary care, female patients were generally underrepresented in the alexithymic population in all diagnostic categories except in the group with asthmatic disorder (Posse & Hallstrom, 1998 a). Alexithymia, as measured by the Schalling Sifneos Personality Scale, was found to be an important denominator in primary care patients with undetected depression and high scores of somatization (Posse & Hallstrom, 1998 b). The alexithymia construct of affect awareness has been found to be a constant trait in 20 % of individuals with teenage onset anorexia nervosa (AN), long after weight restoration (RAstam, Gillberg, Gillberg & Johansson, 1997), lending support for the theory that alexithymia in its trait or primary form, thought to manifest in response to early developmental failure, (Mc Dougall, 1984), may be a risk factor for developing AN - as only one in 20 in the general population without AN appears to be affected by alexithymia to a measurable degree. Several studies have examined the relationship between alexithymia and basic dimensions of personality characteristics. Alexithymia has been found to be associated with measures of neuroticism, introversion and low openness (Mann, Wise, Trinidad & Kohanski, 1994; Parker, Bagby & Taylor, 1989; Taylor, 1984; Taylor, 1994; Wise, Mann & Epstein, 1991; Wise, Mann & Shay, 1992).

The general purpose of this study was to further investigate the alexithymia concept in a female working population. The specific purpose for this study was to assess if higher TAS-scores would be associated with people expressing more somatic problems as well as scoring for depression, i.e. masked depression. The authors sought also to elucidate the relationships between alexithymia and age, education, social disability, feelings of well-being, and somatic as well as psychic anxiety.

METHOD

SUBJECTS

A total of 1032 subjects, all being female professionals employed in the childcare program provided by Huddinge community, were assessed within the occupational health services framework. There were eight professional groups classified in the sample; Primary School Teachers, Occupational Therapists and Teachers for children with special needs (n= 304), Nursery Nurses (n= 295), Nursery Carers (n=115), Social Workers and Executive Managers (n =53), Catering staff (n=43), Cleaning staff (n=19), Pupil Assistants and Language Teachers (n=5) and Personal Assistants for children with special needs (n=3). Twenty-seven subjects did not fit into any of these categories.