Maroti, Ljungar: Differences in alexithymia and emotional awareness in exhaustion syndrome and CFS

[trishrhymes]

Oh dear, those British psychiatrists really have screwed us all over the world. Sorry to here it's just as bad in Sweden. Are your local groups able to inform the Swedish ME specialists about the PACE debacle?

 

[mango]

Are your local groups able to inform the Swedish ME specialists about the PACE debacle?

Yes, RME (the Swedish ME Association) and advocates are doing a great job, regularly sending out excellent newsletters http://rme.nu/nyhetsbrev to a huge number of carefully selected people (currently more than 2000(!) people: physicians, researchers, others working in healthcare, healthcare politicians, government bureaucrats, people at the social insurance agency etc + more than 100 journalists), as well as press releases etc

Also, Dagens Medicin and Läkartidningen, two of the main websites for healthcare professionals, have published (short, not bad) articles on the PACE situation since the FOI data was released

So yes, I really do believe that the info is getting out there

 

[Effi]

@mango Thank you for bringing this researcher to our attention. I agree that it looks like BPS disguising as biomed research. This IMO is something we have to be really vigilant about. They are coercing patients into trusting them and taking part in shabby research that will ultimately always end up biting us. If we don't act up against this, the funding stream towards them will never stop and it will keep on actively causing us harm, both physically and psychologically.

I think they are trying to say that the effect of CBT could be increased by adding a couple of "psycho-educative sessions of emotional awareness training", since CFS patients have insufficient emotional awareness capacity and big difficulties in describing feelings...

(my bolding)
This is exactly what we're seeing in the latest chronic pain treatments: patients are uneducated, so if we educate them about how a faulty pain system works, they will have less pain. (I posted an excerpt about this here.) This view completely disregards the fact that many (if not most) patients are very well aware of their dire situation and have had to learn to cope with the extreme emotions that are attached to a seriously life altering illness. This doesn't seem to be taken into account in these kinds of studies, which skews the outcome from the very beginning.

In an fMRI study where the feeling of fatigue was provoked, patients with CFS showed an increased activation in areas of the brain that form part of a network that has been associated with inhibitory processes and emotional regulation (Caseras, Mataix-Cols, Rimes et al., 2008). The results were interpreted as meaning that patients with CFS tend to over-regulate or suppress their emotional responses, which, if true, could contribute to lower scores in the LEAS.

(my bolding)
Given the fact that the technique of fMRI leaves ample room for false positives, provoking a feeling of 'fatigue' is wildly unspecific, and they're using phrases like 'the results were interpreted as meaning that' ... 'if true, could' ..., I think it is safe to say that this part is a direct result of wishful thinking on their behalf. AKA BS.

those British psychiatrists really have screwed us all over the world

A lot of the research they're quoting is from Dutch researchers, so let's not forget they're to blame too. The Dutch did a study similar to PACE before PACE had even started, so they're pretty much all in the same boat. I mean, sinking ship.

 

[Woolie]

Alexithymia is a construct whose very existence came into being to explain somatisation disorders, The idea was that these chronic complainers cannot identify the physiological sensations of their own emotions (e.g., fear, anger sadness, anxiety), so instead attribute them to illness and go running to the doctor. It is a paradoxical little concept because you need quite a bit of awareness about your lack of emotional awareness to report it on this self-report test.

The attempt to measure it in illness populations is usually associated with an attempt to attribute their symptoms to somatisation (expressing psychological distress by way of bodily symptoms, or misinterpreting normal sensations as signs of real illness). Its been tried quite a few times in CFS populations, and little has been found (I think Wessely even had a go). Scores on alexithymia seems to be strongly associated with depression - I think you're more likely to self-report that you're bad at something if you're very depressed. This is what they found here.

 

[chipmunk1]

Alexithymia is a construct whose very existence came into being to explain somatisation disorders, The idea was that these chronic complainers cannot identify the physiological sensations of their own emotions (e.g., fear, anger sadness, anxiety), so instead attribute them to illness and go running to the doctor. It is a paradoxical little concept because you need quite a bit of awareness about your lack of emotional awareness to report it on this self-report test.

The attempt to measure it in illness populations is usually associated with an attempt to attribute their symptoms to somatisation (expressing psychological distress by way of bodily symptoms, or misinterpreting normal sensations as signs of real illness). Its been tried quite a few times in CFS populations, and little has been found (I think Wessely even had a go). Scores on alexithymia seems to be strongly associated with depression - I think you're more likely to self-report that you're bad at something if you're very depressed. This is what they found here.

It was invented by a trained psychoanalyst (aka Pseudoscientist). Has this concept ever helped anyone or helped us making sense of the world?

If we want to get rid of psychoanalysis in science and medicine, maybe we should get rid of this too?

French psychoanalystJoyce McDougallobjected to the strong focus by clinicians on neurophysiological at the expense of psychological explanations for the genesis and operation of alexithymia, and introduced the alternative term "disaffectation" to stand for psychogenic alexithymia.[30]For McDougall, the disaffected individual had at some point "experienced overwhelming emotion that threatened to attack their sense of integrity and identity", to which they applied psychological defenses to pulverize and eject all emotional representations from consciousness.[31]A similar line of interpretation has been taken up using the methods ofphenomenology.[32]McDougall has also noted that all infants are born unable to identify, organize, and speak about their emotional experiences (the wordinfansis from the Latin "not speaking"), and are "by reason of their immaturity inevitably alexithymic".[33]Based on this fact McDougall proposed in 1985 that the alexithymic part of an adult personality could be "an extremely arrested and infantile psychic structure".[33]The first language of an infant is nonverbal facial expressions. The parent's emotional state is important for determining how any child might develop. Neglect or indifference to varying changes in a child's facial expressions without proper feedback can promote an invalidation of the facial expressions manifested by the child. The parent's ability to reflect self-awareness to the child is another important factor. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can influence the child's capacity to understand emotional expressions

 

[Glycon]

If we want to get rid of psychoanalysis in science and medicine, maybe we should get rid of this too?

What kind of French person is named "Joyce McDougall"? I call shenanigans!

 

[flybro]

The absolute crap that passes for science is ridiculous.

It is opinion pieces dressed up as science, &^%$''#7^&%^%s!

 

[mango]

A friend of mine sent me a link to the study below, which she stumbled upon when reading up on alexithymia. It's by the IACFS/ME president Fred Friedberg.

Alexithymia in chronic fatigue syndrome: associations with momentary, recall, and retrospective measures of somatic complaints and emotions

Friedberg Fred1, Quick J.

1Stony Brook University, Stony Brook, NY 11794-8790, USA.

Psychosom Med. 2007 Jan;69(1):54-60.

Abstract
OBJECTIVE: The relationship between alexithymia and real-time momentary symptom assessments has not been reported. This cross-sectional study hypothesized that alexithymia would be a predictor of somatic symptoms using three different types of symptom measurement (momentary, recall, and retrospective) in the medically unexplained illness of chronic fatigue syndrome (CFS). In addition, it was hypothesized that negative affect would be a significant mediator of the relationship between alexithymia and somatic symptoms. Finally, the relation of alexithymia to physical illness attribution (a CFS illness predictor) was explored.

METHODS: Participants were 111 adults with CFS. Alexithymia was assessed with the Toronto Alexithymia Scale. Momentary ratings of current symptoms and affect were recorded in electronic diaries carried for 3 weeks. Weekly recall of these momentary reports was also recorded. Retrospective measures included 6-month ratings of fatigue and pain, the Fatigue Severity Scale, the Brief Pain Inventory-Short Form, a CFS symptom measure, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and an illness attribution rating.

RESULTS: Partial correlations, controlling for age and sex, yielded no significant associations between general or specific forms of alexithymia and momentary ratings of fatigue or pain. On the other hand, a significant association, partially mediated by anxiety scores, was found between a specific form of alexithymia and a retrospective pain measure. Finally, physical illness attribution was not significantly associated with alexithymia.

CONCLUSION: Based on assessments of real-time and retrospectively measured symptoms, these data provided only modest support for the alexithymia construct as a predictor of somatic symptoms in people with CFS.

https://www.ncbi.nlm.nih.gov/m/pubmed/17244849/

 

[mango]

Here's another older alexithymia study:

Alexithymia in adolescents with chronic fatigue syndrome.

van de Putte EM, et al. J Psychosom Res. 2007.

Abstract
BACKGROUND: Alexithymia is postulated as an important factor in the development of medically unexplained physical symptoms. Chronic fatigue syndrome (CFS) is presently medically unexplained. The aim of this study was to investigate whether the prevalence of alexithymia was higher in adolescents with CFS compared to healthy adolescents. Comorbidity such as anxiety and depression were analyzed as possible confounding factors. Secondly, alexithymia was investigated as a prognostic factor for the recovery of CFS.

METHODS: A cross-sectional study was performed among 40 adolescent outpatients diagnosed with CFS and 36 healthy controls. The 20-item Toronto Alexithymia Scale was used to assess all participants for alexithymia. Additionally, all participants completed a number of questionnaires regarding fatigue (Checklist Individual Strength), somatic complaints (Checklist Somatization Inventory), depression (Children's Depression Inventory), and trait anxiety (Spielberger State Trait Anxiety Questionnaire). A follow-up study was performed among the CFS adolescents 1 1/2 years after the initial assessment.

RESULTS: CFS adolescents scored higher only on the subscale identifying feelings of the TAS-20 [mean difference after adjustment for depression and anxiety 2.8 (95% CI: 0.6; 4.9]. Twelve CFS adolescents (30%) fulfilled criteria for alexithymia. This subgroup was characterized by higher scores for depression and anxiety and equal scores for fatigue and somatic complaints. At follow-up, no differences in recovery were established between the alexithymic and nonalexithymic CFS adolescents.

CONCLUSIONS: Alexithymia neither appears to be a unique correlate of CFS nor to be a prognostic factor for recovery of the CFS illness.

https://www.ncbi.nlm.nih.gov/m/pubmed/17905045/