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Psychosomatics 45:508-516, December 2004
© 2004 The Academy of Psychosomatic Medicine

Alexithymia and Somatosensory Amplification in Functional Dyspepsia

Michael P. Jones, M.D., Ann Schettler, R.N., Kevin Olden, M.D., and Michael D. Crowell, Ph.D.

Received Aug. 13, 2003; revision received Jan. 7, 2004; accepted Feb. 2, 2004. From the Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago; and the Division of Gastroenterology, Mayo Clinic, Scottsdale, Ariz. Address reprint requests to Dr. Jones, Northwestern Memorial Hospital, Galter Pavilion 4-104, 251 East Huron St., Chicago, IL 60611-2908; mpjones{at}nmh.org (e-mail).


  ABSTRACT

 
TOP
 ABSTRACT
INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Somatosensory amplification is the tendency to report somatic sensations as intense and disturbing. Alexithymia is a personality construct characterized by difficulty recognizing emotions and a tendency to focus on external events and bodily sensations. The association of somatosensory amplification and alexithymia with functional symptoms was assessed in 111 patients with functional dyspepsia and 53 healthy comparison subjects. The subjects completed several assessment instruments, including the Somatosensory Amplification Scale and the 20-Item Toronto Alexithymia Scale. The patients with dyspepsia had modestly higher scores on measures of alexithymia (especially difficulty identifying feelings) and somatosensory amplification. Alexithymia and somatosensory amplification may play important roles in symptom generation and perception in a subset of patients with functional dyspepsia, but the importance of these constructs in this patient population appears less than previously reported.

Key Words: functional dyspepsia • alexithymia • somatosensory amplification

  INTRODUCTION

 
TOP
 ABSTRACT
 INTRODUCTION
METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Somatization has been frequently described in association with functional dyspepsia,1–4 yet in the clinical practice of gastroenterology, somatization remains a misunderstood and often mismanaged concept. In its broadest definition, somatization is the articulation of psychosocial and emotional distress through physical symptoms.5,6 Although a minority of patients may seek the sick role without truly feeling unwell (i.e., malingering), most patients with somatization truly perceive themselves as ill.

Somatization is a complex construct and is linked to a variety of patient factors. Somatosensory amplification refers to the tendency to experience somatic sensations as intense, noxious, and disturbing.7 Somatosensory amplification is a useful construct in assessing the perceptual styles of patients with psychosomatic illness. Alexithymia is a personality construct that is useful in the assessment of patients with psychosomatic disorders. Alexithymia refers to difficulty describing one's own emotions in words and the tendency to instead focus on the details of external events at the expense of articulating one's true emotional distress.8 As somatosensory amplification and alexithymia both address facets of somatization, some investigators have reported a positive correlation between the two constructs.9,10

Several studies have demonstrated somatosensory amplification and alexithymia in patients with chronic pain, patients with somatoform disorders, and poorly characterized patients with functional gastrointestinal disorders. To our knowledge, no study has evaluated these constructs in a well-defined group of patients with functional dyspepsia. The aim of this study was to assess the severity of alexithymia and somatosensory amplification in patients with functional dyspepsia (as defined by the Rome II criteria), compared with healthy subjects.


  METHOD

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
RESULTS
 DISCUSSION
 REFERENCES
 
Adult patients with functional dyspepsia were consecutively enrolled from the Gastrointestinal Physiology Laboratory after being referred from the outpatient gastroenterology clinic at Northwestern University. Although enrollment from the physiology laboratory was consecutive, it was not possible to know the total pool of patients with dyspepsia from which these subjects were selected. Functional dyspepsia was defined by using Rome II criteria.11 Briefly, functional dyspepsia is defined as pain or discomfort centered in the upper abdomen. Discomfort may be characterized by or associated with upper abdominal fullness, early satiety, bloating, or nausea. Symptoms were required to be present for >12 weeks in the past 12 months. All subjects were required to have normal results on an upper gastrointestinal endoscopy with further evaluation performed as indicated by the evaluating gastroenterologist. Patients were excluded if they had dominant complaints of heartburn, had prior digestive surgery other than cholecystectomy or appendectomy, or were taking medications known to alter or suspected of altering digestive motility. Subjects were also excluded if they were infected with H. pylori. H. pylori status was determined either by biopsy for histology or by rapid urease testing, whole blood serology, or 13C urea breath testing. For purposes of this study, patients were considered infected if any test for the presence of H. pylori was positive.

Patients with functional dyspepsia were further categorized according to Rome II guidelines as having ulcer-like dyspepsia or dysmotility-like dyspepsia. Patients were considered to have ulcer-like dyspepsia if the predominant symptom was pain centered in the upper abdomen. Patients were considered to have dysmotility-like dyspepsia if their predominant symptom was a nonpainful sensation characterized or associated with upper abdominal fullness, early satiety, bloating, or nausea.

The healthy comparison subjects were recruited by advertisement and consisted largely of hospital staff, house staff, and patients' family members. The comparison subjects were free of digestive complaints and were taking no medication to treat digestive disorders. Comparison subjects were excluded if they had a prior history of abdominal surgery other than cholecystectomy or appendectomy.

The protocol was approved by the Northwestern University Institutional Review Board. Informed consent was obtained from all study participants.

Questionnaires
Subjects were asked to complete several self-report measures pertaining to symptoms, quality of life, and psychologic traits. Dyspepsia severity was evaluated with the Nepean Dyspepsia Index,12,13 a validated, disease-specific measure for assessment of symptoms and disease-specific quality of life over the 2 weeks before administration. Respondents are asked to rate the frequency, intensity, and intrusiveness of 15 common dyspeptic symptoms on a Likert-type scale. The scores are summed for each symptom to give a total symptom score that could range from 0 to 13. Raw Nepean Dyspepsia Index scores are expressed as the percentage of the maximal possible score for comparative purposes. Higher scores indicate greater symptom severity and poorer quality of life.

General quality of life was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey.14–16 The 36-Item Short-Form Health Survey is a well-studied, valid instrument that has been used to determine general quality of life in a variety of clinical contexts, including in patients with functional gastrointestinal disorders. This measure assesses eight health concepts: 1) limitations in physical activities because of health problems, 2) limitations in social activities because of physical or emotional problems, 3) limitations in usual role activities because of physical health problems, 4) bodily pain, 5) general mental health (psychological distress and well-being), 6) limitations in usual role activities because of emotional problems, 7) vitality (energy and fatigue), and 8) general health perceptions. These scales can be grouped into mental and physical composite scores. Lower scores indicate poorer quality of life.

Psychiatric distress was measured with the SCL-90-R, a self-report, clinical symptom rating scale consisting of 90 questions.17 Responses indicate the presence of symptoms associated with nine psychiatric constructs: somatization, obsessive-compulsive behavior, feelings of inadequacy or inferiority (interpersonal sensitivity), depression, anger/hostility, phobic anxiety, paranoid ideation, and psychoticism. Raw scores were converted into t scores by using published values for healthy outpatients. In addition, a global severity index was calculated; scores >63 are associated with significant psychological distress.

Alexithymia was measured with the 20-Item Toronto Alexithymia Scale.18–21 This self-report measure assesses a variety of alexithymia characteristics with 5-point Likert-type scales. In addition to a total score, the measure includes subscale scores for "difficulty identifying feelings," "difficulty describing feelings," and "externally oriented thinking."

Somatosensory amplification was measured with the Somatosensory Amplification Scale developed by Barsky and colleagues.7,22,23 The Somatosensory Amplification Scale asks subjects to rate how much they are bothered by a number of somatic and visceral sensations that are not associated with serious underlying pathology. Somatosensory amplification is associated with hypochondriasis and somatization but is not synonymous with these constructs.

Fifty-six consecutive patients with functional dyspepsia also completed the NEO Five-Factor Inventory, a shortened version of the NEO Personality Inventory.24,25 The NEO Five-Factor Inventory measures the personality dimensions of neuroticism, extraversion, openness, agreeableness, and conscientiousness. Responses to the 60-item measure were converted into t scores, with adjustment for gender, for comparison with standardized means.

Statistical Analysis
Data were expressed as means and standard deviations. Normality of all data sets was determined with the Kolmogorov-Smirnov test. For normally distributed data, correlations were calculated by using Pearson product-moment correlation, and differences between groups were determined with paired or unpaired t tests, as appropriate. Correlations between non-normally distributed or categorical data sets were determined with the Spearman rank-order correlation, and differences between median group scores were determined with the Mann-Whitney test. Statistical significance was set at p<0.05. Statistical calculations were made with GraphPad Prism version 3.00 for Windows (GraphPad Software, San Diego).


  RESULTS

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
DISCUSSION
 REFERENCES
 
Fifty-three comparison subjects were recruited by advertisement. This group included 15 men and 38 women with an average age of 34 years (SD=14). The functional dyspepsia group consisted of 28 men and 83 women with an average age of 39 years (SD=13). The two groups did not differ on the basis of sex (p=0.60, t test), but the dyspeptic group was significantly older than the comparison group (p=0.03, t test). The functional dyspepsia group consisted almost exclusively of patients with motility-like dyspepsia; only 29 of 111 patients had upper abdominal pain as a predominant complaint.

The patients with dyspepsia had significantly poorer quality of life as measured by both general and disease-specific instruments. They scored significantly lower than the comparison subjects on both the physical composite score (mean=39 [SD=13] versus 57 [SD=5], p<0.0001, t test) and mental composite score (mean=33 [SD=9] versus mean=47 [SD=5], p<0.0001, t test) of the 36-Item Short-Form Health Survey. The average Nepean Dyspepsia Index percentage score was 45 (SD=18) for the dyspepsia patients, compared with 11 (SD=5) for the healthy volunteers (p<0.0001, t test). The dyspepsia patients also had greater levels of psychological distress, as measured by the SCL-90-R, than did the comparison subjects (Figure 1). The mean SCL-90-R global symptom severity index for the dyspepsia patients was 64 (SD=46), compared with 15 (SD=18) for the healthy volunteers (p<0.0001, t test). The dyspepsia patients also had significantly higher scores on all SCL-90-R subscales.



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FIGURE 1.  SCL-90-R Global and Subscale Scores for Patients With Functional Dyspepsia and Healthy Comparison Subjectsa

aPatients with dyspepsia scored significantly higher than the comparison subjects on the global SCL-90-R measure and on all subscales except the psychoticism subscale.

bAll values are t scores, except for the global scores, which are total raw scores.


The patients with dyspepsia scored significantly higher than the comparison subjects on both the 20-Item Toronto Alexithymia Scale and the Somatosensory Amplification Scale (Figure 2). The mean score on the alexithymia instrument for the dyspepsia patients was 43 (SD=11), compared with 38 (SD=9) for the healthy volunteers (p<0.005, t test). Scores on the 20-Item Toronto Alexithymia Scale did not significantly correlate with age and did not differ significantly between men and women in both the dyspepsia group and the comparison group. Only 12% of dyspepsia patients had 20-Item Toronto Alexithymia Scale scores ≥61, the suggested cutoff score for identifying individuals with a high level of alexithymia.21 Although there was substantial overlap in scores between the dyspepsia patients and the comparison subjects, 21% of the dyspepsia patients had 20-Item Toronto Alexithymia Scale scores greater than two standard deviations higher than the mean for the comparison group. Differences between the comparison subjects and the dyspepsia patients were limited to the 20-Item Toronto Alexithymia Scale subscale for "difficulty identifying feelings" (Table 1). No significant differences were found for "difficulty describing feelings" or "externally oriented thinking."



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FIGURE 2.  Scatter Plots of Scores on the 20-Item Toronto Alexithymia Scale and the Somatosensory Amplification Scale for Patients With Functional Dyspepsia and Healthy Comparison Subjectsa

aPatients with dyspepsia scored significantly higher than the comparison subjects on both measures. The horizontal bar in each group represents the mean value.



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TABLE 1. Scores on the 20-Item Toronto Alexithymia Scale for Patients With Functional Dyspepsia and Healthy Comparison Subjects



The patients with functional dyspepsia also had significantly higher scores on the Somatosensory Amplification Scale than did the comparison subjects (mean=29 [SD=6] versus mean=26 [SD=5], p<0.002, t test). Previous studies have suggested a correlation between somatosensory amplification, female sex, and age.9 Among the dyspepsia patients, female subjects had significantly higher Somatosensory Amplification Scale scores than male subjects (mean=30 [SD=6] versus mean=26 [SD=6], p=0.0005, t test). There was no gender difference in the comparison group. No correlation was found between age and Somatosensory Amplification Scale scores for either the comparison group (r=–0.22, p=0.12) or the dyspepsia group (r=0.14, p=0.17).

There was no correlation between Somatosensory Amplification Scale and 20-Item Toronto Alexithymia Scale scores among the dyspepsia patients (r=0.16, p=0.12). A modest but significant correlation existed between Somatosensory Amplification Scale scores and scores on the 20-Item Toronto Alexithymia Scale subscale for "difficulty identifying feelings" (r=0.33, p<0.002). No significant correlation existed between Somatosensory Amplification Scale scores and "difficulty describing feelings" (r=0.16, p=0.13) or between Somatosensory Amplification Scale scores and "externally oriented thinking" (r=–0.19, p=0.06).

SCL-90-R global symptom severity scores were significantly correlated with 20-Item Toronto Alexithymia Scale scores (r=0.44, p<0.0001) and with Somatosensory Amplification Scale scores (r=0.36, p=0.0003). Table 2 shows the correlations of the SCL-90-R subscale scores with the Somatosensory Amplification Scale scores, 20-Item Toronto Alexithymia Scale total scores, and "difficulty identifying feelings" subscale scores. "Externally oriented thinking" subscale scores were not significantly correlated with SCL-90-R global symptom severity scores or with any SCL-90-R subscale scores other than the scores for heightened interpersonal sensitivity (r=0.19, p<0.05). For 20-Item Toronto Alexithymia Scale total scores and "difficulty identifying feelings" subscale scores, the strongest associations were seen with scores for interpersonal sensitivity, depression, psychoticism, anger/hostility, and paranoid ideation. Associations of SCL-90-R subscale scores with Somatosensory Amplification Scale scores were not as strong; the strongest correlations were seen with interpersonal sensitivity, somatization, anxiety, and obsessive-compulsive behaviors scores.


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TABLE 2. Correlation of Scores on the SCL-90-R With Scores on Measures of Somatosensory Amplification, Alexithymia, and Difficulty Identifying Feelings Among Patients With Functional Dyspepsia (N=111) and Healthy Comparison Subjects (N=53)



For the dyspepsia patients, there was little correlation between somatosensory amplification, alexithymia, and quality of life as measured in this study. Somatosensory Amplification Scale scores were significantly correlated with quality of life as measured by the Nepean Dyspepsia Index (r=0.27, p=0.008) and the mental composite score of the 36-Item Short-Form Health Survey (r=–0.29, p<0.004) but not the physical composite score (r=–0.88, p=0.39). Although the inverse correlation with the mental composite scores appears to contradict the positive correlation seen with the Nepean Dyspepsia Index, it should be kept in mind that worsening quality of life is reflected by increasing Nepean Dyspepsia Index scores and by decreasing 36-Item Short-Form Health Survey composite scores. The total 20-Item Toronto Alexithymia Scale scores and subscale scores for "difficulty describing feelings" and "externally oriented thinking" were not significantly correlated with either Nepean Dyspepsia Index scores or 36-Item Short-Form Health Survey scores. Scores for "difficulty identifying feelings" were significantly correlated with both Nepean Dyspepsia Index scores (r=0.24, p<0.02) and 36-Item Short-Form Health Survey mental composite scores (r=–0.36, p=0.0001), suggesting that greater difficulty in identifying feelings was associated with poorer quality of life.

Multiple regression was used to further examine the relationship of alexithymia, somatosensory amplification, and psychiatric distress as measured by the SCL-90-R. Candidate variables that correlated significantly with the Nepean Dyspepsia Index score were entered into the model. For the 20-Item Toronto Alexithymia Scale, only "difficulty identifying feelings" subscale scores correlated significantly with Nepean Dyspepsia Index scores. All SCL-90-R subscale scores and the Somatosensory Amplification Scale score were entered. The final model contained only the SCL-90-R subscale scores for somatization (t=5.48, df=106, p<0.0001), depression (t=2.96, df=106, p<0.004), and interpersonal sensitivity (t=2.06, df=106, p<0.05). This model explained 42% of the variance in the Nepean Dyspepsia Index scores. Neither the "difficulty identifying feelings" score nor the Somatosensory Amplification Scale score contributed significantly to the model.

Table 3 shows the associations of the ratings for the 15 dyspeptic symptoms included in the Nepean Dyspepsia Index with the scores on the Somatosensory Amplification Scale, 20-Item Toronto Alexithymia Scale, and "difficulty identifying feelings" subscale. Although Somatosensory Amplification Scale scores were positively correlated with disease-specific quality of life as measured by the total Nepean Dyspepsia Index score, the only specific symptom associations were with cramps (r=0.27, p<0.05), inability to finish a meal (r=0.25, p<0.05), and excessive fullness/slow digestion (r=0.25, p<0.05). Scores on the 20-Item Toronto Alexithymia Scale were not significantly associated with ratings for any of the 15 dyspeptic symptoms. Scores for "difficulty identifying feelings" were significantly correlated with ratings of abdominal discomfort (r=0.27, p<0.02) and bloating (r=0.23, p<0.04).


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TABLE 3. Correlation of Nepean Dyspepsia Index Item Ratings With Measures of Somatosensory Amplification, Alexithymia, and Difficulty Identifying Feelings Among Patients With Functional Dyspepsia (N=111) and Healthy Comparison Subjects (N=53)



Fifty-six patients with dyspepsia (50% of the dyspepsia patients) completed the NEO Five-Factor Inventory. In a one-sample t test, only the mean score for neuroticism (mean=53, SD=13) was significantly different from the standardized mean of 50 (p<0.05) (Figure 3). Somatosensory Amplification Scale scores did not significantly correlate with any of the five personality factors measured by the NEO Five-Factor Inventory. Scores on the 20-Item Toronto Alexithymia Scale were significantly correlated with neuroticism (r=0.65, p<0.0001), extroversion (r= –0.36, p<0.007), and agreeableness (r=–0.29, p= 0.028). Significant correlations with these personality factors also existed for "difficulty identifying feelings" and "difficulty describing feelings" scales. "Externally oriented thinking" was correlated with neuroticism (r=0.43, p= 0.001) and openness (r=–0.44, p=0.0007).



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FIGURE 3.  Scatter Plots of t Scores for Subscales of the NEO Five-Factor Inventory for Patients With Functional Dyspepsia (N=56)a

aOnly scores for neuroticism differed significantly from a standardized mean of 50 (p<0.05, one-sample t test). The horizontal bar in each group represents the mean value.



  DISCUSSION

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
REFERENCES
 
Compared with healthy subjects, patients with functional dyspepsia had modestly but significantly higher scores on measures of somatosensory amplification and alexithymia. The mean difference between the comparison subjects and the dyspepsia patients in Somatosensory Amplification Scale scores was modest and comparable in magnitude to differences reported between outpatients attending a psychosomatic clinic and comparison outpatients in an earlier study.9 This study also reported a positive correlation between somatosensory amplification, female sex, and age. Although the dyspepsia patients in our study did not differ from the comparison subjects with respect to gender, the patients were somewhat older than the comparison subjects. The mean difference in age between the comparison subjects and the dyspepsia patients was 5 years, which is unlikely to be clinically profound. In addition, we did not find a significant correlation between age and Somatosensory Amplification Scale or 20-Item Toronto Alexithymia Scale scores for either the comparison subjects or the dyspepsia patients. Among the dyspepsia patients, women had significantly higher Somatosensory Amplification Scale scores than men. There was no gender difference in the comparison group. Our findings are consistent with those of other studies that examined the relationship between somatosensory amplification, gender, and age.22,23

Among the dyspepsia patients, somatosensory amplification and alexithymia scores correlated significantly but modestly with SCL-90-R subscale scores for somatization (r=0.30 and r=0.26, respectively). That these correlations were not stronger is not a unique observation. Other investigators have reported similar findings, noting that somatosensory amplification and alexithymia are not strictly synonymous with somatization but rather represent perceptual and cognitive aspects of somatization.10 Spinhoven and van der Does26 studied the relationship between somatization and somatosensory amplification in psychiatric outpatients with anxiety and depressive disorders and concluded that somatization reflects primarily somatized anxiety and is largely independent of somatosensory amplification.

The relationship between somatosensory amplification and alexithymia is debated in the existing literature, with investigators arguing both for9,10 and against27 an association. We did not find a correlation between somatosensory amplification and 20-Item Toronto Alexithymia Scale scores, but there was a significant correlation between somatosensory amplification scores and "difficulty identifying feelings" subscale scores.

Although alexithymia scores were significantly higher in the dyspepsia group than in the comparison group, the magnitude of the difference was modest, and only 12% of the subjects had 20-Item Toronto Alexithymia Scale scores ≥61, the cutoff score suggested to be indicative of a high level of alexithymia.21 However, 21% of the dyspepsia patients had alexithymia scores greater than two standard deviations above the mean score for the comparison group. These findings are consistent with previous findings on the prevalence of alexithymia in frequent users of primary care services, but the 21% prevalence is substantially lower than that found in studies of patients with functional gastrointestinal disorders, psychiatric disorders, or hypertension.28–33 To our knowledge, four published studies have evaluated alexithymia in patients with functional gastrointestinal disorders.28,29,32,33 Three of these studies are from a single group and may have included overlapping populations of Italian outpatients. In these studies, Porcelli and colleagues reported that between 56% and 66% of patients with functional digestive disorders had 20-Item Toronto Alexithymia Scale scores ≥61.28,29,33 The fourth study assessed an Italian outpatient population with irritable bowel syndrome.32 The authors reported that 43% of irritable bowel syndrome patients had 20-Item Toronto Alexithymia Scale scores ≥61. Our data, therefore, represent the lowest reported prevalence of a high level of alexithymia in patients with functional digestive disorders. The number of subjects in our study was slightly smaller than but comparable to the number of subjects in the previous studies. The most obvious difference between our study and the previous studies would appear to be cultural differences between the study populations.

The differences between dyspepsia patients and the comparison subjects for the 20-Item Toronto Alexithymia Scale subscale scores were significant only for "difficulty identifying feelings." Scores for "difficulty describing feelings" and "externally oriented thinking" did not differ between the dyspepsia patients and the comparison subjects. The dyspepsia patients in this study population may simply be confusing the physical manifestations of emotionality with symptoms of dyspepsia while either not recognizing the native emotion or failing to connect the two.

In fact, although the Somatosensory Amplification Scale and 20-Item Toronto Alexithymia Scale scores were not strongly correlated with the ratings of specific dyspeptic symptoms, they were significantly correlated with most SCL-90-R subscale scores measuring psychological symptoms. Somatosensory amplification was most strongly correlated with scores for obsessive-compulsive behavior (r=0.35, p=0.0003), anxiety (r=0.32, p<0.002), and somatization (r=0.30, p<0.003). 20-Item Toronto Alexithymia Scale scores were most strongly correlated with scores for interpersonal sensitivity (r=0.53, p<0.0001) and depression (r=0.49, p<0.0001). The "difficulty identifying feelings" scale of the 20-Item Toronto Alexithymia Scale had similar but stronger correlations with the SCL-90-R subscales. Alexithymia and depression have been linked in a number of studies, and somatic symptoms in depression may be predicted by difficulty identifying and communicating emotional distress.34,35

Determining the effect of alexithymia and somatosensory amplification on dyspepsia severity and quality of life were not a priori goals of this study. We performed a post hoc regression analysis to better understand the determinants of disease-specific quality of life in functional dyspepsia. Neither alexithymia nor somatosensory amplification scores contributed significantly to the final model in which SCL-90-R subscale scores for somatization, depression, and interpersonal sensitivity accounted for 42% of the variance in Nepean Dyspepsia Index scores. These results may be influenced by the lower prevalence of alexithymia and somatosensory amplification seen in this population.

Previous observations have shown an association of neuroticism (negative affectivity) and social inadequacy with alexithymia and somatosensory amplification.10,36,37 The dyspepsia patients in our study had scores for neuroticism that were slightly higher than the standardized mean; this difference was statistically but not clinically significant. Scores for extraversion, openness, agreeableness, and conscientiousness were not significantly different than the standardized mean. Significant correlations existed between 20-Item Toronto Alexithymia Scale scores and scores for neuroticism (r=0.65, p<0.0001), extraversion (r=–0.36, p<0.007), and agreeableness (r=–0.29, p<0.03). Somatosensory amplification scores did not correlate with any of the NEO Five-Factor Inventory scale scores.

This study had several limitations that should be considered in interpreting the data. First, the comparison group was small and differed slightly in age from the dyspepsia patient group. The effect of sample size is likely to be modest as small sample sizes increase the risk of falsely rejecting the null hypothesis (type II error), which has not occurred here. The age differences are also unlikely to bias results as there was no correlation of alexithymia and somatosensory amplification scores with age in this population. Second, the fact that we compared healthy volunteers with dyspepsia patients did not allow us to differentiate between illness behavior in general and behaviors specific to psychosomatic or functional disorders. Subjects with organic digestive disorders should be included in future studies. Finally, the low level of alexithymia and somatosensory amplification in the dyspepsia patients in this study is at odds with previous reports. Our findings need to be confirmed in other studies based in the United States.

In summary, our data demonstrate modestly but significantly higher levels of alexithymia and somatosensory amplification in patients with functional dyspepsia, compared with healthy volunteers. These constructs appear to play significant roles in symptom generation and interpretation in a subset of patients, but further study is needed to determine the true prevalence and relevance of these constructs in patients with functional dyspepsia and other functional digestive disorders.


  REFERENCES

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 

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