Alexithymia and pain

In the history of psychosomatic research, one of the central directions is the search for a special psychic quality of psychosomatic specificity, which is a factor predisposing to the emergence of psychosomatic pathology affecting the course and treatment of diseases. The most recent attempt of this kind is the isolation and description of the phenomenon of ilexthymia, which is considered as a set of characteristics characterizing the mental warehouse of individuals predisposing them to diseases of psychosomatic specificity. It should be noted that in recent years it has been associated with an ever wider range of nosological forms (eg, depression, secondary psychosomatic disorders in chronic diseases, etc.) and is characterized in this case as a phenomenon of secondary alexithymia, being a characteristic sign of a severe stressful situation.

Alexithymia is characterized by a person's difficulty or inability to accurately describe their own emotional experiences and understand the feelings of another person, the difficulties in determining the differences between feelings and bodily sensations, fixation on external events to the detriment of inner experiences. Such patients present certain difficulties for the doctor. They can not accurately describe (detail) their feelings, including pain. If they are presented with specific possible options (duration, time of day, provoking factors, dynamics of symptoms, etc.), then they. As a rule, they can choose certain options, but this requires much more time for examination and collection of anamnesis than in patients without alexithymia.

Aleksitimiyu in recent years, considered as a risk factor for the development of many diseases, including such common as diabetes mellitus, bronchial asthma, peptic ulcer and duodenal ulcer, ulcerative colitis, ischemic heart disease, hypertension, alcoholism. There are jobs in which which traced the connection of alexithymia with the risk of the onset of deaths. The point is that the presence of alexithymic traits in the structure of the personality of men 42-60 years increases the risk of their premature death from different causes by 2-3 times. Being a global biological characteristic, alexithymia significantly modifies the psychopathological picture of various diseases.

The predetermining role of alexithymia in the formation of the clinical picture and the prognosis of anxiety-panic disorder is proved, which is expressed in the wide representation of somato-vegetative symptoms, algic symptoms, high frequency of panic attacks and rather low effectiveness of psychopharmacotherapy. When carrying out therapeutic measures, it is necessary to take into account the low quality of life characteristics, high level of anxiety characteristic for alexithymics.

The pathogenesis of alexithymia is associated with abnormalities in the paleostriasis, resulting in the suppression of impulses from the limbic system to the cerebral cortex. Another point of view postulates a state where the left hemisphere does not recognize the emotional experiences that arise in the right hemisphere, as a result of their disturbed interaction. In accordance with this, it was suggested that the person might develop a "functional commissurotomy", alexithymia was interpreted as a "split brain" syndrome. Another hypothesis is close to this hypothesis, treating alexithymia as a defect in the development of the brain with a defect in the corpus callosum or bilateral or anomalous localization of the center of speech in the right hemisphere.

Alexithymia may be secondary. To secondary alexithymia is, in particular, the state of global inhibition of affects as a result of psychotrauma, which is regarded as a protective mechanism, although it is not a psychological defense in the classical sense. But it should be borne in mind that for the alexithymic person is characterized by the so-called "immature" type of protection, especially sot superstrong, intolerable to them affects. The identification of alexithymia in masked depressions and neuroses gave grounds for considering it from the standpoint of neurosis. Alexitimic features are often found in patients with post-traumatic stress disorder, a positive relationship is established between the level of alexithymia, depression and anxiety.

Alexithymia is more common among men with low social status and income, as well as a low level of education. There is a tendency to increase the incidence of alexithymia in the elderly to 34%, while among students, signs of alexithymia are found in 8.2% of men and 1.8% of women. Alexithymia is a very persistent disorder that requires a complex impact, that is, a combination of psychological and pharmacological correction, which should be aimed not only at reducing the level of psychoemotional stress, anxiety, depression symptoms, but also the altered metabolic, immune and hormonal status of the alexithymic personality.

It was established that alexithymia is not associated with cold pain thresholds, does not correlate with sensory components of pain, but is interrelated with affective perception of pain; there is a correlation between the severity of pain, depression, anxiety and alexithymia in musculoskeletal pain and fibromyalgia. In general, the problem of pain and alexithymia has not yet been developed sufficiently

To determine the severity of alexithymia, the 26-point Torontian alexithymic scale, TAS, proposed in 1985 is used. Numerous studies of foreign and domestic authors using TAS have proved the stability, reliability and validity of its factor structure and. Respectively, the results obtained. The Russian version of TAS was adapted in the neuropsychiatric institute named after VM Bekhterev (Yeresko DB, Isurina GS, Koidanovskaya EV and others, 1994). When completing the questionnaire, the subject describes himself using the Likert scale for answers - from "completely disagree" to "completely agree". In this case, one half of the items have a positive code, the other - a negative one. Aleksitimichnym consider people who scored TAS 74 points or more, the absence of alexithymia corresponds to an indicator less than 62 points.

[1], [2], [3], [4], [5], [6],