Alexithymia: usefulness of the concept in eating disorders. Preliminary investigation in a clinical sample

Alessitimia: utilità del costrutto nei disturbi del comportamento alimentare. Indagine preliminare su un campione clinico

L.E. Zappa*, M. Caslini* **, E. Pini* **, G. Garghentini* **, M. Bogni***, S. Bertelli***, S. Scarone***, G. Duranti* **, M. Clerici**

* Unità "Disturbi del Comportamento Alimentare", Dipartimento di Salute Mentale, AO "San Gerardo"; ** Cattedra di Clinica Psichiatrica, Università di Milano-Bicocca; *** Servizio per i Disturbi del Comportamento Alimentare, AO "San Paolo", Milano


The alexithymia construct has been a remarkable feature of EDs: these patients have significant difficulty in identifying, distinguishing and describing emotions – especially anger and negative affect; they try to avoid frightening and unpleasant feelings and restrict the full emotional experience. Some authors have suggested that alexithymia is one of the factors responsable for poor response to treatment, relapse and chronicity in EDs. Since most studies are cross-sectional, it is difficult to understand the direction of causality between alexithymia and EDs; furthermore, literature is unable to provide conclusions on the usefulness of the concept in the clinical field, on its role in the maintenance of disease, and about the influence of usual treatments or the related needs to find alternative approaches to the classical setting.
Aim of this preliminary study is to assess the prevalence of alexithymia in a clinical sample with eating disorders and to consider its relation with epidemiological variables, psychological characteristics, symptom severity, and with the general psychopathology dimensions.


The study has been performed in the Eating Disorders Centres of San Gerardo Hospital, Monza, and San Paolo Hospital, Milan. A sample of 125 patients with eating disorders was evaluated with the self-rated questionnaires Toronto Alexithymia Scale for the assessment of alexithymia, Eating Disorder Inventory-2 for the evaluation of relevant symptoms and psychological characteristics of EDs, and Symptom Checklist-90 for the assessment of general psychopathology.


Our results show an about 38% prevalence of alexithymia in our sample, less than that reported in literature. The higher rate of alexithymia was found in patients with bulimia, but the diagnostic subgroups (anorexia, bulimia, binge eating disorder, not otherwise specified) did not significantly differ. TAS20 did not correlate with clinical or epidemiological variables. Alexithymia is more frequently found among patients with an Axis II diagnosis, confirming it as a possible developmental deficit which underlies regulation problems in personality disorders. TAS20 correlated with EDI-2, particularly with subscales concerning bodily and relational aspects, and, among the diagnostic subgroups, alexithymic bulimic patients obtained significantly higher scores than the non-alexithymic ones. TAS20 correlates with the level of general psychopathology as measured by the SCL-90, confirming alexithymia as a transnosographic dimension in disorders of affect regulation; alexithymic patients obtained significantly higher scores than non alexithymic ones in several subscales, such as Depression, a factor that worsens the alexithymia.


Alexithymia has a certain role in EDs psychopathology. Future developments of the study include further evaluation of the sample after a period of treatment to observe alexithymia level variations, changes induced by ongoing therapy, and the role of alexithymia in predicting treatment outcome of patients with EDs. We underline the need to identify specific and modified interventions for patients with EDs with important and overlapping alexithymic features, which are possibly responsible for relapse or chronic disease.