· Horney (1952) found that some psychoanalytic clients failed to progress in their therapy
· She identified two clusters of indicators one ‘psychological’ the other ‘behavioural’
· Psychological indicators
· A dearth of ‘inner experience’
· Poor emotional awareness
· Concreteness of thinking
· Behavioural indicators
· Behaviour is guided by rules and regulations
· Behaviour is guided by the others’ expectations.
· Many were subject to psychosomatic disorders.
· Many showed compulsive behaviours.
· Krystal (1982–1983) concluded that “alexithymia is possibly the most important single factor diminishing the success of psychoanalysis and psychoanalytic psycho- therapy” (p. 364)
· Distinguishing Somatoform and Psychosomatic Disorders
· Somatoform – characterized by symptoms that indicate a physical illness but that illness is medically unexplained (MUS).
· Conversion disorders – characterized by some loss of physical function (e.g. blindness or paralysis) with no known physical cause
· Psychosomatic – in which mental factors play a role in the development, progression and treatment of an illness
· Ulcers & helicobacter pylori infection (about 80% concurrence)
· Ulcers & Stress (4/5 infected with Helicobacter pylori do not develop ulcers)
· Nemiah and Sifneos (1970)
· Investigated clients with a variety of psychosomatic diseases and
· These clients had
· difficulty in describing their feelings,
· an impoverished fantasy1 life,
· a cognitive style that is externally oriented, literal, and excessively pragmatic
· Sifneos (1973) coined the term alexithymia (from the Greek, a = lack of, lexis = words, thymos = emotions)
· Economic Costs of MUS’s
· Deary, Scott & Wilson (1997)
· Despite a large general latent trait (negative affectivity) the best model was a two-factor model that emphasized that alexithymia could make a contribution to MUS variance beyond that made by negative affectivity.
· Burton et al (2012)
· Patients who had been repeatedly referred with MUS had higher mean inpatient (£3,539), outpatient (£778) and emergency department (£99) costs than those infrequently referred.
· The mean overall costs were similar to those of patients who had been repeatedly referred with medically explained symptoms (£4916 vs £4379).
· Konnopka et al (2012)
· Cost of illness studies examining MUS’s found mean annual health care costs ranging from $1,584 to $6,424.
· On average the cost the US health system is greater than for both depression and anxiety (taken together)
· Quality of Life
· Alexithymia has been associated with higher incidences of
· Eating Disorders
· anorexia (e.g. Cochrane et al., 1993; Schmidt, Jiwany, & Treasure, 1993)
· bulimia (e.g. Cochrane et al., 1993; de Groot, Rodin, & Olmstead, 1995)
· binge-eating disorder (e.g. Pinaquy et al., 2003).
· Problem Gambling (Lumley and Roby, 1995; Parker et al., 2005; Toneatto et al., 2009)
· Alcohol Abuse (e.g. Shishido,Gaher and...