Academic journal article Journal of Evidence-Based Psychotherapies

Alexithymia, a Risk Factor in Alcohol Addiction? a Brief Research Report on Romanian Population

Academic journal article Journal of Evidence-Based Psychotherapies

Alexithymia, a Risk Factor in Alcohol Addiction? a Brief Research Report on Romanian Population

Article excerpt


Alexithymia was evaluated on 30 alcoholic patients (23 male and 7 female) with ages between 20 and 55. Assessment was conducted at the time of hospital admission, 2 weeks (post-pharmacotherapy treatment), 24 weeks and 48 weeks after admission. Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20). Alcohol use and abstinence were evaluated using the Obsessive Compulsive Drinking Scale (OCDS). Patients who became abstinent presented a 75% reduction in the total score after 2 weeks of pharmacological treatment. Total abstinence was observed in the case of 13 patients (43.33%) and persistent for 48 weeks. The prevalence of alexithymia in our group at baseline was 63.33%, and it predominated in the type II alcoholism group. Abstinence was found to be mainly related with the third factor of the TAS-20 scale (i.e., externally oriented thinking). There seems to be a relation between the absence of alexithymia and abstinence, and the presence of alexithymia and alcohol use. Thus, alexithymia might be considered a risk factor for alcohol addiction

Keywords: alcoholism, alexithymia, abstinence, dependence, risk factor

Alexithymia refers to the incapacity of verbalizing personal emotions or feelings. It is derived from the Greek a-lexis-thimia, meaning "absence of words to express emotions". Taylor describes alexithymia as a multidimensional concept organized around four axes (Taylor, Bagby, & Parker, 1992; 1997). On the one hand, there are the emotional components related to (1) deficiencies in the recognition or (2) identification of emotions and on the other hand, the cognitive components related to (3) difficulties in dreaming and (4) in using a nonintrospective concrete way of thinking. Sifneos (1967) describes four cardinal alexithymic manifestations: the incapacity of verbalizing emotions or feelings; a limitation of imaginary life; a tendency to resort to action in order to avoid or solve conflicts; and a detailed description of facts, events, physical symptoms. The nosological status of alexithymia indicates that it is not a disorder, a personality problem or a symptom part of the clinical picture of a medical or another type of illness. In nosological classifications, it never designates a particular clinical problem, and there is no such thing as alexithymic mood disorder, alexithymic psychosis or alexithymic borderline disorder. McDougall (1982) maintains that alexithymic patients are an independent category, characterized by a particular behavioral pattern rather than by the presence of a clinical entity. Thus, alexithymia is a clinical concept designating a behavior observable by clinicians, which coexists with other cognitive and psychological traits (Birt, 2006; Corcos & Speranza, 2003; Loas, Fremaux, Marchand et al., 1993). It can be found independent of clinical structures, and has an important trans-diagnostic feature. The prevalence of alexithymia in the general population varies between 18.8% and 3.5%. For example, Guilbaud (2003) reports a 20.7% incidence of alexithymia in the general population.

Freyberger (1977), as well as other authors, describes two types of alexithymia: primary (trait) and secondary alexithymia (state). According to McLean (1949) primary alexithymia is a biologically based predisposing factor for somatic disorders. This type of alexithymia is considered to be innate, nonresponsive to treatment, reflecting, to a certain extent, traditional psychosomatic views and reuniting their main characteristics (Birt, 2006; Corcos & Speranza, 2003). Secondary alexithymia is present in vital risk patient: kidney failure, cancer, natural or personal disasters (Fukunishi,1992) This type of alexithymia is a reaction to anxiety induced by illness or trauma, and can be transient in the case of illness or permanent following trauma (Taylor,1984;1990). Secondary alexithymia is sometimes conceptualized as a protective factor against the emotional impact and severity of the illness or the traumatic event, assimilated to a defense mechanism (Birt, 2006; Corcos & Speranza, 2003). However, the distinction between primary and secondary alexithymia is still debatable and often it is not used in psychological measures.

Alcoholism is a serious health problem, and one of the main causes of disability worldwide (Ades, 2003). Recent data suggest that alexithymia is found in 78%-48% of alcoholics, with higher values reported in patients hospitalized for withdrawal (Rybakowski, Ziolkowski, Zasadzka et al., 1988; Zilkowski, Gruss, Rybakowski, 1995). Finn, Martin, and Pihi (1987) found that subjects at high genetic risk for alcoholism were more alexithymic than non-alcoholic patients. Some studies show that alexithymia is negatively correlated with abstinence regardless of age, gender, education, level of depression, etc (Farges, Corcos, Speranza et al., 2004; Loas et al., 1993; Loas, Fremaux, Otmani et al., 1997). It should also be emphasized that alexithymia interferes with brain dopaminergic pathways, similar to type II alcoholism (Gorwood, 2005; Taylor et al., 1993). Data also indicate that the alteration of the GABAB-ergic system, which is generally incriminated in alcohol-related pathology, can also be found in individuals with high values of alexithymia.

Althoug interesting, data on the relationship between alexithymia and alcoholism are not yet definitive and we do not know if they reflect a crosscultural pattern. There is no data available at present regarding the relationship between alcoholism and alexithymia on the Romanian population.

Therefore, the aim of the present paper is to discuss, in the form of a brief research report, alexithymia in alcoholics during withdrawal and abstinence and explore its possible role as a risk factor in alcohol addiction.



The design of the study is a longitudinal one, with repeated measures.


A group of 30 alcoholic patients (i.e., alcohol dependence) . based on DSM-IV TR (2003) criteria - (23 men and 7 women), aged between 20 and 55, was included in the study. Twenty patients had type II alcoholism according to Cloninger's (1988) classification (onset before the age of 20, genetic load, and unfavorable evolution), while 10 had type I alcoholism (onset after the age of 20, a more favorable evolution). All women had type I alcoholism. All patients were recruited from "Prof. Dr. Octavian Fodor" Clinical Emergency Hospital, Department of Chronic Psychiatry, Cluj-Napoca, Romania, and all of them gave their consent to participate in the study. Patients were assessed at the time of admission and 2 weeks (post-pharmacotherapy), 24 weeks, and 48 weeks later.


Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), a 20-item self-report questionnaire. Items are assessed on a 5-point scale. The factor analysis of the TAS-20 resulted in factors: (1) difficulties in the identification of personal feelings; (2) difficulties in describing personal or others' feelings; (3) externally oriented thinking rather than inner feelings/experiences. Scores of 56 or higher indicate the presence of alexithymia, results between 44 and 56 reflect a predisposition towards alexithymia (i.e., uncertain alexithymia), and scores lower than 44 indicate the absence of alexithymia.

Alcohol appetence and abstinence were assessed using the Obsessive Compulsive Drinking Scale (OCDS), a 14-item measure, with two subscales: obsessive and compulsive. Cutoff points are: 30 for the total scale, and 15 and 13 for the two subscales. According to this scale, alcohol appetence refers to automatic components (compulsion to drink, persistent ideas about alcohol) and their effect, and to unsuccessful attempts of fighting them. In this context, low appetence scores reflect higher abstinence.


All patients were administered the Toronto Alexithymia Scale and the Obsessive Compulsive Drinking Scale. Patients were assessed at the time of admission and 2 weeks (post-pharmacotherapy), 24 weeks, and 48 weeks later. After admission, all patients received pharmacotherapy (standard treatment at the "Prof. Dr. Octavian Fodor" Clinical Emergency Hospital, Department of Chronic Psychiatry) for 2 weeks.


Following psychopharmacological treatment, an obvious decrease in the total score and the scores of the two subscales (OCDS) was found.

Means and standard deviations of OCDS scores are shown in Table 1, and mean differences in Tables 2, and 3.

After two weeks of pharmacotherapy, the criteria for total abstinence (a 75% reduction of initial values at 2 weeks) were met by 13 patients (43.33%, 8 men and 5 women) (Fig. 1).

Abstinence persisted over the 48-week period of the study. The rest of the participants (13 men and 2 women, 50%) continued to use alcohol (9 of them exhibiting alexithymia). Two of them (both male; 6.66%) were partially abstinent (i.e., they drank occasionally).

The prevalence of alexithymia in the alcoholic group at baseline was 63.33%, with values above 56 being found in 19 participants. Uncertain alexithymia (i.e., potential alexithymia) was found in 6 patients (20%), and 11 participants (36.66%) were not alexithymic (Fig. 2).

Typically, alexithymic patients exhibited type II alcoholism (p<.05); type I alcoholism, with a more favorable evolution, was typically associated with abstinence (p<.05).

Means and standard deviations and mean differences in TAS-20 scores are presented in Tables 4 and 5. From baseline to 2 weeks assessment there are significant differences in total alexithymia scores and in factor III (i.e., externally oriented thinking rather than inner feelings) scores. Significant differences were also found from baseline to 48-weeks assessment in the total alexithymia score, in factor I (i.e., incapacity to define personal feelings), and in factor III. From 2 weeks assessment to 48 weeks assessment we found significant differences for factor 1 only. Overall, factor III seemed more highly related with abstinence, and factors I and II with addiction (all ps<.05).

Additional descriptive data relating alexithymia and alcoholism, on this Romanian sample are as follows:

* 4 cases with abstinence showed alexithymia

* 4 cases without alexithymia showed addiction

* uncertain alexithymia was found in 4 abstinent participants and in 2 alcohol dependent participants

* 7 abstinent participants had no alexithymia

* 9 alcohol dependent participants had alexithymia.


Based on our results, alexithymia seems significantly associated with alcohol addiction; indeed, at baseline 63.33% of alcoholic patients exhibited alexithymia. The fact that following pharmacotherapy we observe major changes in alcoholism levels (OCDS scores), but only moderate or no changes in alexithymia (TAS scores) suggests that alexithymia . mainly factors I and II . could be regarded as a possible risk factor for alcoholism. Uncertain alexithymia cannot be anticipated as a risk factor.

Based on our data and consistent with results reported in the international literature, alexithymia is significantly related with alcohol addiction, and could be a risk factor in type II alcoholism. This conclusion is strengthened by other findings showing that alexithymia interferes with brain dopaminergic pathways, similar to type II alcoholism (Gorwood, 2005; Taylor et al., 1993). Moreover, research indicates that the alteration of the GABAB-ergic system, which is generally incriminated in alcohol-related pathology, can also be found in individuals with high values of alexithymia.

Limitations of this study also need to be addressed. First, the sample is small, so the generalization of our data is limited. However, this is a promising pilot study, the first one on Romanian population, whose conclusions are consistent with those in the international literature. Thus, our results may contribute to the cross-cultural picture of the relationship between alexithymia and alcoholism. Second, we did not have a control group. However, being a longitudinal study, it was informative for our purposes, although the lack of a control group precludes conclusions of the specific relationship between alexithymia and alcoholism.



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[Author Affiliation]

Mircea Al. BIRT*a, Vlaicu SANDOR(b), Aura VAIDA(c),

Maria Edita BIRT(d)

a. "Prof. Dr. Octavian Fodor" Clinical Emergency Hospital & "Babes-Bolyai" University,

Cluj-Napoca, Romania

b. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania

c. "Prof. Dr. Octavian Fodor" Clinical Emergency Hospital, Cluj-Napoca, Romania

d. Centre for Diagnose and Treatment, Cluj-Napoca, Romania

* Correspondence concerning this article should be addressed to:


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