Alexithymia and Eating Disorders: A Critical Review of the Literature

By Nowakowski, Matilda E.; McFarlane, Traci et al. | Journal of Eating Disorders, June 18, 2013 | Go to article overview

Alexithymia and Eating Disorders: A Critical Review of the Literature


Nowakowski, Matilda E., McFarlane, Traci, Cassin, Stephanie, Journal of Eating Disorders


Author(s): Matilda E Nowakowski[sup.1], Traci McFarlane[sup.1,2] and Stephanie Cassin[sup.1]

Alexithymia and eating disorders: a critical review

The concept of alexithymia was first identified by Sifneos [1], who described a set of characteristics observed in psychosomatic patients that included difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, lack of fantasy, and a concrete cognitive style focused on the external environment.

The majority of studies focusing on eating disorders have found higher levels of alexithymia in individuals with eating disorders and disturbed eating compared to healthy controls [2-8]. When the individual characteristics of alexithymia are examined, individuals with eating disorders have specific deficits in identifying and communicating their feelings.

A number of theories have been proposed regarding the underlying role of emotions in eating disorders. It has been suggested that patients use maladaptive eating behaviors (e.g., bingeing, purging, dietary restriction) and excessive exercise as a way to avoid or cope with their emotions [9-11]. Specifically, an early childhood environment in which emotions are viewed as unacceptable or frightening leads to the development of the belief that emotions are bad and should not be experienced or expressed. These beliefs become activated each time that an emotion is experienced, which then leads to a secondary emotion (i.e., an emotion in response to another emotion) such as shame, guilt, or disgust about experiencing an emotion. These secondary emotions increase the patient's distress and decrease his/her coping abilities, thus leading to engagement in eating disorder behaviors in an attempt to avoid or cope with the emotion [12].

Although a robust body of literature illustrates that alexithymia levels, especially difficulties identifying and communicating feelings, are elevated in individuals with eating disorders, there remains much debate surrounding a number of issues, including: 1) whether alexithymia levels vary across eating disorder diagnoses; 2) whether alexithymia is a trait or state variable; and 3) whether current treatments for eating disorders effectively target alexithymia. To date, no review paper has synthesized the research on alexithymia in eating disorders. The purpose of the current paper is to synthesize the research addressing the aforementioned questions in order to increase theoretical knowledge of alexithymia and eating disorders and enhance clinical interventions.

Methods

A systematic review of the literature on alexithymia and eating disorders was conducted in September 2012 using PsycInfo. The following search terms were used in four literature searches: "alexithymia" and "anorexia nervosa", "bulimia nervosa", "eating disorders", or "binge eating disorder". The literature searches were limited to articles focusing on adolescents and adults that were published in peer-reviewed journals after January 1, 1988, and were written in English. We limited our search to articles published in 1988 or later as 1988 is the publication year of the first version of the Toronto Alexithymia Scale [13]. Our systematic review was limited to studies using the Toronto Alexithymia Scale, the most widely used and well-established measure of alexithymia, in order to facilitate comparisons across studies. This initial search identified 198 articles. The reference list of each article was subsequently examined for relevant articles that may have been omitted by PsycInfo, which resulted in 3 more articles being identified. After eliminating duplicates, 119 articles were identified. The article abstracts were then reviewed and coded for the following criteria: 1) one of the three versions of the Toronto Alexithymia Scale was used to assess alexithymia; 2) the study included clinical or non-clinical adolescent and/or adult participants with disturbed eating; 3) the study focused on identifying and/or explaining group differences in alexithymia levels; and 4) the study had a quantitative experimental design. …

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