Neuroticism, alexithymia and medically unexplained symptoms

The contribution that alexithymia can make to the understanding of medically unexplained physical symptoms (MUS) was studied in 244 subjects drawn from a range of medical and non-medical situations. Peopleʹs histories of MUS—also called somatisation—were assessed using physical symptom lists derived from the DSM-III-R somatisation criteria. Two subscales from the Toronto Alexithymia Scale-20 had significant correlations with reported MUS, but also with neuroticism, negative emotion health coping, anxiety, depression, general psychological distress and dysphoric mood. Despite there being a large general latent trait (negative affectivity) underlying most of the measured variables, the best model of the data in men and women was a two-factor model that emphasised that alexithymia could make a contribution to MUS variance beyond that made by negative affectivity. It is suggested that, for the purposes of studying MUS, alexithymia might be reconstructed as a single component construct, related to a confusion among feelings and between feelings and bodily symptoms, rather than its present three-component structure. A two parameter model for the occurrence of medically unexplained physical symptoms is proposed in which negative affectivity acts as a threshold factor (influencing symptom detection) and alexithymia acts as an interference factor (influencing symptom discrimination/recognition).