Original articlePredictive value of alexithymia in patients with eating disorders: A 3-year prospective study
Introduction
The identification of variables that predict treatment outcome in patients with eating disorders is critical if we are to increase the degree of sophistication with which we treat these disorders. Understanding predictors of outcome could theoretically facilitate matching treatments to individuals based on their clinical profile at presentation. Dirks et al. [1] have coined the term “psychic maintenance” to describe the chronic outcome of an illness due to psychological reasons. Among the several psychological features that have been proposed to predict treatment outcome in patients with eating disorders, alexithymia has attracted special interest. Alexithymia is a personality construct characterized by a difficulty in identifying and describing feelings, a diminution of fantasy, and a concrete and externally oriented thinking style [2]. Several arguments, namely, factor analyses and longitudinal studies, have supported the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon linked to depression or to clinical status [3], [4]. Several studies have reported high levels of alexithymia in patients with eating disorders, especially in individuals with anorexia nervosa [5], [6], [7], [8]. There are several reasons to believe that this construct could play a major role in the illness course of eating disorders: due to their cognitive limitations in emotion regulation, alexithymic individuals with eating disorders may resort to maladaptive self-stimulatory behaviors such as starving, bingeing, or drug misuse to self-regulate disruptive emotions [9]. The lack of insight and the externally oriented thinking style of alexithymic subjects may also interfere with their capacity to benefit from psychotherapeutic interventions. However, in spite of the clinical relevance of this issue, clear data on the prognostic value of alexithymic features in eating disorders are still lacking. Two studies conducted on individuals with bulimia have failed to demonstrate a specific impact of alexithymia on the outcome of these patients. However, these studies presented some methodological limitations: samples were relatively small; the longitudinal time period was too short (10 weeks); both studies used an earlier version of the Toronto scale to assess alexithymic features; and finally, the outcome measures did not account for the degree of clinical change between baseline and follow-up [6], [10].
The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a large sample of patients with eating disorders, taking into account the limitations of previous studies.
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Participants and procedures
The subjects of this study were derived from a multicenter research project investigating the psychopathological features of eating disorders (Inserm Network No. 494013). The overall design of the Network was a cross-sectional investigation, with only a subset of research centers involved in a prospective follow-up study. The recruitment centers were academic psychiatric hospitals specialized in adolescents and young adults (age range of reception: 15–30 years). For this study, only female
Results
From the initial sample of the Inserm Network on eating disorders, 144 patients were selected to be included in the follow-up study and retraced 3 years later. Among these subjects, 35 refused to participate or were unavailable. One hundred nine subjects were directly interviewed, of whom seven had to be excluded because they did not completely answered the self-questionnaire. Statistical analyses were performed on a final sample of 102 subjects (72.8%). Sixty-three had an initial diagnosis of
Discussion
The results of our study indicate that one of the facets of the alexithymia construct, the difficulty in identifying feelings, is a negative prognostic factor for the long-term outcome of patients with eating disorders. Patients with the greatest difficulties at identifying emotions at baseline are more often symptomatic at follow-up and show a less favorable clinical improvement. The relative stability shown by alexithymia over time legitimates its use as a potential prognostic factor in
Acknowledgments
This work was conducted within the clinical research project called “Dependence Network 1994–2000,” which has received the support of the Institut National de la Santé et de la Recherche Médicale (Réseau Inserm No. 494013) and of the Fondation de France. The promoter of the project is the Institut Mutualiste Montsouris. We would like to thank Olivier Luminet of the University of Louvain for his helpful advice on this research.
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