Background: Alexithymia and psychopathology may influence the way individuals experience psychological distress and somatic symptoms. This study evaluated patients referred to psychiatric and gastroenterologic outpatient settings in order to investigate the levels of alexithymia and psychopathology, and the possible role of alexithymia in symptom perception and health care utilization. The association between psychiatric disorders and functional gastrointestinal disorders (FGIDs) was also assessed. Methods: Psychopathology (by the Revised 90-item Symptom Checklist), alexithymia (by the 20-item Toronto Alexithymia Scale), and gastrointestinal symptoms (by the Gastrointestinal Symptom Rating Scale) were evaluated in 52 psychiatric outpatients and 58 medical outpatients with FGIDs. Two comorbid subgroups of 25 psychiatric patients with FGIDs and 38 FGID patients with psychiatric disorders were formed and compared. Results: Forty-eight percent of the psychiatric patients had associated FGIDs, and 65.5% of the FGID patients had associated psychiatric disorders. The FGID patients had significantly less psychopathology, but significantly higher alexithymia and more severe gastrointestinal symptoms, than the psychiatric patients. In the comparison of the two subgroups with comorbidity, FGID patients with psychiatric disorders were still more alexithymic and had less psychopathology than psychiatric patients with FGIDs, but gastrointestinal symptoms were not significantly different. Conclusion: Patients with ‘functional’ gastrointestinal symptoms attending a medical care service are likely to be highly alexithymic, whereas those attending a psychiatric care service are likely to show severe psychopathology. Alexithymia seems to influence the presentation of ‘functional’ somatic symptoms and the type of health care utilization.

1.
Drossman DA: The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment. Boston, Little, Brown, 1994.
2.
Mitchell CM, Drossman DA: Survey of the AGA membership relating to patients with functional gastrointestinal disorders. Gastroenterology 1987;92:1282–1284.
3.
Drossman DA, Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE: Psychosocial aspects of the functional gastrointestinal disorders. Gut 1999;45(suppl II):II25–II30.
4.
Osterberg E, Blomquist L, Krakau I, Weinryb RM, Asberg M, Hultcrantz R: A population study on irritable bowel syndrome and mental health. Scand J Gastroenterol 2000;35:264–268.
5.
Blewett A, Allison M, Calcraft B, Moore R, Jenkins P, Sullivan G: Psychiatric disorder and outcome in irritable bowel syndrome. Psychosomatics 1996;37:155–160.
6.
Walker EA, Katon WJ, Jemelka R: Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) study. Am J Med 1992;92(suppl 1A):26–30.
7.
North CS, Alpers DH, Thompson SJ, Spitznagel EL: Gastrointestinal symptoms and psychiatric disorders in the general population. Dig Dis Sci 1996;41:633–640.
8.
Brawman-Mintzer O, Lydiard B, Crawford MM, Emmanuel N, Payeur R, Johnson M, Knapp RG, Ballenger JC: Somatic symptoms in generalized anxiety disorder with and without comorbid psychiatric disorders. Am J Psychiatry 1994;151:930–932.
9.
Tollefson GD, Tollefson SL, Pederson M, Luxenberg M, Dunsmore G: Comorbid irritable bowel syndrome in patients with generalized anxiety and major depression. Ann Clin Psychiatry 1991;3:215–222.
10.
Kaplan DS, Masand PS, Gupta S: The relationship of irritable bowel syndrome and panic disorder. Ann Clin Psychiatry 1996;8:81–88.
11.
Ringel Y: Brain research in functional gastrointestinal disorders. J Clin Gastroenterol 2002;35(suppl 1):S23–S25.
12.
Porcelli P, Taylor GJ, Bagby RM, De Carne M: Alexithymia and functional gastrointestinal disorders. A comparison with inflammatory bowel disease. Psychother Psychosom 1999;68:263–269.
13.
Porcelli P, De Carne M, Fava GA: Assessing somatization in functional gastrointestinal disorders: Integration of different criteria. Psychother Psychosom 2000;69:198–204.
14.
Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
15.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
16.
First MB, Spitzer RL, Gibbon M, Williams JBW: SCID-I. Structured Clinical Interview for DSM-IV Axis I Disorders (Italian version by Guaraldi GP, De Girolamo G, Mazzi F, Morosini P, Lussetti M). Firenze, Organizzazioni Speciali, 2000.
17.
Bagby RM, Parker JDA, Taylor GJ: The twenty-item Toronto Alexithymia Scale. I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23–32.
18.
Bagby RM, Parker JDA, Taylor GJ: The twenty-item Toronto Alexithymia Scale. II. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994;38:33–40.
19.
Bressi C, Taylor GJ, Parker JDA, Bressi G, Brambilla V, Aguglia E, Allegranti I, Bongiorno A, Giberti F, Bucca M, Todarello O, Callegari C, Vender S, Gala C, Invernizzi G: Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study. J Psychosom Res 1996;41:551–559.
20.
Derogatis LR: The SCL-90-R. Administration, Scoring, and Procedures Manual II for the Revised Version. Towson, Clinical Psychometric Research, 1983.
21.
Herschbach P, Henrich G, van Rad M: Psychological factors in functional gastrointestinal disorders: Characteristics of the disorder or the illness behavior? Psychosom Med 1999;61:148–153.
22.
Bach M, Bach D: Alexithymia in somatoform disorder and somatic disease: A comparative study. Psychother Psychosom 1996;65:150–154.
23.
Derogatis LR, Rickels K, Rock AF: The SCL-90 and the MMPI: A step in the validation of a new self-report scale. Br J Psychiatry 1976;128:280–289.
24.
Goldberg DP, Rickels K, Downing R, Hesbacher P: A comparison of two psychiatric screening tests. Br J Psychiatry 1976;129:61–67.
25.
Brophy CJ, Norvell NK, Kiluk DJ: An examination of the factor structure and convergent and discriminant validity of the SCL-90-R in an outpatient clinic population. J Pers Assess 1988;52:334–340.
26.
Svedlund J, Sjödin I, Dotevall G: GSRS. A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988;33:129–134.
27.
Wiklund I: Aspects of quality of life in gastrointestinal disease: Some methodological issues. Scand J Gastroenterol 1993;30(suppl 208): 129–132.
28.
Hochstrasser B, Angst J: The Zurich study. XII. Epidemiology of gastrointestinal complaints and comorbidity with anxiety and depression. Eur Arch Psychiatry Clin Neurosci 1996;246:261–272.
29.
Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Lydiard RB, Mayer EA: Consensus statement on depression, anxiety, and functional gastrointestinal disorders. J Clin Psychiatry 2001;62(suppl 8):48–51.
30.
Drossman DA, Whitehead WE, Toner BB, Diamant N, Hu YJ, Bangdiwala SI: What determines severity among patients with painful functional bowel disorders? Am J Gastroenterol 2000;95:974–980.
31.
Kirmayer LJ, Robbins JM: Three forms of somatization in primary care: Prevalence, co-occurrence and sociodemographic characteristics. J Nerv Ment Dis 1991;179:647–655.
32.
Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
33.
Kellner R: Psychosomatic syndromes, somatization and somatoform disorders. Psychother Psychosom 1994;61:4–24.
34.
Schuepbach WMM, Adler RH, Sabbioni MEE: Accuracy of the clinical diagnosis of ‘psychogenic disorders’ in the presence of physical symptoms suggesting a general medical condition. Psychother Psychosom 2002;71:11–17.
35.
Swartz M, Blazer D, George L, Landerman R: Somatization disorder in a community population. Am J Psychiatry 1986;143:1403–1408.
36.
North CS, Alpers DH: Prevalence of irritable bowel syndrome in a psychiatric patient population; in Goebell H, Holtmann G, Talley NJ (eds): Functional Dyspepsia and Irritable Bowel Syndrome. Concepts and Controversies. Proceedings of the Falk Symposium No. 99. Lancaster, Kluwer Academic Publisher, 1998, pp 205–209.
37.
Todarello O, Taylor GJ, Parker JDA, Fanelli M: Alexithymia in essential hypertensive and psychiatric outpatients: A comparative study. J Psychosom Res 1995;39:987–994.
38.
Bach M, Bach D, Boehmer F, Nutzinger DO: Alexithymia and somatization: Relationship to DSM-III-R diagnosis. J Psychosom Res 1994;38:529–538.
39.
Lumley MA, Stettner L, Wehmer F: How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res 1996;41:505–518.
40.
Lumley MA, Norman S: Alexithymia and health care utilization. Psychosom Med 1996;58:197–202.
41.
Nakao M, Barsky AJ, Kumano H, Kuboki T: Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic. Psychosomatics 2002;43:55–60.
42.
Cochrane J, Goering P, Durbin J, Buterrill D, Dumas J, Wasylenki D: Tertiary mental health services. II. Subpopulations and best practices for service delivery. Can J Psychiatry 2000;45:185–190.
43.
Drossman DA, Thompson WG: Irritable bowel syndrome: A graduated, multicomponent treatment approach. Ann Intern Med 1992;116:1009–1016.
44.
Drossman DA, Whitehead WE, Camilleri M: Irritable bowel syndrome: A technical review for practice guideline development. Gastroenterology 1997;112:2120–2137.
45.
Bennet EJ, Piesse C, Palmer K, Badcock C-A, Tennant CC, Kellow JE: Functional gastrointestinal disorders: Psychological, social, and somatic features. Gut 1998;42:414–420.
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