Background: Interpersonal relationships are substantially codetermined by nonverbal communication, e.g. facial affect. Given the deficits of nonverbal affect recognition and expression in alexithymia, we hypothesized that alexithymics had more interpersonal problems than nonalexithymic individuals, and that the various facets of the alexithymia construct are differentially related to interpersonal problems. Method: 149 subjects participating in an inpatient group psychotherapy program completed the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-C) at the beginning of the treatment. The IIP-C was also administered to a subgroup at the end of the treatment. Results: Based on the alexithymia scores, patients were classified as low- (TAS-20 score ≤51), moderate- or high-alexithymic (TAS-20 score ≧61). High-alexithymic patients had significantly more interpersonal problems than low alexithymics, particularly in the IIP-C scales indicating hostility and social avoidance. The TAS-20 subscale difficulty describing feelings showed the highest correlations with interpersonal problems (r between 0.23 and 0.55). At the end of the treatment, the high alexithymics still scored highest on the IIP-C, but the magnitude of change in interpersonal problems did not differ across the groups. Conclusions: Our findings suggest that the interpersonal style of alexithymic individuals is characterized by a cold and socially avoidant behavior, corresponding to the predominantly insecure attachment pattern found in alexithymia. Additionally, our results indicate that group psychotherapy is as helpful for alexithymic as for nonalexithymic subjects with respect to interpersonal problems. Finally, we propose that alexithymia involves a reduced capacity to use social interactions for affect regulation.

Luminet O, Bagby RM, Wagner H, Taylor GJ, Parker JD: Relation between alexithymia and the five-factor model of personality: A facet-level analysis. J Pers Assess 1999;73:345–358.
Grabe HJ, Spitzer C, Freyberger HJ: Alexithymia and the temperament and character model of personality. Psychother Psychosom 2001;70:261–270.
Taylor GJ, Bagby RM: An overview of the alexithymia construct; in Baron R, Parker JDA (eds): Handbook of Emotional Intelligence. San Francisco, Jossy-Bass, 2000.
Taylor G: Recent developments in alexithymia theory and research. Can J Psychiatry 2000;45:134–142.
Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
Mann L, Wise T, Trinidad A, Kohanski R: Alexithymia, affect recognition, and the five-factor model of personality in normal subjects. Psychol Rep 1994;74:563–567.
Parker J, Taylor G, Bagby R: Alexithymia and the recognition of facial expressions of emotion. Psychother Psychosom 1993;59:197–202.
Lane R, Sechrest L, Reidel R, Weldon V, Kaszniak A, Schwartz G: Impaired verbal and nonverbal emotion recognition in alexithymia. Psychosom Med 1996;58:203–210.
Lane RD, Sechrest L, Riedel R, Shapiro DE, Kaszniak AW: Pervasive emotion recognition deficit common to alexithymia and the repressive coping style. Psychosom Med 2000;62:492–501.
McDonald P, Prkachin K: The expression and perception of facial emotion in alexithymia: A pilot study. Psychosom Med 1990;52:199–210.
Naatanen P, Ryynanen A, Keltikangas-Jarvinen L: The influence of alexithymic characteristics on the self-perception and facial expression of a physiological stress state. Psychother Psychosom 1999;68:252–262.
Troisi A, Delle Chiaie R, Russo F, Russo M, Mosco C, Pasini A: Nonverbal behavior and alexithymic traits in normal subjects. Individual differences in encoding emotions. J Nerv Ment Dis 1996;184:561–566.
Stone LA, Nielson KA: Intact physiological response to arousal with impaired emotional recognition in alexithymia. Psychother Psychosom 2001;70:92–102.
Erickson K, Schulkin J: Facial expressions of emotion: A cognitive neuroscience perspective. Brain Cogn 2003;52:52–60.
Stern DN: The Interpersonal World of the Infant. New York, Basic Books, 1985.
Spitzer C, Michels-Lucht F, Siebel U, Freyberger HJ: The relationship between OPD features of personality structure and symptom-related and interpersonal outcome of inpatient psychotherapy. Z Psychosom Med Psychother 2004;50:70–85.
World Health Organization: Tenth Revision of the International Classification of Diseases. Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, 1991, chapter V.
Bach M, Bach D, de Zwaan M, Serim M, Bohmer F: Validation of the German version of the 20-item Toronto Alexithymia Scale in normal persons and psychiatric patients. Psychother Psychosom Med Psychol 1996;46:23–28.
Bagby RM, Taylor GJ, Parker JD: The twenty-item Toronto Alexithymia Scale. 2. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994;38:33–40.
Bagby RM, Parker JD, Taylor GJ: The twenty-item Toronto Alexithymia Scale. 1. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23–32.
Horowitz LM, Alden LE, Wiggins JS, Pincus AL: Inventory of Interpersonal Problems Manual. Odessa, Psychological Corporation, 2000.
Leary T: Interpersonal Diagnosis of Personality. New York, Ronald Press, 1957.
Brahler E, Horowitz L, Kordy H, Schumacher J, Strauss B: Validation of the Inventory for Interpersonal Problems (IIP). Results of a representative study in East and West Germany. Psychother Psychosom Med Psychol 1999;49:422–431.
Derogatis L: Symptom Checklist-90-R. Baltimore, Clinical Psychometric Research, 1983.
Franke H: Die Symptom-Checkliste von Derogatis. Deutsche Version. Weinheim, Beltz, 1994.
Vittengl J, Clark L, Jarrett R: Interpersonal problems, personality pathology, and social adjustment after cognitive therapy for depression. Psychol Assess 2003;15:29–40.
Troisi A, D’Argenio A, Peracchio F, Petti P: Insecure attachment and alexithymia in young men with mood symptoms. J Nerv Ment Dis 2001;189:311–316.
Wearden A, Cook L, Vaughan-Jones J: Adult attachment, alexithymia, symptom reporting, and health-related coping. J Psychosom Res 2003;55:341–347.
Gallo L, Smith T, Ruiz J: An interpersonal analysis of adult attachment style: Circumplex descriptions, recoiled developmental experiences, self-representations, and interpersonal functioning in adulthood. J Pers 2003;71:141–181.
Horowitz L, Rosenberg S, Bartholomew K: Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy. J Consult Clin Psychol 1993;61:549–560.
Taylor GJ, Bagby RM: New trends in alexithymia research. Psychother Psychosom 2004;73:68–77.
Nichols K, Gergely G, Fonagy P: Experimental protocols for investigating relationships among mother-infant interaction, affect regulation, physiological markers of stress responsiveness, and attachment. Bull Menninger Clin 2001;65:371–379.
Braungart-Rieker J, Garwood M, Powers B, Wang X: Parental sensitivity, infant affect, and affect regulation: Predictors of later attachment. Child Dev 2001;72:252–270.
Main M: Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs multiple (incoherent) models of attachment: Findings and directions for future research; in Parkes CM, Marris P, Stevenson-Hinde J (eds): Attachment across the Life Cycle. New York, Routledge, 1991, pp 127–159.
Frigerio E, Burt D, Montagne B, Murray L, Perrett D: Facial affect perception in alcoholics. Psychiatry Res 2002;113:161–171.
Kornreich C, Philippot P, Foisy M-L, Blairy S, Raynaud E, Dan B, Hess U, Noel X, Pelc I, Verbanck P: Impaired emotional facial expression recognition is associated with interpersonal problems in alcoholism. Alcohol Alcohol. 2002;37:394–400.
Morrison R, Bellack A, Mueser K: Deficits in facial-affect recognition and schizophrenia. Schizophr Bull 1988;14:67–83.
Edwards J, Jackson H, Pattison P: Emotion recognition via facial expression and affective prosody in schizophrenia: A methodological review. Clin Psychol Rev 2002;22:789–832.
Poulsen A: Psychodynamic, time-limited group therapy in rheumatic disease – A controlled study with special reference to alexithymia. Psychother Psychosom 1991;56:12–23.
Fukunishi I, Ichikawa M, Ichikawa T, Matsuzawa K: Effect of family group psychotherapy on alcoholic families. Psychol Rep 1994;74:568–570.
Beresnevaite M: Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients: A preliminary study. Psychother Psychosom 2000;69:117–122.
Taylor GJ, Bagby RM, Luminet O: Assessment of alexithymia: Self-report and observer-rated measures; in Bar-On R, Parker JDA (eds): The Handbook of Emotional Intelligence. San Francisco, Jossey-Bass, 2000, pp 301–319.
Haviland MG, Warren WL, Riggs ML: An observer scale to measure alexithymia. Psychosomatics 2000;41:385–392.
Porcelli P, Affatati V, Bellomo A, De Carne M, Todarello O, Taylor GJ: Alexithymia and psychopathology in patients with psychiatric and functional gastrointestinal disorders. Psychother Psychosom 2004;73:84–91.
Graugaard PK, Holgersen K, Finset A: Communicating with alexithymic and nonalexithymic patients. Psychother Psychosom 2004;73:92–100.
Rufer M, Hand I, Braatz A, Alsleben H, Fricke S, Peter H: A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive behavioural therapy. Psychother Psychosom 2004;73:101–106.
Kooiman CG, van rees Vellinga S, Spinhoven P, Draijser N, Trijsburg RW, Rooijmans HGM: Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood. Psychother Psychosom 2004;73:107–116.
Picardi A, Pasquini P, Cattaruzza MS, Gaetano P, Melchi CF, Baliva G, Camaioni D, Tiago A, Abeni D, Biondi M: Stressful life events, attachment sensitivity and alexithymia in vitiligo. Psychother Psychosom 2003;72:150–158.
Kojima M, Sauda Y, Nagaya T, Tokudome S, Furukama TA: Alexithymia, depression and social support among Japanese workers. Psychother Psychosom 2003;72:307–314.
Rafanelli C, Roncuzzi R, Finos L, Tossani E, Tomba E, Mangelli L, Urbinati S, Pinelli G, Fava GA: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72:343–349.
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