Background: Alexithymia is a personality trait characterized by deficits in regulating, experiencing and verbalizing emotions and has been assumed to be associated with a tendency to express emotional arousal through somatization. Although such a tendency is often observed in patients with dizziness, the exact relationship of alexithymia to dizziness is not yet known. The aim of this study was to examine alexithymic characteristics in patients with dizziness and its relation to health-related quality of life (HRQoL). Sampling and Methods: We assessed 208 patients from an interdisciplinary center for vertigo and balance disorders for characteristics of alexithymia (20-item Toronto Alexithymia Scale), HRQoL (Short-Form 12 Health Survey, SF-12), dizziness (Dizziness Handicap Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were used to evaluate the relationship between alexithymia, dizziness and HRQoL. Results: We found that difficulties in identifying and describing feelings, two important factors of alexithymia, were significantly related to more severe symptoms of dizziness. More pronounced alexithymic characteristics were associated with lower HRQoL, especially in the mental dimension of the SF-12. The results remained significant after controlling for possibly confounding variables such as socioeconomic status and depression. Conclusions: These findings contribute to a better understanding of affect regulation in patients with dizziness, which is important for the development of psychotherapeutic interventions suitable for alexithymic patients with dizziness.

1.
Sifneos PE: The prevalence of ‘alexithymic' characteristics in psychosomatic patients. Psychother Psychosom 1973;22:255-262.
2.
Grabe HJ, Rufer M, Freyberger HJ: Alexithymie: Eine Störung der Affektregulation. Konzepte, Klinik und Therapie. Klinische Praxis. Bern, Huber, 2009.
3.
Taylor GJ, Bagby RM, Parker JDA: Disorders of affect regulation. Alexithymia in medical and psychiatric illness. Cambridge, Cambridge University Press, 1997.
4.
Taylor GJ, Bagby RM, Parker JD: The alexithymia construct. A potential paradigm for psychosomatic medicine. Psychosomatics 1991;32:153-164.
5.
Taylor GJ: Recent developments in alexithymia theory and research. Can J Psychiatry 2000;45:134-142.
6.
Taylor GJ, Bagby RM: New trends in alexithymia research. Psychother Psychosom 2004;73:68-77.
7.
Rufer M, Hand I, Braatz A, et al: A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive-behavioral therapy. Psychother Psychosom 2004;73:101-106.
8.
Rufer M, Ziegler A, Alsleben H, et al: A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder. Compr Psychiatry 2006;47:394-398.
9.
Bankier B, Aigner M, Bach M: Alexithymia in DSM-IV disorder: Comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression. Psychosomatics 2001;42:235-240.
10.
Mattila AK, Saarni SI, Salminen JK, et al: Alexithymia and health-related quality of life in a general population. Psychosomatics 2009;50:59-68.
11.
Lundh L, Simonsson-Sarnecki M: Alexithymia, emotion, and somatic complaints. J Pers 2001;69:483-510.
12.
Mattila AK, Poutanen O, Koivisto A, et al: Alexithymia and life satisfaction in primary healthcare patients. Psychosomatics 2007;48:523-529.
13.
Garcia Nuñez D, Rufer M, Leenen K, et al: Lebensqualität und alexithyme Merkmale bei Patienten mit somatoformer Schmerzstörung. Der Schmerz 2010;24:62-68.
14.
Verissimo R, Mota-Cardoso R, Taylor G: Relationships between alexithymia, emotional control, and quality of life in patients with inflammatory bowel disease. Psychother Psychosom 1998;67:75-80.
15.
ten Voorde M, van der Zaag-Loonen H, van Leeuwen R: Dizziness impairs health-related quality of life. Qual Life Res 2012;6:961-966.
16.
Sullivan M, Clark MR, Katon WJ, et al: Psychiatric and otologic diagnoses in patients complaining of dizziness. Arch Intern Med 1993;153:1479-1484
17.
Sloane PD, Coeytaux RR, Beck RS, et al: Dizziness: state of the science. Ann Intern Med 2001;134:823-832.
18.
Neuhauser HK: Epidemiologie von Schwindelerkrankungen. Der Nervenarzt 2009;80:887-894.
19.
Hegemann S, Rufer M, Straumann D: Schwindel und Gleichgewichtsstörungen als interdisziplinäre Herausforderung. Neurology.ch 2006;3:2-4.
20.
Eckhardt-Henn A, Tschan R, Best C, et al: Somatoforme Schwindelsyndrome. Der Nervenarzt 2009;80:909-917.
21.
Eagger S, Luxon LM, Davies RA, et al: Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry 1992;55:383-387.
22.
Sklare DA, Konrad HR, Maser JD, et al: Special issue on the interface of balance disorders and anxiety: an introduction and overview. The interface of balance disorders and anxiety. J Anxiety Disord 2001;15:1-7.
23.
Bach M, Bach D, de Zwaan M, et al: Validierung der deutschen Version der 20-Item Toronto-Alexithymie-Skala bei Normalpersonen und psychiatrischen Patienten. Psychother Psych Med 1996;46:23-28.
24.
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.
25.
Taylor GJ, Bagby RM, Parker JDA: The 20-Item Toronto Alexithymia Scale: IV. Reliability and factorial validity in different languages and cultures. J Psychosom Res 2003;55:277-283.
26.
Franz M, Popp K, Schaefer R, et al: Alexithymia in the German general population. Soc Psychiatry Psychiatric Epidemiol 2008;43:54-62.
27.
Maurischat C, Ehlebracht-König I, Kühn A, et al: Factorial validity and norm data comparison of the Short Form 12 in patients with inflammatory-rheumatic disease. Rheumatol Intern 2006;26:614-621
28.
Ware JE, JR, Kosinski M, Keller SD: A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-233.
29.
Bullinger M: Erfassung der gesundheitsbezogenen Lebensqualität mit dem SF-36-Health Survey. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2000;43:190-197.
30.
Herrmann C: International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results. J Psychosom Res 1997;42:17-41.
31.
Herrmann C, Buss U: Vorstellung und Validierung einer deutschen Version der ‘Hospital Anxiety and Depression Scale' (HAD-Skala): ein Fragebogen zur Erfassung des psychischen Befindens bei Patienten mit körperlichen Beschwerden. Diagnostica 1994;40:143-154.
32.
Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scand 1983;67:361-370.
33.
Cosco TD, Doyle F, Ward M, et al: Latent structure of the Hospital Anxiety and Depression Scale: a 10-year systematic review. J Psychosom Res 2012;72:180-184.
34.
Kammerlind A, Bergquist-Larsson P, Ledin T, et al: Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Adv Physiother 2005;7:96-107.
35.
Jacobson GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424-427.
36.
Kurre A, van Gool CJAW, Bastiaenen CHG, et al: Translation, cross-cultural adaptation and reliability of the German version of the Dizziness Handicap Inventory. Otol Neurotol 2009;30:359-367.
37.
Enloe LJ, Shields RK: Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Phys Ther 1997;77:890-903.
38.
Bortz J: Statistik für Sozialwissenschaftler. Heidelberg, Springer, 1993.
39.
O'Brien R: A caution regarding rules of thumb for variance inflation factors. Qual Quant 2007;41:673-690.
40.
Bagby RM, Taylor GJ, Parker JDA, et al: The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother Psychosom 2006;75:25-39.
41.
Grabe HJ, Löbel S, Dittrich D, et al: The German version of the Toronto Structured Interview for Alexithymia: factor structure, reliability, and concurrent validity in a psychiatric patient sample. Compr Psychiatry 2009;50:424-430.
42.
Grabe HJ, Ruhrmann S, Ettelt S, et al: Alexithymia in obsessive-compulsive disorder: results from a family study. Psychother Psychosom 2006;75:312-318.
43.
Waller E, Scheidt CE: Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry 2006;18:13-24.
44.
Grabe HJ, Spitzer C, Freyberger HJ: Alexithymia and personality in relation to dimensions of psychopathology. Am J Psychiatry 2004;161:1299-1301.
45.
Kooiman CG, Bolk JH, Brand R, et al: Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients? Psychosom Med 2000;62:768-778.
46.
Mattila AK, Kronholm E, Jula A, et al: Alexithymia and somatization in general population. Psychosom Med 2008;70:716-722.
47.
Lumley MA, Norman S: Alexithymia and health care utilization. Psychosom Med 1996;58:197-202.
48.
Moreno-Jiménez B, López Blanco B, Rodríguez-Muñoz A, et al: The influence of personality factors on health-related quality of life of patients with inflammatory bowel disease. J Psychosom Res 2007;62:39-46.
49.
Valkamo M, Hintikka J, Honkalampi K, et al: Alexithymia in patients with coronary heart disease. J Psychosom Res 2001;50:125-130.
50.
Grassi L, Rossi E, Sabato S, et al: Diagnostic criteria for psychosomatic research and psychosocial variables in breast cancer patients. Psychosomatics 2004;45:483-491.
51.
Rufer M, Jenewein J: Alexithymie und Psychotherapie. Psychodynamische Psychotherapie 2009;8:34-45.
52.
Langs G: Behavioural-oriented medical aspects of vertigo. Psychoneurology 2004;317-321.
53.
Schaaf H: Verhaltenstherapeutische Ansätze bei Schwindelerkrankungen. Psychomed 1998;10:18-21.
54.
Schaaf H: Psychotherapie bei Schwindelerkrankungen, ed 3. Kröning, Asanger, 2011.
55.
Asmundson GJG, Larsen DK, Stein MB: Panic disorder and vestibular disturbance: an overview of empirical findings and clinical implications. Panic disorder in general medicine. J Psychosom Res 1998;44:107-120.
56.
Majohr K, Leenen K, Grabe HJ, et al: Alexithymia and its relationship to dissociation in patients with panic disorder. J Nerv Ment Dis 2011;199:773-777.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.