- Email: [email protected]
Alexithymia in different dermatologic patients
Asian Journal of Psychiatry 25 (2017) 42–45
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Asian pearls
Alexithymia in different dermatologic patients Fahimeh Dehghania,* , Farideh Dehghanib , Parichehr Kafaieb , Mohammad Reza Taghizadehc a
Department of Psychology and Educational Science, Yazd University, Yazd, Iran Department of Dermatology, Yazd University of Medical Sciences, Yazd, Iran c Department of Industrial Management, University of Tehran, Tehran, Iran b
A R T I C L E I N F O
Article history: Received 9 November 2015 Received in revised form 15 May 2016 Accepted 10 October 2016 Available online xxx Keywords: Acne vulgaris Alexithymia Alopecia areata Psoriasis Vitiligo
A B S T R A C T
Alexithymia is a personality trait characterized by difficulties in differentiating and describing feelings. Research indicates that alexithymia can be considered as a possible risk factor for a variety of medical conditions. The purpose of our study was to compare and assess the prevalence of alexithymia in patients with psoriasis, alopecia areata, vitiligo and acne vulgaris. 120 consecutive subjects referred to dermatologic clinic with psoriasis, alopecia areata, vitiligo and acne vulgaris and 30 subjects selected from hospital staff and relatives of patients were enrolled in patient and control groups of our study respectively. Toronto Alexithymia Scale (TAS-20) was used to assess the prevalence of alexithymia. Statistical analysis showed significant differences between the vitiligo, alopecia areata, psoriasis patients and the control group in terms of alexithymia score (p 0.05), but did not find any significant difference between acne patients and control group (p = 0.06). This study has demonstrated high score of alexithymia in patients with psoriasis, alopecia areata and vitiligo compared with control group; however, such association was not found in individuals with acne vulgaris. Hence it is proposed that the evaluation and management of alexithymia would better the treatment of skin disorders and improve the quality of life in patients. ã 2016 Elsevier B.V. All rights reserved.
1. Introduction Alexithymia is a personality construct that is normally distributed in general population, with its prevalence being higher than major depressive disorders (10–13% vs 6.4–8.6%) (Willemsen et al., 2008). Alexithymia is composed of following factors: (a) limited ability in identifying and describing feelings; (b) constricted imaginary activities; and (c) externally oriented- cognitive style (Baiardini et al., 2011).In addition to genetic susceptibility and emotional stress, alexithymia is considered as one of the risk factors for a variety of medical and psychiatric disorders. Although the relationship between alexithymia and dermatology disorders are not fully understood, preliminary data show that alexithymia seems to be associated with alopecia areata (AA), psoriasis, vitiligo and chronic urticaria (Willemsen et al., 2008). In this study we examined patients suffering from four different dermatologic disorders: psoriasis, vitiligo, acne and alopecia areata (AA).
* Corresponding author. E-mail address: [email protected] (F. Dehghani). http://dx.doi.org/10.1016/j.ajp.2016.10.011 1876-2018/ã 2016 Elsevier B.V. All rights reserved.
Psoriasis is a chronic inflammatory skin disease in the onset and exacerbation of which genetic factors and psychological distress play a key role. For a long time, psoriasis was considered as a psychosomatic disorder affected by certain personality types; therefore, it could be a highly suitable candidate for the investigation of alexithymia (Richards et al., 2005). Previous studies have revealed that stress events might trigger vitiligo. These patients have higher scores on alexithymia than controls possibly due to emotional dysregulation or inability to cope with stress (Picardi et al., 2003a; Willemsen et al., 2008). Also, acne is a common dermatologic problem dermatologists encounter almost every day. Acne can have a profound psychological effect, especially if it causes disfigurement of face. In extreme cases, it may lead to great embarrassment, anger, depression and self esteem reduction. Consequently, the separation of acne vulgaris and psychological disturbances is impossible (Mooney, 2014; Sunay et al., 2011). Several clinical investigations have indicated an association between AA and stressful events, while others have suggested that particular personality trait such as alexithymia might reduce the ability to cope with stressful events (Willemsen et al., 2009).
F. Dehghani et al. / Asian Journal of PsychiatryAJP 25 (2017) 42–45
Furthermore, it has been shown that most AA patients with poor response to the treatment were alexithymic (Cordan et al., 2006). As screening and treating of alexithymia can benefit chronic skin diseases, in this article we tried to estimate the prevalence of alexithymia among patients with psoriasis, vitiligo, acne and alopecia areata (AA), and compare the results. 2. Methods 2.1. Participants Since VanVoorhis and Morgan (2007) state Analysis of Variance (ANOVA) requires 30 observations per cell to detect a medium effect size, the clinical sample was comprised of 120 consecutive patients who, more than 18 years, had acne (n = 30), alopecia areata (n = 30), vitiligo (n = 30) and psoriasis (n = 30). The control group included 30 healthy individuals recruited from the hospital staff and relatives of patients who did not currently or previously have any dermatological disorders. First degree relatives were not selected because of the possible influence of genetic factors in the development of alexithymia. Patients with moderate-to-severe disease were enrolled between December 2012 and June 2013. Then, patients with Acne severity index (ASI), Severity of Alopecia Tool score (SALT score), Vitiligo European Task Force (VETF) and Psoriasis Area and Severity Index (PASI) were assessed by a dermatologist. However, those patients with any cognitive impairment or other types of skin diseases other than the required samples were excluded from the study. For inclusion of each case in the study, informed consent was obtained from the participants. In order to ensure confidentiality, there was no identifying information on any of the questionnaires. Therefore, patients were free to quit the study at any time. 2.2. Measures After the informed consent was obtained from the participants, they were asked to complete the Toronto Alexithymia Scale-20. The Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing Alexithymia. This measurement consists of 20 items in which subjects respond to each statement on 5-point likert scales ranging from 1 (strongly disagree) to 5 (strongly agree). The range of scores is from 20 to 100, and scores higher than 61 have been suggested to be alexithymic. In this study the Persian (Iranian language) version of the TAS-20 was used to measure alexithymia. The psychometric properties of Iranian version of the TAS-20 have proven to be satisfactory (Besharat, 2007). Statistical analyses were performed by means of SPSS 20. The differences between TAS score of groups were assessed by analyzing variance. In addition, post-hoc comparisons were made to examine the differences between each of the five diagnostic groups.
43
3. Results The mean ages of the participants were 29.75 11.11 years and 30.7 8.02 years in patient and control groups, respectively (p = 0.66). Demographic characteristics of the groups are shown in Table 1 According to cut-off score, 50% of alopecia areata patients, 46.7% of vitiligo patients, 40% of the psoriasis patients, 40% of acne patients and 13.3% of conrol groups were alexithymic. As a result, significant differences were found between each of the disease groups and the control group (p < 0.05). The ANOVA analysis was conducted to evaluate the differences in TAS-20 scores among patients and control groups. The results indicated that the five groups differed significantly in terms of alexithymia (Table 2). Post-hoc comparisons using LSD’s statistic showed significant differences between the vitiligo, alopecia areata, psoriasis patients, and the control group in terms of alexithymia score (p 0.05). However, they did not reveal any significant difference between acne patients and control group. Also there were no differences between any of patients groups (Table 3). 4. Discussion The results of our study proved that dermatological patients except for acne patients had higher levels of alexithymia scores compared with healthy individuals. The differences between the patients and control groups were statistically significant. The high level of alexithymia has been shown in patients with a number of health problems (Taylor, 2000) including skin disorders (Picardi et al., 2005b). Richards and her colleagues evaluated 300 patients with chronic plaque psoriasis with TAS (TAS-20). The results of their study revealed that the overall prevalence of alexithymia was 33% (the mean score of TAS was 55.62) in these patients, but there were no significant relationships between TAS score and clinical severity, age or duration of disease (Richards et al., 2005). Our study yielded the similar results; TAS scores in patients with psoriasis were higher than those in control groups and the mean score was 57.1 10.42. The association between alexithymia and psoriasis was also shown in the researches by Consoli et al. (2006) and Picardi et al. (2005a); however, some other studies have not demonstrated a significant relationship (Fava et al. 1980; Picardi et al., 2003a; Rubino et al., 1988). Different investigators have used various methods of assessment which explain why some previous studies did not yield similar results (Willemsen et al., 2008). In our study the prevalence of alexithymic psoriasis patients was 40% whereas in previous studies including Consoli et al. (2006), Picardi et al. (2005a) and Allegranti et al. (1993) its prevalence was 35%, 51.5% and 15.6% respectively.
Table 1 Patients and control group demographic characteristics. Characteristics Gender Education
Age (Mean, SD)
Female Male
Vitiligo n (%)
Alopecia Areata n (%)
Psoriasis n (%)
Acne n (%)
Control n (%)
19 (63.3) 11 (36.7) 4 (13.3) 12 (40) 14 (46.7) 31.6 (11.1)
10 (33.3) 20 (66.7) 2 (6.7) 14 (46.7) 14 (46.7) 30.3 (8.4)
18 (60) 12 (40) 5 (16.7) 15 (50) 10 (33.3) 34.9 (13.8)
25 (83.3) 5 (16.7) 0 11 (36.7) 19 (63.3) 22.3 (5.6)
18 (60) 12 (40) 1 (3.3) 6 (20) 23 (76.7) 30.7 (8)
44
F. Dehghani et al. / Asian Journal of PsychiatryAJP 25 (2017) 42–45
Table 2 Patients and Control Group TAS Scores.
Alexithymia
(M SD) N (%)
Vitiligo
Alopecia Areata (M SD)
Psoriasis (M SD)
Acne (M SD)
Control (M SD)
57.2 14.2 14 (46.7)
59.1 11.5 15 (50)
57.1 10.4 12 (40)
56 12.6 12 (40)
50.3 8.4 4 (13.3)
Table 3 Comparison of the groups according to means of TAS. Groups
Disease
Mean Difference
Sig
vitiligo
alopecia areata psoriasis acne control vitiligo psoriasis acne control vitiligo alopecia areata acne control vitiligo alopecia areata psoriasis control vitiligo alopecia areata psoriasis acne
1.9 0.1 1.2 6.9a 1.9 2 3.1 8.8a 0.1 2 1.1 6.8a 1.2 3.1 1.1 5.7 6.9a 8.8a 6.8a 5.7
0.519 0.973 0.689 0.023 0.519 0.498 0.297 0.004 0.973 0.498 0.714 0.025 0.689 0.297 0.714 0.06 0.023 0.004 0.025 0.06
alopecia areata
psoriasis
acne
control
a
F=2.5, p=0.045 p<0.05
We could find only one study carried out on the association of acne vulgaris and alexithymia. The data of Sunay et al. did not show a meaningful association between acne and alexithymia (Sunay et al., 2011) and the findings of our study support their results. Previous investigations demonstrated that TAS score is significantly greater in higher age groups compared with younger age groups (Mattila et al., 2006; Pasini et al., 1992). Because acne is more common in adolescence and early adulthood, the results of our study that reveal the lower score of TAS-20 in acne patients is justifiable. In summary, this study has demonstrated a high score of alexithymia in patients with psoriasis, alopecia areata and vitiligo compared with control group, but not found this association in individuals with acne vulgaris. We propose that the evaluation and management of alexithymia would be helpful for more efficient treatment of skin disorders and improving their life quality. The limitation of our study was the small sample size. Furthermore, investigating larger study groups may be helpful to determine more accurate results.
The mean difference is significant at the 0.05 level.
References
Picardi et al. assessed the relationship between alexithymia and vitiligo. They concluded that Patients with vitiligo scored higher than controls on the TAS-20 and 35.5% of them were alexithymic (Picardi et al., 2003b). In our study, 30 patients with vitiligo enrolled and similar results were obtained. TAS score in our patients was higher than the control group (the mean score was 57.2 14.19) and 36.7% were alexithymic. Some studies suggested that personality characteristics might affect the susceptibility to alopecia areata. The association between alexithymia and alopecia areata has surfaced in previous surveys. 43 patients with alopecia areata enrolled in a study in Turkey and were evaluated using TAS-20. With regard to TAS score (Cordan et al., 2006), there was a statistically significant relationship between alopecia areata and alexithymia. Several other investigations also confirmed that the degree of alexithymia is higher in patients with alopecia areata compared with general population (Sayar et al., 2001; Willemsen et al., 2009). In our study 30 patients with alopecia enrolled and the mean score of TAS-20 score obtained was 59.13 11.51 and 50% were alexithymic showing that our results are in line with other studies assessed the prevalence of alexithymia in patients with alopecia areata. Sayar et al. (2001) and Cordan et al. (2006) state 58% and 44% of alopecia areata patients were alexithymic respectively. Acne vulgaris was another dermatologic disease that was investigated in the present study. Although the TAS score of patients with acne was higher than control group, this difference was not significant. However, the p-value = 0.06 was near significance level of 0.05. It seems that with the expansion of the sample size the p-value changes and the studied group becomes different from the control group. Furthermore, the percentage of alexithymic Acne patients is significantly higher than the control group (40%). Sunay et al. (2011) reported Alexitymia was determined in 23.4% of the subjects in acne group.
Allegranti, I., Gon, T., Magaton-Rizzi, G., Aguglia, E., 1993. Prevalence of alexithymic characteristics in psoriatic patients. Acta Derm. Venereol. 186 (Suppl), 146–147. Baiardini, I., Abbà, S., Ballauri, M., Vuillermoz, G., Braido, F., 2011. Alexithymia and chronic deseases: the state of the art. G. Ital. Med. Lav. Ergon 33, A47–A52. Besharat, M.A., 2007. Reliability and factorial validity of Farsi version of the Toronto Alexithymia Scale with a sample of Iranian students. Psychol. Rep. 101, 209–220. Consoli, S.M., Rolhion, S., Martin, C., Ruel, K., Cambazard, F., Pellet, J., Misery, L., 2006. Low levels of emotional awareness predict a better response to dermatological treatment in patients with psoriasis. Dermatology 212 (2), 128–136. Cordan, Y.A., Basterzi, A., Acar, S.T., Ustunsoy, D., Ikizoglu, G., Demirseren, D., Kanik, A., 2006. Alopecia areata and alexithymia. Turk Psikiyatri Dergisi 17 (2), 101– 106. Fava, G.A., Perini, G.I., Santonastaso, P., Fornasa, C.V., 1980. Life events and psychological distress in dermatologic disorders: psoriasis, chronic urticaria and fungal infections. Br. J. Med. Psychol. 53 (3), 277–282. Mattila, A.K., Salminen, J.K., Nummi, T., Joukamaa, M., 2006. Age is strongly associated with alexithymia in the general population. J. Psychosom. Res. 61 (5), 629–635. Mooney, T., 2014. Preventing psychological distress in patients with acne. Nurs. Stand. 28 (22), 42–48. Pasini, A., Chiaie, R.D., Seripa, S., Ciani, N., 1992. Alexithymia as related to sex, age, and educational level: results of the Toronto Alexithymia Scale in 417 normal subjects. Compr. Psychiatry 33 (1), 42–46. Picardi, A., Mazzotti, E., Gaetano, P., Cattaruzza, M.S., Baliva, G., Melchi, C.F., Biondi, M., Pasquini, P., 2005a. Stress, social support, emotional regulation, and exacerbation of diffuse plaque psoriasis. Psychosomatics 46 (6), 556–564. Picardi, A., Pasquini, P., Abeni, D., Fassone, G., Mazzotti, E., Fava, G.A., 2005b. Psychosomatic assessment of skin diseases in clinical practice. Psychother. Psychosom. 74 (5), 315–322. Picardi, A., Pasquini, P., Cattaruzza, M.S., Gaetano, P., Baliva, G., Melchi, C.F., Tiago, A., Camaioni, D., Abeni, D., Biondi, M., 2003a. Only limited support for a role of psychosomatic factors in psoriasis: results from a case-control study. J. Psychosom. Res. 55 (3), 189–196. Picardi, A., Pasquini, P., Cattaruzza, M.S., Gaetano, P., Melchi, C.F., Baliva, G., Camaioni, D., Tiago, A., Abeni, D., Biondi, M., 2003b. Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study. Psychother. Psychosom. 72 (3), 150–158. Richards, H.L., Fortune, D.G., Griffiths, C.E., Main, C.J., 2005. Alexithymia in patients with psoriasis: clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20. J. Psychosom. Res. 58 (1), 89–96. Rubino, I.A., Sonnino, A., Stefanato, C.M., Pezzarossa, B., Ciani, N., 1988. Separationindividuation, aggression and alexithymia in psoriasis. Acta Derm. Venereol. 146 (Suppl), 87–90.
F. Dehghani et al. / Asian Journal of PsychiatryAJP 25 (2017) 42–45 Sayar, K., Köse, O., Ebrinç, S., Şetin, M., 2001. Hopelessness, depression and alexithymia in young Turkish soldiers suffering from alopecia areata. Dermatol. Psychosom. 2 (1), 12–15. lu, M., 2011. Alexithymia and acne vulgaris: a Sunay, D., Baykir, M., Ateş, G., Ekşiog case control study. Psychiatry Investig. 8 (4), 327–333. Taylor, G.J., 2000. Recent developments in alexithymia theory and research. Can. J. Psychiatry 45, 134–142.
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VanVoorhis, C.R.W., Morgan, B.L., 2007. Understanding power and rules of thumb for determining sample sizes. Tutor. Quant. Methods Psychol. 3 (2), 43–50. Willemsen, R., Haentjens, P., Roseeuw, D., Vanderlinden, J., 2009. Alexithymia in patients with alopecia areata: educational background much more important than traumatic events. J. Eur. Acad. Dermatol. Venereol. 23 (10), 1141–1146. Willemsen, R., Roseeuw, D., Vanderlinden, J., 2008. Alexithymia and dermatology: the state of the art. Int. J. Dermatol. 47 (9), 903–910.
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Asian pearls
Alexithymia in different dermatologic patients Fahimeh Dehghania,* , Farideh Dehghanib , Parichehr Kafaieb , Mohammad Reza Taghizadehc a
Department of Psychology and Educational Science, Yazd University, Yazd, Iran Department of Dermatology, Yazd University of Medical Sciences, Yazd, Iran c Department of Industrial Management, University of Tehran, Tehran, Iran b
A R T I C L E I N F O
Article history: Received 9 November 2015 Received in revised form 15 May 2016 Accepted 10 October 2016 Available online xxx Keywords: Acne vulgaris Alexithymia Alopecia areata Psoriasis Vitiligo
A B S T R A C T
Alexithymia is a personality trait characterized by difficulties in differentiating and describing feelings. Research indicates that alexithymia can be considered as a possible risk factor for a variety of medical conditions. The purpose of our study was to compare and assess the prevalence of alexithymia in patients with psoriasis, alopecia areata, vitiligo and acne vulgaris. 120 consecutive subjects referred to dermatologic clinic with psoriasis, alopecia areata, vitiligo and acne vulgaris and 30 subjects selected from hospital staff and relatives of patients were enrolled in patient and control groups of our study respectively. Toronto Alexithymia Scale (TAS-20) was used to assess the prevalence of alexithymia. Statistical analysis showed significant differences between the vitiligo, alopecia areata, psoriasis patients and the control group in terms of alexithymia score (p 0.05), but did not find any significant difference between acne patients and control group (p = 0.06). This study has demonstrated high score of alexithymia in patients with psoriasis, alopecia areata and vitiligo compared with control group; however, such association was not found in individuals with acne vulgaris. Hence it is proposed that the evaluation and management of alexithymia would better the treatment of skin disorders and improve the quality of life in patients. ã 2016 Elsevier B.V. All rights reserved.
1. Introduction Alexithymia is a personality construct that is normally distributed in general population, with its prevalence being higher than major depressive disorders (10–13% vs 6.4–8.6%) (Willemsen et al., 2008). Alexithymia is composed of following factors: (a) limited ability in identifying and describing feelings; (b) constricted imaginary activities; and (c) externally oriented- cognitive style (Baiardini et al., 2011).In addition to genetic susceptibility and emotional stress, alexithymia is considered as one of the risk factors for a variety of medical and psychiatric disorders. Although the relationship between alexithymia and dermatology disorders are not fully understood, preliminary data show that alexithymia seems to be associated with alopecia areata (AA), psoriasis, vitiligo and chronic urticaria (Willemsen et al., 2008). In this study we examined patients suffering from four different dermatologic disorders: psoriasis, vitiligo, acne and alopecia areata (AA).
* Corresponding author. E-mail address: [email protected] (F. Dehghani). http://dx.doi.org/10.1016/j.ajp.2016.10.011 1876-2018/ã 2016 Elsevier B.V. All rights reserved.
Psoriasis is a chronic inflammatory skin disease in the onset and exacerbation of which genetic factors and psychological distress play a key role. For a long time, psoriasis was considered as a psychosomatic disorder affected by certain personality types; therefore, it could be a highly suitable candidate for the investigation of alexithymia (Richards et al., 2005). Previous studies have revealed that stress events might trigger vitiligo. These patients have higher scores on alexithymia than controls possibly due to emotional dysregulation or inability to cope with stress (Picardi et al., 2003a; Willemsen et al., 2008). Also, acne is a common dermatologic problem dermatologists encounter almost every day. Acne can have a profound psychological effect, especially if it causes disfigurement of face. In extreme cases, it may lead to great embarrassment, anger, depression and self esteem reduction. Consequently, the separation of acne vulgaris and psychological disturbances is impossible (Mooney, 2014; Sunay et al., 2011). Several clinical investigations have indicated an association between AA and stressful events, while others have suggested that particular personality trait such as alexithymia might reduce the ability to cope with stressful events (Willemsen et al., 2009).
F. Dehghani et al. / Asian Journal of PsychiatryAJP 25 (2017) 42–45
Furthermore, it has been shown that most AA patients with poor response to the treatment were alexithymic (Cordan et al., 2006). As screening and treating of alexithymia can benefit chronic skin diseases, in this article we tried to estimate the prevalence of alexithymia among patients with psoriasis, vitiligo, acne and alopecia areata (AA), and compare the results. 2. Methods 2.1. Participants Since VanVoorhis and Morgan (2007) state Analysis of Variance (ANOVA) requires 30 observations per cell to detect a medium effect size, the clinical sample was comprised of 120 consecutive patients who, more than 18 years, had acne (n = 30), alopecia areata (n = 30), vitiligo (n = 30) and psoriasis (n = 30). The control group included 30 healthy individuals recruited from the hospital staff and relatives of patients who did not currently or previously have any dermatological disorders. First degree relatives were not selected because of the possible influence of genetic factors in the development of alexithymia. Patients with moderate-to-severe disease were enrolled between December 2012 and June 2013. Then, patients with Acne severity index (ASI), Severity of Alopecia Tool score (SALT score), Vitiligo European Task Force (VETF) and Psoriasis Area and Severity Index (PASI) were assessed by a dermatologist. However, those patients with any cognitive impairment or other types of skin diseases other than the required samples were excluded from the study. For inclusion of each case in the study, informed consent was obtained from the participants. In order to ensure confidentiality, there was no identifying information on any of the questionnaires. Therefore, patients were free to quit the study at any time. 2.2. Measures After the informed consent was obtained from the participants, they were asked to complete the Toronto Alexithymia Scale-20. The Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing Alexithymia. This measurement consists of 20 items in which subjects respond to each statement on 5-point likert scales ranging from 1 (strongly disagree) to 5 (strongly agree). The range of scores is from 20 to 100, and scores higher than 61 have been suggested to be alexithymic. In this study the Persian (Iranian language) version of the TAS-20 was used to measure alexithymia. The psychometric properties of Iranian version of the TAS-20 have proven to be satisfactory (Besharat, 2007). Statistical analyses were performed by means of SPSS 20. The differences between TAS score of groups were assessed by analyzing variance. In addition, post-hoc comparisons were made to examine the differences between each of the five diagnostic groups.
43
3. Results The mean ages of the participants were 29.75 11.11 years and 30.7 8.02 years in patient and control groups, respectively (p = 0.66). Demographic characteristics of the groups are shown in Table 1 According to cut-off score, 50% of alopecia areata patients, 46.7% of vitiligo patients, 40% of the psoriasis patients, 40% of acne patients and 13.3% of conrol groups were alexithymic. As a result, significant differences were found between each of the disease groups and the control group (p < 0.05). The ANOVA analysis was conducted to evaluate the differences in TAS-20 scores among patients and control groups. The results indicated that the five groups differed significantly in terms of alexithymia (Table 2). Post-hoc comparisons using LSD’s statistic showed significant differences between the vitiligo, alopecia areata, psoriasis patients, and the control group in terms of alexithymia score (p 0.05). However, they did not reveal any significant difference between acne patients and control group. Also there were no differences between any of patients groups (Table 3). 4. Discussion The results of our study proved that dermatological patients except for acne patients had higher levels of alexithymia scores compared with healthy individuals. The differences between the patients and control groups were statistically significant. The high level of alexithymia has been shown in patients with a number of health problems (Taylor, 2000) including skin disorders (Picardi et al., 2005b). Richards and her colleagues evaluated 300 patients with chronic plaque psoriasis with TAS (TAS-20). The results of their study revealed that the overall prevalence of alexithymia was 33% (the mean score of TAS was 55.62) in these patients, but there were no significant relationships between TAS score and clinical severity, age or duration of disease (Richards et al., 2005). Our study yielded the similar results; TAS scores in patients with psoriasis were higher than those in control groups and the mean score was 57.1 10.42. The association between alexithymia and psoriasis was also shown in the researches by Consoli et al. (2006) and Picardi et al. (2005a); however, some other studies have not demonstrated a significant relationship (Fava et al. 1980; Picardi et al., 2003a; Rubino et al., 1988). Different investigators have used various methods of assessment which explain why some previous studies did not yield similar results (Willemsen et al., 2008). In our study the prevalence of alexithymic psoriasis patients was 40% whereas in previous studies including Consoli et al. (2006), Picardi et al. (2005a) and Allegranti et al. (1993) its prevalence was 35%, 51.5% and 15.6% respectively.
Table 1 Patients and control group demographic characteristics. Characteristics Gender Education
Age (Mean, SD)
Female Male
Vitiligo n (%)
Alopecia Areata n (%)
Psoriasis n (%)
Acne n (%)
Control n (%)
19 (63.3) 11 (36.7) 4 (13.3) 12 (40) 14 (46.7) 31.6 (11.1)
10 (33.3) 20 (66.7) 2 (6.7) 14 (46.7) 14 (46.7) 30.3 (8.4)
18 (60) 12 (40) 5 (16.7) 15 (50) 10 (33.3) 34.9 (13.8)
25 (83.3) 5 (16.7) 0 11 (36.7) 19 (63.3) 22.3 (5.6)
18 (60) 12 (40) 1 (3.3) 6 (20) 23 (76.7) 30.7 (8)
44
F. Dehghani et al. / Asian Journal of PsychiatryAJP 25 (2017) 42–45
Table 2 Patients and Control Group TAS Scores.
Alexithymia
(M SD) N (%)
Vitiligo
Alopecia Areata (M SD)
Psoriasis (M SD)
Acne (M SD)
Control (M SD)
57.2 14.2 14 (46.7)
59.1 11.5 15 (50)
57.1 10.4 12 (40)
56 12.6 12 (40)
50.3 8.4 4 (13.3)
Table 3 Comparison of the groups according to means of TAS. Groups
Disease
Mean Difference
Sig
vitiligo
alopecia areata psoriasis acne control vitiligo psoriasis acne control vitiligo alopecia areata acne control vitiligo alopecia areata psoriasis control vitiligo alopecia areata psoriasis acne
1.9 0.1 1.2 6.9a 1.9 2 3.1 8.8a 0.1 2 1.1 6.8a 1.2 3.1 1.1 5.7 6.9a 8.8a 6.8a 5.7
0.519 0.973 0.689 0.023 0.519 0.498 0.297 0.004 0.973 0.498 0.714 0.025 0.689 0.297 0.714 0.06 0.023 0.004 0.025 0.06
alopecia areata
psoriasis
acne
control
a
F=2.5, p=0.045 p<0.05
We could find only one study carried out on the association of acne vulgaris and alexithymia. The data of Sunay et al. did not show a meaningful association between acne and alexithymia (Sunay et al., 2011) and the findings of our study support their results. Previous investigations demonstrated that TAS score is significantly greater in higher age groups compared with younger age groups (Mattila et al., 2006; Pasini et al., 1992). Because acne is more common in adolescence and early adulthood, the results of our study that reveal the lower score of TAS-20 in acne patients is justifiable. In summary, this study has demonstrated a high score of alexithymia in patients with psoriasis, alopecia areata and vitiligo compared with control group, but not found this association in individuals with acne vulgaris. We propose that the evaluation and management of alexithymia would be helpful for more efficient treatment of skin disorders and improving their life quality. The limitation of our study was the small sample size. Furthermore, investigating larger study groups may be helpful to determine more accurate results.
The mean difference is significant at the 0.05 level.
References
Picardi et al. assessed the relationship between alexithymia and vitiligo. They concluded that Patients with vitiligo scored higher than controls on the TAS-20 and 35.5% of them were alexithymic (Picardi et al., 2003b). In our study, 30 patients with vitiligo enrolled and similar results were obtained. TAS score in our patients was higher than the control group (the mean score was 57.2 14.19) and 36.7% were alexithymic. Some studies suggested that personality characteristics might affect the susceptibility to alopecia areata. The association between alexithymia and alopecia areata has surfaced in previous surveys. 43 patients with alopecia areata enrolled in a study in Turkey and were evaluated using TAS-20. With regard to TAS score (Cordan et al., 2006), there was a statistically significant relationship between alopecia areata and alexithymia. Several other investigations also confirmed that the degree of alexithymia is higher in patients with alopecia areata compared with general population (Sayar et al., 2001; Willemsen et al., 2009). In our study 30 patients with alopecia enrolled and the mean score of TAS-20 score obtained was 59.13 11.51 and 50% were alexithymic showing that our results are in line with other studies assessed the prevalence of alexithymia in patients with alopecia areata. Sayar et al. (2001) and Cordan et al. (2006) state 58% and 44% of alopecia areata patients were alexithymic respectively. Acne vulgaris was another dermatologic disease that was investigated in the present study. Although the TAS score of patients with acne was higher than control group, this difference was not significant. However, the p-value = 0.06 was near significance level of 0.05. It seems that with the expansion of the sample size the p-value changes and the studied group becomes different from the control group. Furthermore, the percentage of alexithymic Acne patients is significantly higher than the control group (40%). Sunay et al. (2011) reported Alexitymia was determined in 23.4% of the subjects in acne group.
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