A significant number of multiple sclerosis patients show signs not only of depression and anxiety, but also of alexithymia — an inability to describe or process emotional responses, a research group in Brazil reported.
The study, “High levels of alexithymia in patients with multiple sclerosis,” published in the journal Dementia & Neuropsychologia, also found that MS patients with depression or anxiety were more likely to show signs of alexithymia.
Psychological difficulties are known to accompany multiple sclerosis, a disease of the nervous system with symptoms that affect both motor and cognitive skills. Depression and anxiety are well-studied psychological ills of MS and known to affect health-related quality of life. Alexithymia — a psychological condition characterized by a marked difficulty in identifying, describing, and expressing emotions — is lesser, although estimated to be prevalent in 10% to 53% of the MS population.
Researchers investigated the prevalence of alexithymia among MS patients compared with healthy peers. They also studied how depression, anxiety, and disability status might affect the prevalence of alexithymia in MS patients.
A total of 180 people with relapsing-remitting MS (RRMS; 126 women and 54 men) and 180 healthy volunteers — all with a median age of 37 — participated in the study.
Disability was assessed using the expanded disability status scale (EDSS), which ranges from 0 (low) to 10 (severe disability); the hospital anxiety and depression (HAD) scale was used to determine patients’ anxiety and depression status; and the Toronto alexithymia scale (TAS) was used to assess alexithymia. Median disease duration among patients was eight years, and their median EDSS score was 2.0.
Based on the TAS score, participants had either no alexithymia (score of 51 or lower), were borderline (scores between 52–60), or had alexithymia (a score of 61 or higher).
Researchers also evaluated the influence of age, education level, and employment status on the development of alexithymia.
Results showed that the number of individuals with alexithymia was higher in the MS group (93 patients) than in the healthy control group (27 individuals). Similarly, higher levels of depression and anxiety were observed in MS patients compared with controls.
The researchers noted a correlation between depression, anxiety, and alexithymia. They reported that 14.1% of MS patients with depression and 30.8% with anxiety — as seen in HAD scores ≥12 — exhibited higher levels of alexithymia.
Older MS patients, and those without steady employment and with a lower educational level also had higher rates of alexithymia.
Alexithymia was also seen to be significantly influenced by the disability status of MS patients — the greater the disability, the higher was the level of alexithymia reported. Alexithymia was also associated with worse neurological disability.
Among people serving as controls, alexithymia was higher in those with depression (23% of group) and anxiety (40%).
These findings suggest that better known mood disorders like depression and anxiety may influence the development of lesser-known ones like alexithymia in MS patients, the researchers said, suggesting that this condition also be addressed when evaluating an MS patient’s psychological well-being, so as to improve their personal and professional lives.
“Alexithymia was a relevant finding in patients with MS and should be addressed when psychological testing and care are considered for these individuals,” the team concluded.