Alexithymia, personality and outcome: a naturalistic study in patients with major depression and anxiety disorders

Alessitimia, personalità e outcome: uno studio naturalistico in pazienti con depressione maggiore e disturbi d'ansia

E. Mori, A. Drago, D. De Ronchi, A. Serretti

Istituto di Psichiatria, Università di Bologna


Alexithymia is frequently associated with major depression and anxiety disorders, although the association is not completely understood. According to some authors, alexithymia is secondary to depression and is thus a “state-dependent” condition. Others have suggested that alexithymia is a “stable personality trait”. Moreover, in the literature alexithymia is considered as a negative prognostic factor in the treatment of major depression and anxiety disorders. In this study, we analyze the presence of alexithymia in patients with major depression and anxiety disorders, and investigate the effects of alexithymia and the interaction between alexithymia and personality traits as a modulator of response to combined treatment.


Thirty-four outpatients with major depression or anxiety disorders underwent pharmacotherapy and individual psychodynamic psychotherapy. Subjects were assessed using the “Hamilton Rating Scale for Depression” (HAM-D) and “Hamilton Rating Scale for Anxiety” (HAM-A) at baseline and after eight weeks of treatment. Personality traits were assessed with the SCID II. The Toronto Alexithymia 20-item (TAS-20) scale was administered at variable times throughout the period of treatment in addition to further assessment with the HAM-D and HAM-A. Two statistical models were used incorporating alexithymia either as a state or as a trait factor. Outcome was the change in HAM-D and HAMA from baseline after eight weeks of treatment. The predictor was the TAS score. Personality traits were included as a covariant in the model.


55.9% of subjects were diagnosed as alexythimic, 26.5% were borderline alexythimic and 17.6% were not alexythimic. No major differences were seen from the analysis of alexithymia alone, investigated as a modulator of response to anxiety or depressive symptoms either as a trait or as a state factor. On the other hand, the combination of alexithymia (trait model) with dependent personality traits predicted worse outcome considering the HAM-A scores (p = 0.01).


Alexithymia may interfere with response to treatment in subjects suffering from depressive or anxious diseases when combined with personality traits. Further research is needed to confirm the present results.

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