SYDNEY — Alexithymia is an independent risk factor for impulsive-compulsive disorders (ICDs) in patients with Parkinson's disease (PD), a study indicates.

Alexithymia is a personality trait characterized by deficits in emotional self-awareness. A person with alexithymia has difficulty identifying and describing their feelings and has an externally oriented thinking style.

The trait has been linked to a number of disorders characterized by poor impulse control in the general population, but whether it is associated with impulse control problems in patients with PD was largely unknown, until now.

"This is new and important information for the neuropsychiatric assessment of patients with PD and for cognitive behavioral therapy in PD patients with ICDs," the authors, led by Katharina Goerlich-Dobre, PhD, Department of Neurology, Christian-Albrechts University, Kiel, Germany, write.

"An inclusion of alexithymic features in the neuropsychiatric assessment of PD patients with an emphasis on the patients' emotional awareness may thus help to identify patients at risk of pathological addictive behaviors," Dr. Goerlich-Dobre told Medscape Medical News.

The findings were presented here at the Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders.

Deficits in Emotional Self-awareness

For the study, the investigators assessed ICDs and alexithymia in 91 patients with PD using the Toronto Alexithymia Scale (TAS-20) and the Questionnaire for ICDs in PD rating scale (QUIP-RS), along with other questionnaires measuring impulsivity, depression, anxiety, behavioral inhibition/approach, and emotion regulation strategies.

Dr. Katharina Goerlich-Dobre

Confirming their hypothesis, they found that presence of alexithymia, particularly difficulty identifying and describing feelings, correlated significantly with ICDs (P < .001). The correlation of alexithymia and ICDs persisted even when controlling for impulsivity, anxiety, and depression (P < .01).

"These results confirm previously reported associations between alexithymia and impulsivity, anxiety, depression, and emotion suppression. Extending these findings, we show for the first time that alexithymia, particularly difficulty identifying feelings, is associated with ICDs in PD, independently from impulsivity, anxiety, and depression," said Dr. Goerlich-Dobre. "Deficits in emotional self-awareness, paired with the observed preference of high-scorers on alexithymia to suppress their feelings, seem to be particularly important in this context, as such individuals may be prone to feel overwhelmed by negative feelings that they are unable to identify or to put into words," she added.

"The possibly intense emotional arousal accompanying those feelings may prompt alexithymic individuals to engage in impulsive-compulsive behaviors in order to quickly alleviate their distress, as their access to healthier ways of processing those feelings is compromised," Dr. Goerlich-Dobre said.

"This interpretation is supported by a number of findings linking alexithymia to ICDs in the general population. In addition, this interpretation is in line with the present finding of reduced behavioral inhibition in high-scorers on alexithymia, indicating reduced motivation to avoid unpleasant experiences," she added.

Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders. Abstract LBA-18. Presented June 18, 2013.

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