COPENHAGEN – Alexithymia – difficulty in recognizing and describing one’s emotions – is exceptionally common among psoriasis patients and may represent a novel therapeutic target, according to Dr. Carle Paul.
“We found a significant association between alexithymia and more severe psoriasis, anxiety, depression, decreased quality of life, harmful alcohol consumption, and work impairment,” reported Dr. Paul, professor and chairman of the department of dermatology at the University of Toulouse (France).
Dr. Carle Paul
Alexithymia, a personality construct sometimes referred to as “emotional blindness,” was first described by psychologists in the 1970s. The previous glaring lack of data on the prevalence and consequences of alexithymia in psoriasis patients served as the impetus for the ongoing EPIDEPSO study (Epidemiological Study in Patients With Recently Diagnosed Psoriasis), a prospective 1-year international, epidemiologic, noninterventional observational study involving 719 adults with moderate to severe plaque psoriasis of less than 10 years’ duration. Dr. Paul presented the baseline findings at the at the annual congress of the European Academy of Dermatology and Venereology.
The first noteworthy finding was the strikingly high prevalence of alexithymia in this group of psoriasis patients: 39% of the 719 patients had alexithymia, as defined by a score of 61 or more on the validated, 20-item Toronto Alexithymia Scale.
Patients with alexithymia had slightly but significantly more severe psoriasis as evidenced by their mean Psoriasis Area and Severity Index score of 11.5, compared with 9.8 in unaffected patients. Hand psoriasis was more common in alexithymic patients by a margin of 51%-39%, although the prevalence of psoriasis of the face and neck was similar in the two groups.
Alexithymia was associated with significantly higher rates of several forms of psychiatric comorbidity and problems in living as assessed by validated tests. One comorbid condition stood out above the rest.
“The most striking feature is the very close relationship between alexithymia and anxiety,” according to Dr. Paul. “Among alexithymic patients, 50% had moderate to severe anxiety, as measured by the Hospital Anxiety and Depression Scale–A, whereas in psoriasis patients without alexithymia, this proportion was 12%.”
“Alexithymia identifies a patient population with a high burden of psoriasis, but at the same time, they have difficulty in expressing their emotions and feelings to their doctor. And I think this may explain the fact that some psoriasis patients have difficulties in interacting with doctors, because even though they have a high psoriasis burden, they cannot express how much they suffer from the disease,” the dermatologist continued.
Audience members at this standing-room-only EADV session on new research findings in psoriasis were clearly intrigued by the novel findings about a psychological condition unfamiliar to most. They wanted to know if the Toronto Alexithymia Scale is suitable for use in everyday clinical practice. The answer is yes, Dr. Paul replied, but the practical importance of identifying the large subgroup of patients with alexithymia has yet to be determined.
“We want to find out if we can modify alexithymia with interventions, but we don’t have the prospective data yet,” he added.
Even if alexithymia turns out to be a fixed characteristic not amenable to intervention, however, EPIDEPSO has shown that it could be useful as a red flag because it keeps company with several psychiatric conditions, which are anxiety, depression, and alcohol abuse.
What about causality? others asked. Does alexithymia cause anxiety and depression, or does the emotional toll of psoriasis promote anxiety and depression, which then causes alexithymia? Dr. Paul responded that it’s impossible to say at this point because these initial EPIDEPSO data are cross-sectional; however, the 1-year follow-up may yield insight.
EPIDEPSO is funded by Janssen. Dr. Paul reported receiving a research grant from the company to conduct the study.