Alexithymia, Depressive Experiences, and Dependency in Addictive Disorders

Abstract

Alexithymia, depressive feelings, and dependency are interrelated dimensions that are considered potential “risk factors” for addictive disorders. The aim of this study was to investigate the relationships between these dimensions and to define a comprehensive model of addiction in a large sample of addicted subjects, whether affected by an eating disorder or presenting an alcohol- or a drug use-related disorder. The participants in this study were gathered from a multicenter collaborative study on addictive behaviors conducted in several psychiatric departments in France, Switzerland, and Belgium between January 1995 and March 1999. The clinical sample was composed of 564 patients (149 anorexics, 84 bulimics, 208 alcoholics, 123 drug addicts) of both genders with a mean age of 27.3 ± 8 years. A path analysis was conducted on the 564 dependent patients and 518 matched controls using the scores of the Toronto Alexithymia Scale, the Depressive Experiences Questionnaire, and the Interpersonal Dependency Inventory. Statistical analyses showed good adjustment (Goodness of Fit Index = 0.977) between the observable data and the assumed model, thus supporting the hypothesis that a depressive dimension, whether anaclitic or self-critical, can facilitate the development of dependency in vulnerable alexithymic subjects. This result has interesting clinical implications because identifying specific patterns of relationships leading from alexithymia to dependency can provide clues to the development of targeted strategies for at-risk subjects.

• Goodness of fit index
• Alexithymia
• Self-criticism
• Anaclitism
• Dependency
• Addictive disorders
• Eating disorders

Resumen

La alexitimia, los sentimientos depresivos y la dependencia interpersonal son dimensiones interrelacionadas que se consideran como factores de riesgo para los trastornos adictivos. Los objetivos de este estudio son en primer término investigar las relaciones entre estas dimensiones en una muestra amplia de sujetos adictivos, cuyos trastornos comprometen ya sea las conductas alimentarias, ya sea el uso del alcohol o drogas y, en segundo término, proponer un modelo comprensivo de la adicción. Los participantes en este estudio proceden de un estudio multicéntrico sobre las conductas adictivas realizado en distintos departamentos de psiquiatría en Francia, Suiza y Bélgica entre enero de 1995 y marzo de 1999. La muestra clínica consta de 564 pacientes (149 anorécticos, 84 bulímicos, 208 alcóholicos, 123 toxicómanos) de ambos sexos y con una edad media de 27.3±8. Se efectuó un análisis de pistas causales en los 564 pacientes adictivos y en los 518 controles apareados, utilizando los resultados de la ≪ Toronto Alexithymia Scale ≫ (TAS-20), del ≪ Depressive Exeperience Questionnaire ≫ (DEQ) y del ≪ Interpersonal Dependency Inventory ≫ (IDI). El análisis estadístico mostró un buen ajuste (GFI = 977) entre los datos observados y el modelo propuesto, lo que apoya la hipótesis según la cual una dimensión depresiva, sea ésta anaclítica o autocrítica, puede facilitar el desarrollo de una dependencia interpersonal en sujetos alexitímicos vulnerables. Este resultado tiene implicaciones clínicas interesantes en la medida en que identificar modelos específicos de relación que llevan de la alexitimia a la dependencia puede conducir a diseñar estrategias específicas para sujetos en situación de riesgo.

Résumé

L’alexithymie, les sentiments dépressifs et la dépendance Interpersonnelle sont des dimensions corrélées qui sont considérées comme des facteurs de risque pour les troubles addictifs. L’objectif de cette étude est d’investiguer les relations entre ces dimensions chez un large échantillon de sujets addictifs, qu’ils soient atteints d’un trouble des conduites alimentaires ou d’un troubles de l’usage de l’alcool ou de drogues et de proposer un modèle compréhensif de l’addiction. Les participants de cette étude proviennent d’une étude multicentrique sur les conduites addictives menée dans différents départements de psychiatrie en France, en Suisse et en Belgique entre Janvier 1995 et Mars 1999. L’échantillon clinique se compose de 564 patients (149 anorexiques, 84 boulimiques, 208 alcooliques, 123 toxicomanes) des deux sexes avec un âge moyen de 27.3±8. Une analyse de pistes causales a été effectuée sur les 564 patients addicitfs et sur les 518 contrôles appariés en utilisant les scores de la Toronto Alexithymia Scale (TAS-20), du Depressive Experience Questionnaire (DEQ) et du Interpersonal Dependency Inventory (IDI). L’analyse statistique a montré un bon ajustement (GFI = .977) entre les données observées et le modèle proposé, ce qui soutient l’hypothèse qu’une dimension dépressive, qu’elle soit anaclitique ou auto-critique, peut faciliter le développement d’une dépendance interpersonnelle chez des sujets alexithymiques vulnérables. Ce résultat a des implications cliniques intéressantes car, identifier des modèles spécifiques de relation conduisant de l’alexithymie à la dépendance peut conduire à des stratégies ciblées pour des sujets à risque.

Additional information

Notes on contributors

Mario Speranza

Mario Speranza, M.D., is a child and adolescent psychiatrist. He is currently the Head of the Adolescent Inpatient Unit of the University Hospital of Bicêtre (France). His main interests are developmental psychopathology of eating disorders and depressive disorders.

Maurice Corcos

Maurice Corcos, M.D., is psychiatrist and psychoanalyst at the Adolescent and Young Adult Department of Psychiatry of the Institute Mutualiste Montsouris (Paris, France). His main interests are alexithymia and depression related to addiction and eating disorders.

Philippe Stéphan

Philippe Stéphan, M.D., is a consultant at the outpatient unit for adolescents of the Department of Child and Adolescent Psychiatry at the University of Lausanne (Switzerland). He is mainly interested in addiction epidemiology and alexithymia.

Gwenolé Loas

Gwenolé Loas, M.D., Ph.D., Professor of Psychiatry, is the head of the University Department of Psychiatry, Hospital Pinel (Amiens, France). His main interests are anhedonia, alexithymia, dependent personality, and subjective symptoms in schizophrenia.

Fernando Pérez-Diaz

Fernando Pérez-Diaz is a research engineer. He is currently working for the National Research Council in the Unit for Personality and adaptative behaviours at the Hôpital de la Salpétrière (Paris, France). His main interests are on statistical and mathematical models for addictive behaviors.

François Lang

François Lang, M.D., is professor of child and adolescent psychiatry and Head of the University Department of Child Psychiatry of Saint Etienne (France).

Jean Luc Venisse

Jean Luc Venisse, M.D., is a professor of psychiatry and Head of the Addiction Unit of the Psychiatry Department of the University Hospital Saint-Jacques of Nantes (France). He has largely contributed research on eating disorders and addictive disorders, and has co-edited several books on these topics.

Paul Bizouard

Paul Bizouard, M.D., is a professor of child and adolescent psychiatry and Head of the University Department of Psychiatry of Besançon (France).

Martine Flament

Martine Flament, M.D., Ph.D., psychiatrist, is a research fellow at the INSERM/CNRS UMR 7593. Her main interests are obsessive-compulsive disorders and addictive disorders in adolescents and young adults.

Olivier Halfon

Olivier Halfon, M.D., is a professor and Head of the Hospital Unit for Children and Adolescents, Department of Child and Adolescent Psychiatry, University of Lausanne (Switzerland). His main research interests are focused on addictive behaviors (bulimia nervosa, anorexia nervosa, drug abuse, and suicidal attempts), primarily from neurobiological and epidemiological point of view.

Philippe Jeammet

Philippe Jeammet, M.D., Ph.D., is a professor of adolescent psychiatry (University of Paris VI) and Head of the Adolescent and Young Adult Department of Psychiatry of the Institute Mutualiste Montsouris (Paris, France). He is currently the president of the European Society for Child and Adolescent Psychiatry. His main research interests are focused on psychodynamic treatments of eating disorders and depression.