The relationship between alexithymia, shame, trauma, and body image disorders: investigation over a large clinical sample

Figures & data

Table 1 Average values (±SD) of the total sample and each diagnostic group

	Anorexia nervosa (n = 67)	Bulimia nervosa (n = 52)	EDNOS patterns (n = 24)	P-value
TAS-20	55.5 ± 12.0	57.7 ± 12.2	55.7 ± 13.6	ns
Alexithymia
F1	3.03 ± 0.92	3.31 ± 1.00	3.12 ±1.15	ns
Difficulty in identifying feelings
F2	3.18 ± 0.95	3.32 ± 1.05	3.23 ± 1.06	ns
Difficulty in describing feelings
F3	2.31 ± 0.63	2.21 ± 0.67	2.25 ± 0.60	ns
Externally oriented thinking
ESS	63.6 ± 17.8	69.1 ± 19.1	74.4 ± 18.5	<0.05
Shame feelings
DES-II	17.6 ± 12.9	24.4 ± 15.5	26.7 ± 19.4	<0.05*
Dissociation
TSI-A	1.15 ± 0.50	1.36 ± 0.56	1.39 ± 0.55	ns
Perceived traumatic experiences
TSI-A	0.95 ± 0.67	1.28 ± 0.77	1.23 ± 0.78	<0.05
Intrusive experiences
TSI-A	1.38 ± 0.61	1.61 ± 0.77	1.63 ± 0.73	ns
Impaired self-reference
TSI-A	1.48 ± 0.81	1.82 ± 0.79	1.84 ± 0.89	<0.05
Depression
TSI-A	1.00 ± 0.61	1.41 ± 0.74	1.39 ± 0.76	<0.005
Dissociation
BUT-GSI	1.84 ± 1.15	2.50 ± 1.19	2.55 ± 1.22	0.005
Global severity index
BUT-PST	18.2 ± 10.2	20.8 ± 9.7	24.2 ± 11.6	0.05
Positive symptom total
BUT-A	2.47 ± 1.41	3.19 ± 1.34	3.04 ± 1.28	0.05*
Fear of weight gain
BUT-A	2.06 ± 1.34	2.62 ± 1.36	2.75 ± 1.44	0.005
Body image concerns
BUT-A	1.19 ± 1.12	1.77 ± 1.34	2.10 ± 1.25	0.005
Avoidance
BUT-A	1.56 ± 1.25	2.19 ± 1.28	2.47 ± 1.33	0.005
Depersonalization

Notes: Statistically significant differences as detected by ANOVA and Kruskal–Wallis test. One-way analysis of variance for multiple comparisons (Bonferroni test) and Kruskal–Wallis test*.

Abbreviations: EDNOS, eating disorder not otherwise specified; TAS-20, Toronto Alexithymia Scale-20; F1, factor one; F2, factor two; F3, factor three; ESS, Experience of Shame Scale; DES-II, Dissociative Experience Scale-II; TSI-A, Trauma Symptom Inventory-Alternate Version; BUT-GSI, Body Uneasiness Test Global Severity Index; BUT-PST, Body Uneasiness Test Positive Symptom Total; BUT-A, Body Uneasiness Test Global Severity Index; ns, not significant.

Table 2 Correlations between subjective measures and patients’ age

Total ED sample	BUT-GSI	BUT-PST	ESS	TAS-20	TSI-A	DES-II
Correlation index vs age (level of significance)	r = 0.205 (P < 0.05)	r = 0.178 (P < 0.05)	r = 0.176 (P < 0.05)	r = −0.049 (ns)	r = 0.068 (ns)	r = 0.017 (ns)

Abbreviations: ED, eating disorder; BUT-GSI, Body Uneasiness Test Global Severity Index; BUT-PST, Body Uneasiness Test Positive Symptom Total; ESS, Experience of Shame Scale; TAS-20, Toronto Alexithymia Scale-20; TSI-A, Trauma Symptom Inventory-Alternate Version; DES-II, Dissociative Experience Scale-II; ns, not significant.

Table 3 Correlations among TAS-20, ESS, DES-II, and TSI-A

Correlation index with	Anorexia nervosa				Bulimia nervosa				EDNOS patterns
	TAS-20	ESS	DES-II	TSI-A	TAS-20	ESS	DES-II	TSI-A	TAS-20	ESS	DES-II	TSI-A
TAS-20	–	r = 0.55 P < 0.0001	r = 0.49 P < 0.0001	r = 0.47 P < 0.0001	–	r = 0.39 P < 0.01	r = 0.46 P < 0.001	r = 0.52 P < 0.001	–	ns	r = 0.53 P < 0.05	r = 0.47 P < 0.05
ESS	r = 0.55 P < 0.0001	–	r = 0.51 P < 0.0001	r = 0.71 P < 0.0001	r = 0.39 P < 0.01	–	r = 0.53 P < 0.0001	r = 0.61 P < 0.0001	ns	–	ns	Correlates with some subscales
DES-II	r = 0.49 P < 0.0001	r = 0.51 P < 0.0001	–	r = 0.62 P < 0.0001	r = 0.46 P < 0.001	r = 0.53 P < 0.0001	–	r = 0.66 P < 0.0001	r = 0.53 P < 0.05	ns	–	r = 0.55 P < 0.05
TSI-A	r = 0.47 P < 0.0001	r = 0.71 P < 0.0001	r = 0.62 P < 0.0001	–	r = 0.52 P < 0.001	r = 0.61 P < 0.0001	r = 0.66 P < 0.0001	–	r = 0.47 P < 0.05	Irritability: r = 0.45, P < 0.05; depression: r = 0.49, P < 0.05; impaired self-reference: r = 0.61, P < 0.005	r = 0.55 P < 0.05	–

Abbreviations: TAS-20, Toronto Alexithymia Scale-20; ESS, Experience of Shame Scale; DES-II, Dissociative Experience Scale-II; TSI-A, Trauma Symptom Inventory-Alternate Version; EDNOS, eating disorder not otherwise specified; ns, not significant.

Table 4 Correlations between BUT-GSI and BUT-PST and the other variables

Dependent variable	Anorexia nervosa		Bulimia nervosa		EDNOS patterns
	BUT-GSI	BUT-PST	BUT-GSI	BUT-PST	BUT-GSI	BUT-PST
Correlation index vs	ESS	ESS	ESS	DES-II	TSI-A	No correlation
	r = 0.71, P < 0.0001	r = 0.49, P < 0.0001	r = 0.67, P < 0.0001	r = 0.31, P < 0.05	perceived traumatic conditions
	TAS-20	TSI-A	TSI-A	TAS-20 F1	r = 0.53, P < 0.0001
	r = 0.48, P < 0.0001	Perceived traumatic conditions	depression	r = 0.35, P < 0.05	TAS-20 F1
	TSI-A	r = 0.49, P < 0.0001	r = 0.66, P < 0.0001	ESS	r = 0.65, P < 0.0001
	Perceived traumatic conditions	TAS-20 F1	TSI-A	r = 0.38, P < 0.01	DES-II
	r = 0.44, P < 0.0001	r = 0.58, P < 0.0001	dissociation	TSI-A	r = 0.55, P < 0.01
	DES-II	DES-II	r = 0.59, P < 0.0001	depression	ESS
	r = 0.44, P < 0.0001	r = 0.44, P < 0.0001	TAS-20 F1	r = 0.48, P < 0.0001	r = 0.49, P < 0.05
			r = 0.54, P < 0.0001
Multiple regression vs	ESS	TAS-20 F1	ESS	TSI-A depression	TSI-A
	R^2 = 0.53, P < 0.0001	R^2 = 0.33, P < 0.0001	R^2 = 0.58, P < 0.0001	R^2 = 0.29, P < 0.0001	perceived traumatic conditions
			TSI-A dissociation		R^2 = 0.69, P < 0.0001
			R^2 = 0.08, P < 0.001

Abbreviations: BUT-GSI, Body Uneasiness Test Global Severity Index; BUT-PST, Body Uneasiness Test Positive Symptom Index; EDNOS, eating disorder not otherwise specified; ESS, Experience of Shame Scale; TAS-20, Toronto Alexithymia Scale-20; TSI-A, Trauma Symptom Inventory-Alternate Version; DES-II, Dissociative Experience Scale-II; F1, factor one.