Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder

Abstract

Background and objectives

Avoidant Personality Disorder (AvPD) is considered a mild to moderate personality disorder. However, few studies have focused on the heterogeneity of AvPD in terms of symptoms and severity. In the current study we set out to replicate and extend earlier findings showing that there is variation among patients with AvPD in terms of alexithymia and, further, that this variation is especially associated with specific facets of personality functioning and is not explained by measures of depression, symptom severity, or co-occurring personality disorder traits.

Method

We used intake data from a sample of AvPD patients (n = 56) who had been treated in similar outpatient services. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). Patients filled out questionnaires that were analysed using linear regression models.

Results and conclusions

Using well-established cut-off points for low, intermediate and high levels of alexithymia we found an almost equal distribution of alexithymia groups in our sample. Alexithymia was associated with higher personality dysfunction on twelve out of sixteen facets of personality functioning. For eight of these personality facets the alexithymia total score explained significant variance even after controlling for self-reported depression, symptom severity and clinician ratings of personality disorder. Results suggest that AvPD is heterogeneous and that alexithymia may be important as an indicator of severity of specific personality dysfunction.

Keywords:

• Avoidant personality disorder
• personality functioning
• alexithymia

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Notes on contributors

Sebastian Simonsen

Sebastian Simonsen, PhD, is a senior researcher at Stolpegaard Psychotherapy Centre. His research focuses on psychopathology and psychotherapy for personality disorders. He is certified as an mentalization based therapist.

Ingeborg Ullveit-Moe Eikenaes

Ingeborg Ullveit-Moe Eikenæs, MD, PhD, is head of the National Advisory unit for Personality Psychiatry (NAPP), Oslo University Hospital, Norway. Her research has mainly focused on avoidant personality disorder and the DSM-5-AMPD.

Bo Bach

Bo Bach, PhD, is Research Manager of the Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse. His research mainly focuses on instruments and clinical guidelines for assessment and treatment of ICD-11 personality disorders. He is a supervisor and trainer in schema therapy.

Elfrida Kvarstein

Elfrida Hartveit Kvarstein, MD, PhD is Head senior consultant at the Personality Psychiatry Section, Oslo University Hospital and Associate professor at the University of Oslo. She is leader of the research group of Personality Psychiatry which has a main focus on clinical research on understanding and treatment for personality disorder.

Matthias Gondan

Matthias Gondan, prof., dr. rer. nat. habil., is head of the research group for Quantitative Methods in Psychology at the University of Innsbruck, Austria. His research focuses on measurement problems and knowledge representation, and he supports clinical studies in medicine and psychotherapy research.

Stine Bjerrum Møller

Stine Bjerrum Moeller, PhD, Associate Professor at Department of Psychology University of Southern Denmark. She is a licensed clinical psychologist with extended experience in training and supervision. Her research focus on psychotherapy, mainly within depression and PTSD with special interests in assessment, rumination and anger.

Theresa Wilberg

Theresa Wilberg, MD, PhD, senior researcher and professor at Department for Research and Innovation, Clinic for Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo. Her research focuses on treatment and course of personality disorders, including avoidant personality disorder, social cognition and mentalization based therapy.