Psychopathology of Alexithymia and Multiple Sclerosis

The notion of alexithymia was introduced by Sifneos (Psychother Psychosom 22:255-62, 1973) to define a set of affective and cognitive characteristics observed in patients with psychosomatic diseases. Alexithymia appears to be a multidimensional and transnosographic concept ranging from normal to pathological, and it is important to regard alexithymia as a disorder of emotional regulation, which can be found in different populations and not only in somatic diseases. We present here the many theories of alexithymia (cognitive, neuropsychological, cultural, psychological (attachment theory), and psychoanalytical conceptions) and some evaluation tools to assess alexithymia (quantitative methods: TAS, BIQ) or qualitative methods (Rorschach, analysis of discourse). Alexithymia has been frequently observed in subjects with MS, reflecting a form of emotional disturbance related to the traumatic aspects of the disease. But it may also constitute a form of defense by the freezing or the denial of emotions, which allows patients to adapt psychologically to the situation by reducing distress. It is necessary to take these problems of emotional regulation into account and above all to understand what meaning the patient gives to these difficulties.