Alexithymia, somatization and distress in a chronic pain sample

Objective: To investigate whether chronic pain (CP) patients with somatization have higher alexithymic features; to examine whether pain and distress symptoms mediate the relationship between alexithymia and somatization in CP patients. Method: One hundred thirty-five CP patients were evaluated for alexithymia, somatization, distress, quality of life and pain. Alexithymia was measured with the TAS‐20; somatization was assessed using the PHQ-15; depression and anxiety symptoms were evaluated with the HADS; quality of life was assessed using SF-12; and pain was measured using the BPI. Results: Patients with somatization (37.04%) reported significantly higher TAS‐20 total scores (p < .001) and difficulty in identifying feelings (DIF) (p < .001) than those without somatization. The somatizer group had also a significantly higher disease duration, severity and interference of pain, distress, and a lower quality of life than the non-somatizer group. A hierarchical regression analysis was used to select predictors of somatization. The results showed that the model explained 55% of somatization when the TAS‐20 components, specifically DIF (β = .31; p = .001), were included as predictors. The mediation analysis showed that DIF affected somatization along different pathways. DIF was found as a major factor influencing somatization both directly (p < .001) and above all through the mediation of interference of pain (p < .001) and distress (p < .001). Conclusions: Our study suggests that alexithymia, specifically DIF, may be considered a major psychological factor for somatization risk in CP patients. Longitudinal studies are needed for investigating the role of alexithymia in clinical outcomes.