Exploring the association of alexithymia and romantic attachment with quality of life and pain perception in systemic sclerosis

Introduction: Systemic Sclerosis (SSc) is a rare autoimmune connective tissue disease affecting the skin and internal organs, significantly impacting quality of life (QoL). Alexithymia and insecure romantic attachment may hinder coping and influence pain perception in chronic illness. This study aims to explore the associations among alexithymia, romantic attachment, pain perception, quality of life, and age in women with SSc, and to examine the predictive role of alexithymia, attachment dimensions and age on perceived physical quality of life using multiple linear regression analyses. Methods: Fifty women with SSc were recruited from a hospital in Rome. Participants completed a socio- demographic questionnaire, the 20-item Toronto Alexithymia Scale (TAS-20), the Experiences in Close Relationships–Revised (ECR-R), the Pain Visual Analogue Scale (pVAS), and the WHO Quality of Life Questionnaire–Brief Version (WHOQOL-BREF). Results: Participants had a mean age of 52.98 years (M = 52.98; SD = 12.87) and a mean SSc duration of 10.31 years (M = 10.31; SD = 8.84). TAS-20 scores negatively correlated with all QoL domains and total QoL (r = -0.303 to -0.672, all p < .01). Difficulty in Describing Feelings correlated positively with pain VAS (r = .312, p < .05). ECR-R Avoidance and Anxiety were negatively associated with several QoL dimensions. Difficulty in Describing Feelings emerged as a significant predictor of physical QoL dimension (B = −0.56, β = −.68, p < .001). Overall, 18% scored above the TAS-20 clinical cut-off. Overall, 18% scored above the TAS-20 clinical cut-off. Conclusions: The findings suggest that higher levels of alexithymia and insecure attachment are associated with poorer quality of life and greater pain perception in women with Ssc. In particular, difficulties in describing feelings appear to play a key role in the physical dimension of quality of life, pointing to the clinical relevance of emotion verbalization processes in this population. These results support the relevance of affective regulation processes as potential targets for psychological assessment and intervention in Ssc patients and highlight the importance of multidisciplinary care.