Type 1 diabetes is associated with alexithymia in nondepressed, non-mentally ill diabetic patients: a case-control study

J Psychosom Res. 2009 Oct;67(4):307-13. doi: 10.1016/j.jpsychores.2009.04.011. Epub 2009 Jun 23.


Objective: Alexithymia refers to difficulty in identifying and expressing emotions, and it is a characteristic common to several psychiatric and medical conditions, including autoimmune disorders. Type 1 diabetes (T1D) is an autoimmune disorder with increased psychiatric comorbidity. Previously reported associations between alexithymia and T1D may have been confounded by the presence of depression. The central aim of this study was to examine alexithymia levels in psychiatrically uncomplicated T1D outpatients with that of nondiabetic controls.

Methods: Ninety-six T1D patients without any DSM-IV Axis I diagnoses and 105 age- and sex-matched healthy controls entered the study. Alexithymia and depressive symptoms were assessed with the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory (BDI-21), respectively. Multivariate regression models were used to evaluate the association of alexithymia with the presence of diabetes, duration of diabetes, diabetes control, parameters of treatment intensification, and diabetic complications.

Results: T1D was positively associated with the TAS-20 "identifying feelings" (beta coefficient=2.64, P=.003) and "externally oriented thinking" (beta coefficient=1.73, P=.011) subscales. The prevalence of overall alexithymia (TAS-20 total score, > or =60) was 22.2% in T1D patients and 7.6% in the controls (OR, 4.6; 95% CI, 1.7-12.8). TAS-20 scores were positively associated with diabetes duration and negatively with treatment intensification parameters.

Conclusions: Alexithymia is higher in psychiatrically uncomplicated T1D patients than in healthy controls even after adjustment for confounding depressive symptoms; it is greater with longer diabetes duration and is associated with some reduced parameters of treatment intensification but not with worse outcome in terms of glycemic control or somatic complications.

MeSH terms

  • Adult
  • Affective Symptoms / blood
  • Affective Symptoms / diagnosis
  • Affective Symptoms / psychology*
  • Coronary Disease / blood
  • Coronary Disease / psychology
  • Depression / blood
  • Depression / diagnosis
  • Depression / psychology
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / psychology*
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / psychology
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / psychology
  • Disease Progression
  • Female
  • Glycated Hemoglobin / analysis
  • Health Behavior
  • Humans
  • Male
  • Middle Aged
  • Personality Inventory
  • Self Care / psychology


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human