The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.