Alexithymia in multiple sclerosis: A systematic review of literature

Alexithymia is a multidimensional personality construct characterized by difficulties identifying and describing one's feelings, and externally oriented thinking. Although extensively reported in psychiatric patients, little attention has been paid regarding its occurrence and its pathophysiology in the context of multiple sclerosis (MS).

A research was conducted according to the PRISMA guidelines aiming to identify original research articles in English and French languages about alexithymia in MS. Computerized databases (MEDLINE, PubMed, Scopus) were consulted. The key terms used were the following: ('multiple sclerosis' OR 'MS') AND ('alexithymia' OR 'alexithymic' OR 'emotion processing' OR 'emotion awareness' OR 'Toronto Alexithymia Scale' OR 'Bermond-Vorst Alexithymia Questionnaire') AND ('imaging' OR 'neuroimaging' OR 'magnetic resonance imaging' or 'MRI'). References of the retrieved papers were scanned manually aiming to get additional sources.

14 papers matched the above criteria. The prevalence of alexithymia in MS ranges from 10% to 53%. It seems to be associated with anxiety, depression, fatigue, and some social cognitive aspects. Its relationship with clinical and classical cognitive variables was rarely assessed. Finally, only one study has addressed its pathophysiology and has suggested an aberrant interhemispheric transfer.

Admitting the prevalence of alexithymia in MS and its potential negative impact on the quality of life and interpersonal communication, screening for it is relevant for a better management. Its relationship with clinical, emotional and cognitive confounders merits to be further evaluated. Large-scale studies, employing neuroimaging techniques, are greatly needed in order to disentangle the neural underpinnings of this trait in MS.