Alexithymia in panic disorder and social phobia

Two recent studies have found that small samples of panic disorder patients appear to have elevated levels of alexithymia and raised the possibility that panic patients may constrict emotional experience. An alternate hypothesis is that there is conceptual and measurement overlap between alexithymia and cognitive aspects of panic disorder, and panic patients may in fact score high on only one dimension of alexithymia. One hundred panic disorder patients and 46 social phobics completed the revised 20-item Toronto Alexithymia Scale (TAS) and several anxiety-related measures. Thirty-four percent of panic patients and 28.3% of social phobics were classified as alexithymics, a nonsignificant difference. However, the alexithymia dimension related to difficulties in identifying and differentiating emotions and physical sensations was significantly elevated as compared with the alexithymia dimension related to external-oriented thinking. The former dimension was also significantly correlated with anxiety measures. The apparent finding that a sizeable proportion of panic patients are alexithymic may be an artifact of conceptual and psychometric overlap with cognitive aspects of panic disorder, specifically the interoceptive focus and sensitivity often associated with panic attacks.