Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV Roger C. McIntosh a,⇑ , Gail Ironson a , Michael Antoni a , Mahendra Kumar b , Mary Ann Fletcher c , Neil Schneiderman a a Department of Health Psychology, University of Miami, Miami, FL, USA b Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA c Department of Medicine, Immunology and Psychology, University of Miami Miller School of Medicine, Miami, FL, USA article info Article history: Received 14 June 2013 Received in revised form 22 October 2013 Accepted 25 October 2013 Available online xxxx Keywords: HIV/AIDS Alexithymia Norepinephrine Cortisol Viral load Depression Stress Executive function abstract The neuropathological changes resulting from Human Immunodeficiency Virus (HIV) infection may man- ifest in alexithymia (AL), a multidimensional trait characterized by impairments in the cognitive assim- ilation of feelings and emotions. A sample of 93 HIV survivors scoring high, i.e., P74 on the 26-item Toronto Alexithymia Scale (TAS-26), were compared to 79 low AL (TAS-26 6 54) survivors on measures of neurocognitive, psychological, neuroendocrine and immune function. Neurocognitive function was evinced by a standardized test of psychomotor speed, cognitive flexibility and task switching ability, HIV Dementia and general cognitive status. Patients were also screened for levels of depression, anxiety and psychological stress. A 24-h urinary norepinephrine (NE) and cortisol (CORT) collection was taken; blood was drawn for T lymphocyte subset counts (CD4+CD3+) and HIV-1 viral load. Alexithymic patients exhibited higher levels of executive dysfunction, psychological distress, norepinephrine-to-cortisol (NE/ CORT) ratio and viral load. Linear regression models accounting for sociodemographic and disease-related variables revealed two AL subscales, difficulties identifying and describing feelings, predicted and explained a significant proportion of variance in the outcome measures. Specifically, poorer executive task-switching/cognitive flexibility was associated with greater difficulty describing feelings; dysregu- lated autonomic response (high NE/CORT ratio) and depressive symptoms were predicted by difficulty identifying feelings; higher levels of anxiety and psychological stress were both predicted by greater dif- ficulty describing and identifying feelings. Overall, the psychoneuroimmunological profile of alexithymia in HIV positive persons at mid-stage of infection suggests a greater vulnerability for disease progression. Ó 2013 Elsevier Inc. All rights reserved. 1. Introduction Alexithymia (AL) is construed as a stable personality trait char- acterized especially by poor assimilation of thoughts, feelings and emotions (Honkalampi et al., 2001; Martin and Pihl, 1985; Parker and Taylor, 1997; Picardi et al., 2005; Luminet et al., 2007; Taylor, 2004). Several brain regions and their associated networks have been implicated in alexithymic behavior suggesting a neurobio- logical underpinning for the trait. Amongst the cortical structures implicated include dysfunctional interhemispheric processing via the corpus callosum (Bermond et al., 2005), reduced volume and activity within the anterior cingulate cortex (ACC) (Frewen et al., 2008; Gündel et al., 2004; Kano et al., 2003; Lane et al., 1997), dys- functional connectivity of the insular cortex (Bird et al., 2010), and abnormal activity within the amygdala and striatum (Larsen et al., 2003; Moriguchi and Komaki, 2013; Taylor and Bagby, 2004). Evi- dently, impaired psychosomatic processing attributed to AL can have a negative impact on psychological and immune outcomes in patient and non-patient populations alike (Guilbaud et al., 2003; Lumley et al., 1996; Lumley, 2004; Martin and Pihl, 1985; Taylor et al., 1985, 1997). Those infected with the Human Immuno- deficiency Virus (HIV) may be particularly vulnerable to the devel- opment of AL due to (1) the constellation of overlapping brain regions and cognitive abilities altered by the virus (Bogdanova et al., 2010; Kallianpur et al., 2012; Pfefferbaum et al., 2012), 555(2) reports of undifferentiated emotional processing and blunted electrocortical response during the regulation of emotion (McIntosh et al., 2013; Tartar et al., 2013), and (3) evidence of AL-induced somatoform and stress-related disorders manifesting into dysfunctional psychoimmune functioning in HIV positive adults (Lumley et al., 2007; Temoshok et al., 2008). Despite this, no single study has examined AL in HIV across neuro cognitive, neuroendocrine, psychological and immune domains. 0889-1591/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.bbi.2013.10.024 ⇑ Corresponding author. Address: Department of Health Psychology, University of Miami, Miami, FL 33124, USA. Tel.: +1 305 243 1467; fax: +1 305 243 128. E-mail address: rmcintosh@psy.miami.edu (R.C. McIntosh). Brain, Behavior, and Immunity xxx (2013) xxx–xxx Contents lists available at ScienceDirect Brain, Behavior, and Immunity journal homepage: www.elsevier.com/locate/ybrbi Please cite this article in press as: McIntosh, R.C., et al. Alexithymia is linked to neurocognitive, psychological, neuroendocrine, and immune dysfunction in persons living with HIV. Brain Behav. Immun. (2013), http://dx.doi.org/10.1016/j.bbi.2013.10.024