Alexithymia and global psychosocial functioning: A study on patients with skin disease Angelo Picardi a, 4 , Piero Porcelli b , Eva Mazzotti a , Giovanni Fassone a , Ilaria Lega a , Luisa Ramieri a , Emanuele Sagoni a , Paolo Pasquini a a Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, Rome, Italy b Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Italy Received 6 February 2006; received in revised form 11 July 2006; accepted 12 September 2006 Abstract Objective: The relationship between alexithymia and psycho- social functioning has been investigated in a few studies using indirect measures of adaptation. We aimed at directly evaluating the relationship between alexithymia and global psychosocial functioning, as measured by a standardised scale. Methods: A large, consecutive sample of dermatological inpatients (N=545) completed the 20-item Toronto Alexithymia Scale and the Skindex-29 and were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders and the Global Assessment of Functioning (GAF) scale. Results: Multiple regression analysis was used to control for likely determinants of psychosocial functioning such as age, sex, education, burden of skin symptoms, and psychiatric morbidity. The GAF score was associated with psychiatric morbidity (b=À.63, Pb.001), alexithy- mia (in particular, the difficulty identifying feelings subscale) (b=À.19, Pb.001), and burden of skin symptoms (b=À.07, Pb.05). Conclusion: Given the well-known association between poor psychosocial functioning and several behavioural risk factors for health, our study may provide a further reason for clinicians to pay attention to alexithymic features among their patients. D 2007 Published by Elsevier Inc. Keywords: Alexithymia; Psychosocial functioning; Global assessment of functioning; Dermatology Introduction Thirty years ago, the alexithymia construct was intro- duced as a group of cognitive and affective characteristics typical of patients with psychosomatic disorders [1]. In the last years, there has been a growing interest in the construct that is gradually being integrated in the broader field of emotion research and is currently viewed as a deficit in affect regulation [2,3]. A high prevalence of alexithymia has been found in patients with a variety of health problems [4], including skin diseases [5,6]. For some dermatological conditions, it may play a role as a risk factor, as alexithymia, insecure attachment, and poor social support were found to be associated with the onset of alopecia areata [7] and with exacerbations of vitiligo and plaque psoriasis [8,9]. These findings are consistent with the modern multifactorial model of illness, according to which psychosocial, biologic, and environmental factors interact reciprocally and lead to different clinical outcomes [10]. Patients with skin diseases suffer from various and multidetermined psychological problems, including reduced psychosocial functioning, impaired quality of life, and high prevalence of psychiatric disorders and other clinical conditions of psychosomatic interest such as demoralisa- tion, irritable mood, Type A behaviour, and somatic symptoms secondary to psychiatric disorders [5,11]. The multifactorial model of health and illness paves the way to 0022-3999/07/$ – see front matter D 2007 Published by Elsevier Inc. doi:10.1016/j.jpsychores.2006.09.002 4 Corresponding author. Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, Via dei Monti di Creta, 104 - 00167 Rome, Italy. Tel.: +39 06 66464306; fax: +39 06 66464307. E-mail address: a.picardi@idi.it (A. Picardi). Journal of Psychosomatic Research 62 (2007) 223 – 229