Alexithymia predicts attenuated autonomic reactivity, but prolonged recovery to anger recall in young women

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Abstract

Alexithymia has been prospectively associated with all-cause mortality and with cardiovascular morbidity. Here, stress-induced autonomic reactivity and recovery were examined as potential pathways linking alexithymia to cardiovascular disease. The relation of alexithymia to blood pressure, heart rate, and other cardiovascular parameters derived from impedance cardiography (N=80) and heart rate variability (N=40) was evaluated during rest, an anger recall task and recovery in women (ages 18–30). During anger recall, alexithymia was associated with significantly attenuated heart rate and stroke index reactivity, greater low frequency power, and with marginally dampened blood pressure and high frequency power reactivity. Overall, this response pattern suggests blunted sympathetic activation and diminished vagal withdrawal. Alexithymia was also related to slower diastolic blood pressure and quicker preejection period recovery implying abbreviated sympathetic arousal and possibly greater vagal modulation. These results impart some evidence for the hypoarousal model of alexithymia during reactivity, but the hyperarousal model during recovery. Autonomic dysregulation during and following acute emotional stress is suggested as a possible physiological pathway connecting alexithymia to cardiovascular disease.

Introduction

Alexithymia has traditionally been described as having difficulties with identifying, describing, regulating, and expressing one's emotions Sifneos, 1973, Taylor et al., 1985. This cognitive–affective construct has also been related to being preoccupied with external events, having problems with distinguishing among thoughts, feelings, and bodily sensations, and having a poverty of imagination, daydreams and fantasies (Taylor et al., 1985). Alexithymia has been prospectively associated with all-cause mortality (Kauhanen et al., 1996) and has shown cross-sectional relations to hypertension (Jula et al., 1999) myocardial infarction (Kojima et al., 2001), coronary artery spasm (Numata et al., 1998) and coronary heart disease (Kauhanen et al., 1996).

It is thought that alexithymia may influence cardiovascular and other organic diseases through several physiological, behavioral, cognitive, or social pathways. For instance, Lumley et al. (1996) reviewed several studies showing that alexithymia was associated with negative affect, unhealthy behaviors, nonadherence to medical regimens, and social isolation (also see Linden et al., 1996, Waldstein et al., 2002, Fukunishi et al., 1999, Friedlander et al., 1997, Nemiah et al., 1997, Newton and Contrada, 1994, Wehmer et al., 1995, Berenbaum and Irvin, 1996, Haviland et al., 1988, Kauhanen et al., 1991, Lumley and Norman, 1996, Valkamo et al., 2001). However, more research is needed with respect to the exploration of potential physiological pathways connecting alexithymia to cardiovascular disease.

In this regard, it has been hypothesized that autonomic nervous system (ANS) dysregulation may play a mechanistic role underlying the relation of alexithymia and cardiovascular health Lumley et al., 1996, Linden et al., 1996, Waldstein et al., 2002, Fukunishi et al., 1999, Friedlander et al., 1997. Dysregulation of the autonomic nervous system (i.e., reduced basal parasympathetic and/or exaggerated activation of sympathetic modulation of heart rate and contractility) has been hypothesized to play a role in cardiovascular disease pathogenesis (e.g., Sloan et al., 1999, Kop, 1999, Kop, 2003, Rozanski et al., 1999). However, two opposing models have emerged in the prior literature with respect to alexithymia and ANS regulation—the hypoarousal versus the hyperarousal model of alexithymia. The hypoarousal model of alexithymia posits that dampened sympathetic nervous system activation and limited affective reactivity is associated with alexithymia during emotional provocation. In contrast, the hyperarousal model poses that alexithymia is related to higher tonic levels of sympathetic activity and/or exaggerated sympathetic reactivity (and possibly parasympathetic withdrawal) to emotional stressors. If alexithymia is indeed associated with hyperarousal, then it is possible that this personality factor may be linked to cardiovascular disease pathogenosis via enhanced cardiovascular reactivity Lumley et al., 1996, Linden et al., 1996, Waldstein et al., 2002, Fukunishi et al., 1999, Friedlander et al., 1997, Nemiah et al., 1997, Newton and Contrada, 1994, Wehmer et al., 1995, Berenbaum and Irvin, 1996, Rozanski et al., 1999, Davis et al., 2000, Everson et al., 1995, Prkachin et al., 2001, Neumann and Waldstein, 2001, Sinha et al., 1992. However, as reviewed below, evidence for hyperarousal versus hypoarousal has been mixed in psychophysiological studies of alexithymia.

Several studies have investigated the association between alexithymia and tonic and acute ANS responses to laboratory-based stressors Linden et al., 1996, Waldstein et al., 2002, Fukunishi et al., 1999, Friedlander et al., 1997, Nemiah et al., 1997, Newton and Contrada, 1994, Wehmer et al., 1995 using reliable and well-validated measures of alexithymia such as the Toronto Alexithymia Scale (Taylor et al., 1985). In support of the hypoarousal model, three studies (i.e., Linden et al., 1996, Newton and Contrada, 1994, Wehmer et al., 1995) found that alexithymic men and women displayed attenuated heart rate responses to emotion-provoking tasks. Additionally, Friedlander et al. (1997) found attenuated heart rate reactivity for women, but not for men. Another study (Nemiah et al., 1997) found smaller increases in oxygen consumption during mental arithmetic and emotional imagery among alexithymic men and women. In contrast, Waldstein et al. (2002) found support for the hyperarousal model. These authors found that, in a sample of older men, alexithymia was related to exaggerated blood pressure reactivity to anger-provoking tasks. Thus, five of six studies supported the hypoarousal model of alexithymia, whereas one found evidence for the hyperarousal model of alexithymia during stress.

Tonic levels of physiological function have also been examined with respect to alexithymia, and provide support for the hyperarousal model. Three of seven studies Fukunishi et al., 1999, Friedlander et al., 1997, Newton and Contrada, 1994 suggest that alexithymia is associated with higher baseline levels of sympathetic activity (i.e., sympathovagal balance as measured by heart rate variability) (Fukunishi et al., 1999), skin conductance (Friedlander et al., 1997), and heart rate (Newton and Contrada, 1994)) in groups of relatively young men and women.

In light of the inconsistent findings regarding alexithymia and autonomic function, the present study further examined the relation of alexithymia to resting and reactive autonomic activity. Measures of autonomic poststress recovery were also examined given that prolonged poststress recovery may be another important linkage between alexithymia and cardiovascular disease (Friedlander et al., 1997). Consistent with the prior literature, and since alexithymics are acknowledged to have various problems with emotion recognition and expression, an emotion (specifically anger) provoking task was used here to elicit autonomic activation.

It has also been hypothesized that alexithymics experience problems with accurately characterizing their affective responses to emotional stressors which can result in discordant self-ratings of affect in comparison to their physiological and behavioral responses Lumley et al., 1996, Newton and Contrada, 1994, Berenbaum and Irvin, 1996. For instance, Newton and Contrada (1994) found that compared to nonalexithymics, alexithymic women reported greater negative affect, but evinced lower heart rate responses to a speech task. Similarly, Berenbaum and Irvin (1996) found that although alexithymic men and women displayed greater nonverbal anger responses during an anger provocation task, they reported their experiences as more pleasant than their counterparts. In contrast, Friedlander et al. (1997) found that alexithymic women concordantly reported greater self-reported displeasure and arousal concomitant with greater electrodermal activity than their nonalexithymic counterparts. Moreover, Waldstein et al. (2002) noted no significant differences between alexithymics' and non-alexithymics' state affect ratings despite the enhanced cardiovascular reactivity found among alexithymic men. Due to these inconsistencies, it remains unclear whether negative affect is directly related to ANS function in alexithymics. Consequently, self-reported state anger was examined here in relation to resting, reactive, and recovery measures of ANS function.

The primary purpose of the present study was to investigate the relations among alexithymia, resting autonomic function, and autonomic reactivity (i.e., blood pressure, heart rate, impedance derived measures and HRV) induced by a personally relevant anger recall task, and poststress recovery in healthy, young women. This study contributes to the prior research by utilizing both impedance cardiography and heart rate variability measures when investigating cardiovascular reactivity and recovery in relation to alexithymia. As a secondary aim, state anger was examined in association with alexithymia and concurrent physiological function. In light of the evidence presented thus far, it was hypothesized that, upon evaluating the relation between alexithymia and autonomic measures during the baseline, task, and recovery periods in separate multiple regression analyses: (1) Alexithymia would be associated with higher tonic cardiovascular function and sympathetic activity (and possibly lower vagal tone). (2) Alexithymia would be related to smaller changes in cardiovascular and autonomic reactivity during the anger recall task and thus quicker recovery (return to baseline). (3) Alexithymia would be associated with greater self-reported state anger (discordant with physiological findings) at rest and during the task and recovery periods.

Section snippets

Participants

The sample and relevant data of the present investigation were derived from a previous study examining the effects of hostility and distraction on cardiovascular and autonomic recovery (Neumann et al., in press). Eighty female university students (18–30 years) were recruited from introductory psychology courses and from advertisements at the University of Maryland, Baltimore County (UMBC). The sample included 54% Caucasian, 34% African-American, and 12% Asian-American participants approximating

Procedures

Each participant was seated in a sound-attenuated, temperature-controlled room. They completed a 15-min baseline period, a 3-min anger recall task, and a 10-min recovery period. Participants were asked to rest quietly and to try not to move around, talk, or sleep during the rest period. For the task, the experimenter provided instructions for the personally relevant anger recall task Valkamo et al., 2001, Neumann and Waldstein, 2001, Neumann et al., in press, Ironson et al., 1992, Waldstein et

Preliminary analyses

TAS scores ranged from 35 to 86 (M=61, S.D.=12) with 11 (13%) participants scoring in the clinical range. The distribution of high and low alexithymia participants were uniformly distributed between the distraction conditions (Chi-square=0.014, n.s.). Pearson r correlations or analysis of variance (ANOVA) were performed to examine the relation of alexithymia to sample characteristics (i.e., age, education, BMI, self-reported average alcohol and caffeine consumption, parental history of

Discussion

The present study examined the relation of alexithymia to autonomic reactivity during a personally relevant anger recall task and poststress recovery using impedance cardiography and heart rate variability measures. Results of the investigation revealed that alexithymia was related to select measures of autonomic dysregulation during and following anger recall. However, alexithymia was not related to higher tonic autonomic function, nor was it associated with state anger at rest or during anger

Conclusions

In sum, our results suggest that greater levels of alexithymia are related to attenuated autonomic reactivity to angry events, but prolonged recovery following anger in young women. Our findings impart some evidence for the hypoarousal model of alexithymia during anger provoking events, but the hyperarousal model during recovery. Overall, these results suggest that autonomic nervous system dysregulation during and following emotion provocation may, at least in part, play a role in the

Acknowledgements

This research was supported, in part, by the National Institutes of Health Grant AG15112 and HL07560-19.

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