Affect regulation in alexithymia - An ethological study of displacement behavior during psychiatric interviews

Displacement activities (i.e., self-directed behaviors such as self-touchin g, scratching, and self-grooming) are a reliable ethological indicator of i ncreased emotional and physiological arousal throughout the phylogenetic sc ale. We hypothesized that, in alexithymic individuals, the failure to regul ate cognitively distressing emotions might result in increased displacement behavior. The nonverbal behavior of 30 patients with depressive or anxiety disorders was video-recorded during psychiatric interviews and analyzed us ing an ethological scoring system. Before being interviewed, each patient c ompleted the Twenty-Item Toronto Alexithymia Scale (TAS-20), the Beck Depre ssion Inventory (BDI), and the state form of the State-Trait Anxiety Index (STAI-S). Ethological data confirmed the hypothesis of the study. The patie nts with more pronounced alexithymic features showed a significantly higher frequency of displacement activities during interviews. At the same time, these patients reported levels of self-rated anxiety and depression equival ent to those reported by nonalexithymic patients. Such a dissociation betwe en cognitive appraisal of emotion and nonverbal behavior reflecting increas ed emotional arousal supports the view that alexithymia implies a failure t o elevate emotions from a preconceptual level of organization to the concep tual level of mental representations.