Alexithymic features in stroke: Effects of laterality and gender

Objective: Stroke patients suffer from a high rate of behavioral disorders, and the laterality of the lesion may affect the expression of emotional di sturbances. This study tested the hypothesis that Stroke patients with a le sion in the right hemisphere are at high risk of developing alexithymic fea tures. Methods: Forty-eight patients were interviewed with the Structured C linical Interview for DSM-IV (patient edition), the Mini-Mental State Exami nation, the State-Trait Anxiety Inventory (state form), the Beck Depression Inventory, and the Toronto Alexithymia Scale (20-item version). Alexithymi c differences between stroke patients with a lesion in the right hemisphere and those with a lesion in the left hemisphere were computed by analysis o f covariance, using scores on the Mini-Mental State Examination, Beck Depre ssion Inventory (psychic subscore), and State-Trait Anxiety Inventory as co variates and the score on the Toronto Alexithymia Scale as the dependent va riable. A multivariate analysis of covariance and a series of follow-up ana lyses of covariance with the same covariates were used to discriminate diff erences in Subscores on the Toronto Alexithymia Scale, An exploratory analy sis of covariance was also performed to determine the effect of gender on a lexithymic features in both groups of stroke patients. Results: The 21 stro ke patients with a lesion in the right hemisphere were more alexithymic tha n the 27 patients with a lesion in the left hemisphere. This evidence was s trengthened by the categorical analysis: 48% of the patients with a right-h emisphere lesion had alexithymia, compared with 22% of patients with a left -hemisphere lesion. Univariate analyses of covariance showed significant di fferences between the two groups in difficulty identifying feelings and dif ficulty describing feelings, but not in externally oriented thinking. The l ast exploratory analysis of covariance suggested that gender may influence alexithymic features. Conclusions: This study provides direct evidence that alexithymia, and more specifically difficulty identifying feelings and dif ficulty describing feelings, is more common in stroke patients with a right -hemisphere lesion than in those with a left-hemisphere lesion. It also pro vides preliminary evidence that gender may affect alexithymic expression.