Alexithymie et toxicomanie : lien avec la dépression (original) (raw)

2004, Encephale-revue De Psychiatrie Clinique Biologique Et Therapeutique

Abstract

L’hypothèse principale de cette étude est de confirmer la prévalence élevée de l’alexithymie chez les toxicomanes en vérifiant son indépendance par rapport aux variables sociodémographiques (sexe, âge, catégorie socioprofessionnelle). Dans un deuxième temps, le lien entre alexithymie et état dépressif chez les toxicomanes est étudié. Pour ce faire, un échantillon de 128 toxicomanes répondant aux critères DSM IV de dépendance aux substances psychoactives (alcool exclu) a été apparié selon les variables sociodémographiques à un échantillon témoin de 128 sujets. Différents instruments d’hétéro et d’auto-évaluation ont été utilisés : TAS-20 pour l’alexithymie, BDI à 13 items pour l’évaluation de la symptomatologie dépressive, et MINI. Les résultats, aussi bien en analyse dimensionnelle que catégorielle, confirment la prévalence élevée de l’alexithymie chez les toxicomanes (43,5 %) par rapport à celle des témoins (24,6 %). Cette différence est obtenue grâce à la composante émotionnelle, la composante cognitive ne différenciant pas les deux échantillons. L’alexithymie, dans la population des toxicomanes, est indépendante des variables sociodémographiques. Au BDI, 66,4 % des toxicomanes présentent une symptomatologie dépressive (significativement plus fréquente pour le sexe féminin), contre seulement 26 % des témoins. La complexité des rapports entre alexithymie et dépression est discutée, la TAS et le BDI corrélant significativement, surtout pour le facteur « difficulté à identifier ses émotions ». Dans notre étude, l’alexithymie apparaît comme thymo-dépendante.Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5 %) compared to controls (24.6 %). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients ; 66.4 % of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26 % of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20 % of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20 % between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n = 42) are not any more alexithymic than controls (n = 114). Our results plead for a positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this study do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.

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References (34)

  1. BAGBY RM, TAYLOR GJ, RYAN DP. Toronto Alexithymia Scale : relationship with personality and psychopathology measures, Psy- chother Psychosom 1986 ; 45 : 207-15.
  2. BAGBY RM, TAYLOR GJ, PARKER JD. Reliability and validity of 20 items revised Toronto Alexithymia Scale, Paper presented at the meeting of the American psychosomatic society, New-York, 1992.
  3. BECK AT, BEAMESDERFER A. Assessment of depression : the depresion inventory, Psychological Measurements in Psychophar- macology. Mod Probl Pharmacopsychiatry 1974 ; 7 : 151-9.
  4. COHEN KR. A psychometric study of the concept alexithymia, Doc- toral dissertation, University of Windsor, Ontario, 1989.
  5. FREMAUX D, LOAS G, MARCHAND MP. À propos de : Caracté- ristiques du traitement visuel parallèle chez des sujets sains alexi- thymiques. Encephale 1996 ; XXII : 69-70.
  6. GRANT BF. Comorbidity between DSM-IV drug use disorders and major depression : results of a national survey of adults. J Subst Abuse 1995 ; 7, 4 : 481-97.
  7. HAVILAND MG, Mac MURRAY JP, CUMMINGS MA. The rela- tionship between alexithymia and depressive symptoms in a sample of newly abstinent alcoholic inpatients. Psychother Psychosom 1988 ; 49 : 37-40.
  8. HAVILAND MG, SHAW DG, CUMMINGS MA et al. Alexithymia : subscales and relationship to depression, Psychother Psychosom 1988 ; 50 : 164-70.
  9. HAVILAND MG, HENDRIX MS, SHAW DG et al. Alexithymia in women and men hospitalized for psychoactive substance depen- dence. Comprehens Psychiatry 1994 ; 35 : 124-8.
  10. HAVILAND MG, REISE SP. Structure of the twenty item Toronto Alexithymia Scale. J Person Assess 1996 ; 66, 1 : 116-25.
  11. HORTON PC, GEWIRTZ H, KREUTTER KJ. Alexithymia State and Trait. Psychother Psychosom 1992 ; 58 : 91-6.
  12. JIMERSON DC, WOLFE BE, FRANKO DL et al. Alexithymia rating in boulimia nervosa : clinical correlates. Psychosom Med 1994 ; 56 : 90-3.
  13. KELLER DS, CAROLL KM, NICH C et al. Alexithymia in cocaïne abusers. Am J Addict 1995 ; 4 : 234-44.
  14. KRYSTAL H. Alexithymia and psychotherapy. Am J Psychother 1979 ; 33 : 17-31.
  15. LECRUBIER Y, SHEEHAN DV, WEILLER E et al. The Mini Interna- tional Neuropsychiatric Interview (MINI). A short diagnostic structu- red interview : reliability and validity according to the CIDI. Eur Psy- chiatry 1997 ; 224-31.
  16. LESTER D. Alexithymia, depression and suicidal preocupation. Per- cept Mot Skills 1991 ; 72 : 1058.
  17. LOAS G. Alexithymie et dépression : dimensions distinctes ? In : Bailly D, Vénisse JL, eds. Addictions et Psychiatrie. Paris : Masson, 1999 : 65-70.
  18. LOAS G, FREMAUX D, MARCHAND MP et al. L'alexithymie chez les sujets sains : validation de l'échelle d'alexithymie de Toronto (TAS) dans une population « tout venant » de 144 sujets, application au calcul de la prévalence. Ann Med Psychol 1993 ; 151, 96 : 660-3.
  19. LOAS G, FREMAUX D, MARCHAND MP. Étude de la structure fac- torielle et de la cohérence interne de la version française de l'échelle d'alexithymie de Toronto à 20 items (TAS-20) chez un groupe de 185 sujets sains. Encephale 1995 ; XXI : 117-22.
  20. LOAS G, FREMAUX D, OTMANI O et al. Prévalence de l'alexithymie en population générale. Étude chez 183 sujets « tout venant » et chez 263 étudiants. Ann Med Psychol 1995 ; 5, 153 : 355-7.
  21. LOAS G, OTMANI O, FREMAUX D et al. Étude de la validité externe de la fidélité et détermination des notes seuil des échelles d'alexi- thymie de Toronto (TAS et TAS-20) chez un groupe de malades alcooliques. Encephale 1996 ; XXII : 35-40.
  22. LOAS G, OTMANI O, VERRIER A et al. Factor analysis of the French Version of the 20 items Toronto Alexithymia Scale (TAS-20). Psy- chopathology 1996 ; 29 : 139-44.
  23. LOAS G, OTMANI O, FREMAUX D et al. Is alexithymia a negative factor for maintaining abstinence ? A follow-up study. Comprehens Psychiatry 1997 ; 38, 5 : 296-9.
  24. LOISELLE DCG, DAWSON CV. Toronto Alexithymia Scale : rela- tionships with measures of patient self -disclosure and private self consciousness. Psychother Psychosomatics 1988 ; 50 : 109-16.
  25. PARKER JDA, TAYLOR GJ, BAGBY RM. The alexithymia construct : relationship with sociodemographic variables and intelli- gence. Comprehens Psychiatry 1989 ; 30 : 434-41.
  26. PARKER JDA, BAGBY RM, TAYLOR GJ. Alexithymia and depression : distinct or overlapping constructs. Comprehens Psy- chiatry 1991 ; 32 : 387-94.
  27. PINARD L, NEGRETTE JL, ANNABLE L et al. Alexithymia in subs- tance abusers, persistence and correlates of variance. Am J Addict 1996 ; 5, 1 : 32-9.
  28. RYBAKOWSKI J, ZIOLKOWSKI M, ZASADZKA T et al. High pre- valence of alexithymia in male with alcohol dependance. Drug Alco- hol Depend 1988 ; 21 : 133-6.
  29. SIFNEOS PE. The prevalence of « alexithymic » characteristics in psy- chosomatic patients. Psychother Psychosomatics 1973 ; 22 : 255-62.
  30. TAYLOR GJ, BAGBY RM, PARKER JD. Disorders of affect regulation : alexithymia in medical and psychiatric illness. Londres, UK : Cambridge University Press, 1997.
  31. TAYLOR GJ, PARKER JD, BAGBY RM. A preliminary investigation of alexithymia in men with psychoactive substance dependance. Am J Psychiatry 1990 ; 147, 9 : 1228-30.
  32. TAYLOR GJ, BAGBY RM, PARKER JD. The revised Toronto Alexi- thymia Scale : some reliability, validity and normative data. Psycho- ther Psychosomatics 1992 ; 57 : 34-41.
  33. TROISI A, PASINI A, SARACCO M et al. Psychiatric symptoms in male cannabis users not using other illicit drugs. Addiction 1998 ; 93, 4 : 487-92.
  34. ZIOLKOWSKI M, GRUSS T, RYBAKOWSKI JK. Does alexithymia in male alcoholics constitute a negative factor for maintaining abstinence ? Psychother Psychosomatics 1995 ; 63 : 169-73.