5.

Дискусия – 10, 11 pages

Целта на тази част е да оцени и интерпретира получените резултати и то преди

всичко от гледна точка на изследователския въпрос и хипотезите
1. Резюме на резултатите без статистически данни - кажете какви са най-важните
резултати без никаква статистическа терминология.

2. Анализ на резултатите - След това преминете към дискутиране на отделните резултати.

Тук следва да направите връзка с формулираните хипотези, както и с представената
литература в теоретичната част на работата.

3. Посочете ограниченията и недостатъците на проведеното изследване и

направете изводи за бъдещи изследвания. Това показва, че можете критично да
анализирате и осмисляте работата си и конструктивно да правите планове за
подобрения.

4. Заключение- Следва заключителен абзац(и) с изводите от работата.

1.1 Главната цел на настоящото емпиричното изследване е да се направи

сравнителен анализ на конструктите алекситимия, ментализация и локус на контрол
1.2 Да се провери дали психотичните и психосоматични пациенти ще имат
занижена способност за ментализация.
1. 3 Да се провери дали ниският капацитет за ментализация и високите нива на
алекстимия за свързани.

1.Първата цел на настоящето изследване бе да се направи сравнителен анализ между

пациенти с шизофрения, пациенти със захарен диабет и здрава контролна група по
отношение на конструктите алекситимия, ментализация и локус на контрол, за да се
проучат различията между тези три групи изследвани лица по отношение на способността
им за ментализация, наличие на нива на алекстимия и тип локус на контрол. Въпреки, че
няма данни за проведено подобно сравнително изследване по отношение на тези три
конструкта, получените резултати потвърждават предишни данни, според които
психотични и психосоматични пациенти показват способност за ментализация, както и по-
високи нива на алексимия в сравнение със здрава контролна група (Rasoul Heshmatia F*F,
Esa Jafarib, Jafar Hoseinifarc, Mohsen Ahmadid 2010).
Следващият етап от изследването е свързан със задълбочаване на разбирането ни относно
това дали ниският капацитет за ментализация и високите нива на алекстимия за свързани.
A Comparative Study on Alexithymia in Depressive,
Somatoform, Anxiety, and Psychotic Disorders among Koreans
Sung hwa Son1, Hyunyoung Jo2, Hyo Deog Rim1, Ju Hee Kim3, Hea Won Kim4, Geum Ye
Bae1 and Seung Jae Lee1 2012
explored disorder-related differences in alexithymic characteristics among Korean patients
diagnosed with four major psychiatric disorders (n=388).
patients classified into four groups according to major psychiatric diagnosis were compared. The
groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM;
n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68).
We found that substantial portions of patients in all groups were classified as having alexithymia
and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM,
PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties
describing feelings) than those with SM or AX, These findings suggest that alexithymia might be
associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a
discriminating feature of depressive disorders.

Връзки между алекситимия, депресивност

и психосоматични оплаквания Траянка ГРИГОРОВА - 2018

Настоящият доклад има за цел да проучи факторната структура на въпросника, измер-

ващ алекситимия (TAS 20) върху българска популация и да изследва връзките между конструкта
алекситимия и характеристиките на депресивните състояние и психосоматичните оплаквания
отново върху българска популация. Изследването включва 115 изследвани лица на доброволен прин-
цип. от тях 65% жени и 35% мъже. По отношение на изследваните връзки между алекситимия и депресия се по-
твърждават очакванията, за наличие на положителна такава, особено при първите два фактора
на въпросника. Между алекситимия и психосоматични оплаквания също се установява наличието
на положителна корелация.

Хипотеза 1. Предполага се, че пациентите с параноидна шизофрения ще покажат по-

високи нива на алекситимия в сравнение с пациентите със захарен диабет и
контролната група.
Изследвания, в които шизо имат по високи нива на алекстимия в сравнение с диабет
и здрави:
1. Comparative study of alexithymia in patients with schizophrenia spectrum disorders, non-
psychotic disorders and normal people - Rasoul Heshmatia F*F, Esa Jafarib, Jafar Hoseinifarc,
Mohsen Ahmadid 2010
Results showed that alexithymia had significant difference in patients with schizophrenia
spectrum disorders and normal people; and non-psychotic disorders and normal people, but
differences weren`t significant between patients with schizophrenia spectrum
disorders and non-psychotic disorders. The difficulty in describing feelings, difficulty in
identifying feelings and externallyoriented thinking were higher in patients with schizophrenia
spectrum disorders than other groups. In all groups, males had more problems in describing
feelings and externally-oriented thinking. These results suggest that high level of alexithymia
could contribute to a greater vulnerability for schizophrenia spectrum disorders and it could set
males at high risk for these disorders.

2. A Study of Alexithymia in Schizophrenia and Some Somatic Diseases

T A Kafarov 1, N A Aliev 1, Z N Aliyev 2 – 2020

The study included 60 patients with paranoid schizophrenia , 55 hypertensive patients with
primary heart disease (I11), 53 patients with chronic ischemic heart disease (I25) and 51 patients
with insulin-dependent diabetes mellitus (E10).
Results: The average scores on TAS were higher in patients with schizophrenia compared to
patients with somatic diseases (109,73 and 81,66, respectively). During the analysis of responses
to TAS statements, features of a general and particular nature were identified.
Conclusions: Alexithymia is not a property characteristic of psychosomatic diseases and neurotic
disorders, and is detected in schizophrenic patients and patients with somatic diseases. The
relationship of alexithymia with negative symptoms of schizophrenia suggests that it might
impact on interpersonal relations, social adaptation and development of autistic symptoms in
patients.

3. Comparison of alexithymia in schizophrenia and somatic Diseases - Nadir A. Aliyev1 *,

Teymur A. Gafarov1 , Zafar N. Aliyev2 and Eldar R. Haqverdi1 2017
Somatic diseases, schizophrenia paranoid form the basis of the results of our study examined and
established high level alexithymia in both groups. Paranoid
schizophrenia patients with higher marks alexithymia level than these somatic diseases. The
negative symptoms of schizophrenia patients in weight, compared to about
two times more positive signs included. The negative symptoms of schizophrenia, that is a
positive correlation with the level of alexithymia. Paranoid schizophrenia,
its sense of social isolation is difficult to describe their lack of ability to understand the higher
level of relations between individuals, conflicts and patients and when
alexithymia and other. The results of these studies show that in future relations and the prospects
for the study of schizophrenia and have great relevance in alexithymia.

4. Alexithymia in Depressive, Anxiety, Somatoform,

and Psychotic Disorders: A Comparative Study
Depresif, Anksiyete, Somatoform ve Psikotik Bozukluklarda Aleksitimi:
Karşılaştırmalı Bir Çalışma 2016

This study aimed to compare the prevalence of alexithymia

and determine the differences in structure in patients with depressive,
anxiety, somatoform, and psychotic disorders.
Methods: The study was performed between April and May 2013 with
outpatients who were diagnosed with depressive (n=99), anxiety (n=76),
somatoform (n=37), and psychotic (n=45) disorders under the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
(American Psychiatric Association 2000) and who were being monitored
and treated at the outpatient psychiatry clinic of Erzincan State Hospital.
The data were collected by two psychiatrists using the face-to-face interview
method, which employed a questionnaire and the 20-item Toronto
Alexithymia Scale (TAS-20), in the outpatient clinic environment.
Results: Alexithymic construct was found in 55.6% of the psychotic patients,
45.9% of those with somatoform disorders, 43.4% of those with
anxiety, and 51.5% of the depressive patients. The TAS-20 average scores
were significantly higher in psychotic patients. The Difficulty Identifying
Feelings subscale average scores were found to be significantly lower in
patients with somatoform disorders (p<0.01). Additionally, the TAS-20
average scores in men, young, those with low education were significantly
higher (p<0.001).
Conclusion: The study demonstrated that all patient groups had alexithymic
construct; however, the prevalence of alexithymia was higher
in depressive and psychotic patients. Psychiatric nurses can help in improving
patients’ quality of life through psychosocial interventions aiming
at improved recognition, identification and description of feelings,
communication skills and insight.

Хипотеза 2. Допуска се предположението, че пациентите с параноидна шизофрения

ще покажат по-ниски нива на ментализация в сравнение с пациентите със захарен
диабет и контролната група.
Изследвания, които показват, че шизо имат по ниски нива на ментализация в
сравнение с контрол и диабет:
1. Mentalizing impairment in schizophrenia: A functional MRI study
Pritha Das a,b,c,⁎, Jim Lagopoulos a,b,d, Carissa M. Coulston a,b, Antony F.
Henderson a,b, Gin S. Malhi a,b, 2011
Background: A deficit in Theory of mind (ToM) or ‘mentalizing’ has been purported to underlie the poor social
functioning seen in patients with schizophrenia. To understand the neural basis of this deficit studies have
primarily used tasks requiring ‘off-line’ or explicit mentalizing but, in daily life, successful social interactions
depend upon implicit or ‘on-line’ mentalizing. Therefore in the present study we used functional neuroimaging
and a task that elicits ‘on-line’ mentalizing to investigate the neural basis of ToM deficits in schizophrenia.
Methods: Functional MRI images were acquired from 20 male patients with established schizophrenia and 19
age and gender matched healthy controls while they watched animated sequences involving two triangles. In
the control condition the two triangles moved at random whereas in the experimental condition they moved
interactively with implied intentions. The identification of ToM networks and differential responses between
groups, within this network, was investigated using a random effects model. To account for differences in educational
status between the groups this was included as a covariate in the between group analysis. Correlation
analysis was performed to examine the relationship between neural activity change during mentalizing
and the clinical and functional outcomes of patients.
Results: Patients with schizophrenia had significantly diminished activity in the right superior temporal gyrus
(STG) at the temporoparietal junction (TPJ) and bilaterally within the inferior frontal gyri (IFG). Interestingly,
frontal neural activity showed significant correlation with functional outcomes in patients with schizophrenia.
Conclusions: Findings from this novel study suggest that the ToM deficit inmale schizophrenia patients may reflect
impairment in the automatic or implicit processing ofmentalizing. If replicated, this is an important finding
that provides additional insight into the neural basis of impairments in social functioning that are experienced by
patients with schizophrenia.

2. A Meta-Analysis of Mentalizing Impairments in Adults With Schizophrenia

and Autism Spectrum Disorder Yu Sun Chung*,1, Deanna Barch1,2, and Michael
Strube1 – 2013
Mentalizing has been examined both in autism spectrum
disorder (ASD) and schizophrenia (SCZ) primarily by
either cognitive-linguistic (referred to as verbal) or emotion
recognition from eyes (referred to as visual) mentalizing
tasks. Each type of task is thought to measure different
aspects of mentalizing. Differences in clinical features and
developmental courses of each disorder may predict distinct
patterns of mentalizing performance across disorders
on each type of task. To test this, a meta-analysis was conducted
using 37 studies that assessed mentalizing either
verbally or visually in adults with SCZ or ASD. We found
that the estimated effect sizes of impairments in verbal
and visual mentalizing tasks for both clinical groups were
statistically large and at a similar level (overall Hedges’
g = 0.73-1.05). For each disorder, adults with SCZ showed a
trend towards larger impairments on verbal (overall Hedges’
g = 0.99) than on visual mentalizing task (overall Hedges’
g = 0.73; Qbet = 3.45, p =.06, df =1). Adults with
ASD did not show different levels of impairment on the
verbal versus visual tasks (Qbet = 0.08, p =.78, df =1).
These results suggest that both clinical groups share, at
least in part, some common cognitive processing deficits
associated with mentalizing impairments.

3. The appreciation of visual jokes in people with schizophrenia: a study of

'mentalizing' ability
Rhiannon Corcoran a,,, Connie Cahill b, Christopher D. Frith a,c 1996

It has been suggested that cert It has been suggested that certain characteristic symptoms of schizophrenia reflect a specific
deficit in the ability to
attribute mental states to others ('mentalizing'). Patients with negative features, particularly social withdrawal and
blunted affect, those with thought disorder and patients with paranoid symptoms have difficulties when they try t
difference in the ability to understand the two types of joke, while the schizophrenic patients found the mental state
jokes significantly more difficult to understand. This effect was most marked in patients with behavioural disorders
and those reporting passivity experiences. Those with paranoid delusions also showed a selective comprehension
deficit with the mental state stimuli. Patients who were symptom free at the time of testing showed normal performanceain
characteristic symptoms of schizophrenia reflect a specific deficit in the ability to
attribute mental states to others ('mentalizing'). Patients with negative features, particularly social withdrawal and
blunted affect, those with thought disorder and patients with paranoid symptoms have difficulties when they try to
infer what is going on in the minds of other people. This study examines this notion using two sets of cartoon jokes.
While the first set can be understood purely using physical and semantic analysis, the second set requires that the
viewer appreciates the mental state of the main character in order to 'get' the joke. For control subjects there was no
difference in the ability to understand the two types of joke, while the schizophrenic patients found the mental state
jokes significantly more difficult to understand. This effect was most marked in patients with behavioural disorders
and those reporting passivity experiences. Those with paranoid delusions also showed a selective comprehension
deficit with the mental state stimuli. Patients who were symptom free at the time of testing showed normal
performance

Хипотеза 3. Предполага се, че пациентите с параноидна шизофрения ще покажат по-

високи нива на външен локус на контрол в сравнение с пациентите със захарен
диабет и контролната група.
Изследвания, показващи шизо с външен локус сравнение с диабет и контрол

1. Locus of Control: Relation to Schizophrenia, to Recovery, and to

Depression and Psychosis - A 15-Year Longitudinal Study 2009
Martin Harrow*,
Professor, Department of Psychiatry, University of Illinois College of Medicine, 1601 W. Taylor (M/
C 912), Chicago, IL 60612
Barry G. Hansford, and
Georgetown University Medical Center, 4435 Greenwich Parkway, Washington, DC 20007
Ellen B. Astrachan-Fletcher
Assistant Professor, Department of Psychiatry, University of Illinois College of Medicine, 912 S.
Wood St. (M/C 913), Chicago, IL 60612
Abstract
Purpose—The present prospectively designed 15-year longitudinal research was conducted to
study whether locus of control is linked to diagnosis, to major symptoms, to functioning and recovery,
and to personality for schizophrenia patients, depressive patients, and patients with other major
disorders.
Procedure—The research studied 128 patients from the Chicago Follow-up Study at the acute
phase and reassessed them 5 times over a 15-year period. Patients were evaluated on locus of control,
global outcome, recovery, premorbid developmental achievements, psychosis, diagnosis, depression,
and personality variables.
Results—1.) After the acute phase, schizophrenia patients were not more external than other
diagnostic groups. 2.) Internality is associated with increased recovery in schizophrenia (p<.05). 3.)
A more external locus of control was related to depression (p=.01). 4.) The relationship between
externality and psychosis was significant (p<.05).
Conclusions—In severe psychiatric disorders a more external locus of control is not specific to
schizophrenia and after the acute phase is not associated with one particular diagnostic group. A
more external locus of control is related to fewer periods of recovery, to both depressed mood and
psychosis, and to various aspects of personality (p<.05).

2. THE INTERPLAY AMONG LOCUS OF CONTROL, SUB-CLINICAL

PSYCHOTIC SYMPTOMS AND PSYCHOLOGICAL WELL-BEING IN
WHITES AND ETHNIC MINORITIES 2015
Marc Joshua Weintraub1
 Amy Weisman de Mamani
Saneya H Tawfik
An external locus of control has largely been associated with worse psychological well-being. In general,
patients with schizophrenia demonstrate a more external locus of control compared to non-psychiatric
populations. Prior research in schizophrenia also suggests that the relationship between greater psychotic
symptoms and decreased psychological well-being is stronger for individuals who endorse a more
external locus of control. This relationship has not been tested in a non-clinical population. In an
ethnically diverse sample of 420 participants, this study found, in line with hypotheses, that a more
external locus of control was negatively associated with psychological well-being. While sub-clinical
psychotic symptoms were negatively associated with psychological well-being, locus of control did not
moderate the overall relationship between sub-clinical psychosis and psychological well-being as
expected. Secondary analyses examined the relationships between sub-clinical psychotic symptoms, locus
of control and psychological well-being by ethnicity and suggested that ethnicity moderated the
relationship between an external locus of control and decreased well-being. In other words, for minorities
there was a relationship between greater external locus of control and decreased well-being, but not for
Whites.

3. Cognitive functioning correlates of self-esteem and health locus of control in

schizophrenia – 2013
Chien-Shu Wang1
Jo Yung-Wei Wu2
Wei-Chung Chang3
Shu-Ping Chuang1
Aim: The study aimed to investigate the relationship among sociodemographic factors,
neurocognitive factors, self-esteem, and health locus of control in patients diagnosed with
schizophrenia. We examined the self-esteem, internal health locus of control, and external
health locus of control through sociodemographic and neurocognitive factors.
Methods: Forty-six schizophrenic patients and 31 healthy residents from the community or
hospital were recruited as the control group. All subjects participated in the self-esteem
questionnaire, health locus of control questionnaire, and a series of neuropychological
measures.
Results: Multiple regression analysis revealed that inhibition of attention and external health
locus of control were predictors for self-esteem (r=-0.30, P,0.05; r=0.41, P,0.01); inhibition
of attention and external health locus of control were contributors for internal health locus of
control (r=-0.43, P,0.01; r=0.61, P,0.001); and education was related to external health locus
of control (r=-0.31, P,0.05).
Conclusion: The current study integrated background characteristics and cognitive function
to better understand the impact of self-esteem and health locus of control in schizophrenia.
The findings indicated that inhibition of attention, external health locus of control, and
 education contributed to self-esteem, internal health locus of control and external health
locus of control. However, the overall predicted variance accounted for by these predictors
was small; thus, further research is necessary to examine imperative variables related with
self-esteem and health locus of control in schizophrenia.

Хипотеза 4. Допуска се, че ментализацията ще бъде значимо отрицателно свързана с

нивата на алекситимия при трите изследвани групи.

което показва, че между ментализацията и алекситимия съществува

обратнопропорционална зависимост – с нарастването на едната величина другата
намалява и обратно – с намаляване на едната величина другата нараства.
Следователно Хипотеза 4 се приема за вярна. Ментализацията е
обратнопропорционална на нивата на алекситимия общо за всички изследвани лица,
както и за групата пациенти с параноидна шизофрения и за групата пациенти с
диабет тип 1 и тип 2.
Mentalizing in mothers and children with type 1 diabetes
Stefanella Costa-Cordella1 , Patrick Luyten1,2, Diego Cohen3, Francisca Mena4 and Peter
Fonagy1
1Division of Psychology and Language Sciences, University College London, London,
United Kingdom; 2Faculty of Psychology and Educational Sciences, University
of Leuven, Leuven, Belgium; 3Department of Psychiatry, Universidad de Buenos Aires,
Buenos Aires, Argentina and 4Fundación Diabetes Juvenil de Chile,
Studies suggest that the relationship between psychosocial well-being and type 1 diabetes (T1D) is bidirectional, with T1D
typically having a
negative influence on psychological functioning, which in turn negatively affects the course of T1D. Here, we investigate
the potential role of
the capacity for mentalizing, or reflective functioning, in children and their mothers in diabetes control. We tested
differences in mentalizing
as assessed by the Reflective Functioning Scale in two groups of mother–son dyads with good (GDC) versus poor (PDC)
diabetes control.
Fifty-five boys (8–12 years old) and their mothers were recruited from the Juvenile Diabetes Foundation in Santiago,
Chile. The
mothers were interviewed with the Parental Development Interview and the children with the Child Attachment Interview,
and both
were scored for reflective functioning by using the Reflective Functioning Scale. Self-report measures of stress and
diabetes outcomes
were completed by the mothers and children, and levels of glycated hemoglobin (HbA1c) were assessed as an index of
diabetes control.
The results showed that both maternal and child reflective functioning were higher in the GDC than the PDC group and
were negatively
correlated with HbA1c in the total
Хипотеза 5. Предполага се, че има положителна връзка между наличието на
алекситимия и външния локус на контрол при трите изследвани групи.
1. Relationship between alexithymia and locus of control
R. VERISSIMO*, G.J. TAYLOR**, R.M. BAGBY*** 2000
SUMMARY: The relationship between alexithymia and
locus of control was explored in a clinical group comprised
of 50 general practice patients and 74 patients with inflammatory
bowel disease, and in a nonclinical group comprised
of 218 medical students. Alexithymia was associated positively
with the powerful others and chance dimensions of external
locus of control in both groups, and negatively with
internal locus of control in the nonclinical group. Although
not all correlations reached a level of significance, the overall
pattern of correlations between the facets of the
alexithymia construct and the dimensions of locus of control
was similar in the two groups. The findings are consistent
with clinical reports that alexithymic individuals manifest
an externally-oriented mode of thinking and living.

2. RELATIONSHIP BETWEEN ALEXITHYMIA AND LOCUS OF CONTROL

AMONG GRADUATION STUDENTS: A CASE STUDY FROM FAISALABAD
IMRAN HAIDER ZAIDI1, M. NAEEM MOHSIN2 & WIZRA SAEED - 2013
The current research focused to find out that how Alexithymia and locus of control are interlinked among
graduation students of Pakistan. TAS 20 item (Bagb, Parker & Taylor, 1994) and a 29 item Locus of Control questionnaire
(Rotter, 1966) were used to measure Alexithymia and locus of control respectively. Sample of individuals (N=200) men
(n=100) and women (n=100) selected from different academic institutions of Faisalabad division of Punjab, Pakistan.
For statistical analysis Pearson Product Moment Correlation and independent sample t-test were used. This study
revealed consistent results with the earlier studies. By the results of this research a significant positive correlation between
Alexithymia and locus of control among graduation students indicated. Further this study find out that men experience
high
level of Alexithymia as compared to women. However, current study additionally concluded that men scored high on
internal locus of control and women scored high on external locus of control. Implications of these findings for future
researches are discussed.

3. Predictor effect of Locus Of Control (LOC) on self-care activities and metabolic

control in individuals with type 2 diabetes
Dilek Büyükkaya Besen1, Neslihan Günü
sen1, Hamdiye Arda Sürücü2 and Cansu Ko
sar3
USE THIS STDY INTRO AND DISCUSSION
Background. Previous studies have examined the role of individuals' personal characteristics
in diabetes management and used the locus of control theory to assess
adherence to a diabetes management regimen. These studies have emphasized that
having internal locus of control may be a protective factor in diabetes management.
Objective. The purpose of this study is to determine the predictor effect of locus of
control on self-care activities and A1c level.
Method. The study is descriptive and relational. Researchers used a Diabetes Self-Care
Activities Scale and a Locus of Control Scale to collect data. The study sample consisted
of 129 individuals with type 2 diabetes.
Results. The average score of locus of control of individuals with diabetes was 10.26, and
the frequency of self-care activities in the past week was 2.9 days. A weak but statistically
significant negative relation was found between the locus of control level and self-care
activities of individuals with diabetes, which had no effect on A1c. It was determined
that locus of control predicts 19% of self-care activities.
Conclusion. According to the study results, having internal locus of control had positive
effects on self-care activities. Training and planning activities to improve internal locus
of control can improve diabetes management.
Locus of control is defined in terms of whether individuals believe that outcomes of
events are due to internal or external causes. Individuals with internal locus of control
believe that they have control of the situations they face, and that they are responsible for managing their
lives. Individuals with external locus of control believe what happens to them is beyond their control, and
they attribute everything they face to fate, others, or
chance (Rotter, 1966). According to Rotter (1966), ``internal versus external control refers to the degree
to which persons expect that a reinforcement or an outcome of their behavior is contingent on their own
behavior or personal characteristics versus the degree to which persons expect that the reinforcement or
outcome is a function of chance, luck, or fate, is under the control of powerful others, or is simply
unpredictable.'' LOC affects how one can cope with a stressful situation. Since those with internal LOC
are proactive, they display more problem-focused coping skills than those with external LOC (Da§,
2002). It is important for individuals to encounter a problem while dealing with day-to-day issues in their
own areas of responsibility. If individuals think that they have no responsibility when a problem arises or
is solved, then they do not attempt to solve the problem (Eskin, 2009). In terms of the improvement of
internal locus of control, results of applications support the long lasting effectiveness of cognitive-
restructuring technique that aims to change cognitive structure (Eskin, 2009).
Previous studies have examined the role of individuals' personal characteristics in
diabetes management. These studies have emphasized that having internal locus of control
may be a protective factor in diabetes management. A study by O'Hea et al. (2005) found that diabetes of
individuals with external locus of control progressed more severely and their A1c levels were higher than
those of individuals with internal locus of control. A
study by Morowatisharifabad et al. (2010) found a positive relation between internal locus of control and
adaptation to diabetes treatment. Therefore, developing internal locus of control is a factor to consider in
improving individuals' adaptation to diabetes treatment
(Montague, Nichols & Dutta, 2005). A solid metabolic control of diabetes needs to be ensured because of
its severe complications; therefore, factors that may have affect diabetes management need to
be determined. Individual factors are important in ensuring the metabolic control of
diabetes. Literature shows different research results on the effect of locus of control on
metabolic control of diabetes and self-care activities. While some studies support a positive
relation between internal locus of control and metabolic control of diabetes, in other
studies, no relation was found (Hummer, Vannatta & Thompson, 2011; Bunting & Coates,
2000; Kneckt, Syrjala & Knuuttila, 1999). The findings of this study will contribute to the
literature in explaining this effect and the results of this study can be used in planning
diabetes education programs.

4. Correlates of Health Locus of Control among Patients Diagnosed with Type-II

Diabete Mellitus Dina N. Al Nawafa’h1, Ayman M. Hamdan-Mansour2* 2015
Background: The comorbidity between chronic physical conditions and psychosocial health became
common interest for health professional and researchers. The purpose of this study was to
investigate the relationship among health locus of control, self efficacy, and demographic factors
in patients with type-II diabetes mellitus. Method: Data were collected using cross-sectional, correaltional
design from 793 patients with type-II diabetes in regards to health locus of control
(HLOC) self-efficacy, and biomarkers. Results: The mean score for the internal subscale of HLOC
was 27.2 (SD = 6.32), for the powerful others subscale of HLOC it was 30.9 (SD = 5.7), and for
chance subscale of HLOC it was 18.6 (SD = 6.8). The mean total score of locus of control scale was
76.8 (SD = 13.1) ranging from 19 to 132. The mean score of HbA1C was 7.5 (SD = 2.6). Patients had
moderate to high perception of powerful other health locus of control, and self efficacy. Results
also showed that locus of control had positive and significant correlation with self efficacy (r =
0.18, p > 0.01) and negative relationship with HbA1C (r = −0.11, p > 0.01). On the other hand, age
has no significant correlation with health locus of control. Conclusion: Health care professionals
need to enhance patient’s self-efficacy and internal power of their patients for better health outcomes.
Nurses and other health professionals need to emphasize the psychosocial health aspects
of patients with chronic illnesses, and in particular, those diagnosed with type-II diabetes mellitus

Хипотеза 6. Допуска се, че пациентите със захарен диабет ще покажат по-високи

нива на алекситимия в сравнение с контролната група.
Most studies investigating the relation between alexithymia and diabetes mellitus were conducted both in
children/adolescents and in adult patients with type 1 diabetes and showed a higher prevalence of alexithymia
in individuals with type 1 diabetes than in healthy controls, with values varying between 14.4% and 50% (6-
12).

1. Chatzi L, Bitsios P, Solidaki E. Type 1 diabetes is associated with alexithymia in non-

depressed, non-mentally ill diabetic patients: a case-control study. J Psychosom Res 2009;
67: 307-11.
2. Mnif L, Damak R, Mnif F. Alexithymia impact on type 1 and type 2 diabetes: a case-
control study. Ann Endocrinol (Paris) 2014; 75: 231-19.
3. Abramson L, McClelland DC, Brown D, Kelner Jr S. Alexithymic characteristics and
metabolic control in diabetic and healthy adults. J Nerv Ment Dis 1991; 179: 490-
4.Fukunishi I. Alexithymic characteristics of bulimia nervosa in diabetes mellitus with end-
stage renal disease. Psychol Rep 1997; 8: 627-33.
10. Friedman S, Vila G, Even C. Alexithymia in insulin-dependent diabetes mellitus is
related to depression and not to somatic variables or compliance. J Psychosom Res 2003;
55: 285-7.
11. Manfrini S, Bruni R, Terminio N. Alexithymia in subjects with type 1 diabetes.
Diabetologia 2005; 48 (suppl. 1): s.323-4.
12. Topsever P, Filiz TM, Salman S. Alexithymia in diabetes mellitus. Scott Med J 2006;
51: 15-20.
13. Alexithymia in Diabetes Mellitus P Topsever1, TM Filiz1, S Salman2, A Sengul3, E
Sarac4, R Topalli1, S Gorpelioglu1, T Yilmaz2 2006
Abstract
Background
Diabetes mellitus is a chronic, progressive disease with complex therapy
protocols requiring major coping efforts from patients to achieve and
maintain glycaemic control in order to reduce risk of diabetic
complications. Disease coping strategies including good knowledge of
diabetes and high ability of self-care have been reported to be impaired
by alexithymic features. Alexithymia is a psychological construct
characterised by inability to express emotions verbally, poor imagination
and operational thinking, leading to failure in psychological selfregulation.
Objective
To compare prevalence of alexithymia and mean Toronto Alexithymia
Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls;
to investigate the association of alexithymia with glycemic control in
diabetes.
Method
In this cross- sectional study, TAS-26 scores of 193 diabetic patients and
49 non-diabetic controls were compared. Disease related factors were
obtained from patient records. Alexithymia was used as a continuous
(mean TAS-26 scores) and semi-quantitative (dichotomised into nonalexithymic
11>TAS-26 scores>11 and alexithymic individuals) variable.
Descriptive data are presented as mean±SD, median (range) or %.
Differences in means were compared via Independent-Samples T Test
and One-Way ANOVA. Proportions were analysed with chi-square test
and odds ratios (OR) were calculated via cross tabulation with a
confidence interval (CI) of 95%. P<0.05 was considered statistically
significant.
Results
The control group was similar with respect to age, gender and education
with the diabetic group. In the diabetic study population (n=193,
male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7
years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl,
HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than
in the control group (65 % in diabetics vs. 45 % in controls, p=0.011;
mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor
postprandial glycaemic control (p=0.002), female gender (p=0.026),
combination therapy (p=0.037) and poor educational level (p=0.005)
were positively associated with TAS-26 scores in diabetic individuals.
Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and
under worse glycaemic control

Factors associated with TAS-26 scores and alexithymia in

Individuals ot previous study
Sociodemographic factors
According to the results of the present study, poorly
educated, diabetic women were prone to have alexithymic
features. None of the studies conducted with diabetic
patients explicitly report a significant relationship of
gender and/or educational level with alexithymia, but age,
gender and education have been shown to be determinants
of alexithymia in various other studies of non-diabetic
study populations. Surprisingly, our study revealed female
gender to be positively associated with TAS-26 scores,
whereas, the classical gender related risk factor for
alexithymia is being male.25,26,27 As female diabetic
individuals in the present study population displayed an
unfavourable education status (see results) compared to
males, the above finding might be a type1-error,
confounded by education, which is also supported by the
fact that the gender difference in TAS-26 scores did not
translate into a difference in the prevalence of alexithymia.
Education was found to be associated with TAS-26 scores
as well as with the presence of alexithymia. In the medical
literature, the association of education and alexithymia is
dealt with some controversy, 28 but most of the studies
are in accordance with our result, reporting higher levels of
alexithymia in low educated individuals. 9, 26, 27, 29 Filiz
and colleagues have shown that the previously

14. Alexithymia as a risk factor for type 2 diabetes mellitus

in the metabolic syndrome: a cross-sectional study
Alexandra V. Lemche a, Oleg S. Chaban b, Erwin Lemche c,n
Studies about glycemic control and type of locus of control that influence treatment 2014
Alexithymia is a clinical trait consisting of diminished introspective and interoceptive capacities that has
been shown to implicate elevated autonomic outflow and to bias for hypertension. To estimate relative
risk associated with alexithymia in the metabolic syndrome (MetS), we conducted a cross-sectional
analysis of patients with manifest type 2 diabetes mellitus (T2DM) or familial diabetes risk (N¼101;
67 females; age 45.6713.96) in a nationwide sampled treatment cohort for MetS in the Ukrainian
governmental health care system. Laboratory data of single components of the MetS according to
International Diabetes Federation Consensus were dependent measures in multivariable regression
models with self-reported alexithymia severity (TAS-20) and socio-demographic data. TAS-20 as the sole
surviving psychometric predictor for T2DM in the simplest regression equation provided the best model
fit: OR 1.073, Z¼19.04, (95%CIs 1.065–1.081). For microalbuminuria, the best fitting model was OR 1.030,
Z¼3.49 (95%CIs 1.013–1.048). TAS-20 predicted also triglyceride level at Wald-χ2¼1299.27, Z¼36.05
(95%CIs 0.052–0.058) and blood pressure maximum at Wald-χ2¼2309.05, Z¼48.05 (95%CIs 2.402–
2.606). Our results show that alexithymia severity contributes to MetS by covarying with several of its
single components, and that it may be a substantial concurrent indicator of T2DM and cardiovascular
risks in MetS.

15. Moderating Role of Alexithymia in Relationship Between

Perceived Social Support, Diabetes-Related
Quality of Life, and Glycated Hemoglobin in Patients
With Type 2 Diabetes – 2020
Background: Diabetes is a complex and chronic disease, i.e. associated with patients’ lifestyle
and affects their quality of life. The present study examined the role of alexithymia on the
relationship between social support, health-related quality of life, and glycated hemoglobin in
patients with type 2 diabetes.
Methods: This was an analytical cross-sectional study. The study participants consisted of
100 (60% females) type 2 diabetic out-patients visiting the Labbafinejad Hospital in Tehran
City, Iran, between February 2013 and January 2014. Measures of data collection included
the multidimensional scale of perceived social support, the diabetes-related quality of life, and
alexithymia Scale.
Results: The results of two hierarchical linear regression analyses indicated that alexithymia
moderated the relationship between perceived social support, quality of life, alexithymia scale,
and HbA1c in patients. To evaluate the moderating role, two hierarchical multiple regression
analyses were calculated. The obtained results suggested that alexithymia moderates the
relationship between social support, health-related quality of life, and glycated hemoglobin in
patients with type 2 diabetes (P>0.001).
Conclusion: The study findings contribute to a better understanding of effective psychosocial
factors in the quality of life and HbA1c among patients with diabetes. Therefore, developing
psychological interventions is essential for these patients.

16. Depression differed by midnight cortisol

secretion, alexithymia and anxiety between

diabetes types: a cross sectional

comparison
Eva O. Melin1,2,3* , Maria Thunander1,2,4, Mona Landin-Olsson1,5, Magnus Hillman6 and Hans O. Thulesius2,3,7 2017

Background: Increased prevalence of depression is found in both type 2 diabetes (T2D) and type 1 diabetes (T1D).
Melancholia and atypical depression differ by cortisol secretion and clinical features. The aim was to compare the
clinical presentation of T1D and T2D patients in relation to self-reported depression, self-reported anxiety,
alexithymia,
obesity, and midnight salivary cortisol (MSC).
Methods: Comparative cross-sectional design. The participants were consecutively recruited from one hospital
diabetes
outpatient clinic: 24 T2D patients (31–59 years) and 148 T1D patients (32–59 years). Self-reported depression,
anxiety and
alexithymia were assessed by Hospital Anxiety and Depression scale and Toronto Alexithymia Scale-20. MSC,
HbA1c,
anthropometrics and data from medical records were collected. Multiple logistic regression analyses were
performed.
Results: Comparisons of prevalence between diabetes types showed for T2D/T1D: depression 25%/12% (P = 0.10);
high MSC
(≥9.3 nmol/L) 38%/22% (P = 0.13); alexithymia 25%/13% (P = 0.12); anxiety 38%/35% (P = 0.82). The prevalence
of high MSC
did not differ between depressed and non-depressed T2D patients (17% vs. 44%, P = 0.35), but differed between
depressed
and non-depressed T1D patients (53% vs. 18%, P = 0.003). The alexithymia prevalence differed between depressed
and
non-depressed T2D patients (67% vs.11%, P = 0.018), and between depressed and non-depressed T1D patients
(47% vs. 11%,
P < 0.001). The anxiety prevalence did not differ between depressed and non-depressed T2D patients (67% vs. 28%,
P = 0.15),
but differed between depressed and non-depressed T1D patients (76% vs. 30%, P < 0.001). The obesity prevalence
(BMI
≥30 kg/m2) was 83% for depressed T2D patients and 6% for depressed T1D patients.
In the T2D patients, depression was associated with alexithymia (Adjusted odds ratio (AOR) 15.0). In the T1D
patients,
depression was associated with anxiety (AOR 11.0), foot complications (AOR 8.5), HbA1C >70 mmol/mol (AOR
6.4), and
high MSC (≥9.3 nmol/L) (AOR 4.8).
Conclusions: The depressed T2D patients had traits of atypical depression, without associated high MSC (≥9.3
nmol/L)
and anxiety, but the association with alexithymia was strong. The depressed T1D patients had traits of melancholia
with associated high MSC and anxiety. The obesity prevalence was high in depressed T2D patients and low in
depressed T1D patients

17. Alexithymia in Type I and Type II Diabetes – 2018

Markus Stingl1*, Katrin Naundorf2, Lisa vom Felde1, Bernd Hanewald1

Method: We examined the emotional impairments in 121 type I and type II diabetics by
measuring their extent of alexithymic characteristics via the Toronto-Alexithymia-Scale
(TAS-26).
Results: Both diabetic patients (type I and type II) showed significant more difficulties in
identifying and verbalizing emotions than the norm sample, but a lower external-oriented
thinking style. In this context, we found no differences between type I and type II diabetics.
The implications of these findings for the diabetes care are discussed.
 1. Alexithymia in patients with type 2 diabetes mellitus: the role of anxiety, depression,
and glycemic control 2016 Dilek Avci1 Meral Kelleci2
Objective: This study was aimed at determining the prevalence of alexithymia in patients with type 2 DM and the factors
affecting it.
Methods: This cross-sectional study was conducted with 326 patients with type 2 DM. Study data were collected with the
Personal Information Form, Toronto Alexithymia Scale, and Hospital Anxiety and Depression Scale. Glycemic control was
assessed by glycated haemoglobin (HbA1c) results. The analysis was performed using descriptive statistics, chi-square test, Pear-
son’s correlation, and logistic regression analysis.
Results: Of the patients, 37.7% were determined to have alexithymia. A significant relationship was determined between
alexithymia and HbA1c, depression, and anxiety. According to binary logistic regression analyses, alexithymia was 2.63 times
higher among those who were in a paid employment than those who were not, 2.09 times higher among those whose HbA1c
levels were $7.0% than those whose HbA1c levels were ,7.0%, 3.77 times higher among those whose anxiety subscale scores
were $11 than those whose anxiety subscale scores were #10, and 2.57 times higher among those whose depression subscale
scores were $8 than those whose depression subscale scores were #7.
Conclusion: In this study, it was determined that two out of every five patients with DM had alexithymia. Therefore, their
treatment should be arranged to include mental health care services.

2. Alexithymia and Psychological Distress Affect Perceived Quality of Life in Patients with
Type 2 Diabetes Mellitus
Gabriella Martino 1*, Federica Bellone 1, Viviana Langher 2, Andrea Caputo 2, Antonino
Catalano 1, Maria Catena Quattropani 1§, Nunziata Morabito 1§ - 2019
Backgrounds: Psychological factors may affect patients’ ability to cope with chronic
illness, which occur with a high incidence as they represent age related disorder.
Anxiety, depression and alexithymia could specifically interfere with compliance and
adherence leading to predictable consequences and predicting morbidity and mortality
independently of several confounders. The present work aims at investigating the
relationship between alexithymia and affective dimension such as anxiety and
depression levels, and health related quality of life in T2DM patients. Particularly,
alexithymia was analyzed in its three main facets and time since diagnosis was
considered with also metabolic control.
Methods: Forty seven patients with T2DM were consecutively enrolled and assessed
with a gold standard interview and with a psycho-diagnostic evaluation. Clinical
psychological exploration consisted of HAM-A, BECK-II, SF-36 and TAS-20
administration. Statistical analysis was performed using IBM SPSS statistical version
25. Data were analyzed anonymously.
Results: 47 participants showed moderate depressive symptoms as confirmed by the
mean BDI-II and HAMA-A score (15.14 ± 8.95 and 24.31 ± 6.95, respectively),
suggesting a high prevalence of anxiety in the enrolled subjects. It was observed a
lower perceived QoL as resulted by the MCS and PCS mean values (37.68 ± 9.41 and
39.31 ± 12.29, respectively) and TAS-20 highlighted considerable mean values of
60.53 ± 7.93 in the recruited participants with a prevalence in EOT values (27.51±
4.27), in comparison with mean DID and DDF values (17.26 ± 5.52 and 15.48 ± 3.84,
respectively).
Conclusions: Our study may suggest a predictive role of alexithymia in patients with
T2DM. Moreover, lower PCS and MCS, revealing worst perceived QoL were
associated to both higher anxiety and disease duration.
3. Alexithymia in adults with brittle type 1 diabetes
Lorenzo Pelizza1, Simona Pupo2 2019
Summary. Background: The term “brittle” is used to describe an uncommon subgroup
of patients with type 1 diabetes whose lives are disrupted by severe glycaemic
instability with repeated and prolonged hospitalization. Psychosocial problems and
emotional disturbances are the major perceived underlying causes of brittle diabetes.
Aim of this study is (a) to assess alexithymia in patients with brittle and non-brittle
diabetes, and (2) to examine its relationship with specific parameters of general
psychopathology. Methods: Participants comprised 44 patients with brittle diabetes
and a case-control group of 88 individuals with stable (non-brittle) diabetes, matched
for age, gender, years of education, and diabetes duration. Alexithymia and general
psychopathology were assessed using the “20-item Toronto Alexithymia Scale” (TAS-
20) and the “Symptom Checklist-90-Revised” (SCL-90-R). Results: Patients with
brittle diabetes were more alexithymic than the control group. Alexithymia scores
showed significant correlations with SCL-90-R anxiety and somatization subscales,
but were relatively independent from gender, education, diabetes duration and
complications, depression and glycaemic control. Conclusions: Given the impact of
alexithymia on type 1 diabetes, the early detection and intervention of alexithymic
subjects are very important for a better outcome of diabetes. (www.actabiomedica.it)

Ограничения и възможности за бъдещи изследвания

Когато се обсъждат резултатите от настоящето емпирично изследване, би следвало да
бъдат взети предвид следните ограничения:
Основното ограничение пред настоящото изслецане е броят на изследваните
лица. Те не са достатъчни за целите на генералзиаципта на резулаттите.
Лимитациите описани
Увеличаването на броя лица също представлява препоръка за бъдещи
изследцания събирабнето на по голям брой данни ще даде възможност да
бъдат избегнати различните външни фактори , които била могли да бъдат
част от замърсяващите резулатите.
Последна препоръка е свързана с начина на събиране на данните.....