Improvement of Alexithymia Among People Treated Within Personality Disorder Mental Health Services: A Longitudinal, Observational Study

Hanna Sayar ^1* Theresa Wilberg ^2,3 Ingeborg Ulltveit-Moe Eikenæs ⁴ Andreas Ekberg ^4,5 Kai Leitemo ⁶ Katharina Teresa Enehaug Morken ^7,8 Eileen Oftedal ^10,9 Siri Omvik ¹¹ Dag Anders Ulvestad ^2,5 Geir Pedersen ³ Elfrida Hartveit Kvarstein ^2,3*

• ¹ Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Oslo, Norway
• ² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
• ³ Department of Research and Innovation, Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
• ⁴ Department of Addiction Treatment, Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway, Oslo, Norway
• ⁵ Nydalen Mental Health Center, Division Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
• ⁶ Lovisenberg Diaconal Hospital, Oslo, Oslo, Norway
• ⁷ Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
• ⁸ Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Hordaland, Norway
• ⁹ Group Outpatient Clinic, Stavanger District Psychiatric Center, Division of Adult Mental Health Care, Stavanger University Hospital, Stavanger, Norway
• ¹⁰ Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
• ¹¹ Western Norway University of Applied Sciences, Bergen, Hordaland, Norway

Background: Most mental health services include patients with personality disorder (PD) and comorbid conditions. Alexithymia, a psychological construct referring to difficulties with identifying and describing internal mental states, may represent a challenge to psychotherapeutic treatment of patients with PD. This study aimed to investigate the prevalence of alexithymia among patients in specialized PD mental health services, differences according to PD severity and PD type, and the longitudinal course of alexithymia during treatment.Method: The study included 1019 patients treated in specialized PD treatment units, 70 % with personality difficulties above PD diagnostic threshold (Borderline PD: 31 %, Avoidant PD: 39 %, PDNOS: 15 %, other PDs: 15 %, and 24 % > one PD). Alexithymia was measured repeatedly throughout treatment using the TAS-20 self-report questionnaire. Supplementary outcomes included global psychosocial function and health-related life quality. Linear mixed models were applied for data analysis.Results: Alexithymia was highly prevalent in the sample, 53 % reported high levels and 20 % moderate levels. The TAS-20 subscale Difficulties Identifying Feelings was more strongly associated with Borderline PD, while the subscale Difficulties Describing Feelings was more closely linked to Avoidant PD. For all TAS subscales, poorer capacities were associated with more severe PD, higher levels of anxiety and depression, and poorer psychosocial functioning and life quality. Both alexithymia and measures of psychological functioning improved significantly during treatment with moderate effect sizes regardless of initial PD status. 19 % of the patients reported full remission of alexithymia.Conclusion: Alexithymia is a common problem among patients with PDs and associated with mental health difficulties and psychosocial dysfunction with rates varying across PD type and severity. The study demonstrates moderate improvement of alexithymia during treatment in specialized PD mental health services. Further research should evaluate the effectiveness of different treatments and interventions in reducing alexithymia among PD patients.