Relationship between alexithymia and panic disorder: a longitudinal study to answer an open question

Background: In the present study, we evaluated whether patients with panic disorder (PD) in complete remission were more alexithymic than normal controls. Methods: Fifty-two PD patients ( both during the acute phase of the disorder and after at least 2 months of complete remission) and 52 age- and sex-matched normal subjects completed the Toronto Alexithymia Scale-20 and the Hamilton Rating Scales for Anxiety (Ham-A) and for Depression. Results: A higher rate of alexithymia was found in PD patients than in controls (3.8%) both during the acute phase (44.2%; p < 0.001) and after remission of the disorder (21.2%; p = 0.008). During remission, PD patients showed: ( 1) Ham-A scores significantly higher than controls (p < 0.001); ( 2) only an elevation of the 'difficulty in identifying feeling' (DIF) dimension of alexithymia, and ( 3) a positive relationship between Ham-A scores and DIF levels (p < 0.001). Conclusion: After remission of panic attacks, phobic avoidance and anticipatory anxiety, PD patients are more alexithymic ( even though the levels of alexithymia decreased after the resolution of the acute phase of PD) and anxious than controls. This finding might be explained by an overlap between cognitive aspects of PD and the DIF dimension of alexithymia, since alexithymic and anxious levels are positively related.