Rheumatology International

, Volume 39, Issue 3, pp 461–467 | Cite as

Factors related to alexithymia in patients with systemic sclerosis: a tight relationship with facial image dissatisfaction

  • Fabio BastaEmail author
  • Domenico Paolo Emanuele Margiotta
  • Carmen Mazzuca
  • Veronica Batani
  • Giulio Dolcini
  • Patrizio Moras
  • Marta Vadacca
  • Antonella Afeltra
Observational Research


To assess clinical and psychosocial factors related to alexithymia in systemic sclerosis (SSc). We enrolled 40 consecutive SSc patients in a cross-sectional study evaluating alexithymia with Toronto Alexithymia scale (TAS-20). We measured Beck Depression inventory (BDI), Hamilton Anxiety rating scale (HAM-H), 36-Items Short-Form Healthy Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)—Fatigue, Visual Analog Scale (VAS) pain, Pittsburgh Sleep Quality Index (PSQI), Satisfaction with Appearance Scale (SWAP), and Mouth Handicap in Systemic Sclerosis (MHISS). The prevalence of alexithymia was 42%. Alexithymic patients presented increased depressive (p = ≤ 0.001) and anxiety symptoms (p = ≤ 0.001), sleep disorders (p = 0.03), pain (p = 0.02), esthetic concerns (p = 0.03), disability in activities (p = 0.03) and reduced scores of SF-36 in mental components summary (MCS) (p = ≤ 0.001) and physical components summary (PCS) (p = 0.01). We found significant correlations with sleep disorders (r = 0.41, p = ≤ 0.001), BID (r = 0.35, p = 0.04), facial image dissatisfaction (r = 0.35, p = 0.04), mouth disability (r = 0.51, p = 0.005), depressive (r = 0.6, p = ≤ 0.001), and anxiety symptoms (r = 0.48, p = ≤ 0.001), fatigue (r = − 0.45 p = 0.005), SF-36 PCS (r = − 0.51, p = ≤ 0.001) and MCS (r = − 0.65, p = ≤ 0.001). In multiple linear regression analysis, SWAP facial was the only variable associated with TAS-20 [0.99 (0.48) p = 0.05]. Alexithymia correlates with several psychosocial factors but seems strongly related to facial image dissatisfaction.


Systemic sclerosis Alexithymia Depression Anxiety Pain QoL 


Author contributions

FB was responsible for conceptualization, methodology, data collection, data curation, literature review and article writing. DPEM was responsible for methodology, data curation and formal analysis. CM, VB, GD and PM were responsible for data collection. MV was responsible for literature review, writing and review. AA was responsible for conceptualization, writing, reviewing and editing.


No funding was received for this article.

Compliance with ethical standards

Conflict of interest

Fabio Basta declares he has no conflict of interest, Domenico Paolo Emanuele Margiotta declares he has no conflict of interest, Carmen Mazzuca declares she has no conflict of interest, Veronica Batani declares she has no conflict of interest, Giulio Dolcini declares he has no conflict of interest, Patrizio Moras declares he has no conflict of interest, Marta Vadacca declares she has no conflict of interest, and Antonella Afeltra declares she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of RheumatologyIRCCS Ospedale Pediatrico Bambino GesùRomeItaly
  2. 2.Unit of Allergology, Immunology and RheumatologyCampus Bio-Medico University of RomeRomeItaly

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