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Reduced Heart Rate Variability in Somatic Symptom Disorder: Associations with Alexithymia

  • Lee, Jae Hoon (Department of Neuropsychiatry, Seoul National University Hospital) ;
  • Jang, Ye Eun (Department of Psychiatry, Seoul National University Bundang Hospital) ;
  • Park, Hye Youn (Department of Psychiatry, Seoul National University Bundang Hospital)
  • Received : 2020.06.08
  • Accepted : 2020.06.19
  • Published : 2020.06.30

Abstract

Objectives : We investigated heart rate variability (HRV) patterns in patients with somatic symptom disorder (SSD) and the relationships of these patterns with alexithymia. Methods : In total, 42 patients with SSD and 33 healthy controls were enrolled in this study. Demographic, psychological, and HRV data were assessed at baseline, and 24 patients with SSD were reassessed after 6 months of treatment. The psychological data included somatic symptoms and levels of depression, anxiety, and alexithymia as indicated by the somatic symptom subscale of the Symptom Checklist 90-Revision (SCL-12), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the Toronto Alexithymia Scale 20 (TAS-20), respectively. Results : Patients with SSD had a lower standard deviation of normal-to-normal R-R intervals (SDNN) and lower proportions of adjacent R-R intervals greater than 50 milliseconds (pNN50) compared with controls. These HRV parameters were negatively correlated with alexithymia severity. After treatment, patients exhibited significantly decreased levels of somatic symptoms and reduced anxiety and depression, but there were no significant differences in the HRV parameters. In patients with alexithymia, a high baseline SDNN and pNN50 were associated with a decrease in somatic symptoms. Conclusions : Patients with SSD have different HRV patterns, and several HRV parameters are associated with alexithymia severity. These findings suggest that ANS regulation is involved in the pathophysiology of SSD, mediated by alexithymia. Furthermore, these results suggest that certain HRV parameters may be associated with clinical outcomes of SSD.

Keywords

References

  1. Association AP. Diagnostic and statistical manual of mental disorders ($DSM-5^{(R)}$): American Psychiatric Pub;2013.
  2. Rief W, Martin A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annual Review of Clinical Psychology 2014;10.
  3. Rief W, Barsky AJ. Psychobiological perspectives on somatoform disorders. Psychoneuroendocrinology 2005;30:996-1002. https://doi.org/10.1016/j.psyneuen.2005.03.018
  4. Laederach-Hofmann K, Ruddel H, Mussgay L. Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms? Biological Psychology 2008;79:243-249. https://doi.org/10.1016/j.biopsycho.2008.06.003
  5. Zygmunt A, Stanczyk J. Methods of evaluation of autonomic nervous system function. Arch Med Sci 2010;6:11-18. https://doi.org/10.5114/aoms.2010.13500
  6. Clamor A, Lincoln TM, Thayer JF, Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. The British Journal of Psychiatry 2016;208:9-16. https://doi.org/10.1192/bjp.bp.114.160762
  7. Bassett D. A literature review of heart rate variability in depressive and bipolar disorders. Aust N Z J Psychiatry 2016;50:511-519. https://doi.org/10.1177/0004867415622689
  8. Kidwell M, Ellenbroek BA. Heart and soul: heart rate variability and major depression. Behav Pharmacol 2018;29:152-164. https://doi.org/10.1097/FBP.0000000000000387
  9. Chalmers JA, Quintana DS, Abbott MJ, Kemp AH. Anxiety Disorders are Associated with Reduced Heart Rate Variability. A Meta-Analysis. Front Psychiatry 2014;5:80.
  10. Tak LM, Riese H, de Bock GH, Manoharan A, Kok IC, Rosmalen JG. As good as it gets? A meta-analysis and systematic review of methodological quality of heart rate variability studies in functional somatic disorders. Biol Psychol 2009;82:101-110. https://doi.org/10.1016/j.biopsycho.2009.05.002
  11. Tak LM, Janssens KA, Dietrich A, Slaets JP, Rosmalen JG. Age-specific associations between cardiac vagal activity and functional somatic symptoms: a population-based study. Psychother Psychosom 2010;79:179-187. https://doi.org/10.1159/000296136
  12. Liu Q, Wang EM, Yan XJ, Chen SL. Autonomic functioning in irritable bowel syndrome measured by heart rate variability: a meta-analysis. J Dig Dis 2013;14:638-646. https://doi.org/10.1111/1751-2980.12092
  13. Huang WL, Liao SC, Yang CC, Kuo TB, Chen TT, Chen IM, Gau SS. Measures of Heart Rate Variability in Individuals With Somatic Symptom Disorder. Psychosom Med 2017;79:34-42. https://doi.org/10.1097/PSY.0000000000000362
  14. Lee D, Kim SJ, Cheon J, Hwang EH, Jung YC, Kang JI. Characteristics of Autonomic Activity and Reactivity During Rest and Emotional Processing and Their Clinical Correlations in Somatic Symptom Disorder. Psychosom Med 2018;80:690-697. https://doi.org/10.1097/PSY.0000000000000622
  15. Huang WL, Liao SC, Tu YK, Yang CCH, Kuo TBJ, Gau SS. Autonomic reactivity during reading of a somatic distress script in patients with somatic symptom disorder. J Psychosom Res 2019;123:109729. https://doi.org/10.1016/j.jpsychores.2019.05.007
  16. Duddu V, Isaac MK, Chaturvedi SK. Alexithymia in somatoform and depressive disorders. J Psychosom Res 2003;54:435-438. https://doi.org/10.1016/S0022-3999(02)00440-3
  17. Ozturk A, Kilic A, Deveci E, Kirpinar I. Investigation of facial emotion recognition, alexithymia, and levels of anxiety and depression in patients with somatic symptoms and related disorders. Neuropsychiatr Dis Treat 2016;12:1047-1053.
  18. Nakao M, Takeuchi T. Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness. J Clin Med 2018;7:112. https://doi.org/10.3390/jcm7050112
  19. Lischke A, Pahnke R, Mau-Moeller A, Behrens M, Grabe HJ, Freyberger HJ, Hamm AO, Weippert M. Inter-individual Differences in Heart Rate Variability Are Associated with Inter-individual Differences in Empathy and Alexithymia. Front Psychol 2018;9:229.
  20. First MB, Williams JB, Karg RS, Spitzer RL. User's Guide for the SCID-5-CV: Structured Clinical Interview for DSM-5 Disorders, Clinician Version: American Psychiatric Association; 2016.
  21. Kim K, Kim J, Won H. Korean manual of symptom checklist-90-revision. Seoul: Jung Ang Juk Sung Publisher 1984:8-10.
  22. Zijlema WL, Stolk RP, Lowe B, Rief W, White PD, Rosmalen JG. How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires. Journal of Psychosomatic Research 2013;74:459-468. https://doi.org/10.1016/j.jpsychores.2013.03.093
  23. Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck Depression Inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment 1996;67:588-597. https://doi.org/10.1207/s15327752jpa6703_13
  24. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893-897. https://doi.org/10.1037/0022-006X.56.6.893
  25. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994;38:23-32. https://doi.org/10.1016/0022-3999(94)90005-1
  26. Taylor GJ, Bagby RM, Parker JD. Disorders of affect regulation: Alexithymia in medical and psychiatric illness: Cambridge University Press;1999.
  27. Reyes del Paso GA, Langewitz W, Mulder LJ, Van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology 2013;50:477-487. https://doi.org/10.1111/psyp.12027
  28. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health 2017;5:258. https://doi.org/10.3389/fpubh.2017.00258
  29. Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research-Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol 2017;8:213. https://doi.org/10.3389/fpsyt.2017.00213
  30. Kim GM, Woo JM. Determinants for heart rate variability in a normal Korean population. J Korean Med Sci 2011;26:1293-1298. https://doi.org/10.3346/jkms.2011.26.10.1293
  31. Hua J, Le Scanff C, Larue J, Jose F, Martin J-C, Devillers L, Filaire E. Global stress response during a social stress test: impact of alexithymia and its subfactors. Psychoneuroendocrinology 2014;50:53-61. https://doi.org/10.1016/j.psyneuen.2014.08.003
  32. Goerlich KS. The Multifaceted Nature of Alexithymia-A Neuroscientific Perspective. Frontiers in Psychology 2018;9.
  33. Winkelmann T, Thayer JF, Pohlack S, Nees F, Grimm O, Flor H. Structural brain correlates of heart rate variability in a healthy young adult population. Brain Struct Funct 2017;222: 1061-1068. https://doi.org/10.1007/s00429-016-1185-1
  34. Kim SM, Hong JS, Min KJ, Han DH. Brain Functional Connectivity in Patients With Somatic Symptom Disorder. Psychosom Med 2019;81:313-318. https://doi.org/10.1097/psy.0000000000000681
  35. Li Q, Xiao Y, Li Y, Li L, Lu N, Xu Z, Mou X, Mao S, Wang W, Yuan Y. Altered regional brain function in the treatmentnaive patients with somatic symptom disorder: a resting-state fMRI study. Brain Behav 2016;6:e00521. https://doi.org/10.1002/brb3.521
  36. Tominaga T, Choi H, Nagoshi Y, Wada Y, Fukui K. Relationship between alexithymia and coping strategies in patients with somatoform disorder. Neuropsychiatric Disease and Treatment 2014;10:55. https://doi.org/10.2147/NDT.S55956
  37. Kano M, Endo Y, Fukudo S. Association between alexithymia and functional gastrointestinal disorders. Frontiers in Psychology 2018;9:599. https://doi.org/10.3389/fpsyg.2018.00599
  38. Probst T, Sattel H, Gundel H, Henningsen P, Kruse J, Schneider G, Lahmann C. Moderating effects of Alexithymia on associations between the therapeutic alliance and the outcome of brief psychodynamic-interpersonal psychotherapy for Multisomatoform disorder. Frontiers in Psychiatry 2017;8:261.
  39. Saariaho AS, Saariaho TH, Mattila AK, Karukivi MR, Joukamaa MI. Alexithymia and depression in a chronic pain patient sample. Gen Hosp Psychiatry 2013;35:239-245. https://doi.org/10.1016/j.genhosppsych.2012.11.011
  40. Thapa R, Alvares GA, Zaidi TA, Thomas EE, Hickie IB, Park SH, Guastella AJ. Reduced heart rate variability in adults with autism spectrum disorder. Autism Research;2019.
  41. Bernhardt BC, Valk SL, Silani G, Bird G, Frith U, Singer T. Selective disruption of sociocognitive structural brain networks in autism and alexithymia. Cereb Cortex 2014;24:3258-3267. https://doi.org/10.1093/cercor/bht182
  42. Ernst G. Hidden Signals-The History and Methods of Heart Rate Variability. Front Public Health 2017;5:265. https://doi.org/10.3389/fpubh.2017.00265
  43. Alvares GA, Quintana DS, Hickie IB, Guastella AJ. Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis. J Psychiatry Neurosci 2016;41:89-104. https://doi.org/10.1503/jpn.140217