Effects of childhood trauma on somatization in major depressive disorder: The role of alexithymia.

BACKGROUND: Childhood trauma (CT) is often associated with later psychopathology, including depression, somatization, and alexithymia. The aim of the present study was to investigate the relationships of CT with somatization and alexithymia. Moreover, the effect of specific subtypes of trauma on alexithymia and somatization was also investigated.
METHODS: The present study was conducted on 100 outpatients with major depressive disorder (MDD) and 50 age and gender matched healthy controls (HC). Data were collected on each of the participants, including the Childhood Trauma Questionnaire (CTQ-28), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), a 20-item Toronto Alexithymia Scale (TAS), and a somatization subscale of the Symptom Check List-Revised Form (SCL-90 R). Patient groups were divided into two categories according to the TAS-20 cut-off score. Reliability and validity were assessed, and factor analyses were conducted on the CTQ-28. Next, the relationships among CT subtypes, alexithymia, and somatization were investigated using Pearson's and partial correlation analysis. Additionally, the types of CT that predict alexithymia and somatization were also investigated.
RESULTS: Significantly higher scores on the clinical variables were noted in the patient group compared with the control group, except for physical neglect on the CTQ. The partial correlation of the CT types with somatization and alexithymia showed that the HARS, HDRS, somatization subscale of the SCL-90 R (for alexithymia), and the TAS-total (for somatization) were covariates. None of the CT types was correlated with somatization, whereas physical abuse and emotional neglect were correlated with alexithymia. Moreover, emotional abuse and emotional neglect predicted scores on the TAS and on the somatization subscale of the SCL-90 R. Conclusions CT is associated with alexithymia and ongoing somatic complaints. Alexithymia contributes to the emergence of somatic symptoms in MDD, particularly following CT. Somatization also contributes to alexithymia. Interestingly, the present study found that the relationship of emotional neglect and physical abuse with alexithymia was independent from somatization. Taken together, these results indicate that emotional abuse and neglect predict the later emergence of alexithymia and somatization.