European Child & Adolescent Psychiatry

, Volume 28, Issue 4, pp 461–470 | Cite as

Alexithymia and tic disorders: a study on a sample of children and their mothers

  • Paola R. Silvestri
  • Flavia Chiarotti
  • Sandra Giustini
  • Francesco CardonaEmail author
Original Contribution


Tic disorders are neurodevelopmental disorders characterised by the presence of motor or phonic tics, or both. Patients with tic disorders commonly report premonitory urges of tics. Alexithymia is a psychological trait characterised by a difficulty in identifying and expressing one’s own feelings and by an externally oriented thinking. We aimed to explore alexithymia in children with tic disorders and in their mothers. Global alexithymia scores of both children with tic disorders and of their mothers did not differ from those of the participants from the control group. In the tic disorder group, however, both children and their mothers showed a cognitive style characterised by operational thinking and a lack of imaginative abilities. The mothers of children with tic disorder reported significantly higher parental stress. Alexithymia was not predictive of tic severity but was predictive of the severity of the premonitory urges. The implications of these findings are discussed.


Tourette Tic disorders Premonitory urges Alexithymia Children Mothers 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Scahill L, Sukhodolsky DG, Williams SK, Leckman (2005) Public health significance of tic disorders in children and adolescents. Adv Neurol 96:240–248Google Scholar
  3. 3.
    Cavanna AE, Servo S, Monaco F, Robertson MM (2009) The behavioral spectrum of Gilles de la Tourette syndrome. J Neuropsychiatry Clin Neurosci 21(1):13–23. Google Scholar
  4. 4.
    Robertson MM (2000) Tourette syndrome, associated conditions and the complexities of treatment. Brain 123(Pt 3):425–462Google Scholar
  5. 5.
    Cath DC, Ludolph AG (2013) Other psychiatric comorbidities in Tourette syndrome. In: Martino D, Leckman JF (eds) Tourette syndrome. Oxford University Press, Oxford. Google Scholar
  6. 6.
    Robertson MM (2006) Mood disorders and Gilles de la Tourette’s syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res 61(3):349–358. Google Scholar
  7. 7.
    Woods DW, Piacentini J, Himle MB, Chang S (2005) Premonitory Urge for Tics Scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. J Dev Behav Pediatr 26(6):397–403Google Scholar
  8. 8.
    Ganos C, Garrido A, Navalpotro-Gómez I, Ricciardi L, Martino D, Edwards MJ, Bhatia KP (2015) Premonitory urge to tic in Tourette’s is associated with interoceptive awareness. Mov Disord 30(9):1198–1202. Google Scholar
  9. 9.
    Eddy CM, Cavanna AE, Rickards HE, Hansen PC (2016) Temporo-parietal dysfunction in Tourette syndrome: insights from an fMRI study of Theory of Mind. J Psychiatr Res 81:102–111. Google Scholar
  10. 10.
    Eddy CM, Cavanna AE, Hansen PC (2017) Empathy and aversion: the neural signature of mentalizing in Tourette syndrome. Psychol Med 47:507–517. Google Scholar
  11. 11.
    Eddy CM (2016) The junction between self and other? Temporo-parietal dysfunction in neuropsychiatry. Neuropsychologia 89:465–477. Google Scholar
  12. 12.
    Lin H, Katsovich L, Ghebremichael M, Findley DB, Grantz H, Lombroso PJ, King RA, Zhang H, Leckman JF (2007) Psychosocial stress predicts future symptoms severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder. J Child Psychol Psychiatry 48(2):157–166. Google Scholar
  13. 13.
    Nemiah JC, Sifneos PE (1970) Psychosomatic illness: a problem in communication. Psychother Psychosom 18(1):154–160. Google Scholar
  14. 14.
    Sifneos PE (1973) The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychother Psychosom 22(2):255–262. Google Scholar
  15. 15.
    De Berardis D, Conti C, Iasevoli F, Valchera A, Fornaro M, Cavuto M, Brucchi M, Perna G, Pompili M, Modabbernia A, Lucidi G, Mazza M, Martinotti G, Di Giannantonio M (2014) Alexithymia and its relationships with acute phase proteins and cytokine release: an updated review. J Biol Regul Homeost Agents 28(4):795–799Google Scholar
  16. 16.
    Guilbaud O, Corcos M, Hjalmarsson L, Loas G, Jeammet P (2003) Is there a psychoneuroimmunological pathway between alexithymia and immunity? Immune and physiological correlates of alexithymia. Biomed Pharmacother 57(7):292–295Google Scholar
  17. 17.
    Jones MP, Wessinger S, Crowell MD (2006) Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. Clin Gastroenterol Hepatol 4(4):474–481. Google Scholar
  18. 18.
    Onur E, Alkin T, Sheridan MJ, Wise TN (2013) Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder. Psychiatr Q 84(3):303–311. Google Scholar
  19. 19.
    Son SH, Jo H, Rim HD, Kim JH, Kim HW, Bae GY, Lee SJ (2012) A comparative study on alexithymia in depressive, somatoform, anxiety, and psychotic disorders among Koreans. Psychiatry Investig 9(4):325–331. Google Scholar
  20. 20.
    Kang JI, Namkoong K, Yoo SW, Jhung K, Kim SJ (2012) Abnormalities of emotional awareness and perception in patients with obsessive-compulsive disorder. J Affect Disord 141(2–3):286–293. Google Scholar
  21. 21.
    Roh D, Kim WJ, Kim CH (2011) Alexithymia in obsessive–compulsive disorder. J Nerv Ment Dis 199(9):690–695. Google Scholar
  22. 22.
    Gramaglia C, Ressico F, Gambaro E, Palazzolo A, Mazzarino M, Bert F, Siliquini R, Zeppegno P (2016) Alexithymia, empathy, emotion identification and social inference in anorexia nervosa: a case–control study. Eat Behav 22:46–50. Google Scholar
  23. 23.
    Di Trani M, Renzi A, Vari C, Zavattini GC, Solano L (2017) Gambling disorder and affect regulation: the role of alexithymia and attachment style. J Gambl Stud 33(2):649–659. Google Scholar
  24. 24.
    Costa A, Peppe A, Carlesimo GA, Pasqualetti P, Caltagirone C (2006) Alexithymia in Parkinson’s disease is related to severity of depressive symptoms. Eur J Neurol 13(8):836–841. Google Scholar
  25. 25.
    Eddy CM, Rickards HE (2015) Interaction without intent: the shape of the social world in Huntington’s disease. Soc Cogn Affect Neurosci 10(9):1228–1235. Google Scholar
  26. 26.
    Fukunishi I, Paris W (2001) Intergenerational association of alexithymic characteristics for college students and their mothers. Psychol Rep 89(1):77–84. Google Scholar
  27. 27.
    van der Velde J, Servaas MN, Goerlich KS, Bruggeman R, Horton P, Costafreda SG, Aleman A (2013) Neural correlates of alexithymia: a meta-analysis of emotion processing studies. Neurosci Biobehav Rev 37(8):1774–1785. Google Scholar
  28. 28.
    Eddy CM, Cavanna AE (2015) Triangles, tricks and tics: hyper-mentalizing in response to animated shapes in Tourette syndrome. Cortex 71:68–75. Google Scholar
  29. 29.
    Rieffe C, Oosterveld P, Terwogt MM (2006) An alexithymia questionnaire for children: factorial and concurrent validation results. Personal Individ Differ 40(1):123–133. Google Scholar
  30. 30.
    Bagby RM, Parker JD, Taylor GJ (1994) The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res 38(1):23–32Google Scholar
  31. 31.
    Abidin RR (1995) Parenting stress index, third edition: professional manual. Psychological Assessment Resources Inc, OdessaGoogle Scholar
  32. 32.
    Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28(4):566–573. Google Scholar
  33. 33.
    Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI, King RA, Goodman WK, Cicchetti D, Leckman JF (1997) Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36(6):844–852. Google Scholar
  34. 34.
    Achenbach TM (1991) Manual for the child behavior checklist/4-18 and 1991 profile. Department of Psychiatry, University of Vermont, BurlingtonGoogle Scholar
  35. 35.
    March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36(4):554–565. Google Scholar
  36. 36.
    Kovacs M (1985) The children’s depression, inventory (CDI). Psychopharmacol Bull 21(4):995–998Google Scholar
  37. 37.
    StataCorp (2003) Stata statistical software: release 8. StataCorp LP, College StationGoogle Scholar
  38. 38.
    Berenbaum H, James T (1994) Correlates and retrospectively reported antecedents of alexithymia. Psychosom Med 56(4):353–359Google Scholar
  39. 39.
    Kench S, Irwin HJ (2000) Alexithymia and childhood family environment. J Clin Psychol 56(6):737–745Google Scholar
  40. 40.
    Yelsma P, Hovestadt AJ, Anderson WT, Nilsson JE (2000) Family-of-origin expressiveness: measurement, meaning, and relationship to alexithymia. J Marital Fam Ther 26(3):353–363Google Scholar
  41. 41.
    Eddy CM, Macerollo A, Martino D, Cavanna AE (2015) Interpersonal reactivity differences in Tourette syndrome. Psychiatry Res 228:932–935. Google Scholar
  42. 42.
    Eddy CM (2018) Social cognition and self-other distinctions in neuropsychiatry: insights from schizophrenia and Tourette syndrome. Prog Neuropsychopharmacol Biol Psychiatry 82:69–85. Epub 2017 Nov 28 Google Scholar
  43. 43.
    Allen LB, Qian Lu, Tsao JC, Hayes LP, Zeltzer LK (2011) Depression partially mediates the relationship between alexithymia and somatization in a sample of healthy children. J Health Psychol 16(8):1177–1186. Google Scholar
  44. 44.
    Rieffe C, Oosterveld P, Terwogt MM, Novin S, Nasiri H, Latifian M (2010) Relationship between alexithymia, mood and internalizing symptoms in children and young adolescents: evidence from an Iranian sample. Personal Individ Differ 48:425–430. Google Scholar
  45. 45.
    Lumley MA (2000) Alexithymia and negative emotional conditions. J Psychosom Res 49(1):51–54Google Scholar
  46. 46.
    Taylor GJ, Bagby RM, Parker JDA (1997) Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge University Press, New YorkGoogle Scholar
  47. 47.
    Di Trani M, Costantini MV, Capozzi F, Pepe L, Solano L (2014) Toronto structured interview for alexithymia e 20-item Toronto Alexithymia Scale: confronto in diversi gruppi clinici. In: Taylor GR, Bagby RM, Caretti V, Schimmenti A (eds) La valutazione dell’alessitimia con la TSIA. Raffaello Cortina Editore, Milano, Italia, pp 171–185Google Scholar
  48. 48.
    Balottin L, Nacinovich R, Bomba M, Mannarini S (2014) Alexithymia in parents and adolescent anorexic daughters: comparing the responses to TSIA and TAS-20 scales. Neuropsychiatr Dis Treat 10:1941–1951. Google Scholar
  49. 49.
    Loas G, Dugré-Lebigre C, Fremaux D, Verrier A, Wallier J, Berthoz S, Corcos M (2010) Le questionnaire d’alexithymie pour enfants (QAE): traduction française et étude de validation dans une population de 80 enfants « tout venant ». L’Encephale 36(4):302–306. Google Scholar
  50. 50.
    Loas G, Braun S, Delhaye M, Linkowski P (2017) The measurement of alexithymia in children and adolescents: psychometric properties of the Alexithymia Questionnaire for Children and the twenty-item Toronto Alexithymia Scale in different non-clinical and clinical samples of children and adolescents. PLoS One 12(5):e0177982. Google Scholar
  51. 51.
    Salminen JK, Saarijärvi S, Aärelä E, Toikka T, Kauhanen J (1999) Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosom Res 46(1):75–82Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  2. 2.Center for Behavioral Sciences and Mental HealthIstituto Superiore di SanitàRomeItaly
  3. 3.Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeRomeItaly

Personalised recommendations