Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673 597

unexplained physical symptoms (MUPS) and to assess the

acceptability.

Methods: All consultations of one GP underwent initial screening

for a period of three months. Patients who possibly had MUPS

were classified by their GP. Identified patients were invited for a

research interview and offered treatment.

Results: 1084 consultations of 796 patients were screened; 168

patients aged 25–79 possibly had MUPS. The GP classified the

symptoms of 104 patients as medically unexplained. Regarding

eligibility for CBT, 71 met exclusion criteria. The research inter-

view was offered to 33 patients, 16 of them declined and 12 were

eligible. Seven out of the 12 eligible patients accepted treatment.

Conclusion: In the consulting population, 13% of all patients were

aged 25–79 and had MUPS. For only a minority of these patients

group CBT was suitable and acceptable.

251

DISCLOSURE OF CONCERNS OF FIBROMYALGIA

PATIENTS IN MEDICAL CONSULTATIONS: THE

SIGNIFICANCE OF ALEXITHYMIA

Arnstein Finset, University of Oslo, Norway.

Background and subjects: Research indicates that patients who

express their concerns in a consultation may feel more satisfied and

have less distress. We expected that patients with alexithymia (a

stable trait characterised by a reduced ability to identify and

verbalise emotions) would have problems in expressing emotion-

ally charged concerns and that they would be vulnerable to

frustration and distress after the consultation. We tested these

expectations in a sample of 67 arranged consultations with fibro-

myalgia patients, half of them with alexithyma.

Method: Alexithymia (as measured by TAS-20), anxiety levels

(STAI-trait anxiety), emotional state before and after the consul-

tation (POMS) and patient satisfaction after the consultation were

assessed. The consultations were coded according to Roter’s

Interaction Analysis System (RIAS). The sample was divided into

patients who had expressed few (M: 0.5; SD: 0.6) vs. many (M:

3.0; SD: 2.5) concerns based on median split.

Results: There was a mean (SD) of 1.7 (2.2) concerns in each

consultation. Patients with alexithymia presented significantly

more concerns than patients without alexithymia, 2.3 (2.7) and

1.1 (1.2) respectively p < .05). We then analysed to which extent

the expression of concerns and alexithymia status was related to

patient satisfaction and changes in emotional state from pre- to

post interview.

Satisfaction: There was neither significant main effects of concern

or alexithymia nor an interaction effect on satisfaction.

Emotional state: There was again no main effect of concern on the

dependent variable, but a significant concerns x alexithymia inter-

action effect ( p < .05). Alexithymic patients who presented few

concerned displayed increased post-consultation depressed mood.

Discussion: The expectation that patients with alexithymia

expressed fewer concerns was not confirmed. On the contrary,

alexithymic patients expressed significantly more concerns than

patients without alexithymia. Moreover, we found that alexithymic

patients who did not express concerns in the interview tended to

become more depressed after the interview, confirming the vulner-

ability of alexithymic patients of not resolving emotional concerns

in medical interviews. Implications for communication skills train-

ing are discussed.

223

ATTACHMENT STYLE AND GLYCEMIC CONTROL

IN TYPE 1 DIABETES MELLITUS

Attale C, Guedeney N, Sola A, Slama G, Dantchev N, Consoli

SM. Department of C-L Psychiatry, Georges Pompidou European

Hospital Paris, France.

Background: A recent research area in adult attachment concerns

the application of attachment theory to the field of somatic

diseases. Thus, health behaviours seem to depend on individual’s

attachment style.

Objective: To study in type 1 diabetic patients the links between

glycemic control and attachment style, according to Bartholo-

mew’s model. Methods Clinical and biological characteristics of

100 type 1 diabetics (42 males, 58 females ; mean age 38.1 ± 8.1)

were collected. The quality of glycemic control was defined as of

the average of all the glycosilated hemoglobin levels (HbA1c)

during the last year. Attachment style was assessed via two self-

administered questionnaires: the Relationship Questionnaire (RQ)

and the Relationship Scale Questionnaire (RSQ). Depressive

symptoms were assessed via the CES-D. It was hypothesised that

diabetic patients with an insecure attachment style would have

higher HbA1c levels than patients with a secure attachment style.

Results differ according to the self-report instrument used and to

the level of attachment style analysis (attachment category or

prototype-continuous attachment measures). Prototypical RQ and

RSQ attachment scores were intercorrelated each other (Pearson r

from 0.22 to 0.48). Using the RSQ in a categorical way, HbA1c

levels significantly differed from one category to another (ANOVA

p = .003), preoccupied or fearful diabetic patients exhibiting higher

levels than secure or dismissing categories. Using prototypical

attachment variables, a positive correlation was found between

fearful attachment style and HbA1c (r = 0.25; p = .02). Using

prototypical RQ scores, preoccupied or fearful attachment styles

were positively associated with HbA1c (respectively r = 0.31 and

r = 0.20). HbA1c was higher in patients with complicated diabetes.

After controlling for the presence of at least one complication due

to diabetes, a significant correlation persisted between RQ pre-

occupied attachment style and HbA1c ( p = .005), and a statistical

trend was found for RQ dismissing attachment style ( p = .056).

Conclusion Insecure attachment styles are more or less associated

with increased HbA1c levels. These results should be taken into

account for adjusting the patient-doctor relationship in order to

improve glycemic control.

273

A STRUCTURED INTERVIEW FOR ASSESSING

ALEXITHYMIA

Bagby RM. University of Toronto/Ctr. for Addiction and Mental

Health Toronto, Canada.

Over the past three years the authors of the self-report Toronto

Alexithymia Scale (TAS-20, the most widely used instrument for

measuring the alexithymia construct) have been developing a

structured interview for alexithymia—the Toronto Structured

Interview for Alexithymia (TSIA; Bagby, Taylor, & Parker,

2004). The instrument is composed of 32 questions distributed

across four scales: (1) Difficulty Identifying Feelings; (2) Dif-

ficulty Describing Feelings; (3) Externally Oriented Thinking;

and (4) Reduced Imaginal Activity. There are eight questions on