Psychophysiological decoupling in alexithymic pain disorder patients

•Relevance of high alexithymia in patients with pain disorder.•Link between alexithymia, stress-related affect and autonomic reaction was examined.•Reactivity to stressful stimuli measured by different psycho physiological indices.•Increased affect appraisal versus decreased skin conductance in alexithymic patients.•Psychophysiological decoupling in alexithymic pain disorder patients.

Considering that impaired coping with stress is closely linked with emergence of stress-sensitive disorders most notably in alexithymic individuals, we conducted the first study examining stress-related autonomic reactivity in alexithymic pain disorder patients. Twenty-one pain disorder patients with high and an equivalent patient group with low alexithymia scores were exposed to three types of affect-inductive stimuli with variable affective involvement: arithmetic task, watching arousing video material and giving an oral presentation. Subjective appraisal of the induced emotional experience and physiological reactivity (heart rate, muscle tension and skin conductance) was documented. During oral presentation high alexithymia patients showed significantly lower skin conductance in combination with increased subjective negative affect compared to low alexithymia patients. Our results thus demonstrate a decoupling between physiological and affect processing in pain disorder patients with high alexithymia during a stressful situation that was subjectively associated with negative affect.