Alexithymia is associated with higher pain ratings and greater pressure pain tolerance in adolescents with major depressive disorder: Evidence consistent with sensory-affective dissociation

OBJECTIVE: To examine associations of alexithymia with subjective pain intensity and pressure pain tolerance in adolescents with major depressive disorder (MDD), and to test whether alexithymia shows indirect effects linking depressive severity with these pain outcomes in cross-sectional models. METHODS: 193 adolescents with MDD completed the Hamilton Depression Rating Scale (HAMD) and Toronto Alexithymia Scale-20 (TAS-20). Subjective pain intensity was rated with the NRS-11. Experimental pain indicators included pressure pain threshold (PPT) and pressure pain tolerance (PTO). RESULTS: Pain intensity was associated with HAMD (OR = 1.054, P = 0.010) and TAS-20 (OR = 1.045, P = 0.008). TAS-20 was associated with higher pain tolerance (PTO-1: B = 0.003, P = 0.014; PTO-2: B = 0.004, P = 0.021). Depressive severity was associated with alexithymia (P < 0.001). Indirect effects via alexithymia were significant for tolerance with nonsignificant direct effects (both P < 0.05). For pain intensity, both the direct effect (0.247, P = 0.001) and the indirect effect (0.064, P < 0.05) were significant, with the indirect effect accounting for 20.7% of the total effect. CONCLUSION: Alexithymia is associated with altered pain perception in adolescents with MDD and may statistically account for part of the association between depressive severity and pain outcomes. The pattern is consistent with sensory-affective dissociation and supports considering emotional processing difficulties when assessing and managing pain complaints in depressed adolescents.