AccScience Publishing / JCBP / Online First / DOI: 10.36922/jcbp.2681
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Evaluating alexithymia as a mediator of the relationship between sensory processing sensitivity and health anxiety

Jimmy Bordarie1* Colette Aguerre1 Laëtitia Bolteau2
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1 QualiPsy UR1901, Department of Psychology, University of Tours, Tours, France
2 EMLA, CHRU de Tours, Tours, France
Submitted: 8 January 2024 | Accepted: 6 March 2024 | Published: 1 April 2024
© 2024 by the Author (s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Highly sensitive individuals demonstrate heightened responses to environmental stimuli than their peers, often presenting with anxious and depressive symptomatology akin to those in alexithymic individuals. Alexithymia, referred to as difficulty in describing or identifying emotions, is of particular interest to use as a mediating variable between sensitivity to sensory processing and health anxiety. The present study aims to explore the relationship between sensory processing sensitivity (SPS) and alexithymia, and their collective impact on health anxiety, a correlation which, to the best of our knowledge, has not been previously examined, despite the common preoccupation with health among those affected. Health anxiety, defined by the fear of suffering from a serious and/or chronic illness, or of misinterpreting somatic symptoms as signs of illness, is the focal point of this investigation. The study recruited 814 adults (79.7% women and 20.3% men), with a mean age of 30 years old (standard deviation = 12.5 years), ranging from 18 to 76 years. Participants anonymously answered a questionnaire consisting of the French versions of the Highly Sensitive Person Scale (HSPS-FR), the Toronto Alexithymia Scale-20, and the Health Anxiety Questionnaire (HAQ). Statistical analyses, including correlations, ANOVA, linear regressions, and mediation analysis, were performed using SPSS and the SPSS macro PROCESS. Results revealed significant positive correlations among the three constructs (P < 0.001). Furthermore, both SPS and alexithymia were found to be predictive of health anxiety (P < 0.001). In addition, an indirect partial mediation effect between SPS and health anxiety through alexithymia was observed. This study highlights the intertwined relationship between sensitivity and alexithymia, shedding light on their collective impact on anxiety, particularly health anxiety. Moreover, it facilitates the examination of this relationship within a large population and amidst the specific context of COVID-19. Practical perspectives concerning support for highly sensitive people are discussed, taking into account their potential specific needs.

Sensory processing sensitivity
Health anxiety
Mediation analysis
  1. Aron A, Aron EN. Self-expansion motivation and including other in the self. In: Duck S, editor. Handbook of Personal Relationships: Theory, Research and Interventions. United States: John Wiley and Sons; 1997. p. 251-270.


  1. Dunn W. The sensations of everyday life: Empirical, theoretical, and pragmatic considerations. Am J Occup Ther. 2001;55(6):608-620. doi: 10.5014/ajot.55.6.608


  1. Balestri M, Porcelli S, Souery D, et al. Temperament and character influence on depression treatment outcome. J Affect Disord. 2019;252:464-474. doi: 10.1016/j.jad.2019.04.031


  1. Lionetti F, Aron A, Aron EN, Burns GL, Jagiellowicz J, Pluess M. Dandelions, tulips and orchids: Evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry. 2018;8:24. doi: 10.1038/s41398-017-0090-6


  1. Gere DR, Capps SC, Mitchell DW, Grubbs E. Sensory sensitivities of gifted children. Am J Occup Ther. 2009;63(3):288-295. doi: 10.5014/ajot.63.3.288


  1. Pluess M, Boniwell I. Sensory-processing sensitivity predicts treatment response to a school-based depression prevention program: Evidence of vantage sensitivity. Pers Individ Differ. 2015;82:40-45. doi: 10.1016/j.paid.2015.03.011


  1. Andresen M, Goldmann P, Volodina A. Do overwhelmed expatriates intend to leave? The effects of sensory processing sensitivity, stress, and social capital on expatriates’ turnover intention. Eur Manag Rev. 2018;15(3):315-328. doi: 10.1111/emre.12120


  1. Bordarie J, Aguerre C, Bolteau L. A longitudinal approach of lockdown effects on quality of life and the expression of anxiety-depressive disorders according to sensory processing sensitivity. Psychol Health Med. 2021;27(10):2288-2299. doi: 10.1080/13548506.2021.1968012


  1. Kjellgren A, Lindahl A, Norlander T. Altered states of consciousness and mystical experiences during sensory isolation in flotation tank: Is the highly sensitive personality variable of importance? Imagin Cogn Pers. 2009;29(2):135-146. doi: 10.2190/IC.29.2.d


  1. Brindle K, Moulding R, Bakker K, Nedeljkovic M. Is the relationship between sensory-processing sensitivity and negative affect mediated by emotional regulation? Aust J Psychol. 2015;67(4):214-221. doi: 10.1111/ajpy.12084


  1. Bordarie J, Mourtialon C. Study of the relationship between sensory processing sensitivity and burnout syndrome among speech and language therapists. Int J Environ Res Public Health. 2023;20(23):7132. doi: 10.3390/ijerph20237132


  1. Benham G. The highly sensitive person: Stress and physical symptom reports. Pers Individ Differ. 2006;40(7):1433-1440. doi: 10.1016/j.paid.2005.11.021


  1. Smolewska KA, McCabe SB, Woody EZ. A psychometric evaluation of the Highly Sensitive Person Scale: The components of sensory-processing sensitivity and their relation to the BIS/BAS and “Big Five”. Pers Individ Differ. 2006;40(6):1269-1279. doi: 10.1016/j.paid.2005.09.022


  1. Bordarie J, Aguerre C, Bolteau L. Validation and study of psychometric properties of a French version of the Sensory- Processing Sensitivy scale (HSPS-27). Eur Rev Appl Psychol. 2022;72:100781. doi: 10.1016/j.erap.2022.100781


  1. Liss M, Mailloux J, Erchull MJ. The relationships between sensory processing sensitivity, alexithymia, autism, depression, and anxiety. Pers Individ Differ. 2008;45(3):255-259. doi: 10.1016/j.paid.2008.04.009


  1. Ahadi B, Basharpoor S. Relationship between sensory processing sensitivity, personality dimensions and mental health. J Appl Sci. 2010;10(7):570-574. doi: 10.3923/jas.2010.570.574


  1. Konrad S, Herzberg PY. Psychometric properties and validation of a German high sensitive person scale (HSPS-G). Eur J Psychol Assess. 2017;35(3):364-378. doi: 10.1027/1015-5759/a000411


  1. Sifneos PE. The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychother Psychosom. 1973;22(2- 6):255-262. doi: 10.1159/000286529


  1. Nemiah JC, Freyberger H, Sifneos PE. Alexithymia: A view of the psychosomatic process. In: Hill OW, editor. Modern Trends in Psychosomatic Medicine. Vol. 3. London: Butterworths; 1976. p. 430-439.


  1. Sifneos PE. Alexithymia, clinical issues, politics and crime. Psychother Psychosom. 2000;69(3):113-116. doi: 10.1159/000012377


  1. Brewer R, Cook R, Cardi V, Treasure J, Bird G. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. R Soc Open Sci. 2015;2(1):140382. doi: 10.1098/rsos.140382


  1. Grynberg D, Luminet O, Corneille O, Grèzes J, Berthoz S. Alexithymia in the interpersonal domain: A general deficit of empathy? Pers Individ Differ. 2010;49(8):845-850. doi: 10.1016/j.paid.2010.07.013


  1. Feldmanhall O, Dalgleish T, Mobbs D. Alexithymia decreases altruism in real social decisions. Cortex. 2013;49(3):899-904. doi: 10.1016/j.cortex.2012.10.015


  1. Stephenson R. Introducing alexithymia: A concept within the psychosomatic process. Disabil Rehabil. 1996;18(4):209-214. doi: 10.3109/09638289609166302


  1. Evren C, Sar V, Evren B, Semiz U, Dalbudak E, Cakmak D. Dissociation and alexithymia among men with alcoholism. Psychiatry Clin Neurosci. 2008;62(1):40-47. doi: 10.1111/j.1440-1819.2007.01775.x


  1. Parker JD, Taylor GJ, Bagby RM. Alexithymia: Relationship with ego defense and coping styles. Compr Psychiatry. 1998;39(2):91-98. doi: 10.1016/s0010-440x(98)90084-0


  1. Taylor GJ, Bagby RM. New trends in alexithymia research. Psychother Psychosom. 2004;73(2):68-77. doi: 10.1159/000075537


  1. Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res. 2006;61:629-635. doi: 10.1016/j.jpsychores.2006.04.013


  1. Founta O, Adamzik K, Tobin AM, et al. Psychological distress, alexithymia and alcohol misuse in patients with psoriasis: A cross-sectional study. J Clin Psychol Med Settings. 2019;26(2):200-219. doi: 10.1007/s10880-018-9580-9


  1. Owens K, Asmundson GJ, Hadjistavropoulos T, Owens T. Attentional bias toward illness threat in individuals with elevated health anxiety. Cogn Ther Res. 2004;28(1):57-66. doi: 10.1023/B: COTR.0000016930.85884.29


  1. Bridou M, Aguerre C. L’anxiétéenvers la santé: Définition et intérêt clinique d’un concept novateur et heuristique (Health anxiety: Definition and clinical relevance of an innovative and heuristic concept). Ann Méd Psychol. 2012;170:375-381. doi: 10.1016/j.amp.2010.11.017


  1. MacSwain K, Sherry S, Stewart S, et al. Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety. Pers Individ Differ. 2009;47(8):938-943. doi: 10.1016/j.paid.2009.07.020


  1. Taylor S, Asmundson GJ. Etiology of hypochondriasis: A preliminary behavioural-genetic investigation. Int J Genet Gene Ther. 2012;2:1-5. doi: 10.5348/ijggt-2011-1-SR-1


  1. Norris AL, Marcus DK. Cognition in health anxiety and hypochondriasis: Recent advances. Curr Psychiatry Rev. 2014;10(1):44-49. doi: 10.2174/1573400509666131119004151


  1. Kellner R. Diagnosis and treatments of hypochondriacal syndromes. Psychosomatics. 1992;33(3):278-289. doi: 10.1016/s0033-3182(92)71966-5


  1. Hadjistavropoulos H, Craig K, Hadjistavropoulos T. Cognitive and behavioural responses to illness information: The role of health anxiety. Behav Res Ther. 1998;36:149-164. doi: 10.1016/s0005-7967(98)00014-x


  1. McQuarrie AM, Smith SD, Jakobson LS. Alexithymia and sensory processing sensitivity account for unique variance in the prediction of emotional contagion and empathy. Front Psychol. 2023;14:1072783. doi: 10.3389/fpsyg.2023.1072783


  1. Jakobson LS, Rigby SN. Alexithymia and sensory processing sensitivity: Areas of overlap and links to sensory processing styles. Front Psychol. 2021;12:583786. doi: 10.3389/fpsyg.2021.583786


  1. Freyberger H. Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother Psychosom. 1977;28:337-345. doi: 10.1159/000287080


  1. Porcelli P, Leoci C, Guerra V, Taylor GJ, Bagby RM. A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. J Psychosom Res. 1996;41(6):569-573. doi: 10.1016/s0022-3999(96)00221-8


  1. Sivik T. Alexithymia and hypersensitivity to touch and palpation. Integr Physiol Behav Sci. 1993;28(2):130-136. doi: 10.1007/BF02691215


  1. Smith HL, Sriken J, Erford BT. Clinical and research utility of the highly sensitive Person scale. J Ment Health Counsel. 2019;41(3):221-241. doi: 10.17744/mehc.41.3.03


  1. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia scale - I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23-32. doi: 10.1016/0022-3999(94)90005-1


  1. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale - II. Convergent, discriminant, and concurrent validity. J Psychosom Res. 1994;38(1):33-40. doi: 10.1016/0022-3999(94)90006-X


  1. Loas G, Otmani O, Fremaux D, Lecercle C, Duflot M, Delahousse J. Etude de la validitéexterne, de la fidélitéet détermination des notes seuils des échelles d’alexithymie de Toronto (TAS et TAS -20) chez un groupe de malades alcooliques (Study of external validity, reliability and determination of threshold scores for the Toronto Alexithymia Scales [TAS and TAS-20] in a group of alcohol-dependent patients). L’Encéphale. 1996;22(1):35-40.


  1. Bridou M. Etude des Principaux Freins et Leviers Psychologiques Envers L’examen de Dépistage Du Cancer Colorectal. Le RôLe particulier de L’anxiété Envers La Santé Dans L’adoption de Cette Démarche (Thèse de Doctorat). Tours: UniversitéFrançois Rabelais; 2012.


  1. Lucock MP, Morley S. The health anxiety questionnaire. Br J Health Psychol. 1996;1(2):137-150. doi: 10.1111/j.2044-8287.1996.tb00498.x


  1. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. 2nd ed. New York: Guilford Press; 2018.


  1. Meyer B, Ajchenbrenner M, Bowles DP. Sensory sensitivity, attachment experiences, and rejection responses among adults with borderline and avoidant features. J Pers Disord. 2005;19(6):641-658. doi: 10.1521/pedi.2005.19.6.641


  1. Iimura S. Sensory-processing sensitivity and COVID- 19 stress in a young population: The mediating role of resilience. Pers Individ Differ. 2022;184:111183. doi: 10.1016/j.paid.2021.111183


  1. Goldberg LR. An alternative “description of personality”: The big-five factor structure. J Pers Soc Psychol. 1990;59(6):1216-1229. doi: 10.1037/0022-3514.59.6.1216


  1. McCrae RR, Costa PT. Personality in Adulthood. New York: The Guildford Press; 1990.


  1. Hellwig S, Roth M. Conceptual ambiguities and measurement issues in sensory processing sensitivity. J Res Pers. 2021;93:104130. doi: 10.1016/j.jrp.2021.104130


  1. Greven C, Lionetti F, Booth C, et al. Sensory processing sensitivity in the context of environmental sensitivity: A critical review and development of research agenda. Neurosci Biobehav Rev. 2019;98:287-305. doi: 10.1016/j.neubiorev.2019.01.009


  1. Grabe HJ, Frommer J, Ankerhold A, et al. Alexithymia and outcome in psychotherapy. Psychother Psychosom. 2008;77(3):189-194. doi: 10.1159/000119739


  1. Qin N, Li J, Wu X, et al. Effects of rational emotive behavior therapy on alexithymia, anxiety, depression and sleep quality of older people in nursing homes: A quasi-experimental study. BMC Nurs. 2023;22(1):280. doi: 10.1186/s12912-023-01449-9


  1. Cleland C, Magura S, Foote J, Rosenblum A, Kosanke N. Psychometric properties of the Toronto Alexithymia Scale (TAS- 20) for substance users. J Psychosom Res. 2005;58(3):299-306. doi: 10.1016/j.jpsychores.2004.11.002
Conflict of interest
The authors declare they have no competing interests.
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