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Personality traits of alexithymia and perfectionism in impaired awareness of hypoglycemia in adults with type 1 diabetes – An exploratory study

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article number110634
JournalJournal of Psychosomatic Research
Early online date30 Sep 2021
E-pub ahead of print30 Sep 2021
PublishedNov 2021

Bibliographical note

Funding Information: This study was supported by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London of the National Institute for Health Research (NIHR, award no: CLA_0113_10022 ). Additional support was from The HypoAware study, funded by Diabetes UK (ref: 13/0004653 ). The opinions expressed in this manuscript are those of the authors, not of the NIHR. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Objective: Severe hypoglycemia complicates insulin therapy for type 1 diabetes, with impaired awareness of hypoglycemia (IAH) being a major risk factor. We explored associations between the personality traits, alexithymia and perfectionism, and cognitive barriers to hypoglycemia avoidance described in IAH, and evaluated their prevalence in people with and without IAH. Methods: Cross-sectional exploratory study. Ninety adults with type 1 diabetes, 54 hypoglycemia aware and 36 with IAH, completed validated questionnaires exploring alexithymia (Total Alexithymia Scale [TAS-20]) and perfectionism (Frost Multidimensional Perfectionism Scale [FMPS]); and cognitive barriers related to hypoglycemia avoidance (Attitudes to Awareness Questionnaire [A2A]. Results: Alexithymia and perfectionism scores correlated positively with cognitive barriers associated with IAH. Specifically, alexthymia scores correlated with the ‘Hyperglycaemia Avoidance Prioritised’ factor (r = 0.265; p =.02, n = 77) and the ‘Asymptomatic Hypoglycemia Normalised’ factor (r = 0.252–0.255; p =.03, n = 77). Perfectionism scores correlated with the ‘Hyperglycaemia Avoidance Prioritised’ factor (r = 0.525; p <.001, n = 66). Overall, IAH participants were significantly more likely to score at the high end for alexithymia (17.6% vs. 1.9%, p =.008, n = 87) and at the extreme ends (high and low) for perfectionism (69.0% vs. 40.0%, χ2 (1) = 6.24, p =.01, n = 77). Conclusion: These novel data showing associations between alexithymia and perfectionism scores and maladaptive health beliefs in IAH suggest the intriguing possibility that personality traits may contribute to the risk of IAH, perhaps through their influence on incentives to avoid hypoglycemia. If confirmed, measuring such traits may help tailor early adjunctive psychological intervention to reduce hypoglycemia burden for people with IAH.

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