Patients are in a constant state of worry; when they are well, they worry that they may soon suffer a relapse, and when they do suffer an attack, they worry that it may the beginning of a rapid decline, or the

harbinger of further deficits. Furthermore, MS attacks can be experienced as a veritable traumatic event by patients, as onset is often sudden and unexpected, which can be complex and painful to cope with and accept (Jose 2008). Many patients find it hard to let go of their hopes of living normally, and accept the physical constraints imposed on them by their disease. The wide gap between what they are physically able to do, and what they would like to be able to do, is often hard to accept. Inhibitors,research,lifescience,medical Another noteworthy point is that only two dimensions of alexithymia, namely difficulty describing and difficulty identifying Inhibitors,research,lifescience,medical feelings, were correlated with anxiety and depression, whereas the third component of selleck screening library alexithymia (EOT) is independent of both these disorders. We also observed that this latter factor was the only one to evolve over time, with

a significant fall in this dimension observed at 5 years. It is also the only factor to be specifically correlated with the number of MS relapses. Given that EOT is not correlated with either anxiety or depression, it is possible that it may be a form of defensive strategy for Inhibitors,research,lifescience,medical coping with the traumatic experience of MS relapses. Inhibitors,research,lifescience,medical Accordingly, by orienting their preoccupations and thoughts externally, the patient is able to avoid facing up to their interior feelings, and more particularly, the anxiety arising from the traumatic nature of the course of the disease. We could even go so far as to hypothesize that EOT may represent a form of avoidance and denial of reality employed by the patient to protect themselves against excessively distressing feelings. The fact that the

effect Inhibitors,research,lifescience,medical of this factor decreases over time could suggest more successful adaptation to the disease, in so far as the patient has less need to use this defensive strategy. This is line with the reduction in depression over time, which may also indicate better adjustment to disease after a number of years. These findings are in line with the study by Chwastiak et al. (2002), who reported that depressive symptoms decreased in the long-term after diagnosis. The question arises, also therefore, as to whether the reduction in depression over time can be explained by better adjustment to the different disease-related handicaps, and by improved coping strategies that allow the patient to adapt better, thereby reducing depression. However, our results cannot be extrapolated to all patients with MS, as the population included in this study presented a mild to moderate level of handicap (EDSS: 3.83 ± 2.36), thus limiting applicability of our findings to other groups with a similar profile.