Alexithymia, oral behaviors, and temporomandibular disorders: a dark triad?

Alexithymia is a condition in which cognitive processing of emotions is impaired. Associations between alexithymia and temporomandibular disorders (TMD) have been described in multiple studies, yet the coexistence or influence of oral behaviors has never been addressed. This study aimed to clarify the relationship between alexithymia, oral behaviors, and temporomandibular pain disorders. A total of 264 participants were included in this study. The mean age was 25.70 ± 5.99 years, with a range from 18 to 65 years. Eighty-two (31.1%) were possibly alexithymic, and 93 (35.2%) were alexithymic. A total of 12.5% of the participants were at high risk for TMD. With respect to oral behavior risk, 62.5% were at low risk, and 35.2% were at high risk. Alexithymia appeared to be a positive predictor of TMD risk (p < 0.001). Participants with high-risk oral behaviors were found to have an increased likelihood of TMD risk (p < 0.001). Moreover, both high-risk oral behavior and alexithymia correlated with increased somatic symptom burden levels (p < 0.001). Pain disorders exert significant distress on individuals and lead to poorer quality of life. Understanding the association of alexithymia, somatic symptom burden, and coping strategies with oral behaviors and temporomandibular pain disorders can help improve the management of this condition. By tailoring the chosen therapy to the dominant co-existing psychosocial comorbidities in TMD patients, the risk of treatment failure or relapse may be diminished.